|
BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$49.26
|
|
|
Service Code
|
HCPCS J0592
|
| Hospital Charge Code |
115937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$44.33 |
| Rate for Payer: Aetna Commercial |
$41.87
|
| Rate for Payer: Aetna Commercial |
$53.37
|
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: Aetna Medicare |
$16.33
|
| Rate for Payer: Aetna Medicare |
$12.81
|
| Rate for Payer: Aetna Medicare |
$13.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.62
|
| Rate for Payer: BCBS Complete |
$9.90
|
| Rate for Payer: BCBS Complete |
$9.12
|
| Rate for Payer: BCBS Complete |
$11.62
|
| Rate for Payer: BCBS MAPPO |
$15.70
|
| Rate for Payer: BCBS MAPPO |
$12.31
|
| Rate for Payer: BCBS MAPPO |
$13.38
|
| Rate for Payer: BCBS Trust/PPO |
$40.50
|
| Rate for Payer: BCBS Trust/PPO |
$43.99
|
| Rate for Payer: BCBS Trust/PPO |
$51.62
|
| Rate for Payer: BCN Commercial |
$43.99
|
| Rate for Payer: BCN Commercial |
$51.62
|
| Rate for Payer: BCN Commercial |
$40.50
|
| Rate for Payer: BCN Medicare Advantage |
$15.70
|
| Rate for Payer: BCN Medicare Advantage |
$13.38
|
| Rate for Payer: BCN Medicare Advantage |
$12.31
|
| Rate for Payer: Cash Price |
$50.23
|
| Rate for Payer: Cash Price |
$42.81
|
| Rate for Payer: Cash Price |
$39.41
|
| Rate for Payer: Cofinity Commercial |
$42.36
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Cofinity Commercial |
$54.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.31
|
| Rate for Payer: Healthscope Commercial |
$48.16
|
| Rate for Payer: Healthscope Commercial |
$44.33
|
| Rate for Payer: Healthscope Commercial |
$56.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.13
|
| Rate for Payer: Mclaren Medicaid |
$8.68
|
| Rate for Payer: Mclaren Medicaid |
$11.07
|
| Rate for Payer: Mclaren Medicaid |
$9.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.48
|
| Rate for Payer: Meridian Medicaid |
$11.62
|
| Rate for Payer: Meridian Medicaid |
$9.12
|
| Rate for Payer: Meridian Medicaid |
$9.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$14.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.48
|
| Rate for Payer: Nomi Health Commercial |
$51.49
|
| Rate for Payer: Nomi Health Commercial |
$43.88
|
| Rate for Payer: Nomi Health Commercial |
$40.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.95
|
| Rate for Payer: PACE Senior Care Partners |
$12.71
|
| Rate for Payer: PACE Senior Care Partners |
$11.70
|
| Rate for Payer: PACE Senior Care Partners |
$14.91
|
| Rate for Payer: PACE SWMI |
$15.70
|
| Rate for Payer: PACE SWMI |
$13.38
|
| Rate for Payer: PACE SWMI |
$12.31
|
| Rate for Payer: PHP Commercial |
$41.87
|
| Rate for Payer: PHP Commercial |
$53.37
|
| Rate for Payer: PHP Commercial |
$45.48
|
| Rate for Payer: PHP Medicare Advantage |
$13.38
|
| Rate for Payer: PHP Medicare Advantage |
$12.31
|
| Rate for Payer: PHP Medicare Advantage |
$15.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$54.63
|
| Rate for Payer: Priority Health Medicare |
$15.85
|
| Rate for Payer: Priority Health Medicare |
$13.51
|
| Rate for Payer: Priority Health Medicare |
$12.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.28
|
| Rate for Payer: Railroad Medicare Medicare |
$13.38
|
| Rate for Payer: Railroad Medicare Medicare |
$15.70
|
| Rate for Payer: Railroad Medicare Medicare |
$12.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.35
|
| Rate for Payer: UHC Core |
$41.13
|
| Rate for Payer: UHC Core |
$52.43
|
| Rate for Payer: UHC Core |
$44.68
|
| Rate for Payer: UHC Exchange |
$15.70
|
| Rate for Payer: UHC Exchange |
$13.38
|
| Rate for Payer: UHC Exchange |
$12.31
|
| Rate for Payer: UHC Medicaid |
$8.68
|
| Rate for Payer: UHC Medicaid |
$11.07
|
| Rate for Payer: UHC Medicaid |
$9.43
|
| Rate for Payer: UHC Medicare Advantage |
$13.38
|
| Rate for Payer: UHC Medicare Advantage |
$12.31
|
| Rate for Payer: UHC Medicare Advantage |
$15.70
|
| Rate for Payer: UHCCP Medicaid |
$9.43
|
| Rate for Payer: UHCCP Medicaid |
$8.68
|
| Rate for Payer: UHCCP Medicaid |
$11.07
|
| Rate for Payer: VA VA |
$12.31
|
| Rate for Payer: VA VA |
$15.70
|
| Rate for Payer: VA VA |
$13.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.09
|
|
|
BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$49.26
|
|
|
Service Code
|
HCPCS J0592
|
| Hospital Charge Code |
115937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.28 |
| Max. Negotiated Rate |
$44.33 |
| Rate for Payer: Aetna Commercial |
$41.87
|
| Rate for Payer: Aetna Commercial |
$45.48
|
| Rate for Payer: Aetna Commercial |
$53.37
|
| Rate for Payer: BCBS Trust/PPO |
$44.19
|
