|
BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJECTION SOLUTION
|
Facility
|
IP
|
$16.06
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
1224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.44 |
| Max. Negotiated Rate |
$14.45 |
| Rate for Payer: Aetna Commercial |
$13.65
|
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Aetna Commercial |
$20.66
|
| Rate for Payer: BCBS Trust/PPO |
$18.82
|
| Rate for Payer: BCBS Trust/PPO |
$13.11
|
| Rate for Payer: BCBS Trust/PPO |
$19.84
|
| Rate for Payer: BCN Commercial |
$17.82
|
| Rate for Payer: BCN Commercial |
$12.41
|
| Rate for Payer: BCN Commercial |
$18.78
|
| Rate for Payer: Cash Price |
$12.85
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cofinity Commercial |
$20.90
|
| Rate for Payer: Cofinity Commercial |
$19.83
|
| Rate for Payer: Cofinity Commercial |
$13.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.44
|
| Rate for Payer: Healthscope Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$14.45
|
| 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 |
$12.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.66
|
| Rate for Payer: Nomi Health Commercial |
$13.17
|
| Rate for Payer: Nomi Health Commercial |
$18.91
|
| Rate for Payer: Nomi Health Commercial |
$19.93
|
| Rate for Payer: PHP Commercial |
$19.60
|
| Rate for Payer: PHP Commercial |
$13.65
|
| Rate for Payer: PHP Commercial |
$20.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.99
|
| Rate for Payer: Priority Health HMO/PPO |
$21.14
|
| Rate for Payer: Priority Health HMO/PPO |
$20.06
|
| Rate for Payer: Priority Health HMO/PPO |
$13.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.13
|
| Rate for Payer: UHC Core |
$13.41
|
| Rate for Payer: UHC Core |
$20.29
|
| Rate for Payer: UHC Core |
$19.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.30
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$640.85
|
|
|
Service Code
|
NDC 00904700906
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.20 |
| Max. Negotiated Rate |
$576.76 |
| Rate for Payer: Aetna Commercial |
$544.72
|
| Rate for Payer: Aetna Medicare |
$166.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$200.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$200.27
|
| Rate for Payer: BCBS Complete |
$256.34
|
| Rate for Payer: BCBS MAPPO |
$160.21
|
| Rate for Payer: BCBS Trust/PPO |
$526.84
|
| Rate for Payer: BCN Commercial |
$498.26
|
| Rate for Payer: BCN Medicare Advantage |
$160.21
|
| Rate for Payer: Cash Price |
$512.68
|
| Rate for Payer: Cofinity Commercial |
$551.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.21
|
| Rate for Payer: Healthscope Commercial |
$576.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$480.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.72
|
| Rate for Payer: Nomi Health Commercial |
$525.50
|
| Rate for Payer: PACE Senior Care Partners |
$152.20
|
| Rate for Payer: PACE SWMI |
$160.21
|
| Rate for Payer: PHP Commercial |
$544.72
|
| Rate for Payer: PHP Medicare Advantage |
$160.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.55
|
| Rate for Payer: Priority Health HMO/PPO |
$557.54
|
| Rate for Payer: Priority Health Medicare |
$161.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$429.37
|
| Rate for Payer: Railroad Medicare Medicare |
$160.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$563.95
|
| Rate for Payer: UHC Core |
$535.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$160.21
|
| Rate for Payer: UHC Exchange |
$160.21
|
| Rate for Payer: UHC Medicare Advantage |
$160.21
|
| Rate for Payer: VA VA |
$160.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$480.64
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$640.85
|
|
|
Service Code
|
NDC 00904700906
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$416.55 |
| Max. Negotiated Rate |
$576.76 |
| Rate for Payer: Aetna Commercial |
$544.72
|
| Rate for Payer: BCBS Trust/PPO |
$523.13
|
| Rate for Payer: BCN Commercial |
$495.25
|
| Rate for Payer: Cash Price |
$512.68
|
| Rate for Payer: Cofinity Commercial |
$551.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.68
|
| Rate for Payer: Healthscope Commercial |
$576.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$480.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.72
|
| Rate for Payer: Nomi Health Commercial |
$525.50
|
| Rate for Payer: PHP Commercial |
$544.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.55
|
| Rate for Payer: Priority Health HMO/PPO |
$557.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$429.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$563.95
|
| Rate for Payer: UHC Core |
$535.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$480.64
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$488.28
|
|
|
Service Code
|
NDC 00904701006
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.97 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Aetna Commercial |
