|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$488.28
|
|
|
Service Code
|
NDC 00904701006
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$307.62 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Aetna Commercial |
$415.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.38
|
| Rate for Payer: Cash Price |
$390.62
|
| Rate for Payer: Cofinity Advantage |
$341.80
|
| Rate for Payer: Cofinity Commercial |
$419.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.62
|
| Rate for Payer: Healthscope Commercial |
$439.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$366.21
|
| Rate for Payer: PHP Commercial |
$415.04
|
| Rate for Payer: Priority Health SBD |
$307.62
|
|
|
BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$62.79
|
|
|
Service Code
|
HCPCS J0592
|
| Hospital Charge Code |
115937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.56 |
| Max. Negotiated Rate |
$56.51 |
| Rate for Payer: Aetna Commercial |
$53.37
|
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.81
|
| Rate for Payer: Cash Price |
$42.81
|
| Rate for Payer: Cash Price |
$50.23
|
| Rate for Payer: Cofinity Advantage |
$43.95
|
| Rate for Payer: Cofinity Advantage |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Cofinity Commercial |
$54.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.23
|
| Rate for Payer: Healthscope Commercial |
$48.16
|
| Rate for Payer: Healthscope Commercial |
$56.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.13
|
| Rate for Payer: PHP Commercial |
$45.48
|
| Rate for Payer: PHP Commercial |
$53.37
|
| Rate for Payer: Priority Health SBD |
$33.71
|
| Rate for Payer: Priority Health SBD |
$39.56
|
|
|
BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$62.79
|
|
|
Service Code
|
HCPCS J0592
|
| Hospital Charge Code |
115937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$56.51 |
| Rate for Payer: Aetna Commercial |
$53.37
|
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: Aetna Medicare |
$26.75
|
| Rate for Payer: Aetna Medicare |
$31.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.78
|
| Rate for Payer: BCBS Complete |
$21.40
|
| Rate for Payer: BCBS Complete |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$10.56
|
| Rate for Payer: BCBS Trust/PPO |
$10.56
|
| Rate for Payer: BCN Commercial |
$10.56
|
| Rate for Payer: BCN Commercial |
$10.56
|
| Rate for Payer: Cash Price |
$50.23
|
| Rate for Payer: Cash Price |
$42.81
|
| Rate for Payer: Cash Price |
$50.23
|
| Rate for Payer: Cash Price |
$42.81
|
| Rate for Payer: Cofinity Advantage |
$43.95
|
| Rate for Payer: Cofinity Advantage |
$37.46
|
| Rate for Payer: Cofinity Commercial |
$54.00
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.23
|
| Rate for Payer: Healthscope Commercial |
$48.16
|
| Rate for Payer: Healthscope Commercial |
$56.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.13
|
| Rate for Payer: PHP Commercial |
$53.37
|
| Rate for Payer: PHP Commercial |
$45.48
|
| Rate for Payer: Priority Health SBD |
$39.56
|
| Rate for Payer: Priority Health SBD |
$33.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.95
|
| Rate for Payer: UHC Core |
$6.95
|
| Rate for Payer: UHC Core |
$6.95
|
| Rate for Payer: UHC Exchange |
$6.95
|
| Rate for Payer: UHC Exchange |
$6.95
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$394.38
|
|
|
Service Code
|
NDC 00904715404
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.46 |
| Max. Negotiated Rate |
$354.94 |
| Rate for Payer: Aetna Commercial |
$335.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.35
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cofinity Advantage |
$276.07
|
| Rate for Payer: Cofinity Commercial |
$339.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.50
|
| Rate for Payer: Healthscope Commercial |
$354.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.79
|
| Rate for Payer: PHP Commercial |
$335.22
|
| Rate for Payer: Priority Health SBD |
$248.46
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$140.91
|
|
|
Service Code
|
NDC 50383092493
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.77 |
| Max. Negotiated Rate |
$126.82 |
| Rate for Payer: Aetna Commercial |
$119.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.59
|
| Rate for Payer: Cash Price |
$112.73
|
| Rate for Payer: Cofinity Advantage |
$98.64
|
| Rate for Payer: Cofinity Commercial |
$121.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.73
|
| Rate for Payer: Healthscope Commercial |
$126.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.68
|
| Rate for Payer: PHP Commercial |
$119.77
|
| Rate for Payer: Priority Health SBD |
$88.77
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$394.38
|
|
|
Service Code
|
NDC 00904715404
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.99 |
| Max. Negotiated Rate |
$354.94 |
| Rate for Payer: Aetna Commercial |
$335.22
|
| Rate for Payer: Aetna Medicare |
$197.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.35
|
| Rate for Payer: BCBS Complete |
$157.75
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cofinity Advantage |
$276.07
|
| Rate for Payer: Cofinity Commercial |
$339.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.50
|
| Rate for Payer: Healthscope Commercial |
