Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$361.67

Service Code	NDC 68180031909
Hospital Charge Code	36775
Hospital Revenue Code	637
Min. Negotiated Rate	$227.85
Max. Negotiated Rate	$325.50
Rate for Payer: Aetna Commercial	$307.42
Rate for Payer: Aetna New Business (MI Preferred)	$235.09
Rate for Payer: Cash Price	$289.34
Rate for Payer: Cofinity Advantage	$253.17
Rate for Payer: Cofinity Commercial	$311.04
Rate for Payer: Encore Health Key Benefits Commercial	$289.34
Rate for Payer: Healthscope Commercial	$325.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$307.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$271.25
Rate for Payer: PHP Commercial	$307.42
Rate for Payer: Priority Health SBD	$227.85

BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$8.28

Service Code	NDC 60687031211
Hospital Charge Code	36775
Hospital Revenue Code	637
Min. Negotiated Rate	$3.25
Max. Negotiated Rate	$7.45
Rate for Payer: Aetna Commercial	$7.04
Rate for Payer: Aetna Medicare	$4.14
Rate for Payer: Aetna New Business (MI Preferred)	$5.38
Rate for Payer: BCBS Complete	$3.31
Rate for Payer: Cash Price	$6.62
Rate for Payer: Cofinity Advantage	$5.80
Rate for Payer: Cofinity Commercial	$7.12
Rate for Payer: Encore Health Key Benefits Commercial	$6.62
Rate for Payer: Healthscope Commercial	$7.45
Rate for Payer: MI Amish Medical Board Commercial	$6.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.21
Rate for Payer: PHP Commercial	$7.04
Rate for Payer: Priority Health SBD	$5.22
Rate for Payer: UHC All Payor (Choice/PPO)	$5.38
Rate for Payer: UHC Core	$4.31
Rate for Payer: UHC Exchange	$3.25

BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$139.97

Service Code	NDC 00904750504
Hospital Charge Code	36775
Hospital Revenue Code	637
Min. Negotiated Rate	$88.18
Max. Negotiated Rate	$125.97
Rate for Payer: Aetna Commercial	$118.97
Rate for Payer: Aetna New Business (MI Preferred)	$90.98
Rate for Payer: Cash Price	$111.98
Rate for Payer: Cofinity Advantage	$97.98
Rate for Payer: Cofinity Commercial	$120.37
Rate for Payer: Encore Health Key Benefits Commercial	$111.98
Rate for Payer: Healthscope Commercial	$125.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$118.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$104.98
Rate for Payer: PHP Commercial	$118.97
Rate for Payer: Priority Health SBD	$88.18

BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$361.67

Service Code	NDC 68180031909
Hospital Charge Code	36775
Hospital Revenue Code	637
Min. Negotiated Rate	$142.14
Max. Negotiated Rate	$325.50
Rate for Payer: Aetna Commercial	$307.42
Rate for Payer: Aetna Medicare	$180.84
Rate for Payer: Aetna New Business (MI Preferred)	$235.09
Rate for Payer: BCBS Complete	$144.67
Rate for Payer: Cash Price	$289.34
Rate for Payer: Cofinity Advantage	$253.17
Rate for Payer: Cofinity Commercial	$311.04
Rate for Payer: Encore Health Key Benefits Commercial	$289.34
Rate for Payer: Healthscope Commercial	$325.50
Rate for Payer: MI Amish Medical Board Commercial	$289.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$307.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$271.25
Rate for Payer: PHP Commercial	$307.42
Rate for Payer: Priority Health SBD	$227.85
Rate for Payer: UHC All Payor (Choice/PPO)	$235.09
Rate for Payer: UHC Core	$188.43
Rate for Payer: UHC Exchange	$142.14

BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$828.00

Service Code	NDC 60687031201
Hospital Charge Code	36775
Hospital Revenue Code	637
Min. Negotiated Rate	$325.40
Max. Negotiated Rate	$745.20
Rate for Payer: Aetna Commercial	$703.80
Rate for Payer: Aetna Medicare	$414.00
Rate for Payer: Aetna New Business (MI Preferred)	$538.20
Rate for Payer: BCBS Complete	$331.20
Rate for Payer: Cash Price	$662.40
Rate for Payer: Cofinity Advantage	$579.60
Rate for Payer: Cofinity Commercial	$712.08
Rate for Payer: Encore Health Key Benefits Commercial	$662.40
Rate for Payer: Healthscope Commercial	$745.20
Rate for Payer: MI Amish Medical Board Commercial	$662.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$703.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$621.00
Rate for Payer: PHP Commercial	$703.80
Rate for Payer: Priority Health SBD	$521.64
Rate for Payer: UHC All Payor (Choice/PPO)	$538.20
Rate for Payer: UHC Core	$431.39
Rate for Payer: UHC Exchange	$325.40

BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$8.28

Service Code	NDC 60687031211
Hospital Charge Code	36775
Hospital Revenue Code	637
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$7.45
Rate for Payer: Aetna Commercial	$7.04
Rate for Payer: Aetna New Business (MI Preferred)	$5.38
Rate for Payer: Cash Price	$6.62
Rate for Payer: Cofinity Advantage	$5.80
Rate for Payer: Cofinity Commercial	$7.12
Rate for Payer: Encore Health Key Benefits Commercial	$6.62
Rate for Payer: Healthscope Commercial	$7.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.21
Rate for Payer: PHP Commercial	$7.04
Rate for Payer: Priority Health SBD	$5.22

BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$828.00

Service Code	NDC 60687031201
Hospital Charge Code	36775
Hospital Revenue Code	637
Min. Negotiated Rate	$521.64
Max. Negotiated Rate	$745.20
Rate for Payer: Aetna Commercial	$703.80
Rate for Payer: Aetna New Business (MI Preferred)	$538.20
Rate for Payer: Cash Price	$662.40
Rate for Payer: Cofinity Advantage	$579.60
Rate for Payer: Cofinity Commercial	$712.08
Rate for Payer: Encore Health Key Benefits Commercial	$662.40
Rate for Payer: Healthscope Commercial	$745.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$703.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$621.00
Rate for Payer: PHP Commercial	$703.80
Rate for Payer: Priority Health SBD	$521.64

BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$139.97

Service Code	NDC 00904750504
Hospital Charge Code	36775
Hospital Revenue Code	637
Min. Negotiated Rate	$55.01
Max. Negotiated Rate	$125.97
Rate for Payer: Aetna Commercial	$118.97
Rate for Payer: Aetna Medicare	$69.98
Rate for Payer: Aetna New Business (MI Preferred)	$90.98
Rate for Payer: BCBS Complete	$55.99
Rate for Payer: Cash Price	$111.98
Rate for Payer: Cofinity Advantage	$97.98
Rate for Payer: Cofinity Commercial	$120.37
Rate for Payer: Encore Health Key Benefits Commercial	$111.98
Rate for Payer: Healthscope Commercial	$125.97
Rate for Payer: MI Amish Medical Board Commercial	$111.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$118.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$104.98
Rate for Payer: PHP Commercial	$118.97
Rate for Payer: Priority Health SBD	$88.18
Rate for Payer: UHC All Payor (Choice/PPO)	$90.98
Rate for Payer: UHC Core	$72.92
Rate for Payer: UHC Exchange	$55.01

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$327.83

Service Code	NDC 24979010207
Hospital Charge Code	36776
Hospital Revenue Code	637
Min. Negotiated Rate	$206.53
Max. Negotiated Rate	$295.05
Rate for Payer: Aetna Commercial	$278.66
Rate for Payer: Aetna New Business (MI Preferred)	$213.09
Rate for Payer: Cash Price	$262.26
Rate for Payer: Cofinity Advantage	$229.48
Rate for Payer: Cofinity Commercial	$281.93
Rate for Payer: Encore Health Key Benefits Commercial	$262.26
Rate for Payer: Healthscope Commercial	$295.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$278.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$245.87
Rate for Payer: PHP Commercial	$278.66
Rate for Payer: Priority Health SBD	$206.53

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$210.82

Service Code	NDC 60687079321
Hospital Charge Code	36776
Hospital Revenue Code	637
Min. Negotiated Rate	$132.82
Max. Negotiated Rate	$189.74
Rate for Payer: Aetna Commercial	$179.20
Rate for Payer: Aetna New Business (MI Preferred)	$137.03
Rate for Payer: Cash Price	$168.66
Rate for Payer: Cofinity Advantage	$147.57
Rate for Payer: Cofinity Commercial	$181.31
Rate for Payer: Encore Health Key Benefits Commercial	$168.66
Rate for Payer: Healthscope Commercial	$189.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$179.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$158.12
Rate for Payer: PHP Commercial	$179.20
Rate for Payer: Priority Health SBD	$132.82

