|
HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE
|
Facility
|
IP
|
$753.63
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
17381
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$489.86 |
| Max. Negotiated Rate |
$753.63 |
| Rate for Payer: Aetna Commercial |
$678.27
|
| Rate for Payer: ASR ASR |
$731.02
|
| Rate for Payer: ASR Commercial |
$731.02
|
| Rate for Payer: BCBS Trust/PPO |
$614.13
|
| Rate for Payer: BCN Commercial |
$584.29
|
| Rate for Payer: Cash Price |
$602.90
|
| Rate for Payer: Cofinity Commercial |
$708.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$602.90
|
| Rate for Payer: Healthscope Commercial |
$753.63
|
| Rate for Payer: Healthscope Whirlpool |
$731.02
|
| Rate for Payer: Mclaren Commercial |
$678.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$640.59
|
| Rate for Payer: Nomi Health Commercial |
$617.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$489.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$663.19
|
|
|
HYLAN G-F 20 16 MG/2 ML INTRA-ARTICULAR SYRINGE
|
Facility
|
OP
|
$753.63
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
17381
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$753.63 |
| Rate for Payer: Aetna Commercial |
$678.27
|
| Rate for Payer: Aetna Medicare |
$9.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.45
|
| Rate for Payer: ASR ASR |
$731.02
|
| Rate for Payer: ASR Commercial |
$731.02
|
| Rate for Payer: BCBS Complete |
$5.16
|
| Rate for Payer: BCBS MAPPO |
$9.16
|
| Rate for Payer: BCBS Trust/PPO |
$617.15
|
| Rate for Payer: BCN Commercial |
$584.29
|
| Rate for Payer: BCN Medicare Advantage |
$9.16
|
| Rate for Payer: Cash Price |
$602.90
|
| Rate for Payer: Cash Price |
$602.90
|
| Rate for Payer: Cofinity Commercial |
$708.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$602.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.16
|
| Rate for Payer: Healthscope Commercial |
$753.63
|
| Rate for Payer: Healthscope Whirlpool |
$731.02
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.16
|
| Rate for Payer: Mclaren Commercial |
$678.27
|
| Rate for Payer: Mclaren Medicaid |
$4.91
|
| Rate for Payer: Mclaren Medicare |
$9.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.62
|
| Rate for Payer: Meridian Medicaid |
$5.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$640.59
|
| Rate for Payer: Nomi Health Commercial |
$617.98
|
| Rate for Payer: PACE Medicare |
$8.70
|
| Rate for Payer: PACE SWMI |
$9.16
|
| Rate for Payer: PHP Commercial |
$10.08
|
| Rate for Payer: PHP Medicaid |
$4.91
|
| Rate for Payer: PHP Medicare Advantage |
$9.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$489.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.60
|
| Rate for Payer: Priority Health Medicare |
$9.16
|
| Rate for Payer: Priority Health Narrow Network |
$7.68
|
| Rate for Payer: Railroad Medicare Medicare |
$9.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$663.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.16
|
| Rate for Payer: UHC Exchange |
$14.20
|
| Rate for Payer: UHC Medicare Advantage |
$9.16
|
| Rate for Payer: UHCCP DNSP |
$9.16
|
| Rate for Payer: UHCCP Medicaid |
$4.91
|
| Rate for Payer: VA VA |
$9.16
|
|
|
HYLAN G-F 20 48 MG/6 ML INTRA-ARTICULAR SYRINGE
|
Facility
|
IP
|
$2,037.98
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
118765
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,324.69 |
| Max. Negotiated Rate |
$2,037.98 |
| Rate for Payer: Aetna Commercial |
$1,834.18
|
| Rate for Payer: ASR ASR |
$1,976.84
|
| Rate for Payer: ASR Commercial |
$1,976.84
|
| Rate for Payer: BCBS Trust/PPO |
$1,660.75
|
| Rate for Payer: BCN Commercial |
$1,580.05
|
| Rate for Payer: Cash Price |
$1,630.39
|
| Rate for Payer: Cofinity Commercial |
$1,915.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,630.38
|
| Rate for Payer: Healthscope Commercial |
$2,037.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,976.84
|
| Rate for Payer: Mclaren Commercial |
$1,834.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,732.28
