|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
IP
|
$21.17
|
|
|
Service Code
|
NDC 0409-1749-70
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.91 |
| Max. Negotiated Rate |
$19.05 |
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: BCBS Trust/PPO |
$16.36
|
| Rate for Payer: BCN Commercial |
$16.36
|
| Rate for Payer: Cash Price |
$16.94
|
| Rate for Payer: Cofinity Commercial |
$18.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.94
|
| Rate for Payer: Healthscope Commercial |
$19.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.99
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.63
|
| Rate for Payer: UHC Core |
$17.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.88
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
IP
|
$26.17
|
|
|
Service Code
|
NDC 63323-462-04
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.96 |
| Max. Negotiated Rate |
$23.55 |
| Rate for Payer: Aetna Commercial |
$22.24
|
| Rate for Payer: BCBS Trust/PPO |
$20.22
|
| Rate for Payer: BCN Commercial |
$20.22
|
| Rate for Payer: Cash Price |
$20.94
|
| Rate for Payer: Cofinity Commercial |
$22.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.94
|
| Rate for Payer: Healthscope Commercial |
$23.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.24
|
| Rate for Payer: PHP Commercial |
$22.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.03
|
| Rate for Payer: UHC Core |
$21.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.63
|
|
|
BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJECTION SOLUTION
|
Facility
IP
|
$19.10
|
|
|
Service Code
|
NDC 0409-1749-29
|
| Hospital Charge Code |
105634
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$17.19 |
| Rate for Payer: Aetna Commercial |
$16.24
|
| Rate for Payer: BCBS Trust/PPO |
$14.76
|
| Rate for Payer: BCN Commercial |
$14.76
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cofinity Commercial |
$16.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$17.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.24
|
| Rate for Payer: PHP Commercial |
$16.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.81
|
| Rate for Payer: UHC Core |
$15.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
|
|
BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJECTION SOLUTION
|
Facility
IP
|
$31.11
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1222
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$26.44
|
| Rate for Payer: Aetna Commercial |
$21.20
|
| Rate for Payer: Aetna Commercial |
$18.49
|
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: Aetna Commercial |
$21.45
|
| Rate for Payer: BCBS Trust/PPO |
$18.15
|
| Rate for Payer: BCBS Trust/PPO |
$19.50
|
| Rate for Payer: BCBS Trust/PPO |
$16.81
|
| Rate for Payer: BCBS Trust/PPO |
$24.04
|
| Rate for Payer: BCBS Trust/PPO |
$19.27
|
| Rate for Payer: BCN Commercial |
$19.27
|
| Rate for Payer: BCN Commercial |
$24.04
|
| Rate for Payer: BCN Commercial |
$19.50
|
| Rate for Payer: BCN Commercial |
$16.81
|
| Rate for Payer: BCN Commercial |
$18.15
|
| Rate for Payer: Cash Price |
$24.89
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$18.79
|
| Rate for Payer: Cash Price |
$19.95
|
| Rate for Payer: Cash Price |
$20.18
|
| Rate for Payer: Cofinity Commercial |
$20.20
|
| Rate for Payer: Cofinity Commercial |
$26.75
|
| Rate for Payer: Cofinity Commercial |
$21.45
|
| Rate for Payer: Cofinity Commercial |
$18.70
|
| Rate for Payer: Cofinity Commercial |
$21.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.40
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$21.14
|
| Rate for Payer: Healthscope Commercial |
$22.71
|
| Rate for Payer: Healthscope Commercial |
$22.45
|
| Rate for Payer: Healthscope Commercial |
$28.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$21.45
|
| Rate for Payer: PHP Commercial |
$21.20
|
| Rate for Payer: PHP Commercial |
$18.49
|
| Rate for Payer: PHP Commercial |
$26.44
|
| Rate for Payer: PHP Commercial |
$21.45
|
| Rate for Payer: PHP Commercial |
$19.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.67
|
| Rate for Payer: UHC Core |
$18.16
|
| Rate for Payer: UHC Core |
$21.07
|
| Rate for Payer: UHC Core |
$20.82
|
| Rate for Payer: UHC Core |
$19.61
|
| Rate for Payer: UHC Core |
$25.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.31
|
|
|
BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJECTION SOLUTION
|
Facility
IP
|
$27.16
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
105640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.56 |
| Max. Negotiated Rate |
$24.44 |
| Rate for Payer: Aetna Commercial |
$23.09
|
| Rate for Payer: Aetna Commercial |
$13.02
|
| Rate for Payer: Aetna Commercial |
$23.05
|
| Rate for Payer: Aetna Commercial |
$17.38
|
| Rate for Payer: Aetna Commercial |
$16.24
|
| Rate for Payer: Aetna Commercial |
$23.66
|
