|
BUPROPION HCL XL 300 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$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
|
IP
|
$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
|
IP
|
$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
|
|
|
BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS
|
Facility
|
IP
|
$10,148.56
|
|
|
Service Code
|
APR-DRG 8421
|
| Min. Negotiated Rate |
$9,665.29 |
| Max. Negotiated Rate |
$10,148.56 |
| Rate for Payer: BCBS Complete |
$10,148.56
|
| Rate for Payer: Mclaren Medicaid |
$9,665.29
|
| Rate for Payer: Meridian Medicaid |
$10,148.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,665.29
|
| Rate for Payer: UHC Medicaid |
$9,665.29
|
| Rate for Payer: UHCCP Medicaid |
$9,665.29
|
|
|
BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS
|
Facility
|
IP
|
$94,776.24
|
|
|
Service Code
|
APR-DRG 8424
|
| Min. Negotiated Rate |
$90,263.08 |
| Max. Negotiated Rate |
$94,776.24 |
| Rate for Payer: BCBS Complete |
$94,776.24
|
| Rate for Payer: Mclaren Medicaid |
$90,263.08
|
| Rate for Payer: Meridian Medicaid |
$94,776.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$90,263.08
|
| Rate for Payer: UHC Medicaid |
$90,263.08
|
| Rate for Payer: UHCCP Medicaid |
$90,263.08
|
|
|
BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS
|
Facility
|
IP
|
$25,033.72
|
|
|
Service Code
|
APR-DRG 8423
|
| Min. Negotiated Rate |
$23,841.64 |
| Max. Negotiated Rate |
$25,033.72 |
| Rate for Payer: BCBS Complete |
$25,033.72
|
| Rate for Payer: Mclaren Medicaid |
$23,841.64
|
| Rate for Payer: Meridian Medicaid |
$25,033.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$23,841.64
|
| Rate for Payer: UHC Medicaid |
$23,841.64
|
| Rate for Payer: UHCCP Medicaid |
$23,841.64
|
|
|
BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS
|
Facility
|
IP
|
$19,848.22
|
|
|
Service Code
|
APR-DRG 8422
|
| Min. Negotiated Rate |
$18,903.07 |
| Max. Negotiated Rate |
$19,848.22 |
| Rate for Payer: BCBS Complete |
$19,848.22
|
| Rate for Payer: Mclaren Medicaid |
$18,903.07
|
| Rate for Payer: Meridian Medicaid |
$19,848.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$18,903.07
|
| Rate for Payer: UHC Medicaid |
$18,903.07
|
| Rate for Payer: UHCCP Medicaid |
$18,903.07
|
|
|
BUROSUMAB-TWZA 10 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$19,987.02
|
|
|
Service Code
|
HCPCS J0584
|
| Hospital Charge Code |
186422
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12,591.82 |
| Max. Negotiated Rate |
$17,988.32 |
| Rate for Payer: Aetna Commercial |
$16,988.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,991.56
|
| Rate for Payer: Cash Price |
$15,989.62
|
| Rate for Payer: Cofinity Advantage |
$13,990.91
|
| Rate for Payer: Cofinity Commercial |
$17,188.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,989.62
|
| Rate for Payer: Healthscope Commercial |
$17,988.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,988.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,990.26
|
| Rate for Payer: PHP Commercial |
$16,988.97
|
| Rate for Payer: Priority Health SBD |
$12,591.82
|
|
|
BUROSUMAB-TWZA 10 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$19,987.02
|
|
|
Service Code
|
HCPCS J0584
|
| Hospital Charge Code |
186422
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$260.83 |
| Max. Negotiated Rate |
$17,988.32 |
| Rate for Payer: Aetna Commercial |
$16,988.97
|
| Rate for Payer: Aetna Medicare |
$518.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12,991.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.40
|
| Rate for Payer: BCBS Complete |
$273.90
|
| Rate for Payer: BCBS MAPPO |
$498.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,249.45
|
| Rate for Payer: BCN Commercial |
$1,249.45
|
| Rate for Payer: BCN Medicare Advantage |
$498.72
|
| Rate for Payer: Cash Price |
$15,989.62
|
| Rate for Payer: Cash Price |
$15,989.62
|
| Rate for Payer: Cofinity Advantage |
$13,990.91
|
| Rate for Payer: Cofinity Commercial |
$17,188.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15,989.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.72
|
| Rate for Payer: Healthscope Commercial |
$17,988.32
|
| Rate for Payer: Mclaren Medicaid |
$260.83
|
| Rate for Payer: Mclaren Medicare |
$498.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.66
|
| Rate for Payer: Meridian Medicaid |
$523.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$548.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,988.97
|
| Rate for Payer: Nomi Health Commercial |
$1,496.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14,990.26
|
| Rate for Payer: PACE Medicare |
$473.78
|
| Rate for Payer: PACE SWMI |
$498.72
|
| Rate for Payer: PHP Commercial |
$16,988.97
|
| Rate for Payer: PHP Medicare Advantage |
$498.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,526.94
|
| Rate for Payer: Priority Health Medicare |
$498.72
|
| Rate for Payer: Priority Health SBD |
$12,591.82
|
| Rate for Payer: Priority Health Tiered Network |
$1,221.55
|
| Rate for Payer: Railroad Medicare Medicare |
$498.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$821.73
|
| Rate for Payer: UHC Core |