|
| Rate for Payer: Nomi Health Commercial |
$1,671.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,324.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,793.42
|
|
|
HYLAN G-F 20 48 MG/6 ML INTRA-ARTICULAR SYRINGE
|
Facility
|
OP
|
$2,037.98
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
118765
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$2,037.98 |
| Rate for Payer: Aetna Commercial |
$1,834.18
|
| Rate for Payer: Aetna Medicare |
$9.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.45
|
| Rate for Payer: ASR ASR |
$1,976.84
|
| Rate for Payer: ASR Commercial |
$1,976.84
|
| Rate for Payer: BCBS Complete |
$5.16
|
| Rate for Payer: BCBS MAPPO |
$9.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,668.90
|
| Rate for Payer: BCN Commercial |
$1,580.05
|
| Rate for Payer: BCN Medicare Advantage |
$9.16
|
| Rate for Payer: Cash Price |
$1,630.39
|
| Rate for Payer: Cash Price |
$1,630.39
|
| Rate for Payer: Cofinity Commercial |
$1,915.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,630.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.16
|
| Rate for Payer: Healthscope Commercial |
$2,037.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,976.84
|
| Rate for Payer: Humana Choice PPO Medicare |
$9.16
|
| Rate for Payer: Mclaren Commercial |
$1,834.18
|
| Rate for Payer: Mclaren Medicaid |
$4.91
|
| Rate for Payer: Mclaren Medicare |
$9.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.62
|
| Rate for Payer: Meridian Medicaid |
$5.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,732.28
|
| Rate for Payer: Nomi Health Commercial |
$1,671.14
|
| Rate for Payer: PACE Medicare |
$8.70
|
| Rate for Payer: PACE SWMI |
$9.16
|
| Rate for Payer: PHP Commercial |
$10.08
|
| Rate for Payer: PHP Medicaid |
$4.91
|
| Rate for Payer: PHP Medicare Advantage |
$9.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,324.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.60
|
| Rate for Payer: Priority Health Medicare |
$9.16
|
| Rate for Payer: Priority Health Narrow Network |
$7.68
|
| Rate for Payer: Railroad Medicare Medicare |
$9.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,793.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.16
|
| Rate for Payer: UHC Exchange |
$14.20
|
| Rate for Payer: UHC Medicare Advantage |
$9.16
|
| Rate for Payer: UHCCP DNSP |
$9.16
|
| Rate for Payer: UHCCP Medicaid |
$4.91
|
| Rate for Payer: VA VA |
$9.16
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$302.40
|
|
|
Service Code
|
NDC 43199001101
|
| Hospital Charge Code |
17023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.56 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$272.16
|
| Rate for Payer: ASR ASR |
$293.33
|
| Rate for Payer: ASR Commercial |
$293.33
|
| Rate for Payer: BCBS Trust/PPO |
$246.43
|
| Rate for Payer: BCN Commercial |
$234.45
|
| Rate for Payer: Cash Price |
$241.92
|
| Rate for Payer: Cofinity Commercial |
$284.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.92
|
| Rate for Payer: Healthscope Commercial |
$302.40
|
| Rate for Payer: Healthscope Whirlpool |
$293.33
|
| Rate for Payer: Mclaren Commercial |
$272.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.04
|
| Rate for Payer: Nomi Health Commercial |
$247.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.11
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$302.40
|
|
|
Service Code
|
NDC 43199001101
|
| Hospital Charge Code |
17023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.96 |
| Max. Negotiated Rate |
$302.40 |
| Rate for Payer: Aetna Commercial |
$272.16
|
| Rate for Payer: Aetna Medicare |
$151.20
|
| Rate for Payer: ASR ASR |
$293.33
|
| Rate for Payer: ASR Commercial |
$293.33
|
| Rate for Payer: BCBS Complete |
$120.96
|
| Rate for Payer: BCBS Trust/PPO |
$247.64
|
| Rate for Payer: BCN Commercial |
$234.45
|
| Rate for Payer: Cash Price |
$241.92
|
| Rate for Payer: Cofinity Commercial |
$284.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.92
|
| Rate for Payer: Healthscope Commercial |