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$60.42

Service Code	NDC 68180032006
Hospital Charge Code	36776
Hospital Revenue Code	637
Min. Negotiated Rate	$23.75
Max. Negotiated Rate	$54.38
Rate for Payer: Aetna Commercial	$51.36
Rate for Payer: Aetna Medicare	$30.21
Rate for Payer: Aetna New Business (MI Preferred)	$39.27
Rate for Payer: BCBS Complete	$24.17
Rate for Payer: Cash Price	$48.34
Rate for Payer: Cofinity Advantage	$42.29
Rate for Payer: Cofinity Commercial	$51.96
Rate for Payer: Encore Health Key Benefits Commercial	$48.34
Rate for Payer: Healthscope Commercial	$54.38
Rate for Payer: MI Amish Medical Board Commercial	$48.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$45.31
Rate for Payer: PHP Commercial	$51.36
Rate for Payer: Priority Health SBD	$38.06
Rate for Payer: UHC All Payor (Choice/PPO)	$39.27
Rate for Payer: UHC Core	$31.48
Rate for Payer: UHC Exchange	$23.75

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$7.03

Service Code	NDC 60687079311
Hospital Charge Code	36776
Hospital Revenue Code	637
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$6.33
Rate for Payer: Aetna Commercial	$5.98
Rate for Payer: Aetna New Business (MI Preferred)	$4.57
Rate for Payer: Cash Price	$5.62
Rate for Payer: Cofinity Advantage	$4.92
Rate for Payer: Cofinity Commercial	$6.05
Rate for Payer: Encore Health Key Benefits Commercial	$5.62
Rate for Payer: Healthscope Commercial	$6.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.27
Rate for Payer: PHP Commercial	$5.98
Rate for Payer: Priority Health SBD	$4.43

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$9.39

Service Code	NDC 50268014111
Hospital Charge Code	36776
Hospital Revenue Code	637
Min. Negotiated Rate	$3.69
Max. Negotiated Rate	$8.45
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna Medicare	$4.70
Rate for Payer: Aetna New Business (MI Preferred)	$6.10
Rate for Payer: BCBS Complete	$3.76
Rate for Payer: Cash Price	$7.51
Rate for Payer: Cofinity Advantage	$6.57
Rate for Payer: Cofinity Commercial	$8.08
Rate for Payer: Encore Health Key Benefits Commercial	$7.51
Rate for Payer: Healthscope Commercial	$8.45
Rate for Payer: MI Amish Medical Board Commercial	$7.51
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.04
Rate for Payer: PHP Commercial	$7.98
Rate for Payer: Priority Health SBD	$5.92
Rate for Payer: UHC All Payor (Choice/PPO)	$6.10
Rate for Payer: UHC Core	$4.89
Rate for Payer: UHC Exchange	$3.69

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$158.55

Service Code	NDC 00904657304
Hospital Charge Code	36776
Hospital Revenue Code	637
Min. Negotiated Rate	$99.89
Max. Negotiated Rate	$142.69
Rate for Payer: Aetna Commercial	$134.77
Rate for Payer: Aetna New Business (MI Preferred)	$103.06
Rate for Payer: Cash Price	$126.84
Rate for Payer: Cofinity Advantage	$110.98
Rate for Payer: Cofinity Commercial	$136.35
Rate for Payer: Encore Health Key Benefits Commercial	$126.84
Rate for Payer: Healthscope Commercial	$142.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.91
Rate for Payer: PHP Commercial	$134.77
Rate for Payer: Priority Health SBD	$99.89

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$9.39

Service Code	NDC 50268014111
Hospital Charge Code	36776
Hospital Revenue Code	637
Min. Negotiated Rate	$5.92
Max. Negotiated Rate	$8.45
Rate for Payer: Aetna Commercial	$7.98
Rate for Payer: Aetna New Business (MI Preferred)	$6.10
Rate for Payer: Cash Price	$7.51
Rate for Payer: Cofinity Advantage	$6.57
Rate for Payer: Cofinity Commercial	$8.08
Rate for Payer: Encore Health Key Benefits Commercial	$7.51
Rate for Payer: Healthscope Commercial	$8.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$7.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.04
Rate for Payer: PHP Commercial	$7.98
Rate for Payer: Priority Health SBD	$5.92

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$181.26

Service Code	NDC 68180032009
Hospital Charge Code	36776
Hospital Revenue Code	637
Min. Negotiated Rate	$114.19
Max. Negotiated Rate	$163.13
Rate for Payer: Aetna Commercial	$154.07
Rate for Payer: Aetna New Business (MI Preferred)	$117.82
Rate for Payer: Cash Price	$145.01
Rate for Payer: Cofinity Advantage	$126.88
Rate for Payer: Cofinity Commercial	$155.88
Rate for Payer: Encore Health Key Benefits Commercial	$145.01
Rate for Payer: Healthscope Commercial	$163.13
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$154.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$135.94
Rate for Payer: PHP Commercial	$154.07
Rate for Payer: Priority Health SBD	$114.19