| Rate for Payer: BCBS Trust/PPO |
$40.68
|
| Rate for Payer: BCBS Trust/PPO |
$51.86
|
| Rate for Payer: BCN Commercial |
$44.19
|
| Rate for Payer: BCN Commercial |
$40.68
|
| Rate for Payer: BCN Commercial |
$51.86
|
| Rate for Payer: Cash Price |
$39.41
|
| 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: Cofinity Commercial |
$42.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.23
|
| Rate for Payer: Healthscope Commercial |
$48.16
|
| Rate for Payer: Healthscope Commercial |
$44.33
|
| Rate for Payer: Healthscope Commercial |
$56.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$40.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$45.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.37
|
| Rate for Payer: Nomi Health Commercial |
$40.39
|
| Rate for Payer: Nomi Health Commercial |
$43.88
|
| Rate for Payer: Nomi Health Commercial |
$51.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.09
|
| Rate for Payer: PHP Commercial |
$41.87
|
| Rate for Payer: PHP Commercial |
$53.37
|
| Rate for Payer: PHP Commercial |
$45.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$54.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$46.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$42.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.35
|
| Rate for Payer: UHC Core |
$41.13
|
| Rate for Payer: UHC Core |
$52.43
|
| Rate for Payer: UHC Core |
$44.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.13
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$394.38
|
|
|
Service Code
|
NDC 00904715404
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$274.49 |
| Max. Negotiated Rate |
$354.94 |
| Rate for Payer: Aetna Commercial |
$335.22
|
| Rate for Payer: BCBS Trust/PPO |
$325.72
|
| Rate for Payer: BCN Commercial |
$325.72
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cofinity Commercial |
$339.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.50
|
| Rate for Payer: Healthscope Commercial |
$354.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.22
|
| Rate for Payer: Nomi Health Commercial |
$323.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.79
|
| Rate for Payer: PHP Commercial |
$335.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$343.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$347.05
|
| Rate for Payer: UHC Core |
$329.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.79
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$394.38
|
|
|
Service Code
|
NDC 00904715404
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.53 |
| Max. Negotiated Rate |
$354.94 |
| Rate for Payer: Aetna Commercial |
$335.22
|
| Rate for Payer: Aetna Medicare |
$102.54
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$123.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$123.24
|
| Rate for Payer: BCBS Complete |
$73.00
|
| Rate for Payer: BCBS MAPPO |
$98.59
|
| Rate for Payer: BCBS Trust/PPO |
$324.22
|
| Rate for Payer: BCN Commercial |
$324.22
|
| Rate for Payer: BCN Medicare Advantage |
$98.59
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cofinity Commercial |
$339.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.59
|
| Rate for Payer: Healthscope Commercial |
$354.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.79
|
| Rate for Payer: Mclaren Medicaid |
$69.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.52
|
| Rate for Payer: Meridian Medicaid |
$73.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$113.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$108.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.22
|
| Rate for Payer: Nomi Health Commercial |
$323.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.79
|
| Rate for Payer: PACE Senior Care Partners |
$93.67
|
| Rate for Payer: PACE SWMI |
$98.59
|
| Rate for Payer: PHP Commercial |
$335.22
|
| Rate for Payer: PHP Medicare Advantage |
$98.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$343.11
|
| Rate for Payer: Priority Health Medicare |
$99.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$274.49
|
| Rate for Payer: Railroad Medicare Medicare |
$98.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$347.05
|
| Rate for Payer: UHC Core |
$329.31
|
| Rate for Payer: UHC Exchange |
$98.59
|
| Rate for Payer: UHC Medicaid |
$69.53
|
| Rate for Payer: UHC Medicare Advantage |
$98.59
|
| Rate for Payer: UHCCP Medicaid |
$69.53
|
| Rate for Payer: VA VA |
$98.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.79
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$200.55
|
|
|
Service Code
|
NDC 00054017613
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Aetna Commercial |