| Rate for Payer: Aetna Commercial |
$15.21
|
| Rate for Payer: BCBS Trust/PPO |
$20.96
|
| Rate for Payer: BCBS Trust/PPO |
$15.80
|
| Rate for Payer: BCBS Trust/PPO |
$14.76
|
| Rate for Payer: BCBS Trust/PPO |
$20.99
|
| Rate for Payer: BCBS Trust/PPO |
$21.51
|
| Rate for Payer: BCBS Trust/PPO |
$13.83
|
| Rate for Payer: BCBS Trust/PPO |
$11.84
|
| Rate for Payer: BCN Commercial |
$20.96
|
| Rate for Payer: BCN Commercial |
$21.51
|
| Rate for Payer: BCN Commercial |
$20.99
|
| Rate for Payer: BCN Commercial |
$14.76
|
| Rate for Payer: BCN Commercial |
$11.84
|
| Rate for Payer: BCN Commercial |
$13.83
|
| Rate for Payer: BCN Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cash Price |
$12.26
|
| Rate for Payer: Cash Price |
$21.73
|
| Rate for Payer: Cash Price |
$22.27
|
| Rate for Payer: Cash Price |
$15.28
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cash Price |
$16.36
|
| Rate for Payer: Cofinity Commercial |
$17.59
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Cofinity Commercial |
$23.36
|
| Rate for Payer: Cofinity Commercial |
$16.43
|
| Rate for Payer: Cofinity Commercial |
$23.32
|
| Rate for Payer: Cofinity Commercial |
$13.18
|
| Rate for Payer: Cofinity Commercial |
$23.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.70
|
| Rate for Payer: Healthscope Commercial |
$24.44
|
| Rate for Payer: Healthscope Commercial |
$17.19
|
| Rate for Payer: Healthscope Commercial |
$16.10
|
| Rate for Payer: Healthscope Commercial |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$13.79
|
| Rate for Payer: Healthscope Commercial |
$25.06
|
| Rate for Payer: Healthscope Commercial |
$24.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.09
|
| Rate for Payer: PHP Commercial |
$23.09
|
| Rate for Payer: PHP Commercial |
$15.21
|
| Rate for Payer: PHP Commercial |
$16.24
|
| Rate for Payer: PHP Commercial |
$23.66
|
| Rate for Payer: PHP Commercial |
$23.05
|
| Rate for Payer: PHP Commercial |
$17.38
|
| Rate for Payer: PHP Commercial |
$13.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.50
|
| Rate for Payer: UHC Core |
$22.65
|
| Rate for Payer: UHC Core |
$17.08
|
| Rate for Payer: UHC Core |
$14.94
|
| Rate for Payer: UHC Core |
$22.68
|
| Rate for Payer: UHC Core |
$12.79
|
| Rate for Payer: UHC Core |
$23.25
|
| Rate for Payer: UHC Core |
$15.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.88
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
IP
|
$27.90
|
|
|
Service Code
|
NDC 63323-473-02
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.02 |
| Max. Negotiated Rate |
$25.11 |
| Rate for Payer: Aetna Commercial |
$23.72
|
| Rate for Payer: BCBS Trust/PPO |
$21.56
|
| Rate for Payer: BCN Commercial |
$21.56
|
| Rate for Payer: Cash Price |
$22.32
|
| Rate for Payer: Cofinity Commercial |
$23.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.32
|
| Rate for Payer: Healthscope Commercial |
$25.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.72
|
| Rate for Payer: PHP Commercial |
$23.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.55
|
| Rate for Payer: UHC Core |
$23.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.92
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) IN 8.25 % DEXTROSE INJECTION
|
Facility
IP
|
$22.31
|
|
|
Service Code
|
NDC 0409-3613-01
|
| Hospital Charge Code |
9316
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.61 |
| Max. Negotiated Rate |
$20.08 |
| Rate for Payer: Aetna Commercial |
$18.96
|
| Rate for Payer: BCBS Trust/PPO |
$17.24
|
| Rate for Payer: BCN Commercial |
$17.24
|
| Rate for Payer: Cash Price |
$17.85
|
| Rate for Payer: Cofinity Commercial |
$19.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$20.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.96
|
| Rate for Payer: PHP Commercial |
$18.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.63
|
| Rate for Payer: UHC Core |
$18.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.73
|
|
|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION
|
Facility
IP
|
$23.06
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$20.75 |
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna Commercial |
$24.40
|
| Rate for Payer: Aetna Commercial |
$20.66
|
| Rate for Payer: BCBS Trust/PPO |
$17.82
|
| Rate for Payer: BCBS Trust/PPO |
$18.78
|
| Rate for Payer: BCBS Trust/PPO |
$22.19
|
| Rate for Payer: BCN Commercial |
$17.82
|
| Rate for Payer: BCN Commercial |
$22.19
|
| Rate for Payer: BCN Commercial |
$18.78
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cash Price |
$22.97
|
| Rate for Payer: Cofinity Commercial |
$24.69
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$20.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$25.84
|
| Rate for Payer: Healthscope Commercial |
$21.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.40
|
| Rate for Payer: PHP Commercial |
$24.40