$821.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$498.72
|
| Rate for Payer: UHC Exchange |
$821.73
|
| Rate for Payer: UHC Medicaid |
$260.83
|
| Rate for Payer: UHCCP Medicaid |
$260.83
|
| Rate for Payer: VA VA |
$498.72
|
|
|
BUROSUMAB-TWZA 20 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$39,974.07
|
|
|
Service Code
|
HCPCS J0584
|
| Hospital Charge Code |
186423
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$260.83 |
| Max. Negotiated Rate |
$35,976.66 |
| Rate for Payer: Aetna Commercial |
$33,977.96
|
| Rate for Payer: Aetna Medicare |
$518.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25,983.15
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.40
|
| Rate for Payer: BCBS Complete |
$273.90
|
| Rate for Payer: BCBS MAPPO |
$498.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,249.45
|
| Rate for Payer: BCN Commercial |
$1,249.45
|
| Rate for Payer: BCN Medicare Advantage |
$498.72
|
| Rate for Payer: Cash Price |
$31,979.26
|
| Rate for Payer: Cash Price |
$31,979.26
|
| Rate for Payer: Cofinity Advantage |
$27,981.85
|
| Rate for Payer: Cofinity Commercial |
$34,377.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31,979.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.72
|
| Rate for Payer: Healthscope Commercial |
$35,976.66
|
| Rate for Payer: Mclaren Medicaid |
$260.83
|
| Rate for Payer: Mclaren Medicare |
$498.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.66
|
| Rate for Payer: Meridian Medicaid |
$523.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$548.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33,977.96
|
| Rate for Payer: Nomi Health Commercial |
$1,496.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29,980.55
|
| Rate for Payer: PACE Medicare |
$473.78
|
| Rate for Payer: PACE SWMI |
$498.72
|
| Rate for Payer: PHP Commercial |
$33,977.96
|
| Rate for Payer: PHP Medicare Advantage |
$498.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,526.94
|
| Rate for Payer: Priority Health Medicare |
$498.72
|
| Rate for Payer: Priority Health SBD |
$25,183.66
|
| Rate for Payer: Priority Health Tiered Network |
$1,221.55
|
| Rate for Payer: Railroad Medicare Medicare |
$498.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$821.73
|
| Rate for Payer: UHC Core |
$821.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$498.72
|
| Rate for Payer: UHC Exchange |
$821.73
|
| Rate for Payer: UHC Medicaid |
$260.83
|
| Rate for Payer: UHCCP Medicaid |
$260.83
|
| Rate for Payer: VA VA |
$498.72
|
|
|
BUROSUMAB-TWZA 20 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$39,974.07
|
|
|
Service Code
|
HCPCS J0584
|
| Hospital Charge Code |
186423
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25,183.66 |
| Max. Negotiated Rate |
$35,976.66 |
| Rate for Payer: Aetna Commercial |
$33,977.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25,983.15
|
| Rate for Payer: Cash Price |
$31,979.26
|
| Rate for Payer: Cofinity Advantage |
$27,981.85
|
| Rate for Payer: Cofinity Commercial |
$34,377.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31,979.26
|
| Rate for Payer: Healthscope Commercial |
$35,976.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33,977.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29,980.55
|
| Rate for Payer: PHP Commercial |
$33,977.96
|
| Rate for Payer: Priority Health SBD |
$25,183.66
|
|
|
BUROSUMAB-TWZA 30 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
OP
|
$43,165.88
|
|
|
Service Code
|
HCPCS J0584
|
| Hospital Charge Code |
186424
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$260.83 |
| Max. Negotiated Rate |
$38,849.29 |
| Rate for Payer: Aetna Commercial |
$36,691.00
|
| Rate for Payer: Aetna Medicare |
$518.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28,057.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$623.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$623.40
|
| Rate for Payer: BCBS Complete |
$273.90
|
| Rate for Payer: BCBS MAPPO |
$498.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,249.45
|
| Rate for Payer: BCN Commercial |
$1,249.45
|
| Rate for Payer: BCN Medicare Advantage |
$498.72
|
| Rate for Payer: Cash Price |
$34,532.70
|
| Rate for Payer: Cash Price |
$34,532.70
|
| Rate for Payer: Cofinity Advantage |
$30,216.12
|
| Rate for Payer: Cofinity Commercial |
$37,122.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34,532.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$498.72
|
| Rate for Payer: Healthscope Commercial |
$38,849.29
|
| Rate for Payer: Mclaren Medicaid |
$260.83
|
| Rate for Payer: Mclaren Medicare |
$498.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$523.66
|
| Rate for Payer: Meridian Medicaid |
$523.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$573.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$548.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36,691.00
|
| Rate for Payer: Nomi Health Commercial |
$1,496.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32,374.41
|
| Rate for Payer: PACE Medicare |
$473.78
|
| Rate for Payer: PACE SWMI |
$498.72
|
| Rate for Payer: PHP Commercial |
$36,691.00
|
