Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION

Facility

$22.31

Service Code	NDC 00409361301
Hospital Charge Code	9316
Hospital Revenue Code	250
Min. Negotiated Rate	$8.92
Max. Negotiated Rate	$20.08
Rate for Payer: Aetna Commercial	$18.96
Rate for Payer: Aetna Medicare	$11.16
Rate for Payer: Aetna New Business (MI Preferred)	$14.50
Rate for Payer: BCBS Complete	$8.92
Rate for Payer: Cash Price	$17.85
Rate for Payer: Cofinity Commercial	$15.62
Rate for Payer: Cofinity Commercial	$19.19
Rate for Payer: Cofinity Medicare Advantage	$15.62
Rate for Payer: Encore Health Key Benefits Commercial	$17.85
Rate for Payer: Healthscope Commercial	$20.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.96
Rate for Payer: PHP Commercial	$18.96
Rate for Payer: Priority Health Cigna Priority Health	$14.50
Rate for Payer: Priority Health SBD	$14.06

BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION

Facility

$22.31

Service Code	NDC 00409361301
Hospital Charge Code	9316
Hospital Revenue Code	250
Min. Negotiated Rate	$14.06
Max. Negotiated Rate	$20.08
Rate for Payer: Aetna Commercial	$18.96
Rate for Payer: Aetna New Business (MI Preferred)	$14.50
Rate for Payer: Cash Price	$17.85
Rate for Payer: Cofinity Commercial	$15.62
Rate for Payer: Cofinity Commercial	$19.19
Rate for Payer: Cofinity Medicare Advantage	$15.62
Rate for Payer: Encore Health Key Benefits Commercial	$17.85
Rate for Payer: Healthscope Commercial	$20.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.96
Rate for Payer: PHP Commercial	$18.96
Rate for Payer: Priority Health Cigna Priority Health	$14.50
Rate for Payer: Priority Health SBD	$14.06

BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION

Facility

$28.17

Service Code	NDC 00409176119
Hospital Charge Code	9316
Hospital Revenue Code	250
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$25.35
Rate for Payer: Aetna Commercial	$23.94
Rate for Payer: Aetna New Business (MI Preferred)	$18.31
Rate for Payer: Cash Price	$22.54
Rate for Payer: Cofinity Commercial	$19.72
Rate for Payer: Cofinity Commercial	$24.23
Rate for Payer: Cofinity Medicare Advantage	$19.72
Rate for Payer: Encore Health Key Benefits Commercial	$22.54
Rate for Payer: Healthscope Commercial	$25.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.94
Rate for Payer: PHP Commercial	$23.94
Rate for Payer: Priority Health Cigna Priority Health	$18.31
Rate for Payer: Priority Health SBD	$17.75

BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION

Facility

$28.17

Service Code	NDC 00409176119
Hospital Charge Code	9316
Hospital Revenue Code	250
Min. Negotiated Rate	$11.27
Max. Negotiated Rate	$25.35
Rate for Payer: Aetna Commercial	$23.94
Rate for Payer: Aetna Medicare	$14.08
Rate for Payer: Aetna New Business (MI Preferred)	$18.31
Rate for Payer: BCBS Complete	$11.27
Rate for Payer: Cash Price	$22.54
Rate for Payer: Cofinity Commercial	$19.72
Rate for Payer: Cofinity Commercial	$24.23
Rate for Payer: Cofinity Medicare Advantage	$19.72
Rate for Payer: Encore Health Key Benefits Commercial	$22.54
Rate for Payer: Healthscope Commercial	$25.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.94
Rate for Payer: PHP Commercial	$23.94
Rate for Payer: Priority Health Cigna Priority Health	$18.31
Rate for Payer: Priority Health SBD	$17.75

BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION

Facility

$28.17

Service Code	NDC 00409176102
Hospital Charge Code	9316
Hospital Revenue Code	250
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$25.35
Rate for Payer: Aetna Commercial	$23.94
Rate for Payer: Aetna New Business (MI Preferred)	$18.31
Rate for Payer: Cash Price	$22.54
Rate for Payer: Cofinity Commercial	$19.72
Rate for Payer: Cofinity Commercial	$24.23
Rate for Payer: Cofinity Medicare Advantage	$19.72
Rate for Payer: Encore Health Key Benefits Commercial	$22.54
Rate for Payer: Healthscope Commercial	$25.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.94
Rate for Payer: PHP Commercial	$23.94
Rate for Payer: Priority Health Cigna Priority Health	$18.31
Rate for Payer: Priority Health SBD	$17.75

BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION

Facility

$28.17

Service Code	NDC 00409176102
Hospital Charge Code	9316
Hospital Revenue Code	250
Min. Negotiated Rate	$11.27
Max. Negotiated Rate	$25.35
Rate for Payer: Aetna Commercial	$23.94
Rate for Payer: Aetna Medicare	$14.08
Rate for Payer: Aetna New Business (MI Preferred)	$18.31
Rate for Payer: BCBS Complete	$11.27
Rate for Payer: Cash Price	$22.54
Rate for Payer: Cofinity Commercial	$19.72
Rate for Payer: Cofinity Commercial	$24.23
Rate for Payer: Cofinity Medicare Advantage	$19.72
Rate for Payer: Encore Health Key Benefits Commercial	$22.54
Rate for Payer: Healthscope Commercial	$25.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.94
Rate for Payer: PHP Commercial	$23.94
Rate for Payer: Priority Health Cigna Priority Health	$18.31
Rate for Payer: Priority Health SBD	$17.75

BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION

Facility

$16.06

Service Code	HCPCS J0665
Hospital Charge Code	1224
Hospital Revenue Code	636
Min. Negotiated Rate	$10.12
Max. Negotiated Rate	$14.45
Rate for Payer: Aetna Commercial	$13.65
Rate for Payer: Aetna Commercial	$20.66
Rate for Payer: Aetna Commercial	$23.03
Rate for Payer: Aetna New Business (MI Preferred)	$15.80
Rate for Payer: Aetna New Business (MI Preferred)	$10.44
Rate for Payer: Aetna New Business (MI Preferred)	$17.61
Rate for Payer: Cash Price	$19.44
Rate for Payer: Cash Price	$12.85
Rate for Payer: Cash Price	$21.67
Rate for Payer: Cofinity Commercial	$11.24
Rate for Payer: Cofinity Commercial	$13.81
Rate for Payer: Cofinity Commercial	$17.01
Rate for Payer: Cofinity Commercial	$20.90
Rate for Payer: Cofinity Commercial	$18.96
Rate for Payer: Cofinity Commercial	$23.30
Rate for Payer: Cofinity Medicare Advantage	$18.96
Rate for Payer: Cofinity Medicare Advantage	$11.24
Rate for Payer: Cofinity Medicare Advantage	$17.01
Rate for Payer: Encore Health Key Benefits Commercial	$21.67
Rate for Payer: Encore Health Key Benefits Commercial	$19.44
Rate for Payer: Encore Health Key Benefits Commercial	$12.85
Rate for Payer: Healthscope Commercial	$21.87
Rate for Payer: Healthscope Commercial	$14.45
Rate for Payer: Healthscope Commercial	$24.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.03
Rate for Payer: PHP Commercial	$20.66
Rate for Payer: PHP Commercial	$23.03
Rate for Payer: PHP Commercial	$13.65
Rate for Payer: Priority Health Cigna Priority Health	$17.61
Rate for Payer: Priority Health Cigna Priority Health	$15.80
Rate for Payer: Priority Health Cigna Priority Health	$10.44
Rate for Payer: Priority Health SBD	$15.31
Rate for Payer: Priority Health SBD	$17.07
Rate for Payer: Priority Health SBD	$10.12

BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION

Facility

$27.09

Service Code	HCPCS J0665
Hospital Charge Code	1224
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$24.38
Rate for Payer: Aetna Commercial	$23.03
Rate for Payer: Aetna Commercial	$13.65
Rate for Payer: Aetna Commercial	$20.66
Rate for Payer: Aetna Medicare	$8.03
Rate for Payer: Aetna Medicare	$12.15
Rate for Payer: Aetna Medicare	$13.54
Rate for Payer: Aetna New Business (MI Preferred)	$15.80
Rate for Payer: Aetna New Business (MI Preferred)	$10.44
Rate for Payer: Aetna New Business (MI Preferred)	$17.61
Rate for Payer: BCBS Complete	$9.72
Rate for Payer: BCBS Complete	$6.42
Rate for Payer: BCBS Complete	$10.84
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$19.44
Rate for Payer: Cash Price	$12.85
Rate for Payer: Cash Price	$21.67
Rate for Payer: Cash Price	$19.44
Rate for Payer: Cash Price	$12.85
Rate for Payer: Cash Price	$21.67
Rate for Payer: Cofinity Commercial	$17.01
Rate for Payer: Cofinity Commercial	$11.24
Rate for Payer: Cofinity Commercial	$13.81
Rate for Payer: Cofinity Commercial	$20.90
Rate for Payer: Cofinity Commercial	$18.96
Rate for Payer: Cofinity Commercial	$23.30
Rate for Payer: Cofinity Medicare Advantage	$18.96
Rate for Payer: Cofinity Medicare Advantage	$17.01
Rate for Payer: Cofinity Medicare Advantage	$11.24
Rate for Payer: Encore Health Key Benefits Commercial	$12.85
Rate for Payer: Encore Health Key Benefits Commercial	$19.44
Rate for Payer: Encore Health Key Benefits Commercial	$21.67
Rate for Payer: Healthscope Commercial	$21.87
Rate for Payer: Healthscope Commercial	$14.45
Rate for Payer: Healthscope Commercial	$24.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.03
Rate for Payer: PHP Commercial	$20.66
Rate for Payer: PHP Commercial	$23.03
Rate for Payer: PHP Commercial	$13.65
Rate for Payer: Priority Health Cigna Priority Health	$15.80
Rate for Payer: Priority Health Cigna Priority Health	$17.61
Rate for Payer: Priority Health Cigna Priority Health	$10.44
Rate for Payer: Priority Health SBD	$10.12
Rate for Payer: Priority Health SBD	$17.07
Rate for Payer: Priority Health SBD	$15.31

BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH

Facility

$954.38

Service Code	NDC 59011075104
Hospital Charge Code	107661
Hospital Revenue Code	637
Min. Negotiated Rate	$381.75
Max. Negotiated Rate	$858.94
Rate for Payer: Aetna Commercial	$811.22
Rate for Payer: Aetna Medicare	$477.19
Rate for Payer: Aetna New Business (MI Preferred)	$620.35
Rate for Payer: BCBS Complete	$381.75
Rate for Payer: Cash Price	$763.50
Rate for Payer: Cofinity Commercial	$668.07
Rate for Payer: Cofinity Commercial	$820.77
Rate for Payer: Cofinity Medicare Advantage	$668.07
Rate for Payer: Encore Health Key Benefits Commercial	$763.50
Rate for Payer: Healthscope Commercial	$858.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$811.22
Rate for Payer: PHP Commercial	$811.22
Rate for Payer: Priority Health Cigna Priority Health	$620.35
Rate for Payer: Priority Health SBD	$601.26

BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH

Facility

$954.38

Service Code	NDC 59011075104
Hospital Charge Code	107661
Hospital Revenue Code	637
Min. Negotiated Rate	$601.26
Max. Negotiated Rate	$858.94
Rate for Payer: Aetna Commercial	$811.22
Rate for Payer: Aetna New Business (MI Preferred)	$620.35
Rate for Payer: Cash Price	$763.50
Rate for Payer: Cofinity Commercial	$668.07
Rate for Payer: Cofinity Commercial	$820.77
Rate for Payer: Cofinity Medicare Advantage	$668.07
Rate for Payer: Encore Health Key Benefits Commercial	$763.50
Rate for Payer: Healthscope Commercial	$858.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$811.22
Rate for Payer: PHP Commercial	$811.22
Rate for Payer: Priority Health Cigna Priority Health	$620.35
Rate for Payer: Priority Health SBD	$601.26

BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET

Facility

$640.85

Service Code	NDC 00904700906
Hospital Charge Code	34713
Hospital Revenue Code	637
Min. Negotiated Rate	$256.34
Max. Negotiated Rate	$576.76
Rate for Payer: Aetna Commercial	$544.72
Rate for Payer: Aetna Medicare	$320.42
Rate for Payer: Aetna New Business (MI Preferred)	$416.55
Rate for Payer: BCBS Complete	$256.34
Rate for Payer: Cash Price	$512.68
Rate for Payer: Cofinity Commercial	$448.60
Rate for Payer: Cofinity Commercial	$551.13
Rate for Payer: Cofinity Medicare Advantage	$448.60
Rate for Payer: Encore Health Key Benefits Commercial	$512.68
Rate for Payer: Healthscope Commercial	$576.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$544.72
Rate for Payer: PHP Commercial	$544.72
Rate for Payer: Priority Health Cigna Priority Health	$416.55
Rate for Payer: Priority Health SBD	$403.74

BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET

Facility

$640.85

Service Code	NDC 00904700906
Hospital Charge Code	34713
Hospital Revenue Code	637
Min. Negotiated Rate	$403.74
Max. Negotiated Rate	$576.76
Rate for Payer: Aetna Commercial	$544.72
Rate for Payer: Aetna New Business (MI Preferred)	$416.55
Rate for Payer: Cash Price	$512.68
Rate for Payer: Cofinity Commercial	$448.60
Rate for Payer: Cofinity Commercial	$551.13
Rate for Payer: Cofinity Medicare Advantage	$448.60
Rate for Payer: Encore Health Key Benefits Commercial	$512.68
Rate for Payer: Healthscope Commercial	$576.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$544.72
Rate for Payer: PHP Commercial	$544.72
Rate for Payer: Priority Health Cigna Priority Health	$416.55
Rate for Payer: Priority Health SBD	$403.74

BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH

Facility

$458.11

Service Code	NDC 00093365640
Hospital Charge Code	107660
Hospital Revenue Code	637
Min. Negotiated Rate	$183.24
Max. Negotiated Rate	$412.30
Rate for Payer: Aetna Commercial	$389.39
Rate for Payer: Aetna Medicare	$229.06
Rate for Payer: Aetna New Business (MI Preferred)	$297.77
Rate for Payer: BCBS Complete	$183.24
Rate for Payer: Cash Price	$366.49
Rate for Payer: Cofinity Commercial	$320.68
Rate for Payer: Cofinity Commercial	$393.97
Rate for Payer: Cofinity Medicare Advantage	$320.68
Rate for Payer: Encore Health Key Benefits Commercial	$366.49
Rate for Payer: Healthscope Commercial	$412.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$389.39
Rate for Payer: PHP Commercial	$389.39
Rate for Payer: Priority Health Cigna Priority Health	$297.77
Rate for Payer: Priority Health SBD	$288.61

BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH

Facility

$565.00

Service Code	NDC 59011075004
Hospital Charge Code	107660
Hospital Revenue Code	637
Min. Negotiated Rate	$226.00
Max. Negotiated Rate	$508.50
Rate for Payer: Aetna Commercial	$480.25
Rate for Payer: Aetna Medicare	$282.50
Rate for Payer: Aetna New Business (MI Preferred)	$367.25
Rate for Payer: BCBS Complete	$226.00
Rate for Payer: Cash Price	$452.00
Rate for Payer: Cofinity Commercial	$395.50
Rate for Payer: Cofinity Commercial	$485.90
Rate for Payer: Cofinity Medicare Advantage	$395.50
Rate for Payer: Encore Health Key Benefits Commercial	$452.00
Rate for Payer: Healthscope Commercial	$508.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$480.25
Rate for Payer: PHP Commercial	$480.25
Rate for Payer: Priority Health Cigna Priority Health	$367.25
Rate for Payer: Priority Health SBD	$355.95

BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH

Facility

$458.11

Service Code	NDC 00093365640
Hospital Charge Code	107660
Hospital Revenue Code	637
Min. Negotiated Rate	$288.61
Max. Negotiated Rate	$412.30
Rate for Payer: Aetna Commercial	$389.39
Rate for Payer: Aetna New Business (MI Preferred)	$297.77
Rate for Payer: Cash Price	$366.49
Rate for Payer: Cofinity Commercial	$320.68
Rate for Payer: Cofinity Commercial	$393.97
Rate for Payer: Cofinity Medicare Advantage	$320.68
Rate for Payer: Encore Health Key Benefits Commercial	$366.49
Rate for Payer: Healthscope Commercial	$412.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$389.39
Rate for Payer: PHP Commercial	$389.39
Rate for Payer: Priority Health Cigna Priority Health	$297.77
Rate for Payer: Priority Health SBD	$288.61

BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH

Facility

$565.00

Service Code	NDC 59011075004
Hospital Charge Code	107660
Hospital Revenue Code	637
Min. Negotiated Rate	$355.95
Max. Negotiated Rate	$508.50
Rate for Payer: Aetna Commercial	$480.25
Rate for Payer: Aetna New Business (MI Preferred)	$367.25
Rate for Payer: Cash Price	$452.00
Rate for Payer: Cofinity Commercial	$395.50
Rate for Payer: Cofinity Commercial	$485.90
Rate for Payer: Cofinity Medicare Advantage	$395.50
Rate for Payer: Encore Health Key Benefits Commercial	$452.00
Rate for Payer: Healthscope Commercial	$508.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$480.25
Rate for Payer: PHP Commercial	$480.25
Rate for Payer: Priority Health Cigna Priority Health	$367.25
Rate for Payer: Priority Health SBD	$355.95

BUPRENORPHINE 7.5 MCG/HOUR WEEKLY TRANSDERMAL PATCH

Facility

$145.71

Service Code	NDC 00093323921
Hospital Charge Code	172295
Hospital Revenue Code	637
Min. Negotiated Rate	$58.28
Max. Negotiated Rate	$131.14
Rate for Payer: Aetna Commercial	$123.85
Rate for Payer: Aetna Medicare	$72.86
Rate for Payer: Aetna New Business (MI Preferred)	$94.71
Rate for Payer: BCBS Complete	$58.28
Rate for Payer: Cash Price	$116.57
Rate for Payer: Cofinity Commercial	$102.00
Rate for Payer: Cofinity Commercial	$125.31
Rate for Payer: Cofinity Medicare Advantage	$102.00
Rate for Payer: Encore Health Key Benefits Commercial	$116.57
Rate for Payer: Healthscope Commercial	$131.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$123.85
Rate for Payer: PHP Commercial	$123.85
Rate for Payer: Priority Health Cigna Priority Health	$94.71
Rate for Payer: Priority Health SBD	$91.80