$302.40
|
| Rate for Payer: Healthscope Whirlpool |
$293.33
|
| Rate for Payer: Mclaren Commercial |
$272.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.04
|
| Rate for Payer: Nomi Health Commercial |
$247.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$264.96
|
| Rate for Payer: Priority Health Narrow Network |
$211.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$266.11
|
|
|
HYOSCYAMINE SULFATE 0.125 MG TABLET
|
Facility
|
OP
|
$204.45
|
|
|
Service Code
|
NDC 47781001301
|
| Hospital Charge Code |
3783
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.78 |
| Max. Negotiated Rate |
$204.45 |
| Rate for Payer: Aetna Commercial |
$184.00
|
| Rate for Payer: Aetna Medicare |
$102.22
|
| Rate for Payer: ASR ASR |
$198.32
|
| Rate for Payer: ASR Commercial |
$198.32
|
| Rate for Payer: BCBS Complete |
$81.78
|
| Rate for Payer: BCBS Trust/PPO |
$167.42
|
| Rate for Payer: BCN Commercial |
$158.51
|
| Rate for Payer: Cash Price |
$163.56
|
| Rate for Payer: Cofinity Commercial |
$192.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.56
|
| Rate for Payer: Healthscope Commercial |
$204.45
|
| Rate for Payer: Healthscope Whirlpool |
$198.32
|
| Rate for Payer: Mclaren Commercial |
$184.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.78
|
| Rate for Payer: Nomi Health Commercial |
$167.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.14
|
| Rate for Payer: Priority Health Narrow Network |
$143.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.92
|
|
|
HYOSCYAMINE SULFATE 0.125 MG TABLET
|
Facility
|
IP
|
$204.45
|
|
|
Service Code
|
NDC 47781001301
|
| Hospital Charge Code |
3783
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.89 |
| Max. Negotiated Rate |
$204.45 |
| Rate for Payer: Aetna Commercial |
$184.00
|
| Rate for Payer: ASR ASR |
$198.32
|
| Rate for Payer: ASR Commercial |
$198.32
|
| Rate for Payer: BCBS Trust/PPO |
$166.61
|
| Rate for Payer: BCN Commercial |
$158.51
|
| Rate for Payer: Cash Price |
$163.56
|
| Rate for Payer: Cofinity Commercial |
$192.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.56
|
| Rate for Payer: Healthscope Commercial |
$204.45
|
| Rate for Payer: Healthscope Whirlpool |
$198.32
|
| Rate for Payer: Mclaren Commercial |
$184.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.78
|
| Rate for Payer: Nomi Health Commercial |
$167.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$179.92
|
|
|
HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION (EG, ENDOMETRIAL RESECTION, ELECTROSURGICAL ABLATION, THERMOABLATION)
|
Facility
|
OP
|
$7,496.78
|
|
|
Service Code
|
CPT 58563
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,592.43 |
| Max. Negotiated Rate |
$7,496.78 |
| Rate for Payer: Aetna Medicare |
$4,836.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,045.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,045.79
|
| Rate for Payer: BCBS Complete |
$2,722.06
|
| Rate for Payer: BCBS MAPPO |
$4,836.63
|
| Rate for Payer: BCN Medicare Advantage |
$4,836.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4,836.63
|
| Rate for Payer: Humana Choice PPO Medicare |
$4,836.63
|
| Rate for Payer: Mclaren Medicaid |
$2,592.43
|
| Rate for Payer: Mclaren Medicare |
$4,836.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,078.46
|
| Rate for Payer: Meridian Medicaid |
$2,722.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,562.12
|
| Rate for Payer: PACE Medicare |
$4,594.80
|
| Rate for Payer: PACE SWMI |
$4,836.63
|
| Rate for Payer: PHP Commercial |
$5,320.29
|
| Rate for Payer: PHP Medicaid |
$2,592.43
|
| Rate for Payer: PHP Medicare Advantage |
$4,836.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$2,592.43
|
| Rate for Payer: Priority Health Medicare |
$4,836.63
|
| Rate for Payer: Railroad Medicare Medicare |
$4,836.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$4,836.63
|
| Rate for Payer: UHC Exchange |
$7,496.78
|
| Rate for Payer: UHC Medicare Advantage |
$4,836.63
|
| Rate for Payer: UHCCP DNSP |
$4,836.63
|