$354.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$315.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.79
|
| Rate for Payer: PHP Commercial |
$335.22
|
| Rate for Payer: Priority Health SBD |
$248.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.35
|
| Rate for Payer: UHC Core |
$205.47
|
| Rate for Payer: UHC Exchange |
$154.99
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$200.55
|
|
|
Service Code
|
NDC 00054017613
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.35 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Aetna Commercial |
$170.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.36
|
| Rate for Payer: Cash Price |
$160.44
|
| Rate for Payer: Cofinity Advantage |
$140.38
|
| Rate for Payer: Cofinity Commercial |
$172.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.44
|
| Rate for Payer: Healthscope Commercial |
$180.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.41
|
| Rate for Payer: PHP Commercial |
$170.47
|
| Rate for Payer: Priority Health SBD |
$126.35
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$200.55
|
|
|
Service Code
|
NDC 00054017613
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.82 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Aetna Commercial |
$170.47
|
| Rate for Payer: Aetna Medicare |
$100.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.36
|
| Rate for Payer: BCBS Complete |
$80.22
|
| Rate for Payer: Cash Price |
$160.44
|
| Rate for Payer: Cofinity Advantage |
$140.38
|
| Rate for Payer: Cofinity Commercial |
$172.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.44
|
| Rate for Payer: Healthscope Commercial |
$180.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.41
|
| Rate for Payer: PHP Commercial |
$170.47
|
| Rate for Payer: Priority Health SBD |
$126.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.36
|
| Rate for Payer: UHC Core |
$104.49
|
| Rate for Payer: UHC Exchange |
$78.82
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$140.91
|
|
|
Service Code
|
NDC 50383092493
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.38 |
| Max. Negotiated Rate |
$126.82 |
| Rate for Payer: Aetna Commercial |
$119.77
|
| Rate for Payer: Aetna Medicare |
$70.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.59
|
| Rate for Payer: BCBS Complete |
$56.36
|
| Rate for Payer: Cash Price |
$112.73
|
| Rate for Payer: Cofinity Advantage |
$98.64
|
| Rate for Payer: Cofinity Commercial |
$121.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.73
|
| Rate for Payer: Healthscope Commercial |
$126.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.68
|
| Rate for Payer: PHP Commercial |
$119.77
|
| Rate for Payer: Priority Health SBD |
$88.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.59
|
| Rate for Payer: UHC Core |
$73.41
|
| Rate for Payer: UHC Exchange |
$55.38
|
|
|
BUPRENORPHINE HCL 75 MCG BUCCAL FILM
|
Facility
|
OP
|
$1,455.11
|
|
|
Service Code
|
NDC 59385002160
|
| Hospital Charge Code |
176431
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$571.86 |
| Max. Negotiated Rate |
$1,309.60 |
| Rate for Payer: Aetna Commercial |
$1,236.84
|
| Rate for Payer: Aetna Medicare |
$727.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$945.82
|
| Rate for Payer: BCBS Complete |
$582.04
|
| Rate for Payer: Cash Price |
$1,164.09
|
| Rate for Payer: Cofinity Advantage |
$1,018.58
|
| Rate for Payer: Cofinity Commercial |
$1,251.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,164.09
|
| Rate for Payer: Healthscope Commercial |
$1,309.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,164.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,236.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,091.33
|
| Rate for Payer: PHP Commercial |
$1,236.84
|
| Rate for Payer: Priority Health SBD |
$916.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$945.82
|
| Rate for Payer: UHC Core |
$758.11
|
| Rate for Payer: UHC Exchange |
$571.86
|
|
|
BUPRENORPHINE HCL 75 MCG BUCCAL FILM
|
Facility
|
IP
|
$1,455.11
|
|
|
Service Code
|
NDC 59385002160
|
| Hospital Charge Code |
176431
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$916.72 |
| Max. Negotiated Rate |
$1,309.60 |
| Rate for Payer: Aetna Commercial |
$1,236.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$945.82
|
| Rate for Payer: Cash Price |
$1,164.09
|
| Rate for Payer: Cofinity Advantage |
$1,018.58
|
| Rate for Payer: Cofinity Commercial |
$1,251.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,164.09
|
| Rate for Payer: Healthscope Commercial |
$1,309.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,236.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,091.33
|
| Rate for Payer: PHP Commercial |
$1,236.84
|
| Rate for Payer: Priority Health SBD |
$916.72
|
|
|
BUPRENORPHINE HCL 75 MCG BUCCAL FILM
|
Facility
|
IP
|
$24.26
|
|
|
Service Code
|
NDC 59385002101
|
| Hospital Charge Code |
176431
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$21.83 |
| Rate for Payer: Aetna Commercial |
$20.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.77
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Cofinity Advantage |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$20.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.41
