|
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
|
OP
|
$4.70
|
|
|
Service Code
|
NDC 00121091400
|
| 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
|
OP
|
$2.66
|
|
|
Service Code
|
NDC 60687074317
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Aetna Commercial |
$2.39
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: ASR ASR |
$2.58
|
| Rate for Payer: ASR Commercial |
$2.58
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.18
|
| 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: Priority Health HMO/PPO/Tiered Network |
$2.33
|
| Rate for Payer: Priority Health Narrow Network |
$1.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.34
|
|
|
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$2.64
|
|
|
Service Code
|
NDC 68094049459
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.64 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: Aetna Medicare |
$1.32
|
| Rate for Payer: ASR ASR |
$2.56
|
| Rate for Payer: ASR Commercial |
$2.56
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.16
|
| 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: Priority Health HMO/PPO/Tiered Network |
$2.31
|
| Rate for Payer: Priority Health Narrow Network |
$1.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.32
|
|
|
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
|
OP
|
$2.66
|
|
|
Service Code
|
NDC 60687074340
|
| Hospital Charge Code |
10246
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.66 |
| Rate for Payer: Aetna Commercial |
$2.39
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: ASR ASR |
$2.58
|
| Rate for Payer: ASR Commercial |
$2.58
|
| Rate for Payer: BCBS Complete |
$1.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.18
|
| 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: Priority Health HMO/PPO/Tiered Network |
$2.33
|
| Rate for Payer: Priority Health Narrow Network |
$1.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.34
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
NDC 00904791461
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: ASR ASR |
$19.40
|
| Rate for Payer: ASR Commercial |
$19.40
|
| Rate for Payer: BCBS Trust/PPO |
$16.30
|
| Rate for Payer: BCN Commercial |
$15.51
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$18.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$20.00
|
| Rate for Payer: Healthscope Whirlpool |
$19.40
|
| Rate for Payer: Mclaren Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.00
|
| Rate for Payer: Nomi Health Commercial |
$16.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.60
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
OP
|
$2.24
|
|
|
Service Code
|
NDC 47682010064
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: Aetna Commercial |
$2.02
|
| Rate for Payer: Aetna Medicare |
$1.12
|
| Rate for Payer: ASR ASR |
$2.17
|
| Rate for Payer: ASR Commercial |
$2.17
|
| Rate for Payer: BCBS Complete |
$0.90
|
| Rate for Payer: BCBS Trust/PPO |
$1.83
|
| Rate for Payer: BCN Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cofinity Commercial |
$2.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.79
|
| Rate for Payer: Healthscope Commercial |
$2.24
|
| Rate for Payer: Healthscope Whirlpool |
$2.17
|
| Rate for Payer: Mclaren Commercial |
$2.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.90
|
| Rate for Payer: Nomi Health Commercial |
$1.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.96
|
| Rate for Payer: Priority Health Narrow Network |
$1.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.97
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
NDC 00904791461
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: ASR ASR |
$19.40
|
| Rate for Payer: ASR Commercial |
$19.40
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$16.38
|
| Rate for Payer: BCN Commercial |
$15.51
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$18.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.00
|
| Rate for Payer: Healthscope Commercial |
$20.00
|
| Rate for Payer: Healthscope Whirlpool |
$19.40
|
| Rate for Payer: Mclaren Commercial |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.00
|
| Rate for Payer: Nomi Health Commercial |
$16.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.52
|
| Rate for Payer: Priority Health Narrow Network |
$14.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.60
|
|
|
IBUPROFEN 200 MG TABLET
|
Facility
|
IP
|
$2.24
|
|
|
Service Code
|
NDC 47682010064
|
| Hospital Charge Code |
3841
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$2.24 |
| Rate for Payer: Aetna Commercial |
$2.02
|
| Rate for Payer: ASR ASR |
$2.17
|
| Rate for Payer: ASR Commercial |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$1.83
|