BUPRENORPHINE 7.5 MCG/HOUR WEEKLY TRANSDERMAL PATCH

Facility

$582.82

Service Code	NDC 00093323940
Hospital Charge Code	172295
Hospital Revenue Code	637
Min. Negotiated Rate	$233.13
Max. Negotiated Rate	$524.54
Rate for Payer: Aetna Commercial	$495.40
Rate for Payer: Aetna Medicare	$291.41
Rate for Payer: Aetna New Business (MI Preferred)	$378.83
Rate for Payer: BCBS Complete	$233.13
Rate for Payer: Cash Price	$466.26
Rate for Payer: Cofinity Commercial	$407.97
Rate for Payer: Cofinity Commercial	$501.23
Rate for Payer: Cofinity Medicare Advantage	$407.97
Rate for Payer: Encore Health Key Benefits Commercial	$466.26
Rate for Payer: Healthscope Commercial	$524.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$495.40
Rate for Payer: PHP Commercial	$495.40
Rate for Payer: Priority Health Cigna Priority Health	$378.83
Rate for Payer: Priority Health SBD	$367.18

BUPRENORPHINE 7.5 MCG/HOUR WEEKLY TRANSDERMAL PATCH

Facility

$145.71

Service Code	NDC 00093323921
Hospital Charge Code	172295
Hospital Revenue Code	637
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$131.14
Rate for Payer: Aetna Commercial	$123.85
Rate for Payer: Aetna New Business (MI Preferred)	$94.71
Rate for Payer: Cash Price	$116.57
Rate for Payer: Cofinity Commercial	$102.00
Rate for Payer: Cofinity Commercial	$125.31
Rate for Payer: Cofinity Medicare Advantage	$102.00
Rate for Payer: Encore Health Key Benefits Commercial	$116.57
Rate for Payer: Healthscope Commercial	$131.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$123.85
Rate for Payer: PHP Commercial	$123.85
Rate for Payer: Priority Health Cigna Priority Health	$94.71
Rate for Payer: Priority Health SBD	$91.80

BUPRENORPHINE 7.5 MCG/HOUR WEEKLY TRANSDERMAL PATCH

Facility

$582.82

Service Code	NDC 00093323940
Hospital Charge Code	172295
Hospital Revenue Code	637
Min. Negotiated Rate	$367.18
Max. Negotiated Rate	$524.54
Rate for Payer: Aetna Commercial	$495.40
Rate for Payer: Aetna New Business (MI Preferred)	$378.83
Rate for Payer: Cash Price	$466.26
Rate for Payer: Cofinity Commercial	$407.97
Rate for Payer: Cofinity Commercial	$501.23
Rate for Payer: Cofinity Medicare Advantage	$407.97
Rate for Payer: Encore Health Key Benefits Commercial	$466.26
Rate for Payer: Healthscope Commercial	$524.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$495.40
Rate for Payer: PHP Commercial	$495.40
Rate for Payer: Priority Health Cigna Priority Health	$378.83
Rate for Payer: Priority Health SBD	$367.18

BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET

Facility

$488.28

Service Code	NDC 00904701006
Hospital Charge Code	34714
Hospital Revenue Code	637
Min. Negotiated Rate	$195.31
Max. Negotiated Rate	$439.45
Rate for Payer: Aetna Commercial	$415.04
Rate for Payer: Aetna Medicare	$244.14
Rate for Payer: Aetna New Business (MI Preferred)	$317.38
Rate for Payer: BCBS Complete	$195.31
Rate for Payer: Cash Price	$390.62
Rate for Payer: Cofinity Commercial	$341.80
Rate for Payer: Cofinity Commercial	$419.92
Rate for Payer: Cofinity Medicare Advantage	$341.80
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: PHP Commercial	$415.04
Rate for Payer: Priority Health Cigna Priority Health	$317.38
Rate for Payer: Priority Health SBD	$307.62

BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET

Facility

$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 Commercial	$341.80
Rate for Payer: Cofinity Commercial	$419.92
Rate for Payer: Cofinity Medicare Advantage	$341.80
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: PHP Commercial	$415.04
Rate for Payer: Priority Health Cigna Priority Health	$317.38
Rate for Payer: Priority Health SBD	$307.62

BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION

Facility

$53.51

Service Code	HCPCS J0592
Hospital Charge Code	115937
Hospital Revenue Code	636
Min. Negotiated Rate	$11.37
Max. Negotiated Rate	$48.16
Rate for Payer: Aetna Commercial	$45.48
Rate for Payer: Aetna Commercial	$53.37
Rate for Payer: Aetna Medicare	$31.40
Rate for Payer: Aetna Medicare	$26.76
Rate for Payer: Aetna New Business (MI Preferred)	$34.78
Rate for Payer: Aetna New Business (MI Preferred)	$40.81
Rate for Payer: BCBS Complete	$25.12
Rate for Payer: BCBS Complete	$21.40
Rate for Payer: BCBS Trust/PPO	$11.37
Rate for Payer: BCBS Trust/PPO	$11.37
Rate for Payer: BCN Commercial	$11.37
Rate for Payer: BCN Commercial	$11.37
Rate for Payer: Cash Price	$50.23
Rate for Payer: Cash Price	$50.23
Rate for Payer: Cash Price	$42.81
Rate for Payer: Cash Price	$42.81
Rate for Payer: Cofinity Commercial	$37.46
Rate for Payer: Cofinity Commercial	$54.00
Rate for Payer: Cofinity Commercial	$43.95
Rate for Payer: Cofinity Commercial	$46.02
Rate for Payer: Cofinity Medicare Advantage	$43.95
Rate for Payer: Cofinity Medicare Advantage	$37.46
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: PHP Commercial	$53.37
Rate for Payer: PHP Commercial	$45.48
Rate for Payer: Priority Health Cigna Priority Health	$34.78
Rate for Payer: Priority Health Cigna Priority Health	$40.81
Rate for Payer: Priority Health SBD	$39.56
Rate for Payer: Priority Health SBD	$33.71

BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION

Facility

$53.51

Service Code	HCPCS J0592
Hospital Charge Code	115937
Hospital Revenue Code	636
Min. Negotiated Rate	$33.71
Max. Negotiated Rate	$48.16
Rate for Payer: Aetna Commercial	$45.48
Rate for Payer: Aetna Commercial	$53.37
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 Commercial	$37.46
Rate for Payer: Cofinity Commercial	$43.95
Rate for Payer: Cofinity Commercial	$54.00
Rate for Payer: Cofinity Commercial	$46.02
Rate for Payer: Cofinity Medicare Advantage	$43.95
Rate for Payer: Cofinity Medicare Advantage	$37.46
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	$45.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.37
Rate for Payer: PHP Commercial	$45.48
Rate for Payer: PHP Commercial	$53.37
Rate for Payer: Priority Health Cigna Priority Health	$40.81
Rate for Payer: Priority Health Cigna Priority Health	$34.78
Rate for Payer: Priority Health SBD	$39.56
Rate for Payer: Priority Health SBD	$33.71

BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET

Facility

$195.30

Service Code	NDC 00054017613
Hospital Charge Code	34711
Hospital Revenue Code	637
Min. Negotiated Rate	$123.04
Max. Negotiated Rate	$175.77
Rate for Payer: Aetna Commercial	$166.00
Rate for Payer: Aetna New Business (MI Preferred)	$126.94
Rate for Payer: Cash Price	$156.24
Rate for Payer: Cofinity Commercial	$136.71
Rate for Payer: Cofinity Commercial	$167.96
Rate for Payer: Cofinity Medicare Advantage	$136.71
Rate for Payer: Encore Health Key Benefits Commercial	$156.24
Rate for Payer: Healthscope Commercial	$175.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$166.00
Rate for Payer: PHP Commercial	$166.00
Rate for Payer: Priority Health Cigna Priority Health	$126.94
Rate for Payer: Priority Health SBD	$123.04

Know your out-of-pocket cost for care.

All Charges