| Rate for Payer: PHP Medicare Advantage |
$498.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$260.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,526.94
|
| Rate for Payer: Priority Health Medicare |
$498.72
|
| Rate for Payer: Priority Health SBD |
$27,194.50
|
| Rate for Payer: Priority Health Tiered Network |
$1,221.55
|
| Rate for Payer: Railroad Medicare Medicare |
$498.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$821.73
|
| Rate for Payer: UHC Core |
$821.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$498.72
|
| Rate for Payer: UHC Exchange |
$821.73
|
| Rate for Payer: UHC Medicaid |
$260.83
|
| Rate for Payer: UHCCP Medicaid |
$260.83
|
| Rate for Payer: VA VA |
$498.72
|
|
|
BUROSUMAB-TWZA 30 MG/ML SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$43,165.88
|
|
|
Service Code
|
HCPCS J0584
|
| Hospital Charge Code |
186424
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27,194.50 |
| Max. Negotiated Rate |
$38,849.29 |
| Rate for Payer: Aetna Commercial |
$36,691.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28,057.82
|
| Rate for Payer: Cash Price |
$34,532.70
|
| Rate for Payer: Cofinity Advantage |
$30,216.12
|
| Rate for Payer: Cofinity Commercial |
$37,122.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34,532.70
|
| Rate for Payer: Healthscope Commercial |
$38,849.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36,691.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$32,374.41
|
| Rate for Payer: PHP Commercial |
$36,691.00
|
| Rate for Payer: Priority Health SBD |
$27,194.50
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
IP
|
$96.35
|
|
|
Service Code
|
NDC 16729020201
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.70 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.63
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Advantage |
$67.44
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Healthscope Commercial |
$86.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.26
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health SBD |
$60.70
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
OP
|
$122.20
|
|
|
Service Code
|
NDC 23155002401
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.02 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna Medicare |
$61.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.43
|
| Rate for Payer: BCBS Complete |
$48.88
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Advantage |
$85.54
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.65
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health SBD |
$76.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.43
|
| Rate for Payer: UHC Core |
$63.67
|
| Rate for Payer: UHC Exchange |
$48.02
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
IP
|
$319.60
|
|
|
Service Code
|
NDC 51079098620
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.35 |
| Max. Negotiated Rate |
$287.64 |
| Rate for Payer: Aetna Commercial |
$271.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.74
|
| Rate for Payer: Cash Price |
$255.68
|
| Rate for Payer: Cofinity Advantage |
$223.72
|
| Rate for Payer: Cofinity Commercial |
$274.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.68
|
| Rate for Payer: Healthscope Commercial |
$287.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$239.70
|
| Rate for Payer: PHP Commercial |
$271.66
|
| Rate for Payer: Priority Health SBD |
$201.35
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
OP
|
$96.35
|
|
|
Service Code
|
NDC 16729020201
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.87 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna Medicare |
$48.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.63
|
| Rate for Payer: BCBS Complete |
$38.54
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Advantage |
$67.44
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Healthscope Commercial |
$86.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.26
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health SBD |
$60.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.63
|
| Rate for Payer: UHC Core |
$50.20
|
| Rate for Payer: UHC Exchange |
$37.87
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
IP
|
$145.70
|
|
|
Service Code
|
NDC 24689090701
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.79 |
| Max. Negotiated Rate |
$131.13 |
| Rate for Payer: Aetna Commercial |
$123.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.70
|
| Rate for Payer: Cash Price |
$116.56
|
| Rate for Payer: Cofinity Advantage |
$101.99
|
| Rate for Payer: Cofinity Commercial |
$125.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.56
|
| Rate for Payer: Healthscope Commercial |
$131.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.28
|
| Rate for Payer: PHP Commercial |
$123.84
|
| Rate for Payer: Priority Health SBD |
$91.79
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
OP
|
$319.60
|
|
|
Service Code
|
NDC 51079098620
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.60 |
| Max. Negotiated Rate |
$287.64 |
| Rate for Payer: Aetna Commercial |
$271.66
|
| Rate for Payer: Aetna Medicare |