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: PHP Commercial |
$20.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.26
|
| Rate for Payer: UHC Core |
$19.26
|
| Rate for Payer: UHC Core |
$20.29
|
| Rate for Payer: UHC Core |
$23.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.30
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL FILM
|
Facility
IP
|
$384.35
|
|
|
Service Code
|
NDC 47781-355-03
|
| Hospital Charge Code |
106176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.42 |
| Max. Negotiated Rate |
$345.92 |
| Rate for Payer: Aetna Commercial |
$326.70
|
| Rate for Payer: BCBS Trust/PPO |
$297.03
|
| Rate for Payer: BCN Commercial |
$297.03
|
| Rate for Payer: Cash Price |
$307.48
|
| Rate for Payer: Cofinity Commercial |
$330.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$307.48
|
| Rate for Payer: Healthscope Commercial |
$345.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$288.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$326.70
|
| Rate for Payer: PHP Commercial |
$326.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$334.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$234.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$338.23
|
| Rate for Payer: UHC Core |
$320.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$288.26
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL FILM
|
Facility
IP
|
$12.82
|
|
|
Service Code
|
NDC 47781-355-11
|
| Hospital Charge Code |
106176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$11.54 |
| Rate for Payer: Aetna Commercial |
$10.90
|
| Rate for Payer: BCBS Trust/PPO |
$9.91
|
| Rate for Payer: BCN Commercial |
$9.91
|
| Rate for Payer: Cash Price |
$10.26
|
| Rate for Payer: Cofinity Commercial |
$11.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.26
|
| Rate for Payer: Healthscope Commercial |
$11.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.90
|
| Rate for Payer: PHP Commercial |
$10.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.28
|
| Rate for Payer: UHC Core |
$10.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.62
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
IP
|
$626.15
|
|
|
Service Code
|
NDC 0904-7009-06
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$381.89 |
| Max. Negotiated Rate |
$563.54 |
| Rate for Payer: Aetna Commercial |
$532.23
|
| Rate for Payer: BCBS Trust/PPO |
$483.89
|
| Rate for Payer: BCN Commercial |
$483.89
|
| Rate for Payer: Cash Price |
$500.92
|
| Rate for Payer: Cofinity Commercial |
$538.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$500.92
|
| Rate for Payer: Healthscope Commercial |
$563.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$469.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$532.23
|
| Rate for Payer: PHP Commercial |
$532.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$544.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$381.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$551.01
|
| Rate for Payer: UHC Core |
$522.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$469.61
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
IP
|
$482.04
|
|
|
Service Code
|
NDC 0904-7010-06
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$433.84 |
| Rate for Payer: Aetna Commercial |
$409.73
|
| Rate for Payer: BCBS Trust/PPO |
$372.52
|
| Rate for Payer: BCN Commercial |
$372.52
|
| Rate for Payer: Cash Price |
$385.63
|
| Rate for Payer: Cofinity Commercial |
$414.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.63
|
| Rate for Payer: Healthscope Commercial |
$433.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$409.73
|
| Rate for Payer: PHP Commercial |
$409.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$419.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$294.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$424.20
|
| Rate for Payer: UHC Core |
$402.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.53
|
|
|
BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION
|
Facility
IP
|
$53.51
|
|
|
Service Code
|
HCPCS J0592
|
| Hospital Charge Code |
115937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.64 |
| Max. Negotiated Rate |
$48.16 |
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: Aetna Commercial |
$53.37
|
| Rate for Payer: BCBS Trust/PPO |
$48.52
|
| Rate for Payer: BCBS Trust/PPO |
$41.35
|
| Rate for Payer: BCN Commercial |
$41.35
|
| Rate for Payer: BCN Commercial |
$48.52
|
| Rate for Payer: Cash Price |
$50.23
|
| Rate for Payer: Cash Price |
$42.81
|
| 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 |
$56.51
|
| Rate for Payer: Healthscope Commercial |
$48.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.37
|
| Rate for Payer: PHP Commercial |
$53.37
|
| Rate for Payer: PHP Commercial |
$45.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.09
|
| Rate for Payer: UHC Core |
$44.68
|
| Rate for Payer: UHC Core |