| Rate for Payer: UHCCP Medicaid |
$2,592.43
|
| Rate for Payer: VA VA |
$4,836.63
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$4.75
|
|
|
Service Code
|
NDC 00121183605
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: Aetna Medicare |
$2.38
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: ASR Commercial |
$4.61
|
| Rate for Payer: BCBS Complete |
$1.90
|
| Rate for Payer: BCBS Trust/PPO |
$3.89
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.16
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$4.70
|
|
|
Service Code
|
NDC 00121091400
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Aetna Commercial |
$4.23
|
| Rate for Payer: ASR ASR |
$4.56
|
| Rate for Payer: ASR Commercial |
$4.56
|
| Rate for Payer: BCBS Trust/PPO |
$3.83
|
| Rate for Payer: BCN Commercial |
$3.64
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cofinity Commercial |
$4.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$4.70
|
| Rate for Payer: Healthscope Whirlpool |
$4.56
|
| Rate for Payer: Mclaren Commercial |
$4.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.00
|
| Rate for Payer: Nomi Health Commercial |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.14
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2.54
|
|
|
Service Code
|
NDC 00121091700
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: Aetna Medicare |
$1.27
|
| Rate for Payer: ASR ASR |
$2.46
|
| Rate for Payer: ASR Commercial |
$2.46
|
| Rate for Payer: BCBS Complete |
$1.02
|
| Rate for Payer: BCBS Trust/PPO |
$2.08
|
| Rate for Payer: BCN Commercial |
$1.97
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Healthscope Commercial |
$2.54
|
| Rate for Payer: Healthscope Whirlpool |
$2.46
|
| Rate for Payer: Mclaren Commercial |
$2.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Nomi Health Commercial |
$2.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.23
|
| Rate for Payer: Priority Health Narrow Network |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.24
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$3.72
|
|
|
Service Code
|
NDC 68094049461
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: ASR ASR |
$3.61
|
| Rate for Payer: ASR Commercial |
$3.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.03
|
| Rate for Payer: BCN Commercial |
$2.88
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.72
|
| Rate for Payer: Healthscope Whirlpool |
$3.61
|
| Rate for Payer: Mclaren Commercial |
$3.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: Nomi Health Commercial |
$3.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.27
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$3.86
|
|
|
Service Code
|
NDC 68094060061
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Aetna Medicare |
$1.93
|
| Rate for Payer: ASR ASR |
$3.74
|
| Rate for Payer: ASR Commercial |
$3.74
|
| Rate for Payer: BCBS Complete |
$1.54
|
| Rate for Payer: BCBS Trust/PPO |
$3.16
|
| Rate for Payer: BCN Commercial |
$2.99
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Cofinity Commercial |
$3.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.09
|
| Rate for Payer: Healthscope Commercial |
$3.86
|
| Rate for Payer: Healthscope Whirlpool |
$3.74
|
| Rate for Payer: Mclaren Commercial |
$3.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.28
|
| Rate for Payer: Nomi Health Commercial |
$3.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.38
|
| Rate for Payer: Priority Health Narrow Network |
$2.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.40
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$3.86
|
|
|
Service Code
|
NDC 68094060059
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: ASR ASR |
$3.74
|
| Rate for Payer: ASR Commercial |
$3.74
|
| Rate for Payer: BCBS Trust/PPO |
$3.15
|
| Rate for Payer: BCN Commercial |
$2.99
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Cofinity Commercial |
$3.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.09
|
| Rate for Payer: Healthscope Commercial |
$3.86
|