$170.47
|
| Rate for Payer: Aetna Medicare |
$52.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.67
|
| Rate for Payer: BCBS Complete |
$37.12
|
| Rate for Payer: BCBS MAPPO |
$50.14
|
| Rate for Payer: BCBS Trust/PPO |
$164.87
|
| Rate for Payer: BCN Commercial |
$164.87
|
| Rate for Payer: BCN Medicare Advantage |
$50.14
|
| Rate for Payer: Cash Price |
$160.44
|
| Rate for Payer: Cofinity Commercial |
$172.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.14
|
| Rate for Payer: Healthscope Commercial |
$180.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.41
|
| Rate for Payer: Mclaren Medicaid |
$35.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.64
|
| Rate for Payer: Meridian Medicaid |
$37.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$55.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.47
|
| Rate for Payer: Nomi Health Commercial |
$164.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.41
|
| Rate for Payer: PACE Senior Care Partners |
$47.63
|
| Rate for Payer: PACE SWMI |
$50.14
|
| Rate for Payer: PHP Commercial |
$170.47
|
| Rate for Payer: PHP Medicare Advantage |
$50.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$174.48
|
| Rate for Payer: Priority Health Medicare |
$50.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.58
|
| Rate for Payer: Railroad Medicare Medicare |
$50.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.48
|
| Rate for Payer: UHC Core |
$167.46
|
| Rate for Payer: UHC Exchange |
$50.14
|
| Rate for Payer: UHC Medicaid |
$35.36
|
| Rate for Payer: UHC Medicare Advantage |
$50.14
|
| Rate for Payer: UHCCP Medicaid |
$35.36
|
| Rate for Payer: VA VA |
$50.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.41
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$200.55
|
|
|
Service Code
|
NDC 00054017613
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.58 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Aetna Commercial |
$170.47
|
| Rate for Payer: BCBS Trust/PPO |
$165.63
|
| Rate for Payer: BCN Commercial |
$165.63
|
| Rate for Payer: Cash Price |
$160.44
|
| Rate for Payer: Cofinity Commercial |
$172.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.44
|
| Rate for Payer: Healthscope Commercial |
$180.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.47
|
| Rate for Payer: Nomi Health Commercial |
$164.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.41
|
| Rate for Payer: PHP Commercial |
$170.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$174.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$176.48
|
| Rate for Payer: UHC Core |
$167.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.41
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
|
IP
|
$265.20
|
|
|
Service Code
|
NDC 50268014315
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.58 |
| Max. Negotiated Rate |
$238.68 |
| Rate for Payer: Aetna Commercial |
$225.42
|
| Rate for Payer: BCBS Trust/PPO |
$219.03
|
| Rate for Payer: BCN Commercial |
$219.03
|
| Rate for Payer: Cash Price |
$212.16
|
| Rate for Payer: Cofinity Commercial |
$228.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.16
|
| Rate for Payer: Healthscope Commercial |
$238.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.42
|
| Rate for Payer: Nomi Health Commercial |
$217.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.90
|
| Rate for Payer: PHP Commercial |
$225.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$230.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.38
|
| Rate for Payer: UHC Core |
$221.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.90
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
|
IP
|
$5.31
|
|
|
Service Code
|
NDC 50268014311
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.51
|
| Rate for Payer: BCBS Trust/PPO |
$4.39
|
| Rate for Payer: BCN Commercial |
$4.39
|
| Rate for Payer: Cash Price |
$4.25
|
| Rate for Payer: Cofinity Commercial |
$4.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.25
|
| Rate for Payer: Healthscope Commercial |
$4.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.51
|
| Rate for Payer: Nomi Health Commercial |
$4.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.98
|
| Rate for Payer: PHP Commercial |
$4.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.67
|
| Rate for Payer: UHC Core |
$4.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.98
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
|
OP
|
$5.31
|
|
|
Service Code
|
NDC 50268014311
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.51
|
| Rate for Payer: Aetna Medicare |
$1.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.66