$415.04
|
| Rate for Payer: Aetna Medicare |
$126.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$152.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$152.59
|
| Rate for Payer: BCBS Complete |
$195.31
|
| Rate for Payer: BCBS MAPPO |
$122.07
|
| Rate for Payer: BCBS Trust/PPO |
$401.41
|
| Rate for Payer: BCN Commercial |
$379.64
|
| Rate for Payer: BCN Medicare Advantage |
$122.07
|
| Rate for Payer: Cash Price |
$390.62
|
| Rate for Payer: Cofinity Commercial |
$419.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.07
|
| Rate for Payer: Healthscope Commercial |
$439.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.04
|
| Rate for Payer: Nomi Health Commercial |
$400.39
|
| Rate for Payer: PACE Senior Care Partners |
$115.97
|
| Rate for Payer: PACE SWMI |
$122.07
|
| Rate for Payer: PHP Commercial |
$415.04
|
| Rate for Payer: PHP Medicare Advantage |
$122.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.38
|
| Rate for Payer: Priority Health HMO/PPO |
$424.80
|
| Rate for Payer: Priority Health Medicare |
$123.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$327.15
|
| Rate for Payer: Railroad Medicare Medicare |
$122.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.69
|
| Rate for Payer: UHC Core |
$407.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.07
|
| Rate for Payer: UHC Exchange |
$122.07
|
| Rate for Payer: UHC Medicare Advantage |
$122.07
|
| Rate for Payer: VA VA |
$122.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.21
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$488.28
|
|
|
Service Code
|
NDC 00904701006
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$317.38 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Aetna Commercial |
$415.04
|
| Rate for Payer: BCBS Trust/PPO |
$398.58
|
| Rate for Payer: BCN Commercial |
$377.34
|
| Rate for Payer: Cash Price |
$390.62
|
| Rate for Payer: Cofinity Commercial |
$419.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.62
|
| Rate for Payer: Healthscope Commercial |
$439.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.04
|
| Rate for Payer: Nomi Health Commercial |
$400.39
|
| Rate for Payer: PHP Commercial |
$415.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.38
|
| Rate for Payer: Priority Health HMO/PPO |
$424.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$327.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$429.69
|
| Rate for Payer: UHC Core |
$407.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.21
|
|
|
BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$62.79
|
|
|
Service Code
|
HCPCS J0592
|
| Hospital Charge Code |
115937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$56.51 |
| 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 |
$13.91
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16.72
|
| Rate for Payer: BCBS Complete |
$21.40
|
| Rate for Payer: BCBS Complete |
$25.12
|
| Rate for Payer: BCBS MAPPO |
$13.38
|
| Rate for Payer: BCBS MAPPO |
$15.70
|
| Rate for Payer: BCBS Trust/PPO |
$51.62
|
| Rate for Payer: BCBS Trust/PPO |
$43.99
|
| Rate for Payer: BCN Commercial |
$48.82
|
| Rate for Payer: BCN Commercial |
$41.60
|
| Rate for Payer: BCN Medicare Advantage |
$15.70
|
| Rate for Payer: BCN Medicare Advantage |
$13.38
|
| Rate for Payer: Cash Price |
$50.23
|
| Rate for Payer: Cash Price |
$42.81
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Cofinity Commercial |
$54.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.70
|
| Rate for Payer: Healthscope Commercial |
$48.16
|
| 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 |
$40.13
|
| 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: MI Amish Medical Board Commercial |
$15.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.37
|
| 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: PACE Senior Care Partners |
$14.91
|
| Rate for Payer: PACE Senior Care Partners |
$12.71
|
| Rate for Payer: PACE SWMI |
$15.70
|
| Rate for Payer: PACE SWMI |
$13.38
|
| 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 |
$15.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.78
|
| Rate for Payer: Priority Health HMO/PPO |
$46.55
|
| Rate for Payer: 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 Narrow/Tiered Network |
$42.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.85
|
| Rate for Payer: Railroad Medicare Medicare |
$13.38
|
| Rate for Payer: Railroad Medicare Medicare |
$15.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.26
|
| Rate for Payer: UHC Core |
$52.43
|
| Rate for Payer: UHC Core |
$44.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.38
|
| Rate for Payer: UHC Exchange |
$13.38
|
| Rate for Payer: UHC Exchange |
$15.70
|
| Rate for Payer: UHC Medicare Advantage |
$13.38
|
| Rate for Payer: UHC Medicare Advantage |
$15.70
|