$159.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.74
|
| Rate for Payer: BCBS Complete |
$127.84
|
| Rate for Payer: Cash Price |
$255.68
|
| Rate for Payer: Cofinity Advantage |
$223.72
|
| Rate for Payer: Cofinity Commercial |
$274.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.68
|
| Rate for Payer: Healthscope Commercial |
$287.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$255.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$271.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$239.70
|
| Rate for Payer: PHP Commercial |
$271.66
|
| Rate for Payer: Priority Health SBD |
$201.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.74
|
| Rate for Payer: UHC Core |
$166.51
|
| Rate for Payer: UHC Exchange |
$125.60
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
IP
|
$122.20
|
|
|
Service Code
|
NDC 23155002401
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.99 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.43
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Advantage |
$85.54
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.65
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health SBD |
$76.99
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
OP
|
$145.70
|
|
|
Service Code
|
NDC 24689090701
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.26 |
| Max. Negotiated Rate |
$131.13 |
| Rate for Payer: Aetna Commercial |
$123.84
|
| Rate for Payer: Aetna Medicare |
$72.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.70
|
| Rate for Payer: BCBS Complete |
$58.28
|
| Rate for Payer: Cash Price |
$116.56
|
| Rate for Payer: Cofinity Advantage |
$101.99
|
| Rate for Payer: Cofinity Commercial |
$125.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.56
|
| Rate for Payer: Healthscope Commercial |
$131.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$116.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.28
|
| Rate for Payer: PHP Commercial |
$123.84
|
| Rate for Payer: Priority Health SBD |
$91.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.70
|
| Rate for Payer: UHC Core |
$75.91
|
| Rate for Payer: UHC Exchange |
$57.26
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
IP
|
$426.55
|
|
|
Service Code
|
NDC 51079096020
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$268.73 |
| Max. Negotiated Rate |
$383.89 |
| Rate for Payer: Aetna Commercial |
$362.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.26
|
| Rate for Payer: Cash Price |
$341.24
|
| Rate for Payer: Cofinity Advantage |
$298.58
|
| Rate for Payer: Cofinity Commercial |
$366.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.24
|
| Rate for Payer: Healthscope Commercial |
$383.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.91
|
| Rate for Payer: PHP Commercial |
$362.57
|
| Rate for Payer: Priority Health SBD |
$268.73
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
OP
|
$426.55
|
|
|
Service Code
|
NDC 51079096020
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.63 |
| Max. Negotiated Rate |
$383.89 |
| Rate for Payer: Aetna Commercial |
$362.57
|
| Rate for Payer: Aetna Medicare |
$213.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.26
|
| Rate for Payer: BCBS Complete |
$170.62
|
| Rate for Payer: Cash Price |
$341.24
|
| Rate for Payer: Cofinity Advantage |
$298.58
|
| Rate for Payer: Cofinity Commercial |
$366.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$341.24
|
| Rate for Payer: Healthscope Commercial |
$383.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$341.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.91
|
| Rate for Payer: PHP Commercial |
$362.57
|
| Rate for Payer: Priority Health SBD |
$268.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.26
|
| Rate for Payer: UHC Core |
$222.23
|
| Rate for Payer: UHC Exchange |
$167.63
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
IP
|
$4.27
|
|
|
Service Code
|
NDC 51079096001
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Aetna Commercial |
$3.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.78
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cofinity Advantage |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.42
|
| Rate for Payer: Healthscope Commercial |
$3.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.20
|
| Rate for Payer: PHP Commercial |
$3.63
|
| Rate for Payer: Priority Health SBD |
$2.69
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
OP
|
$4.27
|
|
|
Service Code
|
NDC 51079096001
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Aetna Commercial |
$3.63
|
| Rate for Payer: Aetna Medicare |
$2.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.78
|
| Rate for Payer: BCBS Complete |
$1.71
|
| Rate for Payer: Cash Price |
$3.42
|
| Rate for Payer: Cofinity Advantage |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.42
|
| Rate for Payer: Healthscope Commercial |
$3.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.20
|
| Rate for Payer: PHP Commercial |
$3.63
|
| Rate for Payer: Priority Health SBD |
$2.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.78
|
| Rate for Payer: UHC Core |
$2.22
|
| Rate for Payer: UHC Exchange |
$1.68
|
|