|
| Rate for Payer: BCBS Complete |
$0.98
|
| Rate for Payer: BCBS MAPPO |
$1.33
|
| Rate for Payer: BCBS Trust/PPO |
$4.37
|
| Rate for Payer: BCN Commercial |
$4.37
|
| Rate for Payer: BCN Medicare Advantage |
$1.33
|
| Rate for Payer: Cash Price |
$4.25
|
| Rate for Payer: Cofinity Commercial |
$4.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.33
|
| Rate for Payer: Healthscope Commercial |
$4.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.98
|
| Rate for Payer: Mclaren Medicaid |
$0.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.39
|
| Rate for Payer: Meridian Medicaid |
$0.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.51
|
| Rate for Payer: Nomi Health Commercial |
$4.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.98
|
| Rate for Payer: PACE Senior Care Partners |
$1.26
|
| Rate for Payer: PACE SWMI |
$1.33
|
| Rate for Payer: PHP Commercial |
$4.51
|
| Rate for Payer: PHP Medicare Advantage |
$1.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4.62
|
| Rate for Payer: Priority Health Medicare |
$1.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.70
|
| Rate for Payer: Railroad Medicare Medicare |
$1.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.67
|
| Rate for Payer: UHC Core |
$4.43
|
| Rate for Payer: UHC Exchange |
$1.33
|
| Rate for Payer: UHC Medicaid |
$0.94
|
| Rate for Payer: UHC Medicare Advantage |
$1.33
|
| Rate for Payer: UHCCP Medicaid |
$0.94
|
| Rate for Payer: VA VA |
$1.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.98
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
|
OP
|
$265.20
|
|
|
Service Code
|
NDC 50268014315
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.75 |
| Max. Negotiated Rate |
$238.68 |
| Rate for Payer: Aetna Commercial |
$225.42
|
| Rate for Payer: Aetna Medicare |
$68.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.88
|
| Rate for Payer: BCBS Complete |
$49.09
|
| Rate for Payer: BCBS MAPPO |
$66.30
|
| Rate for Payer: BCBS Trust/PPO |
$218.02
|
| Rate for Payer: BCN Commercial |
$218.02
|
| Rate for Payer: BCN Medicare Advantage |
$66.30
|
| Rate for Payer: Cash Price |
$212.16
|
| Rate for Payer: Cofinity Commercial |
$228.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.30
|
| Rate for Payer: Healthscope Commercial |
$238.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.90
|
| Rate for Payer: Mclaren Medicaid |
$46.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.61
|
| Rate for Payer: Meridian Medicaid |
$49.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$76.25
|
| Rate for Payer: Molina Medicare/Medicaid |
$72.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.42
|
| Rate for Payer: Nomi Health Commercial |
$217.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.90
|
| Rate for Payer: PACE Senior Care Partners |
$62.98
|
| Rate for Payer: PACE SWMI |
$66.30
|
| Rate for Payer: PHP Commercial |
$225.42
|
| Rate for Payer: PHP Medicare Advantage |
$66.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$230.72
|
| Rate for Payer: Priority Health Medicare |
$66.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.58
|
| Rate for Payer: Railroad Medicare Medicare |
$66.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.38
|
| Rate for Payer: UHC Core |
$221.44
|
| Rate for Payer: UHC Exchange |
$66.30
|
| Rate for Payer: UHC Medicaid |
$46.75
|
| Rate for Payer: UHC Medicare Advantage |
$66.30
|
| Rate for Payer: UHCCP Medicaid |
$46.75
|
| Rate for Payer: VA VA |
$66.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.90
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
IP
|
$4.53
|
|
|
Service Code
|
NDC 51079094301
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: BCBS Trust/PPO |
$3.74
|
| Rate for Payer: BCN Commercial |
$3.74
|
| 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 Commercial |
$3.85
|
| Rate for Payer: Nomi Health Commercial |
$3.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.40
|
| Rate for Payer: PHP Commercial |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.15
|
| 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
|
OP
|
$4.53
|
|
|
Service Code
|
NDC 51079094301
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna Medicare |
$1.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.42
|
| Rate for Payer: BCBS Complete |
$0.84
|
| Rate for Payer: BCBS MAPPO |
$1.13
|
| Rate for Payer: BCBS Trust/PPO |
$3.72
|
| Rate for Payer: BCN Commercial |
$3.72
|
| Rate for Payer: BCN Medicare Advantage |
$1.13
|
| 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: Health Alliance Plan Medicare Advantage |
$1.13
|