| Rate for Payer: Healthscope Whirlpool |
$3.74
|
| Rate for Payer: Mclaren Commercial |
$3.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.28
|
| Rate for Payer: Nomi Health Commercial |
$3.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.40
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$3.72
|
|
|
Service Code
|
NDC 68094049461
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.35
|
| Rate for Payer: Aetna Medicare |
$1.86
|
| Rate for Payer: ASR ASR |
$3.61
|
| Rate for Payer: ASR Commercial |
$3.61
|
| Rate for Payer: BCBS Complete |
$1.49
|
| Rate for Payer: BCBS Trust/PPO |
$3.05
|
| Rate for Payer: BCN Commercial |
$2.88
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cofinity Commercial |
$3.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.98
|
| Rate for Payer: Healthscope Commercial |
$3.72
|
| Rate for Payer: Healthscope Whirlpool |
$3.61
|
| Rate for Payer: Mclaren Commercial |
$3.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.16
|
| Rate for Payer: Nomi Health Commercial |
$3.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.26
|
| Rate for Payer: Priority Health Narrow Network |
$2.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.27
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$4.70
|
|
|
Service Code
|
NDC 00121091405
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Aetna Commercial |
$4.23
|
| Rate for Payer: Aetna Medicare |
$2.35
|
| Rate for Payer: ASR ASR |
$4.56
|
| Rate for Payer: ASR Commercial |
$4.56
|
| Rate for Payer: BCBS Complete |
$1.88
|
| Rate for Payer: BCBS Trust/PPO |
$3.85
|
| Rate for Payer: BCN Commercial |
$3.64
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cofinity Commercial |
$4.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$4.70
|
| Rate for Payer: Healthscope Whirlpool |
$4.56
|
| Rate for Payer: Mclaren Commercial |
$4.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.00
|
| Rate for Payer: Nomi Health Commercial |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.12
|
| Rate for Payer: Priority Health Narrow Network |
$3.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.14
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$4.70
|
|
|
Service Code
|
NDC 00121091405
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: Aetna Commercial |
$4.23
|
| Rate for Payer: ASR ASR |
$4.56
|
| Rate for Payer: ASR Commercial |
$4.56
|
| Rate for Payer: BCBS Trust/PPO |
$3.83
|
| Rate for Payer: BCN Commercial |
$3.64
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cofinity Commercial |
$4.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$4.70
|
| Rate for Payer: Healthscope Whirlpool |
$4.56
|
| Rate for Payer: Mclaren Commercial |
$4.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.00
|
| Rate for Payer: Nomi Health Commercial |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.14
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$3.86
|
|
|
Service Code
|
NDC 68094060061
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.51 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: ASR ASR |
$3.74
|
| Rate for Payer: ASR Commercial |
$3.74
|
| Rate for Payer: BCBS Trust/PPO |
$3.15
|
| Rate for Payer: BCN Commercial |
$2.99
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Cofinity Commercial |
$3.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.09
|
| Rate for Payer: Healthscope Commercial |
$3.86
|
| Rate for Payer: Healthscope Whirlpool |
$3.74
|
| Rate for Payer: Mclaren Commercial |
$3.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.28
|
| Rate for Payer: Nomi Health Commercial |
$3.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.40
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$3.86
|
|
|
Service Code
|
NDC 68094060059
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Aetna Commercial |
$3.47
|
| Rate for Payer: Aetna Medicare |
$1.93
|
| Rate for Payer: ASR ASR |
$3.74
|
| Rate for Payer: ASR Commercial |
$3.74
|
| Rate for Payer: BCBS Complete |
$1.54
|
| Rate for Payer: BCBS Trust/PPO |
$3.16
|