| Rate for Payer: VA VA |
$13.38
|
| Rate for Payer: VA VA |
$15.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$40.13
|
|
|
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 |
$34.78 |
| 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 |
$43.68
|
| Rate for Payer: BCBS Trust/PPO |
$51.26
|
| Rate for Payer: BCN Commercial |
$41.35
|
| Rate for Payer: BCN Commercial |
$48.52
|
| Rate for Payer: Cash Price |
$42.81
|
| Rate for Payer: Cash Price |
$50.23
|
| Rate for Payer: Cofinity Commercial |
$54.00
|
| Rate for Payer: Cofinity Commercial |
$46.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.81
|
| Rate for Payer: Healthscope Commercial |
$48.16
|
| Rate for Payer: Healthscope Commercial |
$56.51
|
| 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 Commercial |
$45.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.37
|
| Rate for Payer: Nomi Health Commercial |
$43.88
|
| Rate for Payer: Nomi Health Commercial |
$51.49
|
| Rate for Payer: PHP Commercial |
$45.48
|
| Rate for Payer: PHP Commercial |
$53.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.78
|
| Rate for Payer: Priority Health HMO/PPO |
$54.63
|
| Rate for Payer: Priority Health HMO/PPO |
$46.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$35.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.26
|
| 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
|
OP
|
$386.40
|
|
|
Service Code
|
NDC 00904715404
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.77 |
| Max. Negotiated Rate |
$347.76 |
| Rate for Payer: Aetna Commercial |
$328.44
|
| Rate for Payer: Aetna Medicare |
$100.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$120.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$120.75
|
| Rate for Payer: BCBS Complete |
$154.56
|
| Rate for Payer: BCBS MAPPO |
$96.60
|
| Rate for Payer: BCBS Trust/PPO |
$317.66
|
| Rate for Payer: BCN Commercial |
$300.43
|
| Rate for Payer: BCN Medicare Advantage |
$96.60
|
| Rate for Payer: Cash Price |
$309.12
|
| Rate for Payer: Cofinity Commercial |
$332.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.60
|
| Rate for Payer: Healthscope Commercial |
$347.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$111.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.44
|
| Rate for Payer: Nomi Health Commercial |
$316.85
|
| Rate for Payer: PACE Senior Care Partners |
$91.77
|
| Rate for Payer: PACE SWMI |
$96.60
|
| Rate for Payer: PHP Commercial |
$328.44
|
| Rate for Payer: PHP Medicare Advantage |
$96.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.16
|
| Rate for Payer: Priority Health HMO/PPO |
$336.17
|
| Rate for Payer: Priority Health Medicare |
$97.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.89
|
| Rate for Payer: Railroad Medicare Medicare |
$96.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$340.03
|
| Rate for Payer: UHC Core |
$322.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.60
|
| Rate for Payer: UHC Exchange |
$96.60
|
| Rate for Payer: UHC Medicare Advantage |
$96.60
|
| Rate for Payer: VA VA |
$96.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.80
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$195.30
|
|
|
Service Code
|
NDC 00054017613
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.38 |
| Max. Negotiated Rate |
$175.77 |
| Rate for Payer: Aetna Commercial |
$166.00
|
| Rate for Payer: Aetna Medicare |
$50.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$61.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$61.03
|
| Rate for Payer: BCBS Complete |
$78.12
|
| Rate for Payer: BCBS MAPPO |
$48.82
|
| Rate for Payer: BCBS Trust/PPO |
$160.56
|
| Rate for Payer: BCN Commercial |
$151.85
|
| Rate for Payer: BCN Medicare Advantage |
$48.82
|
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Cofinity Commercial |
$167.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.82
|
| Rate for Payer: Healthscope Commercial |
$175.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.00
|
| Rate for Payer: Nomi Health Commercial |
$160.15
|
| Rate for Payer: PACE Senior Care Partners |
$46.38
|
| Rate for Payer: PACE SWMI |
$48.82
|
| Rate for Payer: PHP Commercial |
$166.00
|
| Rate for Payer: PHP Medicare Advantage |
$48.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.94
|
| Rate for Payer: Priority Health HMO/PPO |
$169.91
|
| Rate for Payer: Priority Health Medicare |
$49.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.85
|
| Rate for Payer: Railroad Medicare Medicare |
$48.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.86
|
| Rate for Payer: UHC Core |
$163.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.82
|
| Rate for Payer: UHC Exchange |
$48.82
|
| Rate for Payer: UHC Medicare Advantage |
$48.82
|
| Rate for Payer: VA VA |
$48.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.48
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$386.40
