|
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 |
$146.47
|
| 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 |
$146.47
|
|
|
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
|
|
|
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
|
$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 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
|
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 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
|
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
|
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
|
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
|
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
|
$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
|
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
|
$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
|
|
|
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
|
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 150 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
IP
|
$239.40
|
|
|
Service Code
|
NDC 00185041560
|
| Hospital Charge Code |
18386
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.61 |
| Max. Negotiated Rate |
$215.46 |
| Rate for Payer: Aetna Commercial |
$203.49
|
| Rate for Payer: BCBS Trust/PPO |
$195.42
|
| Rate for Payer: BCN Commercial |
$185.01
|
| Rate for Payer: Cash Price |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$205.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.52
|
| Rate for Payer: Healthscope Commercial |
$215.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.49
|
| Rate for Payer: Nomi Health Commercial |
$196.31
|
| Rate for Payer: PHP Commercial |
$203.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.61
|
| Rate for Payer: Priority Health HMO/PPO |
$208.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.67
|
| Rate for Payer: UHC Core |
$199.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.55
|
|
|
BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
OP
|
$239.40
|
|
|
Service Code
|
NDC 00185041560
|
| Hospital Charge Code |
18386
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.86 |
| Max. Negotiated Rate |
$215.46 |
| Rate for Payer: Aetna Commercial |
$203.49
|
| Rate for Payer: Aetna Medicare |
$62.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.81
|
| Rate for Payer: BCBS Complete |
$95.76
|
| Rate for Payer: BCBS MAPPO |
$59.85
|
| Rate for Payer: BCBS Trust/PPO |
$196.81
|
| Rate for Payer: BCN Commercial |
$186.13
|
| Rate for Payer: BCN Medicare Advantage |
$59.85
|
| Rate for Payer: Cash Price |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$205.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.85
|
| Rate for Payer: Healthscope Commercial |
$215.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.49
|
| Rate for Payer: Nomi Health Commercial |
$196.31
|
| Rate for Payer: PACE Senior Care Partners |
$56.86
|
| Rate for Payer: PACE SWMI |
$59.85
|
| Rate for Payer: PHP Commercial |
$203.49
|
| Rate for Payer: PHP Medicare Advantage |
$59.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.61
|
| Rate for Payer: Priority Health HMO/PPO |
$208.28
|
| Rate for Payer: Priority Health Medicare |
$60.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$160.40
|
| Rate for Payer: Railroad Medicare Medicare |
$59.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.67
|
| Rate for Payer: UHC Core |
$199.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.85
|
| Rate for Payer: UHC Exchange |
$59.85
|
| Rate for Payer: UHC Medicare Advantage |
$59.85
|
| Rate for Payer: VA VA |
$59.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.55
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$111.60
|
|
|
Service Code
|
NDC 10370010103
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$100.44 |
| Rate for Payer: Aetna Commercial |
$94.86
|
| Rate for Payer: Aetna Medicare |
$29.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$34.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$34.88
|
| Rate for Payer: BCBS Complete |
$44.64
|
| Rate for Payer: BCBS MAPPO |
$27.90
|
| Rate for Payer: BCBS Trust/PPO |
$91.75
|
| Rate for Payer: BCN Commercial |
$86.77
|
| Rate for Payer: BCN Medicare Advantage |
$27.90
|
| 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: Health Alliance Plan Medicare Advantage |
$27.90
|
| Rate for Payer: Healthscope Commercial |
$100.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.86
|
| Rate for Payer: Nomi Health Commercial |
$91.51
|
| Rate for Payer: PACE Senior Care Partners |
$26.50
|
| Rate for Payer: PACE SWMI |
$27.90
|
| Rate for Payer: PHP Commercial |
$94.86
|
| Rate for Payer: PHP Medicare Advantage |
$27.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.54
|
| Rate for Payer: Priority Health HMO/PPO |
$97.09
|
| Rate for Payer: Priority Health Medicare |
$28.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.77
|
| Rate for Payer: Railroad Medicare Medicare |
$27.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.21
|
| Rate for Payer: UHC Core |
$93.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.90
|
| Rate for Payer: UHC Exchange |
$27.90
|
| Rate for Payer: UHC Medicare Advantage |
$27.90
|
| Rate for Payer: VA VA |
$27.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.70
|
|
|
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 |
$91.17 |
| Max. Negotiated Rate |
$126.23 |
| Rate for Payer: Aetna Commercial |
$119.22
|