| Rate for Payer: BCN Commercial |
$2.99
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Cofinity Commercial |
$3.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.09
|
| Rate for Payer: Healthscope Commercial |
$3.86
|
| Rate for Payer: Healthscope Whirlpool |
$3.74
|
| Rate for Payer: Mclaren Commercial |
$3.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.28
|
| Rate for Payer: Nomi Health Commercial |
$3.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.38
|
| Rate for Payer: Priority Health Narrow Network |
$2.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.40
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2.64
|
|
|
Service Code
|
NDC 68094049459
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$2.64 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: ASR ASR |
$2.56
|
| Rate for Payer: ASR Commercial |
$2.56
|
| Rate for Payer: BCBS Trust/PPO |
$2.15
|
| Rate for Payer: BCN Commercial |
$2.05
|
| Rate for Payer: Cash Price |
$2.11
|
| Rate for Payer: Cofinity Commercial |
$2.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.11
|
| Rate for Payer: Healthscope Commercial |
$2.64
|
| Rate for Payer: Healthscope Whirlpool |
$2.56
|
| Rate for Payer: Mclaren Commercial |
$2.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.24
|
| Rate for Payer: Nomi Health Commercial |
$2.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.32
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2.66
|
|
|
Service Code
|
NDC 60687074317
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Aetna Commercial |
$2.39
|
| Rate for Payer: ASR ASR |
$2.58
|
| Rate for Payer: ASR Commercial |
$2.58
|
| Rate for Payer: BCBS Trust/PPO |
$2.17
|
| Rate for Payer: BCN Commercial |
$2.06
|
| Rate for Payer: Cash Price |
$2.13
|
| Rate for Payer: Cofinity Commercial |
$2.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.13
|
| Rate for Payer: Healthscope Commercial |
$2.66
|
| Rate for Payer: Healthscope Whirlpool |
$2.58
|
| Rate for Payer: Mclaren Commercial |
$2.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.26
|
| Rate for Payer: Nomi Health Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.34
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2.54
|
|
|
Service Code
|
NDC 00121091700
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: ASR ASR |
$2.46
|
| Rate for Payer: ASR Commercial |
$2.46
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCN Commercial |
$1.97
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Healthscope Commercial |
$2.54
|
| Rate for Payer: Healthscope Whirlpool |
$2.46
|
| Rate for Payer: Mclaren Commercial |
$2.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Nomi Health Commercial |
$2.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.24
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 00121183605
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.28
|
| Rate for Payer: ASR ASR |
$4.61
|
| Rate for Payer: ASR Commercial |
$4.61
|
| Rate for Payer: BCBS Trust/PPO |
$3.87
|
| Rate for Payer: BCN Commercial |
$3.68
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Commercial |
$4.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.75
|
| Rate for Payer: Healthscope Whirlpool |
$4.61
|
| Rate for Payer: Mclaren Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Nomi Health Commercial |
$3.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.18
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$2.54
|
|
|
Service Code
|
NDC 00121091705
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: ASR ASR |
$2.46
|
| Rate for Payer: ASR Commercial |
$2.46
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCN Commercial |
$1.97
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.03
|
| Rate for Payer: Healthscope Commercial |
$2.54
|
| Rate for Payer: Healthscope Whirlpool |
$2.46
|
| Rate for Payer: Mclaren Commercial |
$2.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.16
|
| Rate for Payer: Nomi Health Commercial |
$2.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.24
|
|
