|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
IP
|
$88.35
|
|
|
Service Code
|
NDC 69097-875-02
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.88 |
| Max. Negotiated Rate |
$79.52 |
| Rate for Payer: Aetna Commercial |
$75.10
|
| Rate for Payer: BCBS Trust/PPO |
$68.28
|
| Rate for Payer: BCN Commercial |
$68.28
|
| Rate for Payer: Cash Price |
$70.68
|
| Rate for Payer: Cofinity Commercial |
$75.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.68
|
| Rate for Payer: Healthscope Commercial |
$79.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$75.10
|
| Rate for Payer: PHP Commercial |
$75.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.75
|
| Rate for Payer: UHC Core |
$73.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.26
|
|
|
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
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
IP
|
$429.40
|
|
|
Service Code
|
NDC 0904-6899-61
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$261.89 |
| Max. Negotiated Rate |
$386.46 |
| Rate for Payer: Aetna Commercial |
$364.99
|
| Rate for Payer: BCBS Trust/PPO |
$331.84
|
| Rate for Payer: BCN Commercial |
$331.84
|
| Rate for Payer: Cash Price |
$343.52
|
| Rate for Payer: Cofinity Commercial |
$369.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$343.52
|
| Rate for Payer: Healthscope Commercial |
$386.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$322.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$364.99
|
| Rate for Payer: PHP Commercial |
$364.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$300.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$373.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$261.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$377.87
|
| Rate for Payer: UHC Core |
$358.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$322.05
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
IP
|
$108.10
|
|
|
Service Code
|
NDC 0093-1003-01
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.93 |
| Max. Negotiated Rate |
$97.29 |
| Rate for Payer: Aetna Commercial |
$91.88
|
| Rate for Payer: BCBS Trust/PPO |
$83.54
|
| Rate for Payer: BCN Commercial |
$83.54
|
| Rate for Payer: Cash Price |
$86.48
|
| Rate for Payer: Cofinity Commercial |
$92.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.48
|
| Rate for Payer: Healthscope Commercial |
$97.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.88
|
| Rate for Payer: PHP Commercial |
$91.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.13
|
| Rate for Payer: UHC Core |
$90.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.08
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
IP
|
$455.05
|
|
|
Service Code
|
NDC 51079-960-20
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$277.53 |
| Max. Negotiated Rate |
$409.54 |
| Rate for Payer: Aetna Commercial |
$386.79
|
| Rate for Payer: BCBS Trust/PPO |
$351.66
|
| Rate for Payer: BCN Commercial |
$351.66
|
| Rate for Payer: Cash Price |
$364.04
|
| Rate for Payer: Cofinity Commercial |
$391.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.04
|
| Rate for Payer: Healthscope Commercial |
$409.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$341.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$386.79
|
| Rate for Payer: PHP Commercial |
$386.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$395.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$277.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$400.44
|
| Rate for Payer: UHC Core |
$379.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$341.29
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
IP
|
$105.75
|
|
|
Service Code
|
NDC 68382-180-01
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$95.18 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: BCBS Trust/PPO |
$81.72
|
| Rate for Payer: BCN Commercial |
$81.72
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.06
|
| Rate for Payer: UHC Core |
$88.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
IP
|
$91.65
|
|
|
Service Code
|
NDC 23155-023-01
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.90 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: BCBS Trust/PPO |
$70.83
|
| Rate for Payer: BCN Commercial |
$70.83
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.90
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.65
|
| Rate for Payer: UHC Core |
$76.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
IP
|
$65.80
|
|
|
Service Code
|
NDC 16729-200-01
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.13 |
| Max. Negotiated Rate |
$59.22 |
| Rate for Payer: Aetna Commercial |
$55.93
|
| Rate for Payer: BCBS Trust/PPO |
$50.85
|
| Rate for Payer: BCN Commercial |
$50.85
|
| Rate for Payer: Cash Price |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$56.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.64
|
| Rate for Payer: Healthscope Commercial |
$59.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.93
|
| Rate for Payer: PHP Commercial |
$55.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.90
|
| Rate for Payer: UHC Core |
$54.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.35
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
IP
|
$2.21
|
|
|
Service Code
|
NDC 51079-985-01
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$1.99 |
| Rate for Payer: Aetna Commercial |
$1.88
|
| Rate for Payer: BCBS Trust/PPO |
$1.71
|
| Rate for Payer: BCN Commercial |
$1.71
|
| Rate for Payer: Cash Price |
$1.77
|
| Rate for Payer: Cofinity Commercial |
$1.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.77
|
| Rate for Payer: Healthscope Commercial |
$1.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.88
|
| Rate for Payer: PHP Commercial |
$1.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.94
|
| Rate for Payer: UHC Core |
$1.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.66
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
IP
|
$220.90
|
|
|
Service Code