|
|
|
Service Code
|
NDC 00904715404
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.16 |
| Max. Negotiated Rate |
$347.76 |
| Rate for Payer: Aetna Commercial |
$328.44
|
| Rate for Payer: BCBS Trust/PPO |
$315.42
|
| Rate for Payer: BCN Commercial |
$298.61
|
| Rate for Payer: Cash Price |
$309.12
|
| Rate for Payer: Cofinity Commercial |
$332.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.12
|
| Rate for Payer: Healthscope Commercial |
$347.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.44
|
| Rate for Payer: Nomi Health Commercial |
$316.85
|
| Rate for Payer: PHP Commercial |
$328.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.16
|
| Rate for Payer: Priority Health HMO/PPO |
$336.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$258.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$340.03
|
| Rate for Payer: UHC Core |
$322.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.80
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$195.30
|
|
|
Service Code
|
NDC 00054017613
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.94 |
| Max. Negotiated Rate |
$175.77 |
| Rate for Payer: Aetna Commercial |
$166.00
|
| Rate for Payer: BCBS Trust/PPO |
$159.42
|
| Rate for Payer: BCN Commercial |
$150.93
|
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Cofinity Commercial |
$167.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.24
|
| Rate for Payer: Healthscope Commercial |
$175.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.00
|
| Rate for Payer: Nomi Health Commercial |
$160.15
|
| Rate for Payer: PHP Commercial |
$166.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.94
|
| Rate for Payer: Priority Health HMO/PPO |
$169.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.86
|
| Rate for Payer: UHC Core |
$163.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.48
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
|
IP
|
$4.92
|
|
|
Service Code
|
NDC 50268014311
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: BCBS Trust/PPO |
$4.02
|
| Rate for Payer: BCN Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$4.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.18
|
| Rate for Payer: Nomi Health Commercial |
$4.03
|
| Rate for Payer: PHP Commercial |
$4.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health HMO/PPO |
$4.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.33
|
| Rate for Payer: UHC Core |
$4.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.69
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
NDC 50268014315
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.90 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Aetna Commercial |
$209.10
|
| Rate for Payer: BCBS Trust/PPO |
$200.81
|
| Rate for Payer: BCN Commercial |
$190.11
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$211.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.80
|
| Rate for Payer: Healthscope Commercial |
$221.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.10
|
| Rate for Payer: Nomi Health Commercial |
$201.72
|
| Rate for Payer: PHP Commercial |
$209.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.90
|
| Rate for Payer: Priority Health HMO/PPO |
$214.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.48
|
| Rate for Payer: UHC Core |
$205.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.50
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
NDC 50268014315
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.42 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Aetna Commercial |
$209.10
|
| Rate for Payer: Aetna Medicare |
$63.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$76.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$76.88
|
| Rate for Payer: BCBS Complete |
$98.40
|
| Rate for Payer: BCBS MAPPO |
$61.50
|
| Rate for Payer: BCBS Trust/PPO |
$202.24
|
| Rate for Payer: BCN Commercial |
$191.26
|
| Rate for Payer: BCN Medicare Advantage |
$61.50
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$211.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.50
|
| Rate for Payer: Healthscope Commercial |
$221.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$209.10
|
| Rate for Payer: Nomi Health Commercial |
$201.72
|
| Rate for Payer: PACE Senior Care Partners |
$58.42
|
| Rate for Payer: PACE SWMI |
$61.50
|
| Rate for Payer: PHP Commercial |
$209.10
|
| Rate for Payer: PHP Medicare Advantage |
$61.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.90
|
| Rate for Payer: Priority Health HMO/PPO |
$214.02
|
| Rate for Payer: Priority Health Medicare |
$62.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.82
|
| Rate for Payer: Railroad Medicare Medicare |
$61.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.48
|
| Rate for Payer: UHC Core |
$205.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.50
|
| Rate for Payer: UHC Exchange |