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$105.05

Service Code	NDC 16729044410
Hospital Charge Code	36776
Hospital Revenue Code	637
Min. Negotiated Rate	$66.18
Max. Negotiated Rate	$94.55
Rate for Payer: Aetna Commercial	$89.29
Rate for Payer: Aetna New Business (MI Preferred)	$68.28
Rate for Payer: Cash Price	$84.04
Rate for Payer: Cofinity Advantage	$73.53
Rate for Payer: Cofinity Commercial	$90.34
Rate for Payer: Encore Health Key Benefits Commercial	$84.04
Rate for Payer: Healthscope Commercial	$94.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$78.79
Rate for Payer: PHP Commercial	$89.29
Rate for Payer: Priority Health SBD	$66.18

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$158.55

Service Code	NDC 00904657304
Hospital Charge Code	36776
Hospital Revenue Code	637
Min. Negotiated Rate	$62.31
Max. Negotiated Rate	$142.69
Rate for Payer: Aetna Commercial	$134.77
Rate for Payer: Aetna Medicare	$79.28
Rate for Payer: Aetna New Business (MI Preferred)	$103.06
Rate for Payer: BCBS Complete	$63.42
Rate for Payer: Cash Price	$126.84
Rate for Payer: Cofinity Advantage	$110.98
Rate for Payer: Cofinity Commercial	$136.35
Rate for Payer: Encore Health Key Benefits Commercial	$126.84
Rate for Payer: Healthscope Commercial	$142.69
Rate for Payer: MI Amish Medical Board Commercial	$126.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$134.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.91
Rate for Payer: PHP Commercial	$134.77
Rate for Payer: Priority Health SBD	$99.89
Rate for Payer: UHC All Payor (Choice/PPO)	$103.06
Rate for Payer: UHC Core	$82.60
Rate for Payer: UHC Exchange	$62.31

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$192.10

Service Code	NDC 00904746904
Hospital Charge Code	36776
Hospital Revenue Code	637
Min. Negotiated Rate	$75.50
Max. Negotiated Rate	$172.89
Rate for Payer: Aetna Commercial	$163.28
Rate for Payer: Aetna Medicare	$96.05
Rate for Payer: Aetna New Business (MI Preferred)	$124.86
Rate for Payer: BCBS Complete	$76.84
Rate for Payer: Cash Price	$153.68
Rate for Payer: Cofinity Advantage	$134.47
Rate for Payer: Cofinity Commercial	$165.21
Rate for Payer: Encore Health Key Benefits Commercial	$153.68
Rate for Payer: Healthscope Commercial	$172.89
Rate for Payer: MI Amish Medical Board Commercial	$153.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$163.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$144.07
Rate for Payer: PHP Commercial	$163.28
Rate for Payer: Priority Health SBD	$121.02
Rate for Payer: UHC All Payor (Choice/PPO)	$124.86
Rate for Payer: UHC Core	$100.08
Rate for Payer: UHC Exchange	$75.50

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$210.82

Service Code	NDC 60687079321
Hospital Charge Code	36776
Hospital Revenue Code	637
Min. Negotiated Rate	$82.85
Max. Negotiated Rate	$189.74
Rate for Payer: Aetna Commercial	$179.20
Rate for Payer: Aetna Medicare	$105.41
Rate for Payer: Aetna New Business (MI Preferred)	$137.03
Rate for Payer: BCBS Complete	$84.33
Rate for Payer: Cash Price	$168.66
Rate for Payer: Cofinity Advantage	$147.57
Rate for Payer: Cofinity Commercial	$181.31
Rate for Payer: Encore Health Key Benefits Commercial	$168.66
Rate for Payer: Healthscope Commercial	$189.74
Rate for Payer: MI Amish Medical Board Commercial	$168.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$179.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$158.12
Rate for Payer: PHP Commercial	$179.20
Rate for Payer: Priority Health SBD	$132.82
Rate for Payer: UHC All Payor (Choice/PPO)	$137.03
Rate for Payer: UHC Core	$109.84
Rate for Payer: UHC Exchange	$82.85

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$105.05

Service Code	NDC 16729044410
Hospital Charge Code	36776
Hospital Revenue Code	637
Min. Negotiated Rate	$41.28
Max. Negotiated Rate	$94.55
Rate for Payer: Aetna Commercial	$89.29
Rate for Payer: Aetna Medicare	$52.52
Rate for Payer: Aetna New Business (MI Preferred)	$68.28
Rate for Payer: BCBS Complete	$42.02
Rate for Payer: Cash Price	$84.04
Rate for Payer: Cofinity Advantage	$73.53
Rate for Payer: Cofinity Commercial	$90.34
Rate for Payer: Encore Health Key Benefits Commercial	$84.04
Rate for Payer: Healthscope Commercial	$94.55
Rate for Payer: MI Amish Medical Board Commercial	$84.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$89.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$78.79
Rate for Payer: PHP Commercial	$89.29
Rate for Payer: Priority Health SBD	$66.18
Rate for Payer: UHC All Payor (Choice/PPO)	$68.28
Rate for Payer: UHC Core	$54.73
Rate for Payer: UHC Exchange	$41.28