|
| Rate for Payer: Healthscope Commercial |
$21.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.20
|
| Rate for Payer: PHP Commercial |
$20.62
|
| Rate for Payer: Priority Health SBD |
$15.28
|
|
|
BUPRENORPHINE HCL 75 MCG BUCCAL FILM
|
Facility
|
OP
|
$24.26
|
|
|
Service Code
|
NDC 59385002101
|
| Hospital Charge Code |
176431
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$21.83 |
| Rate for Payer: Aetna Commercial |
$20.62
|
| Rate for Payer: Aetna Medicare |
$12.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.77
|
| Rate for Payer: BCBS Complete |
$9.70
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Cofinity Advantage |
$16.98
|
| Rate for Payer: Cofinity Commercial |
$20.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.41
|
| Rate for Payer: Healthscope Commercial |
$21.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.20
|
| Rate for Payer: PHP Commercial |
$20.62
|
| Rate for Payer: Priority Health SBD |
$15.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.77
|
| Rate for Payer: UHC Core |
$12.64
|
| Rate for Payer: UHC Exchange |
$9.53
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
|
IP
|
$289.05
|
|
|
Service Code
|
NDC 62332012731
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.10 |
| Max. Negotiated Rate |
$260.14 |
| Rate for Payer: Aetna Commercial |
$245.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.88
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Advantage |
$202.34
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$260.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.79
|
| Rate for Payer: PHP Commercial |
$245.69
|
| Rate for Payer: Priority Health SBD |
$182.10
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
|
OP
|
$518.40
|
|
|
Service Code
|
NDC 00904663661
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$203.73 |
| Max. Negotiated Rate |
$466.56 |
| Rate for Payer: Aetna Commercial |
$440.64
|
| Rate for Payer: Aetna Medicare |
$259.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.96
|
| Rate for Payer: BCBS Complete |
$207.36
|
| Rate for Payer: Cash Price |
$414.72
|
| Rate for Payer: Cofinity Advantage |
$362.88
|
| Rate for Payer: Cofinity Commercial |
$445.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.72
|
| Rate for Payer: Healthscope Commercial |
$466.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$414.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.80
|
| Rate for Payer: PHP Commercial |
$440.64
|
| Rate for Payer: Priority Health SBD |
$326.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.96
|
| Rate for Payer: UHC Core |
$270.09
|
| Rate for Payer: UHC Exchange |
$203.73
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
|
OP
|
$318.72
|
|
|
Service Code
|
NDC 60505015701
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.26 |
| Max. Negotiated Rate |
$286.85 |
| Rate for Payer: Aetna Commercial |
$270.91
|
| Rate for Payer: Aetna Medicare |
$159.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.17
|
| Rate for Payer: BCBS Complete |
$127.49
|
| Rate for Payer: Cash Price |
$254.98
|
| Rate for Payer: Cofinity Advantage |
$223.10
|
| Rate for Payer: Cofinity Commercial |
$274.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.98
|
| Rate for Payer: Healthscope Commercial |
$286.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$239.04
|
| Rate for Payer: PHP Commercial |
$270.91
|
| Rate for Payer: Priority Health SBD |
$200.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.17
|
| Rate for Payer: UHC Core |
$166.05
|
| Rate for Payer: UHC Exchange |
$125.26
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
|
IP
|
$318.72
|
|
|
Service Code
|
NDC 60505015701
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.79 |
| Max. Negotiated Rate |
$286.85 |
| Rate for Payer: Aetna Commercial |
$270.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.17
|
| Rate for Payer: Cash Price |
$254.98
|
| Rate for Payer: Cofinity Advantage |
$223.10
|
| Rate for Payer: Cofinity Commercial |
$274.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.98
|
| Rate for Payer: Healthscope Commercial |
$286.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$239.04
|
| Rate for Payer: PHP Commercial |
$270.91
|
| Rate for Payer: Priority Health SBD |
$200.79
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
|
OP
|
$289.05
|
|
|
Service Code
|
NDC 62332012731
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$260.14 |
| Rate for Payer: Aetna Commercial |
$245.69
|
| Rate for Payer: Aetna Medicare |
$144.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.88
|
| Rate for Payer: BCBS Complete |
$115.62
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Advantage |
$202.34
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$260.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.79
|
| Rate for Payer: PHP Commercial |
$245.69
|
| Rate for Payer: Priority Health SBD |
$182.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.88
|
| Rate for Payer: UHC Core |
$150.60
|
| Rate for Payer: UHC Exchange |
$113.60
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
|
IP
|
$518.40
|
|
|
Service Code
|
NDC 00904663661
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$326.59 |