| Rate for Payer: BCN Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cofinity Commercial |
$2.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.79
|
| Rate for Payer: Healthscope Commercial |
$2.24
|
| Rate for Payer: Healthscope Whirlpool |
$2.17
|
| Rate for Payer: Mclaren Commercial |
$2.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.90
|
| Rate for Payer: Nomi Health Commercial |
$1.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.97
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$164.50
|
|
|
Service Code
|
NDC 67877032001
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna Commercial |
$148.05
|
| Rate for Payer: Aetna Medicare |
$82.25
|
| Rate for Payer: ASR ASR |
$159.56
|
| Rate for Payer: ASR Commercial |
$159.56
|
| Rate for Payer: BCBS Complete |
$65.80
|
| Rate for Payer: BCBS Trust/PPO |
$134.71
|
| Rate for Payer: BCN Commercial |
$127.54
|
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$154.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.60
|
| Rate for Payer: Healthscope Commercial |
$164.50
|
| Rate for Payer: Healthscope Whirlpool |
$159.56
|
| Rate for Payer: Mclaren Commercial |
$148.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.82
|
| Rate for Payer: Nomi Health Commercial |
$134.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.13
|
| Rate for Payer: Priority Health Narrow Network |
$115.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.76
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$404.20
|
|
|
Service Code
|
NDC 60687045701
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.68 |
| Max. Negotiated Rate |
$404.20 |
| Rate for Payer: Aetna Commercial |
$363.78
|
| Rate for Payer: Aetna Medicare |
$202.10
|
| Rate for Payer: ASR ASR |
$392.07
|
| Rate for Payer: ASR Commercial |
$392.07
|
| Rate for Payer: BCBS Complete |
$161.68
|
| Rate for Payer: BCBS Trust/PPO |
$331.00
|
| Rate for Payer: BCN Commercial |
$313.38
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$379.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$404.20
|
| Rate for Payer: Healthscope Whirlpool |
$392.07
|
| Rate for Payer: Mclaren Commercial |
$363.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Nomi Health Commercial |
$331.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$354.16
|
| Rate for Payer: Priority Health Narrow Network |
$283.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.70
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$157.45
|
|
|
Service Code
|
NDC 49483060301
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.34 |
| Max. Negotiated Rate |
$157.45 |
| Rate for Payer: Aetna Commercial |
$141.70
|
| Rate for Payer: ASR ASR |
$152.73
|
| Rate for Payer: ASR Commercial |
$152.73
|
| Rate for Payer: BCBS Trust/PPO |
$128.31
|
| Rate for Payer: BCN Commercial |
$122.07
|
| Rate for Payer: Cash Price |
$125.96
|
| Rate for Payer: Cofinity Commercial |
$148.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.96
|
| Rate for Payer: Healthscope Commercial |
$157.45
|
| Rate for Payer: Healthscope Whirlpool |
$152.73
|
| Rate for Payer: Mclaren Commercial |
$141.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.83
|
| Rate for Payer: Nomi Health Commercial |
$129.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.56
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$185.65
|
|
|
Service Code
|
NDC 00904585461
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$185.65 |
| Rate for Payer: Aetna Commercial |
$167.08
|
| Rate for Payer: ASR ASR |
$180.08
|
| Rate for Payer: ASR Commercial |
$180.08
|
| Rate for Payer: BCBS Trust/PPO |
$151.29
|
| Rate for Payer: BCN Commercial |
$143.93
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$174.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$185.65
|
| Rate for Payer: Healthscope Whirlpool |
$180.08
|
| Rate for Payer: Mclaren Commercial |
$167.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.37
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$4.04
|
|
|
Service Code
|
NDC 60687045711
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.63 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna Commercial |
$3.64
|
| Rate for Payer: ASR ASR |
$3.92
|
| Rate for Payer: ASR Commercial |
$3.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.29
|
| Rate for Payer: BCN Commercial |
$3.13
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.23
|
| Rate for Payer: Healthscope Commercial |
$4.04
|
| Rate for Payer: Healthscope Whirlpool |
$3.92
|
| Rate for Payer: Mclaren Commercial |
$3.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.43
|
| Rate for Payer: Nomi Health Commercial |
$3.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.56
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$4.04