$61.50
|
| Rate for Payer: UHC Medicare Advantage |
$61.50
|
| Rate for Payer: VA VA |
$61.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.50
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
NDC 50268014311
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Aetna Commercial |
$4.18
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.54
|
| Rate for Payer: BCBS Complete |
$1.97
|
| Rate for Payer: BCBS MAPPO |
$1.23
|
| Rate for Payer: BCBS Trust/PPO |
$4.04
|
| Rate for Payer: BCN Commercial |
$3.83
|
| Rate for Payer: BCN Medicare Advantage |
$1.23
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.23
|
| Rate for Payer: Healthscope Commercial |
$4.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.18
|
| Rate for Payer: Nomi Health Commercial |
$4.03
|
| Rate for Payer: PACE Senior Care Partners |
$1.17
|
| Rate for Payer: PACE SWMI |
$1.23
|
| Rate for Payer: PHP Commercial |
$4.18
|
| Rate for Payer: PHP Medicare Advantage |
$1.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health HMO/PPO |
$4.28
|
| Rate for Payer: Priority Health Medicare |
$1.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.30
|
| Rate for Payer: Railroad Medicare Medicare |
$1.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.33
|
| Rate for Payer: UHC Core |
$4.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.23
|
| Rate for Payer: UHC Exchange |
$1.23
|
| Rate for Payer: UHC Medicare Advantage |
$1.23
|
| Rate for Payer: VA VA |
$1.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.69
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
IP
|
$472.15
|
|
|
Service Code
|
NDC 60505015801
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$306.90 |
| Max. Negotiated Rate |
$424.94 |
| Rate for Payer: Aetna Commercial |
$401.33
|
| Rate for Payer: BCBS Trust/PPO |
$385.42
|
| Rate for Payer: BCN Commercial |
$364.88
|
| 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: PHP Commercial |
$401.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$306.90
|
| Rate for Payer: Priority Health HMO/PPO |
$410.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$316.34
|
| 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
|
$4.53
|
|
|
Service Code
|
NDC 51079094301
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| 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 |
$1.81
|
| Rate for Payer: BCBS MAPPO |
$1.13
|
| Rate for Payer: BCBS Trust/PPO |
$3.72
|
| Rate for Payer: BCN Commercial |
$3.52
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.85
|
| Rate for Payer: Nomi Health Commercial |
$3.71
|
| 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 Cigna Priority Health |
$2.94
|
| Rate for Payer: Priority Health HMO/PPO |
$3.94
|
| Rate for Payer: Priority Health Medicare |
$1.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.04
|
| 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 Dual Complete DSNP |
$1.13
|
| Rate for Payer: UHC Exchange |
$1.13
|
| Rate for Payer: UHC Medicare Advantage |
$1.13
|
| Rate for Payer: VA VA |
$1.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.40
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
OP
|
$472.15
|
|
|
Service Code
|
NDC 60505015801
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.14 |
| 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 |
$188.86
|
| Rate for Payer: BCBS MAPPO |
$118.04
|
| Rate for Payer: BCBS Trust/PPO |
$388.15
|
| Rate for Payer: BCN Commercial |
$367.10
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$401.33
|
| Rate for Payer: Nomi Health Commercial |
$387.16
|
| 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 Cigna Priority Health |
$306.90
|
| Rate for Payer: Priority Health HMO/PPO |
$410.77
|
| Rate for Payer: Priority Health Medicare |
$119.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$316.34
|
| 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 Dual Complete DSNP |
$118.04
|
| Rate for Payer: UHC Exchange |
$118.04
|
| Rate for Payer: UHC Medicare Advantage |
$118.04
|
| Rate for Payer: VA VA |
$118.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.11
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
IP
|
$4.53
|
|
|
Service Code
|
NDC 51079094301
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: BCBS Trust/PPO |
$3.70
|
| 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 Commercial |
$3.85
|
| Rate for Payer: Nomi Health Commercial |
$3.71
|
| Rate for Payer: PHP Commercial |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.94
|
| Rate for Payer: Priority Health HMO/PPO |
$3.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.04
|
| 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 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 |
$224.64 |
| Max. Negotiated Rate |
$311.04 |
| Rate for Payer: Aetna Commercial |
$293.76
|
| Rate for Payer: BCBS Trust/PPO |
$282.11
|