| Rate for Payer: Healthscope Commercial |
$4.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.40
|
| Rate for Payer: Mclaren Medicaid |
$0.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.19
|
| Rate for Payer: Meridian Medicaid |
$0.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.85
|
| Rate for Payer: Nomi Health Commercial |
$3.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.40
|
| Rate for Payer: PACE Senior Care Partners |
$1.08
|
| Rate for Payer: PACE SWMI |
$1.13
|
| Rate for Payer: PHP Commercial |
$3.85
|
| Rate for Payer: PHP Medicare Advantage |
$1.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.94
|
| Rate for Payer: Priority Health Medicare |
$1.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.15
|
| Rate for Payer: Railroad Medicare Medicare |
$1.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.99
|
| Rate for Payer: UHC Core |
$3.78
|
| Rate for Payer: UHC Exchange |
$1.13
|
| Rate for Payer: UHC Medicaid |
$0.80
|
| Rate for Payer: UHC Medicare Advantage |
$1.13
|
| Rate for Payer: UHCCP Medicaid |
$0.80
|
| Rate for Payer: VA VA |
$1.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.40
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
IP
|
$472.15
|
|
|
Service Code
|
NDC 60505015801
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$328.62 |
| Max. Negotiated Rate |
$424.94 |
| Rate for Payer: Aetna Commercial |
$401.33
|
| Rate for Payer: BCBS Trust/PPO |
$389.95
|
| Rate for Payer: BCN Commercial |
$389.95
|
| Rate for Payer: Cash Price |
$377.72
|
| Rate for Payer: Cofinity Commercial |
$406.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.72
|
| Rate for Payer: Healthscope Commercial |
$424.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$401.33
|
| Rate for Payer: Nomi Health Commercial |
$387.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.11
|
| Rate for Payer: PHP Commercial |
$401.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$410.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$328.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$415.49
|
| Rate for Payer: UHC Core |
$394.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.11
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
OP
|
$472.15
|
|
|
Service Code
|
NDC 60505015801
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.24 |
| Max. Negotiated Rate |
$424.94 |
| Rate for Payer: Aetna Commercial |
$401.33
|
| Rate for Payer: Aetna Medicare |
$122.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$147.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$147.55
|
| Rate for Payer: BCBS Complete |
$87.39
|
| Rate for Payer: BCBS MAPPO |
$118.04
|
| Rate for Payer: BCBS Trust/PPO |
$388.15
|
| Rate for Payer: BCN Commercial |
$388.15
|
| Rate for Payer: BCN Medicare Advantage |
$118.04
|
| Rate for Payer: Cash Price |
$377.72
|
| Rate for Payer: Cofinity Commercial |
$406.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$377.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.04
|
| Rate for Payer: Healthscope Commercial |
$424.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.11
|
| Rate for Payer: Mclaren Medicaid |
$83.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.94
|
| Rate for Payer: Meridian Medicaid |
$87.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$129.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$401.33
|
| Rate for Payer: Nomi Health Commercial |
$387.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.11
|
| Rate for Payer: PACE Senior Care Partners |
$112.14
|
| Rate for Payer: PACE SWMI |
$118.04
|
| Rate for Payer: PHP Commercial |
$401.33
|
| Rate for Payer: PHP Medicare Advantage |
$118.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$410.77
|
| Rate for Payer: Priority Health Medicare |
$119.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$328.62
|
| Rate for Payer: Railroad Medicare Medicare |
$118.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$415.49
|
| Rate for Payer: UHC Core |
$394.25
|
| Rate for Payer: UHC Exchange |
$118.04
|
| Rate for Payer: UHC Medicaid |
$83.24
|
| Rate for Payer: UHC Medicare Advantage |
$118.04
|
| Rate for Payer: UHCCP Medicaid |
$83.24
|
| Rate for Payer: VA VA |
$118.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.11
|
|
|
BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
IP
|
$3.46
|
|
|
Service Code
|
NDC 51079039101
|
| Hospital Charge Code |
18385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$3.11 |
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: BCBS Trust/PPO |
$2.86
|
| Rate for Payer: BCN Commercial |
$2.86
|
| 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 Commercial |