|
NDC 51079-985-20
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.73 |
| Max. Negotiated Rate |
$198.81 |
| Rate for Payer: Aetna Commercial |
$187.76
|
| Rate for Payer: BCBS Trust/PPO |
$170.71
|
| Rate for Payer: BCN Commercial |
$170.71
|
| Rate for Payer: Cash Price |
$176.72
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.72
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.76
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.39
|
| Rate for Payer: UHC Core |
$184.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.68
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
IP
|
$220.90
|
|
|
Service Code
|
NDC 0904-7122-61
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.73 |
| Max. Negotiated Rate |
$198.81 |
| Rate for Payer: Aetna Commercial |
$187.76
|
| Rate for Payer: BCBS Trust/PPO |
$170.71
|
| Rate for Payer: BCN Commercial |
$170.71
|
| Rate for Payer: Cash Price |
$176.72
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.72
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.76
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.39
|
| Rate for Payer: UHC Core |
$184.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.68
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
IP
|
$225.15
|
|
|
Service Code
|
NDC 16729-201-01
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.32 |
| Max. Negotiated Rate |
$202.64 |
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: BCBS Trust/PPO |
$174.00
|
| Rate for Payer: BCN Commercial |
$174.00
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.38
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.13
|
| Rate for Payer: UHC Core |
$188.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
IP
|
$408.90
|
|
|
Service Code
|
NDC 72888-063-01
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$249.39 |
| Max. Negotiated Rate |
$368.01 |
| Rate for Payer: Aetna Commercial |
$347.56
|
| Rate for Payer: BCBS Trust/PPO |
$316.00
|
| Rate for Payer: BCN Commercial |
$316.00
|
| Rate for Payer: Cash Price |
$327.12
|
| Rate for Payer: Cofinity Commercial |
$351.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.12
|
| Rate for Payer: Healthscope Commercial |
$368.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$347.56
|
| Rate for Payer: PHP Commercial |
$347.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$355.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$249.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.83
|
| Rate for Payer: UHC Core |
$341.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.68
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
IP
|
$302.75
|
|
|
Service Code
|
NDC 0527-1695-01
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.65 |
| Max. Negotiated Rate |
$272.48 |
| Rate for Payer: Aetna Commercial |
$257.34
|
| Rate for Payer: BCBS Trust/PPO |
$233.97
|
| Rate for Payer: BCN Commercial |
$233.97
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: Cofinity Commercial |
$260.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.20
|
| Rate for Payer: Healthscope Commercial |
$272.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.34
|
| Rate for Payer: PHP Commercial |
$257.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.92
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.42
|
| Rate for Payer: UHC Core |
$252.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.06
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
IP
|
$735.70
|
|
|
Service Code
|
NDC 0603-2544-21
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$448.70 |
| Max. Negotiated Rate |
$662.13 |
| Rate for Payer: Aetna Commercial |
$625.34
|
| Rate for Payer: BCBS Trust/PPO |
$568.55
|
| Rate for Payer: BCN Commercial |
$568.55
|
| Rate for Payer: Cash Price |
$588.56
|
| Rate for Payer: Cofinity Commercial |
$632.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.56
|
| Rate for Payer: Healthscope Commercial |
$662.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$625.34
|
| Rate for Payer: PHP Commercial |
$625.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$514.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$640.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$448.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.42
|
| Rate for Payer: UHC Core |
$614.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.78
|
|
|
BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE
|
Facility
IP
|
$712.60
|
|
|
Service Code
|
NDC 0591-3219-01
|
| Hospital Charge Code |
8922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$434.61 |
| Max. Negotiated Rate |
$641.34 |
| Rate for Payer: Aetna Commercial |
$605.71
|
| Rate for Payer: BCBS Trust/PPO |
$550.70
|
| Rate for Payer: BCN Commercial |
$550.70
|
| Rate for Payer: Cash Price |
$570.08
|
| Rate for Payer: Cofinity Commercial |
$612.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.08
|
| Rate for Payer: Healthscope Commercial |
$641.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$605.71
|
| Rate for Payer: PHP Commercial |
$605.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$498.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$619.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$434.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$627.09
|
| Rate for Payer: UHC Core |
$595.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.45
|
|
|
CALAMINE 8 %-ZINC OXIDE 8 % LOTION
|
Facility
IP
|
$14.34
|
|
|
Service Code
|
NDC 0395-0413-96
|
| Hospital Charge Code |
78879
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$12.91 |
| Rate for Payer: Aetna Commercial |
$12.19
|
| Rate for Payer: BCBS Trust/PPO |
$11.08
|
| Rate for Payer: BCN Commercial |
$11.08
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.47
|
| Rate for Payer: Healthscope Commercial |
$12.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.19
|
| Rate for Payer: PHP Commercial |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.62
|
| Rate for Payer: UHC Core |