| 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 Commercial |
$293.76
|
| Rate for Payer: Nomi Health Commercial |
$283.39
|
| Rate for Payer: PHP Commercial |
$293.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.64
|
| Rate for Payer: Priority Health HMO/PPO |
$300.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$231.55
|
| 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 00185041060
|
| Hospital Charge Code |
18385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.57 |
| Max. Negotiated Rate |
$162.78 |
| Rate for Payer: Aetna Commercial |
$153.74
|
| Rate for Payer: BCBS Trust/PPO |
$147.64
|
| 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 Commercial |
$153.74
|
| Rate for Payer: Nomi Health Commercial |
$148.31
|
| Rate for Payer: PHP Commercial |
$153.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.57
|
| Rate for Payer: Priority Health HMO/PPO |
$157.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.18
|
| 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 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 |
$0.82 |
| 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 |
$1.38
|
| Rate for Payer: BCBS MAPPO |
$0.87
|
| Rate for Payer: BCBS Trust/PPO |
$2.84
|
| Rate for Payer: BCN Commercial |
$2.69
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.94
|
| Rate for Payer: Nomi Health Commercial |
$2.84
|
| 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 Cigna Priority Health |
$2.25
|
| Rate for Payer: Priority Health HMO/PPO |
$3.01
|
| Rate for Payer: Priority Health Medicare |
$0.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.32
|
| 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 Dual Complete DSNP |
$0.87
|
| Rate for Payer: UHC Exchange |
$0.87
|
| Rate for Payer: UHC Medicare Advantage |
$0.87
|
| 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 |
$82.08 |
| 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 |
$138.24
|
| Rate for Payer: BCBS MAPPO |
$86.40
|
| Rate for Payer: BCBS Trust/PPO |
$284.12
|
| Rate for Payer: BCN Commercial |
$268.70
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.76
|
| Rate for Payer: Nomi Health Commercial |
$283.39
|
| 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 Cigna Priority Health |
$224.64
|
| Rate for Payer: Priority Health HMO/PPO |
$300.67
|
| Rate for Payer: Priority Health Medicare |
$87.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$231.55
|
| 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 Dual Complete DSNP |
$86.40
|
| Rate for Payer: UHC Exchange |
$86.40
|
| Rate for Payer: UHC Medicare Advantage |
$86.40
|
| Rate for Payer: VA VA |
$86.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.20
|
|
|
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 |
$2.25 |
| Max. Negotiated Rate |
$3.11 |
| Rate for Payer: Aetna Commercial |
$2.94
|
| Rate for Payer: BCBS Trust/PPO |
$2.82
|
| 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 Commercial |
$2.94
|
| Rate for Payer: Nomi Health Commercial |
$2.84
|
| Rate for Payer: PHP Commercial |
$2.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.25
|
| Rate for Payer: Priority Health HMO/PPO |
$3.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.32
|
| 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
|
OP
|
$180.87
|
|
|
Service Code
|
NDC 00185041060
|
| Hospital Charge Code |
18385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.96 |
| Max. Negotiated Rate |
$162.78 |
| Rate for Payer: Aetna Commercial |
$153.74
|
| Rate for Payer: Aetna Medicare |
$47.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.52
|
| Rate for Payer: BCBS Complete |
$72.35
|
| Rate for Payer: BCBS MAPPO |
$45.22
|
| Rate for Payer: BCBS Trust/PPO |
$148.69
|
| Rate for Payer: BCN Commercial |
$140.63
|
| Rate for Payer: BCN Medicare Advantage |
$45.22
|
| 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: Health Alliance Plan Medicare Advantage |
$45.22
|
| Rate for Payer: Healthscope Commercial |
$162.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.74
|
| Rate for Payer: Nomi Health Commercial |
$148.31
|
| Rate for Payer: PACE Senior Care Partners |
$42.96
|
| Rate for Payer: PACE SWMI |
$45.22
|
| Rate for Payer: PHP Commercial |
$153.74
|
| Rate for Payer: PHP Medicare Advantage |
$45.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.57
|
| Rate for Payer: Priority Health HMO/PPO |
$157.36
|
| Rate for Payer: Priority Health Medicare |
$45.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.18
|
| Rate for Payer: Railroad Medicare Medicare |
$45.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.17
|
| Rate for Payer: UHC Core |
$151.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.22
|
| Rate for Payer: UHC Exchange |
$45.22
|
| Rate for Payer: UHC Medicare Advantage |
$45.22
|
| Rate for Payer: VA VA |
$45.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.65
|
|