| Max. Negotiated Rate |
$466.56 |
| Rate for Payer: Aetna Commercial |
$440.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.96
|
| Rate for Payer: Cash Price |
$414.72
|
| Rate for Payer: Cofinity Advantage |
$362.88
|
| Rate for Payer: Cofinity Commercial |
$445.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.72
|
| Rate for Payer: Healthscope Commercial |
$466.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.80
|
| Rate for Payer: PHP Commercial |
$440.64
|
| Rate for Payer: Priority Health SBD |
$326.59
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
IP
|
$452.16
|
|
|
Service Code
|
NDC 51079094320
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.86 |
| Max. Negotiated Rate |
$406.94 |
| Rate for Payer: Aetna Commercial |
$384.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.90
|
| Rate for Payer: Cash Price |
$361.73
|
| Rate for Payer: Cofinity Advantage |
$316.51
|
| Rate for Payer: Cofinity Commercial |
$388.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.73
|
| Rate for Payer: Healthscope Commercial |
$406.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.12
|
| Rate for Payer: PHP Commercial |
$384.34
|
| Rate for Payer: Priority Health SBD |
$284.86
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
IP
|
$408.48
|
|
|
Service Code
|
NDC 00904663561
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.34 |
| Max. Negotiated Rate |
$367.63 |
| Rate for Payer: Aetna Commercial |
$347.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.51
|
| Rate for Payer: Cash Price |
$326.78
|
| Rate for Payer: Cofinity Advantage |
$285.94
|
| Rate for Payer: Cofinity Commercial |
$351.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.78
|
| Rate for Payer: Healthscope Commercial |
$367.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$306.36
|
| Rate for Payer: PHP Commercial |
$347.21
|
| Rate for Payer: Priority Health SBD |
$257.34
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
OP
|
$408.48
|
|
|
Service Code
|
NDC 00904663561
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.53 |
| Max. Negotiated Rate |
$367.63 |
| Rate for Payer: Aetna Commercial |
$347.21
|
| Rate for Payer: Aetna Medicare |
$204.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.51
|
| Rate for Payer: BCBS Complete |
$163.39
|
| Rate for Payer: Cash Price |
$326.78
|
| Rate for Payer: Cofinity Advantage |
$285.94
|
| Rate for Payer: Cofinity Commercial |
$351.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.78
|
| Rate for Payer: Healthscope Commercial |
$367.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$326.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$306.36
|
| Rate for Payer: PHP Commercial |
$347.21
|
| Rate for Payer: Priority Health SBD |
$257.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.51
|
| Rate for Payer: UHC Core |
$212.82
|
| Rate for Payer: UHC Exchange |
$160.53
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
IP
|
$4.53
|
|
|
Service Code
|
NDC 51079094301
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.94
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cofinity Advantage |
$3.17
|
| Rate for Payer: Cofinity Commercial |
$3.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.62
|
| Rate for Payer: Healthscope Commercial |
$4.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.40
|
| Rate for Payer: PHP Commercial |
$3.85
|
| Rate for Payer: Priority Health SBD |
$2.85
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
OP
|
$4.53
|
|
|
Service Code
|
NDC 51079094301
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.78 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna Medicare |
$2.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.94
|
| Rate for Payer: BCBS Complete |
$1.81
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cofinity Advantage |
$3.17
|
| Rate for Payer: Cofinity Commercial |
$3.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.62
|
| Rate for Payer: Healthscope Commercial |
$4.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.40
|
| Rate for Payer: PHP Commercial |
$3.85
|
| Rate for Payer: Priority Health SBD |
$2.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.94
|
| Rate for Payer: UHC Core |
$2.36
|
| Rate for Payer: UHC Exchange |
$1.78
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
OP
|
$452.16
|
|
|
Service Code
|
NDC 51079094320
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.70 |
| Max. Negotiated Rate |
$406.94 |
| Rate for Payer: Aetna Commercial |
$384.34
|
| Rate for Payer: Aetna Medicare |
$226.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.90
|
| Rate for Payer: BCBS Complete |
$180.86
|
| Rate for Payer: Cash Price |
$361.73
|
| Rate for Payer: Cofinity Advantage |
$316.51
|
| Rate for Payer: Cofinity Commercial |
$388.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.73
|
| Rate for Payer: Healthscope Commercial |
$406.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$361.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.12
|
| Rate for Payer: PHP Commercial |
$384.34
|
| Rate for Payer: Priority Health SBD |
$284.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.90
|
| Rate for Payer: UHC Core |
$235.58
|
| Rate for Payer: UHC Exchange |
$177.70
|
|