$11.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.76
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
IP
|
$243.26
|
|
|
Service Code
|
NDC 49884-161-11
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.36 |
| Max. Negotiated Rate |
$218.93 |
| Rate for Payer: Aetna Commercial |
$206.77
|
| Rate for Payer: BCBS Trust/PPO |
$187.99
|
| Rate for Payer: BCN Commercial |
$187.99
|
| Rate for Payer: Cash Price |
$194.61
|
| Rate for Payer: Cofinity Commercial |
$209.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.61
|
| Rate for Payer: Healthscope Commercial |
$218.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$206.77
|
| Rate for Payer: PHP Commercial |
$206.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$211.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$148.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.07
|
| Rate for Payer: UHC Core |
$203.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.44
|
|
|
CALCITONIN (SALMON) 200 UNIT/ACTUATION NASAL SPRAY
|
Facility
IP
|
$112.28
|
|
|
Service Code
|
NDC 60505-0823-6
|
| Hospital Charge Code |
15738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.48 |
| Max. Negotiated Rate |
$101.05 |
| Rate for Payer: Aetna Commercial |
$95.44
|
| Rate for Payer: BCBS Trust/PPO |
$86.77
|
| Rate for Payer: BCN Commercial |
$86.77
|
| Rate for Payer: Cash Price |
$89.82
|
| Rate for Payer: Cofinity Commercial |
$96.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.82
|
| Rate for Payer: Healthscope Commercial |
$101.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.44
|
| Rate for Payer: PHP Commercial |
$95.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.81
|
| Rate for Payer: UHC Core |
$93.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.21
|
|
|
CALCITONIN (SALMON) 200 UNIT/ML INJECTION SOLUTION
|
Facility
IP
|
$3,124.80
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,905.82 |
| Max. Negotiated Rate |
$2,812.32 |
| Rate for Payer: Aetna Commercial |
$2,656.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,414.85
|
| Rate for Payer: BCN Commercial |
$2,414.85
|
| Rate for Payer: Cash Price |
$2,499.84
|
| Rate for Payer: Cofinity Commercial |
$2,687.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,499.84
|
| Rate for Payer: Healthscope Commercial |
$2,812.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,343.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,656.08
|
| Rate for Payer: PHP Commercial |
$2,656.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,187.36
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,718.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,905.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,749.82
|
| Rate for Payer: UHC Core |
$2,609.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,343.60
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
IP
|
$3.07
|
|
|
Service Code
|
NDC 60687-345-11
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna Commercial |
$2.61
|
| Rate for Payer: BCBS Trust/PPO |
$2.37
|
| Rate for Payer: BCN Commercial |
$2.37
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$2.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.61
|
| Rate for Payer: PHP Commercial |
$2.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.70
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.30
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
IP
|
$61.28
|
|
|
Service Code
|
NDC 23155-662-03
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.37 |
| Max. Negotiated Rate |
$55.15 |
| Rate for Payer: Aetna Commercial |
$52.09
|
| Rate for Payer: BCBS Trust/PPO |
$47.36
|
| Rate for Payer: BCN Commercial |
$47.36
|
| Rate for Payer: Cash Price |
$49.02
|
| Rate for Payer: Cofinity Commercial |
$52.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$49.02
|
| Rate for Payer: Healthscope Commercial |
$55.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$52.09
|
| Rate for Payer: PHP Commercial |
$52.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.93
|
| Rate for Payer: UHC Core |
$51.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.96
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
IP
|
$306.72
|
|
|
Service Code
|
NDC 60687-345-01
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.07 |
| Max. Negotiated Rate |
$276.05 |
| Rate for Payer: Aetna Commercial |
$260.71
|
| Rate for Payer: BCBS Trust/PPO |
$237.03
|
| Rate for Payer: BCN Commercial |
$237.03
|
| Rate for Payer: Cash Price |
$245.38
|
| Rate for Payer: Cofinity Commercial |
$263.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.38
|
| Rate for Payer: Healthscope Commercial |
$276.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$260.71
|
| Rate for Payer: PHP Commercial |
$260.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$266.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$187.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$269.91
|
| Rate for Payer: UHC Core |
$256.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.04
|
|
|
CALCITRIOL 0.25 MCG CAPSULE
|
Facility
IP
|
$422.40
|
|
|
Service Code
|
NDC 0054-0007-25
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.62 |
| Max. Negotiated Rate |
$380.16 |
| Rate for Payer: Aetna Commercial |
$359.04
|
| Rate for Payer: BCBS Trust/PPO |
$326.43
|
| Rate for Payer: BCN Commercial |
$326.43
|
| Rate for Payer: Cash Price |
$337.92
|
| Rate for Payer: Cofinity Commercial |
$363.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$337.92
|
| Rate for Payer: Healthscope Commercial |
$380.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$316.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$359.04
|
| Rate for Payer: PHP Commercial |
$359.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$367.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$257.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$371.71
|
| Rate for Payer: UHC Core |
$352.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$316.80
|
|