$2.94
|
| Rate for Payer: Nomi Health Commercial |
$2.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.60
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.41
|
| 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 51079039120
|
| Hospital Charge Code |
18385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.54 |
| Max. Negotiated Rate |
$311.04 |
| Rate for Payer: Aetna Commercial |
$293.76
|
| Rate for Payer: BCBS Trust/PPO |
$285.43
|
| Rate for Payer: BCN Commercial |
$285.43
|
| 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 Commercial |
$293.76
|
| Rate for Payer: Nomi Health Commercial |
$283.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.20
|
| Rate for Payer: PHP Commercial |
$293.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$300.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.54
|
| 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
|
OP
|
$3.46
|
|
|
Service Code
|
NDC 51079039101
|
| Hospital Charge Code |
18385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$3.11 |
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: Aetna Medicare |
$0.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.08
|
| Rate for Payer: BCBS Complete |
$0.64
|
| Rate for Payer: BCBS MAPPO |
$0.87
|
| Rate for Payer: BCBS Trust/PPO |
$2.84
|
| Rate for Payer: BCN Commercial |
$2.84
|
| Rate for Payer: BCN Medicare Advantage |
$0.87
|
| 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: Health Alliance Plan Medicare Advantage |
$0.87
|
| Rate for Payer: Healthscope Commercial |
$3.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.60
|
| Rate for Payer: Mclaren Medicaid |
$0.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.91
|
| Rate for Payer: Meridian Medicaid |
$0.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Nomi Health Commercial |
$2.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.60
|
| Rate for Payer: PACE Senior Care Partners |
$0.82
|
| Rate for Payer: PACE SWMI |
$0.87
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: PHP Medicare Advantage |
$0.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.01
|
| Rate for Payer: Priority Health Medicare |
$0.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.41
|
| Rate for Payer: Railroad Medicare Medicare |
$0.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.04
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Medicaid |
$0.61
|
| Rate for Payer: UHC Medicare Advantage |
$0.87
|
| Rate for Payer: UHCCP Medicaid |
$0.61
|
| Rate for Payer: VA VA |
$0.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.60
|
|
|
BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
OP
|
$345.60
|
|
|
Service Code
|
NDC 51079039120
|
| Hospital Charge Code |
18385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.93 |
| Max. Negotiated Rate |
$311.04 |
| Rate for Payer: Aetna Commercial |
$293.76
|
| Rate for Payer: Aetna Medicare |
$89.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$108.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$108.00
|
| Rate for Payer: BCBS Complete |
$63.97
|
| Rate for Payer: BCBS MAPPO |
$86.40
|
| Rate for Payer: BCBS Trust/PPO |
$284.12
|
| Rate for Payer: BCN Commercial |
$284.12
|
| Rate for Payer: BCN Medicare Advantage |
$86.40
|
| 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: Health Alliance Plan Medicare Advantage |
$86.40
|
| Rate for Payer: Healthscope Commercial |
$311.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.20
|
| Rate for Payer: Mclaren Medicaid |
$60.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.72
|
| Rate for Payer: Meridian Medicaid |
$63.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.76
|
| Rate for Payer: Nomi Health Commercial |
$283.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.20
|
| Rate for Payer: PACE Senior Care Partners |
$82.08
|
| Rate for Payer: PACE SWMI |
$86.40
|
| Rate for Payer: PHP Commercial |
$293.76
|
| Rate for Payer: PHP Medicare Advantage |
$86.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$300.67
|
| Rate for Payer: Priority Health Medicare |
$87.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.54
|
| Rate for Payer: Railroad Medicare Medicare |
$86.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.13
|
| Rate for Payer: UHC Core |
$288.58
|
| Rate for Payer: UHC Exchange |
$86.40
|
| Rate for Payer: UHC Medicaid |
$60.93
|
| Rate for Payer: UHC Medicare Advantage |
$86.40
|
| Rate for Payer: UHCCP Medicaid |
$60.93
|
| Rate for Payer: VA VA |
$86.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.20
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$615.84