$52.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.09
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
IP
|
$381.57
|
|
|
Service Code
|
NDC 0904-7154-04
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.72 |
| Max. Negotiated Rate |
$343.41 |
| Rate for Payer: Aetna Commercial |
$324.33
|
| Rate for Payer: BCBS Trust/PPO |
$294.88
|
| Rate for Payer: BCN Commercial |
$294.88
|
| Rate for Payer: Cash Price |
$305.26
|
| Rate for Payer: Cofinity Commercial |
$328.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$305.26
|
| Rate for Payer: Healthscope Commercial |
$343.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$286.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$324.33
|
| Rate for Payer: PHP Commercial |
$324.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$267.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$331.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$232.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$335.78
|
| Rate for Payer: UHC Core |
$318.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$286.18
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
IP
|
$192.15
|
|
|
Service Code
|
NDC 0054-0176-13
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.19 |
| Max. Negotiated Rate |
$172.94 |
| Rate for Payer: Aetna Commercial |
$163.33
|
| Rate for Payer: BCBS Trust/PPO |
$148.49
|
| Rate for Payer: BCN Commercial |
$148.49
|
| Rate for Payer: Cash Price |
$153.72
|
| Rate for Payer: Cofinity Commercial |
$165.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.72
|
| Rate for Payer: Healthscope Commercial |
$172.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.33
|
| Rate for Payer: PHP Commercial |
$163.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.09
|
| Rate for Payer: UHC Core |
$160.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.11
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
IP
|
$4.87
|
|
|
Service Code
|
NDC 50268-143-11
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$4.38 |
| Rate for Payer: Aetna Commercial |
$4.14
|
| Rate for Payer: BCBS Trust/PPO |
$3.76
|
| Rate for Payer: BCN Commercial |
$3.76
|
| Rate for Payer: Cash Price |
$3.90
|
| Rate for Payer: Cofinity Commercial |
$4.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.90
|
| Rate for Payer: Healthscope Commercial |
$4.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.14
|
| Rate for Payer: PHP Commercial |
$4.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.29
|
| Rate for Payer: UHC Core |
$4.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.65
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
IP
|
$243.36
|
|
|
Service Code
|
NDC 50268-143-15
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.43 |
| Max. Negotiated Rate |
$219.02 |
| Rate for Payer: Aetna Commercial |
$206.86
|
| Rate for Payer: BCBS Trust/PPO |
$188.07
|
| Rate for Payer: BCN Commercial |
$188.07
|
| Rate for Payer: Cash Price |
$194.69
|
| Rate for Payer: Cofinity Commercial |
$209.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.69
|
| Rate for Payer: Healthscope Commercial |
$219.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$206.86
|
| Rate for Payer: PHP Commercial |
$206.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.16
|
| Rate for Payer: UHC Core |
$203.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.52
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
IP
|
$4.53
|
|
|
Service Code
|
NDC 51079-943-01
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: BCBS Trust/PPO |
$3.50
|
| Rate for Payer: BCN Commercial |
$3.50
|
| Rate for Payer: Cash Price |
$3.62
|
| 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: Lakeland Regional Health Systems Commercial |
$3.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.85
|
| Rate for Payer: PHP Commercial |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.99
|
| Rate for Payer: UHC Core |
$3.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.40
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
IP
|
$152.75
|
|
|
Service Code
|
NDC 60505-0158-1
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.16 |
| Max. Negotiated Rate |
$137.48 |
| Rate for Payer: Aetna Commercial |
$129.84
|
| Rate for Payer: BCBS Trust/PPO |
$118.05
|
| Rate for Payer: BCN Commercial |
$118.05
|
| Rate for Payer: Cash Price |
$122.20
|
| Rate for Payer: Cofinity Commercial |
$131.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.20
|
| Rate for Payer: Healthscope Commercial |
$137.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$129.84
|
| Rate for Payer: PHP Commercial |
$129.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$134.42
|
| Rate for Payer: UHC Core |
$127.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.56
|
|
|
BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
IP
|
$3.46
|
|
|
Service Code
|