| Rate for Payer: BCBS Trust/PPO |
$114.49
|
| Rate for Payer: BCN Commercial |
$108.39
|
| 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: PHP Commercial |
$119.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.17
|
| Rate for Payer: Priority Health HMO/PPO |
$122.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.97
|
| 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
|
$615.84
|
|
|
Service Code
|
NDC 00904708461
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.26 |
| 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 |
$246.34
|
| Rate for Payer: BCBS MAPPO |
$153.96
|
| Rate for Payer: BCBS Trust/PPO |
$506.28
|
| Rate for Payer: BCN Commercial |
$478.82
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.46
|
| Rate for Payer: Nomi Health Commercial |
$504.99
|
| 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 Cigna Priority Health |
$400.30
|
| Rate for Payer: Priority Health HMO/PPO |
$535.78
|
| Rate for Payer: Priority Health Medicare |
$155.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$412.61
|
| 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 Dual Complete DSNP |
$153.96
|
| Rate for Payer: UHC Exchange |
$153.96
|
| Rate for Payer: UHC Medicare Advantage |
$153.96
|
| 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
|
$615.84
|
|
|
Service Code
|
NDC 00904708461
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$400.30 |
| Max. Negotiated Rate |
$554.26 |
| Rate for Payer: Aetna Commercial |
$523.46
|
| Rate for Payer: BCBS Trust/PPO |
$502.71
|
| Rate for Payer: BCN Commercial |
$475.92
|
| 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: Healthscope Commercial |
$554.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$461.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.46
|
| Rate for Payer: Nomi Health Commercial |
$504.99
|
| Rate for Payer: PHP Commercial |
$523.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$400.30
|
| Rate for Payer: Priority Health HMO/PPO |
$535.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$412.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$541.94
|
| Rate for Payer: UHC Core |
$514.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$461.88
|
|
|
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 |
$72.54 |
| Max. Negotiated Rate |
$100.44 |
| Rate for Payer: Aetna Commercial |
$94.86
|
| Rate for Payer: BCBS Trust/PPO |
$91.10
|
| Rate for Payer: BCN Commercial |
$86.24
|
| Rate for Payer: Cash Price |
$89.28
|
| Rate for Payer: Cofinity Commercial |
$95.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.28
|
| Rate for Payer: Healthscope Commercial |
$100.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.86
|
| Rate for Payer: Nomi Health Commercial |
$91.51
|
| Rate for Payer: PHP Commercial |
$94.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.54
|
| Rate for Payer: Priority Health HMO/PPO |
$97.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.77
|
| 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
|
$88.35
|
|
|
Service Code
|
NDC 69097087502
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.98 |
| Max. Negotiated Rate |
$79.52 |
| Rate for Payer: Aetna Commercial |
$75.10
|
| Rate for Payer: Aetna Medicare |
$22.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.61
|
| Rate for Payer: BCBS Complete |
$35.34
|
| Rate for Payer: BCBS MAPPO |
$22.09
|
| Rate for Payer: BCBS Trust/PPO |
$72.63
|
| Rate for Payer: BCN Commercial |
$68.69
|
| Rate for Payer: BCN Medicare Advantage |
$22.09
|
| 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: Health Alliance Plan Medicare Advantage |
$22.09
|
| Rate for Payer: Healthscope Commercial |
$79.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.10
|
| Rate for Payer: Nomi Health Commercial |
$72.45
|
| Rate for Payer: PACE Senior Care Partners |
$20.98
|
| Rate for Payer: PACE SWMI |
$22.09
|
| Rate for Payer: PHP Commercial |
$75.10
|
| Rate for Payer: PHP Medicare Advantage |
$22.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.43
|
| Rate for Payer: Priority Health HMO/PPO |
$76.86
|
| Rate for Payer: Priority Health Medicare |
$22.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.19
|
| Rate for Payer: Railroad Medicare Medicare |
$22.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.75
|
| Rate for Payer: UHC Core |
$73.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.09
|
| Rate for Payer: UHC Exchange |
$22.09
|
| Rate for Payer: UHC Medicare Advantage |
$22.09
|
| Rate for Payer: VA VA |
$22.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.26
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$177.66
|
|
|
Service Code
|
NDC 68180031909
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$159.89 |
| Rate for Payer: Aetna Commercial |
$151.01
|
| Rate for Payer: BCBS Trust/PPO |
$145.02
|
| Rate for Payer: BCN Commercial |
$137.30
|
| Rate for Payer: Cash Price |
$142.13
|
| Rate for Payer: Cofinity Commercial |
$152.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.13
|
| Rate for Payer: Healthscope Commercial |
$159.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.01
|
| Rate for Payer: Nomi Health Commercial |
$145.68
|
| Rate for Payer: PHP Commercial |
$151.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.48
|
| Rate for Payer: Priority Health HMO/PPO |
$154.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.34
|
| Rate for Payer: UHC Core |
$148.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.25
|
|