|
|
|
Service Code
|
NDC 00904708461
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.57 |
| Max. Negotiated Rate |
$554.26 |
| Rate for Payer: Aetna Commercial |
$523.46
|
| Rate for Payer: Aetna Medicare |
$160.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$192.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$192.45
|
| Rate for Payer: BCBS Complete |
$113.99
|
| Rate for Payer: BCBS MAPPO |
$153.96
|
| Rate for Payer: BCBS Trust/PPO |
$506.28
|
| Rate for Payer: BCN Commercial |
$506.28
|
| Rate for Payer: BCN Medicare Advantage |
$153.96
|
| Rate for Payer: Cash Price |
$492.67
|
| Rate for Payer: Cofinity Commercial |
$529.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.96
|
| Rate for Payer: Healthscope Commercial |
$554.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$461.88
|
| Rate for Payer: Mclaren Medicaid |
$108.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.66
|
| Rate for Payer: Meridian Medicaid |
$113.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$169.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.46
|
| Rate for Payer: Nomi Health Commercial |
$504.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$461.88
|
| Rate for Payer: PACE Senior Care Partners |
$146.26
|
| Rate for Payer: PACE SWMI |
$153.96
|
| Rate for Payer: PHP Commercial |
$523.46
|
| Rate for Payer: PHP Medicare Advantage |
$153.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$535.78
|
| Rate for Payer: Priority Health Medicare |
$155.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$428.62
|
| Rate for Payer: Railroad Medicare Medicare |
$153.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$541.94
|
| Rate for Payer: UHC Core |
$514.23
|
| Rate for Payer: UHC Exchange |
$153.96
|
| Rate for Payer: UHC Medicaid |
$108.57
|
| Rate for Payer: UHC Medicare Advantage |
$153.96
|
| Rate for Payer: UHCCP Medicaid |
$108.57
|
| Rate for Payer: VA VA |
$153.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$461.88
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$88.35
|
|
|
Service Code
|
NDC 69097087502
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.49 |
| Max. Negotiated Rate |
$79.52 |
| Rate for Payer: Aetna Commercial |
$75.10
|
| Rate for Payer: BCBS Trust/PPO |
$72.97
|
| Rate for Payer: BCN Commercial |
$72.97
|
| 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 Commercial |
$75.10
|
| Rate for Payer: Nomi Health Commercial |
$72.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.26
|
| Rate for Payer: PHP Commercial |
$75.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.49
|
| 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
|
$361.67
|
|
|
Service Code
|
NDC 68180031909
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.72 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna Commercial |
$307.42
|
| Rate for Payer: BCBS Trust/PPO |
$298.70
|
| Rate for Payer: BCN Commercial |
$298.70
|
| Rate for Payer: Cash Price |
$289.34
|
| Rate for Payer: Cofinity Commercial |
$311.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.34
|
| Rate for Payer: Healthscope Commercial |
$325.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.42
|
| Rate for Payer: Nomi Health Commercial |
$296.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.25
|
| Rate for Payer: PHP Commercial |
$307.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$314.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$251.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$318.27
|
| Rate for Payer: UHC Core |
$301.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.25
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$111.60
|
|
|
Service Code
|
NDC 10370010103
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.67 |
| Max. Negotiated Rate |
$100.44 |
| Rate for Payer: Aetna Commercial |
$94.86
|
| Rate for Payer: BCBS Trust/PPO |
$92.17
|
| Rate for Payer: BCN Commercial |
$92.17
|
| 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 Commercial |
$94.86
|
| Rate for Payer: Nomi Health Commercial |
$91.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.70
|
| Rate for Payer: PHP Commercial |
$94.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$97.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.67
|
| 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
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$140.26
|
|
|
Service Code
|
NDC 00904708404
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.73 |
| Max. Negotiated Rate |
$126.23 |
| Rate for Payer: Aetna Commercial |
$119.22
|
| Rate for Payer: Aetna Medicare |
$36.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.83