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$181.26

Service Code	NDC 68180032009
Hospital Charge Code	36776
Hospital Revenue Code	637
Min. Negotiated Rate	$71.24
Max. Negotiated Rate	$163.13
Rate for Payer: Aetna Commercial	$154.07
Rate for Payer: Aetna Medicare	$90.63
Rate for Payer: Aetna New Business (MI Preferred)	$117.82
Rate for Payer: BCBS Complete	$72.50
Rate for Payer: Cash Price	$145.01
Rate for Payer: Cofinity Advantage	$126.88
Rate for Payer: Cofinity Commercial	$155.88
Rate for Payer: Encore Health Key Benefits Commercial	$145.01
Rate for Payer: Healthscope Commercial	$163.13
Rate for Payer: MI Amish Medical Board Commercial	$145.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$154.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$135.94
Rate for Payer: PHP Commercial	$154.07
Rate for Payer: Priority Health SBD	$114.19
Rate for Payer: UHC All Payor (Choice/PPO)	$117.82
Rate for Payer: UHC Core	$94.44
Rate for Payer: UHC Exchange	$71.24

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$60.42

Service Code	NDC 68180032006
Hospital Charge Code	36776
Hospital Revenue Code	637
Min. Negotiated Rate	$38.06
Max. Negotiated Rate	$54.38
Rate for Payer: Aetna Commercial	$51.36
Rate for Payer: Aetna New Business (MI Preferred)	$39.27
Rate for Payer: Cash Price	$48.34
Rate for Payer: Cofinity Advantage	$42.29
Rate for Payer: Cofinity Commercial	$51.96
Rate for Payer: Encore Health Key Benefits Commercial	$48.34
Rate for Payer: Healthscope Commercial	$54.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$45.31
Rate for Payer: PHP Commercial	$51.36
Rate for Payer: Priority Health SBD	$38.06

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$7.03

Service Code	NDC 60687079311
Hospital Charge Code	36776
Hospital Revenue Code	637
Min. Negotiated Rate	$2.76
Max. Negotiated Rate	$6.33
Rate for Payer: Aetna Commercial	$5.98
Rate for Payer: Aetna Medicare	$3.52
Rate for Payer: Aetna New Business (MI Preferred)	$4.57
Rate for Payer: BCBS Complete	$2.81
Rate for Payer: Cash Price	$5.62
Rate for Payer: Cofinity Advantage	$4.92
Rate for Payer: Cofinity Commercial	$6.05
Rate for Payer: Encore Health Key Benefits Commercial	$5.62
Rate for Payer: Healthscope Commercial	$6.33
Rate for Payer: MI Amish Medical Board Commercial	$5.62
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$5.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.27
Rate for Payer: PHP Commercial	$5.98
Rate for Payer: Priority Health SBD	$4.43
Rate for Payer: UHC All Payor (Choice/PPO)	$4.57
Rate for Payer: UHC Core	$3.66
Rate for Payer: UHC Exchange	$2.76

BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE

Facility

$327.83

Service Code	NDC 24979010207
Hospital Charge Code	36776
Hospital Revenue Code	637
Min. Negotiated Rate	$128.84
Max. Negotiated Rate	$295.05
Rate for Payer: Aetna Commercial	$278.66
Rate for Payer: Aetna Medicare	$163.91
Rate for Payer: Aetna New Business (MI Preferred)	$213.09
Rate for Payer: BCBS Complete	$131.13
Rate for Payer: Cash Price	$262.26
Rate for Payer: Cofinity Advantage	$229.48
Rate for Payer: Cofinity Commercial	$281.93
Rate for Payer: Encore Health Key Benefits Commercial	$262.26
Rate for Payer: Healthscope Commercial	$295.05
Rate for Payer: MI Amish Medical Board Commercial	$262.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$278.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$245.87
Rate for Payer: PHP Commercial	$278.66
Rate for Payer: Priority Health SBD	$206.53
Rate for Payer: UHC All Payor (Choice/PPO)	$213.09
Rate for Payer: UHC Core	$170.80
Rate for Payer: UHC Exchange	$128.84

Know your out-of-pocket cost for care.

All Charges