|
|
|
Service Code
|
NDC 60687045711
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Aetna Commercial |
$3.64
|
| Rate for Payer: Aetna Medicare |
$2.02
|
| Rate for Payer: ASR ASR |
$3.92
|
| Rate for Payer: ASR Commercial |
$3.92
|
| Rate for Payer: BCBS Complete |
$1.62
|
| Rate for Payer: BCBS Trust/PPO |
$3.31
|
| Rate for Payer: BCN Commercial |
$3.13
|
| Rate for Payer: Cash Price |
$3.23
|
| Rate for Payer: Cofinity Commercial |
$3.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.23
|
| Rate for Payer: Healthscope Commercial |
$4.04
|
| Rate for Payer: Healthscope Whirlpool |
$3.92
|
| Rate for Payer: Mclaren Commercial |
$3.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.43
|
| Rate for Payer: Nomi Health Commercial |
$3.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.54
|
| Rate for Payer: Priority Health Narrow Network |
$2.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.56
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$185.65
|
|
|
Service Code
|
NDC 00904585461
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.26 |
| Max. Negotiated Rate |
$185.65 |
| Rate for Payer: Aetna Commercial |
$167.08
|
| Rate for Payer: Aetna Medicare |
$92.82
|
| Rate for Payer: ASR ASR |
$180.08
|
| Rate for Payer: ASR Commercial |
$180.08
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCBS Trust/PPO |
$152.03
|
| Rate for Payer: BCN Commercial |
$143.93
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$174.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$185.65
|
| Rate for Payer: Healthscope Whirlpool |
$180.08
|
| Rate for Payer: Mclaren Commercial |
$167.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.67
|
| Rate for Payer: Priority Health Narrow Network |
$130.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.37
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$164.50
|
|
|
Service Code
|
NDC 67877032001
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.92 |
| Max. Negotiated Rate |
$164.50 |
| Rate for Payer: Aetna Commercial |
$148.05
|
| Rate for Payer: ASR ASR |
$159.56
|
| Rate for Payer: ASR Commercial |
$159.56
|
| Rate for Payer: BCBS Trust/PPO |
$134.05
|
| Rate for Payer: BCN Commercial |
$127.54
|
| Rate for Payer: Cash Price |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$154.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.60
|
| Rate for Payer: Healthscope Commercial |
$164.50
|
| Rate for Payer: Healthscope Whirlpool |
$159.56
|
| Rate for Payer: Mclaren Commercial |
$148.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$139.82
|
| Rate for Payer: Nomi Health Commercial |
$134.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.76
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
OP
|
$157.45
|
|
|
Service Code
|
NDC 49483060301
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.98 |
| Max. Negotiated Rate |
$157.45 |
| Rate for Payer: Aetna Commercial |
$141.70
|
| Rate for Payer: Aetna Medicare |
$78.72
|
| Rate for Payer: ASR ASR |
$152.73
|
| Rate for Payer: ASR Commercial |
$152.73
|
| Rate for Payer: BCBS Complete |
$62.98
|
| Rate for Payer: BCBS Trust/PPO |
$128.94
|
| Rate for Payer: BCN Commercial |
$122.07
|
| Rate for Payer: Cash Price |
$125.96
|
| Rate for Payer: Cofinity Commercial |
$148.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.96
|
| Rate for Payer: Healthscope Commercial |
$157.45
|
| Rate for Payer: Healthscope Whirlpool |
$152.73
|
| Rate for Payer: Mclaren Commercial |
$141.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.83
|
| Rate for Payer: Nomi Health Commercial |
$129.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.96
|
| Rate for Payer: Priority Health Narrow Network |
$110.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$138.56
|
|
|
IBUPROFEN 600 MG TABLET
|
Facility
|
IP
|
$404.20
|
|
|
Service Code
|
NDC 60687045701
|
| Hospital Charge Code |
3844
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$262.73 |
| Max. Negotiated Rate |
$404.20 |
| Rate for Payer: Aetna Commercial |
$363.78
|
| Rate for Payer: ASR ASR |
$392.07
|
| Rate for Payer: ASR Commercial |
$392.07
|
| Rate for Payer: BCBS Trust/PPO |
$329.38
|
| Rate for Payer: BCN Commercial |
$313.38
|
| Rate for Payer: Cash Price |
$323.36
|
| Rate for Payer: Cofinity Commercial |
$379.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$323.36
|
| Rate for Payer: Healthscope Commercial |
$404.20
|
| Rate for Payer: Healthscope Whirlpool |
$392.07
|
| Rate for Payer: Mclaren Commercial |
$363.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$343.57
|
| Rate for Payer: Nomi Health Commercial |
$331.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$262.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$355.70