|
| Rate for Payer: BCBS Complete |
$25.96
|
| Rate for Payer: BCBS MAPPO |
$35.06
|
| Rate for Payer: BCBS Trust/PPO |
$115.31
|
| Rate for Payer: BCN Commercial |
$115.31
|
| Rate for Payer: BCN Medicare Advantage |
$35.06
|
| Rate for Payer: Cash Price |
$112.21
|
| Rate for Payer: Cofinity Commercial |
$120.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.06
|
| Rate for Payer: Healthscope Commercial |
$126.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.19
|
| Rate for Payer: Mclaren Medicaid |
$24.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.82
|
| Rate for Payer: Meridian Medicaid |
$25.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.22
|
| Rate for Payer: Nomi Health Commercial |
$115.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.19
|
| Rate for Payer: PACE Senior Care Partners |
$33.31
|
| Rate for Payer: PACE SWMI |
$35.06
|
| Rate for Payer: PHP Commercial |
$119.22
|
| Rate for Payer: PHP Medicare Advantage |
$35.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$122.03
|
| Rate for Payer: Priority Health Medicare |
$35.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.62
|
| Rate for Payer: Railroad Medicare Medicare |
$35.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.43
|
| Rate for Payer: UHC Core |
$117.12
|
| Rate for Payer: UHC Exchange |
$35.06
|
| Rate for Payer: UHC Medicaid |
$24.73
|
| Rate for Payer: UHC Medicare Advantage |
$35.06
|
| Rate for Payer: UHCCP Medicaid |
$24.73
|
| Rate for Payer: VA VA |
$35.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.19
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$140.26
|
|
|
Service Code
|
NDC 00904708404
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.62 |
| Max. Negotiated Rate |
$126.23 |
| Rate for Payer: Aetna Commercial |
$119.22
|
| Rate for Payer: BCBS Trust/PPO |
$115.84
|
| Rate for Payer: BCN Commercial |
$115.84
|
| Rate for Payer: Cash Price |
$112.21
|
| Rate for Payer: Cofinity Commercial |
$120.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.21
|
| Rate for Payer: Healthscope Commercial |
$126.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.22
|
| Rate for Payer: Nomi Health Commercial |
$115.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.19
|
| Rate for Payer: PHP Commercial |
$119.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$122.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.43
|
| Rate for Payer: UHC Core |
$117.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.19
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$677.28
|
|
|
Service Code
|
NDC 00904750561
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.40 |
| Max. Negotiated Rate |
$609.55 |
| Rate for Payer: Aetna Commercial |
$575.69
|
| Rate for Payer: Aetna Medicare |
$176.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$211.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$211.65
|
| Rate for Payer: BCBS Complete |
$125.36
|
| Rate for Payer: BCBS MAPPO |
$169.32
|
| Rate for Payer: BCBS Trust/PPO |
$556.79
|
| Rate for Payer: BCN Commercial |
$556.79
|
| Rate for Payer: BCN Medicare Advantage |
$169.32
|
| Rate for Payer: Cash Price |
$541.82
|
| Rate for Payer: Cofinity Commercial |
$582.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.32
|
| Rate for Payer: Healthscope Commercial |
$609.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.96
|
| Rate for Payer: Mclaren Medicaid |
$119.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$177.79
|
| Rate for Payer: Meridian Medicaid |
$125.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$194.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$186.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$575.69
|
| Rate for Payer: Nomi Health Commercial |
$555.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.96
|
| Rate for Payer: PACE Senior Care Partners |
$160.85
|
| Rate for Payer: PACE SWMI |
$169.32
|
| Rate for Payer: PHP Commercial |
$575.69
|
| Rate for Payer: PHP Medicare Advantage |
$169.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$589.23
|
| Rate for Payer: Priority Health Medicare |
$171.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$471.39
|
| Rate for Payer: Railroad Medicare Medicare |
$169.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$596.01
|
| Rate for Payer: UHC Core |
$565.53
|
| Rate for Payer: UHC Exchange |
$169.32
|
| Rate for Payer: UHC Medicaid |
$119.40
|
| Rate for Payer: UHC Medicare Advantage |
$169.32
|
| Rate for Payer: UHCCP Medicaid |
$119.40
|
| Rate for Payer: VA VA |
$169.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.96
|
|