NDC 51079-391-01
|
| Hospital Charge Code |
18385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$3.11 |
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: BCBS Trust/PPO |
$2.67
|
| Rate for Payer: BCN Commercial |
$2.67
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cofinity Commercial |
$2.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.77
|
| Rate for Payer: Healthscope Commercial |
$3.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.94
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.04
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.60
|
|
|
BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
IP
|
$345.60
|
|
|
Service Code
|
NDC 51079-391-20
|
| Hospital Charge Code |
18385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.78 |
| Max. Negotiated Rate |
$311.04 |
| Rate for Payer: Aetna Commercial |
$293.76
|
| Rate for Payer: BCBS Trust/PPO |
$267.08
|
| Rate for Payer: BCN Commercial |
$267.08
|
| Rate for Payer: Cash Price |
$276.48
|
| Rate for Payer: Cofinity Commercial |
$297.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.48
|
| Rate for Payer: Healthscope Commercial |
$311.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$293.76
|
| Rate for Payer: PHP Commercial |
$293.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$300.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.13
|
| Rate for Payer: UHC Core |
$288.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.20
|
|
|
BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
IP
|
$180.87
|
|
|
Service Code
|
NDC 0185-0410-60
|
| Hospital Charge Code |
18385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.31 |
| Max. Negotiated Rate |
$162.78 |
| Rate for Payer: Aetna Commercial |
$153.74
|
| Rate for Payer: BCBS Trust/PPO |
$139.78
|
| Rate for Payer: BCN Commercial |
$139.78
|
| Rate for Payer: Cash Price |
$144.70
|
| Rate for Payer: Cofinity Commercial |
$155.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.70
|
| Rate for Payer: Healthscope Commercial |
$162.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.74
|
| Rate for Payer: PHP Commercial |
$153.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.61
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$110.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.17
|
| Rate for Payer: UHC Core |
$151.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.65
|
|
|
BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
IP
|
$239.40
|
|
|
Service Code
|
NDC 0185-0415-60
|
| Hospital Charge Code |
18386
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.01 |
| Max. Negotiated Rate |
$215.46 |
| Rate for Payer: Aetna Commercial |
$203.49
|
| Rate for Payer: BCBS Trust/PPO |
$185.01
|
| Rate for Payer: BCN Commercial |
$185.01
|
| Rate for Payer: Cash Price |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$205.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.52
|
| Rate for Payer: Healthscope Commercial |
$215.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$203.49
|
| Rate for Payer: PHP Commercial |
$203.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$208.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$146.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.67
|
| Rate for Payer: UHC Core |
$199.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.55
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
IP
|
$129.02
|
|
|
Service Code
|
NDC 68180-319-09
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.69 |
| Max. Negotiated Rate |
$116.12 |
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: BCBS Trust/PPO |
$99.71
|
| Rate for Payer: BCN Commercial |
$99.71
|
| Rate for Payer: Cash Price |
$103.22
|
| Rate for Payer: Cofinity Commercial |
$110.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$103.22
|
| Rate for Payer: Healthscope Commercial |
$116.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.67
|
| Rate for Payer: PHP Commercial |
$109.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.54
|
| Rate for Payer: UHC Core |
$107.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.76
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
IP
|
$111.60
|
|
|
Service Code
|
NDC 10370-101-03
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.06 |
| Max. Negotiated Rate |
$100.44 |
| Rate for Payer: Aetna Commercial |
$94.86
|
| Rate for Payer: BCBS Trust/PPO |
$86.24
|
| Rate for Payer: BCN Commercial |
$86.24
|
| Rate for Payer: Cash Price |
$89.28
|
| Rate for Payer: Cofinity Commercial |
$95.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.28
|
| Rate for Payer: Healthscope Commercial |
$100.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.86
|
| Rate for Payer: PHP Commercial |
$94.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.21
|
| Rate for Payer: UHC Core |
$93.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.70
|
|