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$155.10
|
|
|
Service Code
|
NDC 67877032101
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.82 |
| Max. Negotiated Rate |
$155.10 |
| Rate for Payer: Aetna Commercial |
$139.59
|
| Rate for Payer: ASR ASR |
$150.45
|
| Rate for Payer: ASR Commercial |
$150.45
|
| Rate for Payer: BCBS Trust/PPO |
$126.39
|
| Rate for Payer: BCN Commercial |
$120.25
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$145.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$155.10
|
| Rate for Payer: Healthscope Whirlpool |
$150.45
|
| Rate for Payer: Mclaren Commercial |
$139.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Nomi Health Commercial |
$127.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.49
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
OP
|
$16.22
|
|
|
Service Code
|
NDC 00904585561
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: Aetna Commercial |
$14.60
|
| Rate for Payer: Aetna Medicare |
$8.11
|
| Rate for Payer: ASR ASR |
$15.73
|
| Rate for Payer: ASR Commercial |
$15.73
|
| Rate for Payer: BCBS Complete |
$6.49
|
| Rate for Payer: BCBS Trust/PPO |
$13.28
|
| Rate for Payer: BCN Commercial |
$12.58
|
| Rate for Payer: Cash Price |
$12.97
|
| Rate for Payer: Cofinity Commercial |
$15.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.98
|
| Rate for Payer: Healthscope Commercial |
$16.22
|
| Rate for Payer: Healthscope Whirlpool |
$15.73
|
| Rate for Payer: Mclaren Commercial |
$14.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.79
|
| Rate for Payer: Nomi Health Commercial |
$13.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.21
|
| Rate for Payer: Priority Health Narrow Network |
$11.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.27
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
OP
|
$155.10
|
|
|
Service Code
|
NDC 67877032101
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.04 |
| Max. Negotiated Rate |
$155.10 |
| Rate for Payer: Aetna Commercial |
$139.59
|
| Rate for Payer: Aetna Medicare |
$77.55
|
| Rate for Payer: ASR ASR |
$150.45
|
| Rate for Payer: ASR Commercial |
$150.45
|
| Rate for Payer: BCBS Complete |
$62.04
|
| Rate for Payer: BCBS Trust/PPO |
$127.01
|
| Rate for Payer: BCN Commercial |
$120.25
|
| Rate for Payer: Cash Price |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$145.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.08
|
| Rate for Payer: Healthscope Commercial |
$155.10
|
| Rate for Payer: Healthscope Whirlpool |
$150.45
|
| Rate for Payer: Mclaren Commercial |
$139.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$131.84
|
| Rate for Payer: Nomi Health Commercial |
$127.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$135.90
|
| Rate for Payer: Priority Health Narrow Network |
$108.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.49
|
|
|
IBUPROFEN 800 MG TABLET
|
Facility
|
IP
|
$16.22
|
|
|
Service Code
|
NDC 00904585561
|
| Hospital Charge Code |
3845
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: Aetna Commercial |
$14.60
|
| Rate for Payer: ASR ASR |
$15.73
|
| Rate for Payer: ASR Commercial |
$15.73
|
| Rate for Payer: BCBS Trust/PPO |
$13.22
|
| Rate for Payer: BCN Commercial |
$12.58
|
| Rate for Payer: Cash Price |
$12.97
|
| Rate for Payer: Cofinity Commercial |
$15.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.98
|
| Rate for Payer: Healthscope Commercial |
$16.22
|
| Rate for Payer: Healthscope Whirlpool |
$15.73
|
| Rate for Payer: Mclaren Commercial |
$14.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.79
|
| Rate for Payer: Nomi Health Commercial |
$13.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.27
|
|
|
IMMUNE GLOB G 40 GRAM/400 ML(10%)-GLY-IGA AVE 46 MCG/ML INJECTION SOLN
|
Facility
|
IP
|
$17,218.15
|
|
|
Service Code
|
HCPCS J1561
|
| Hospital Charge Code |
172845
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11,191.80 |
| Max. Negotiated Rate |
$17,218.15 |
| Rate for Payer: Aetna Commercial |
$15,496.34
|
| Rate for Payer: ASR ASR |
$16,701.61
|
| Rate for Payer: ASR Commercial |
$16,701.61
|
| Rate for Payer: BCBS Trust/PPO |
$14,031.07
|
| Rate for Payer: BCN Commercial |
$13,349.23
|
| Rate for Payer: Cash Price |
$13,774.52
|
| Rate for Payer: Cofinity Commercial |
$16,185.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,774.52
|
| Rate for Payer: Healthscope Commercial |
$17,218.15
|
| Rate for Payer: Healthscope Whirlpool |
$16,701.61
|
| Rate for Payer: Mclaren Commercial |
$15,496.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,635.43
|
| Rate for Payer: Nomi Health Commercial |
$14,118.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,191.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15,151.97
|
|
