|
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
|
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
|
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
|
$88.35
|
|
|
Service Code
|
NDC 69097087502
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.43 |
| Max. Negotiated Rate |
$79.52 |
| Rate for Payer: Aetna Commercial |
$75.10
|
| Rate for Payer: BCBS Trust/PPO |
$72.12
|
| Rate for Payer: BCN Commercial |
$68.28
|
| Rate for Payer: Cash Price |
$70.68
|
| Rate for Payer: Cofinity Commercial |
$75.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.68
|
| Rate for Payer: Healthscope Commercial |
$79.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.10
|
| Rate for Payer: Nomi Health Commercial |
$72.45
|
| Rate for Payer: PHP Commercial |
$75.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.43
|
| Rate for Payer: Priority Health HMO/PPO |
$76.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.19
|
| 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
|
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 |
$32.08
|
| 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
|
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
|
$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
|
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 |
$133.24
|
| 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 |
$133.24
|
|
|
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 |
$105.20
|
| 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 |
$105.20
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$177.66
|
|
|
Service Code
|
NDC 68180031909
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.19 |
| Max. Negotiated Rate |
$159.89 |
| Rate for Payer: Aetna Commercial |
$151.01
|
| Rate for Payer: Aetna Medicare |
$46.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.52
|
| Rate for Payer: BCBS Complete |
$71.06
|
| Rate for Payer: BCBS MAPPO |
$44.42
|
| Rate for Payer: BCBS Trust/PPO |
$146.05
|
| Rate for Payer: BCN Commercial |
$138.13
|
| Rate for Payer: BCN Medicare Advantage |
$44.42
|
| 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: Health Alliance Plan Medicare Advantage |
$44.42
|
| Rate for Payer: Healthscope Commercial |
$159.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.01
|
| Rate for Payer: Nomi Health Commercial |
$145.68
|
| Rate for Payer: PACE Senior Care Partners |
$42.19
|
| Rate for Payer: PACE SWMI |
$44.42
|
| Rate for Payer: PHP Commercial |
$151.01
|
| Rate for Payer: PHP Medicare Advantage |
$44.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.48
|
| Rate for Payer: Priority Health HMO/PPO |
$154.56
|
| Rate for Payer: Priority Health Medicare |
$44.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$119.03
|
| Rate for Payer: Railroad Medicare Medicare |
$44.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.34
|
| Rate for Payer: UHC Core |
$148.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.42
|
| Rate for Payer: UHC Exchange |
$44.42
|
| Rate for Payer: UHC Medicare Advantage |
$44.42
|
| Rate for Payer: VA VA |
$44.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.24
|
|
|
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 |
$33.31 |
| 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 |
$56.10
|
| Rate for Payer: BCBS MAPPO |
$35.06
|
| Rate for Payer: BCBS Trust/PPO |
$115.31
|
| Rate for Payer: BCN Commercial |
$109.05
|
| 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 |
$105.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.22
|
| Rate for Payer: Nomi Health Commercial |
$115.01
|
| 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 Cigna Priority Health |
$91.17
|
| Rate for Payer: Priority Health HMO/PPO |
$122.03
|
| Rate for Payer: Priority Health Medicare |
$35.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.97
|
| 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 Dual Complete DSNP |
$35.06
|
| Rate for Payer: UHC Exchange |
$35.06
|
| Rate for Payer: UHC Medicare Advantage |
$35.06
|
| Rate for Payer: VA VA |
$35.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.20
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
IP
|
$122.20
|
|
|
Service Code
|
NDC 00093100301
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.43 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: BCBS Trust/PPO |
$99.75
|
| Rate for Payer: BCN Commercial |
$94.44
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: Nomi Health Commercial |
$100.20
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.43
|
| Rate for Payer: Priority Health HMO/PPO |
$106.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.54
|
| Rate for Payer: UHC Core |
$102.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
NDC 00904689961
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$234.65 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Aetna Commercial |
$306.85
|
| Rate for Payer: BCBS Trust/PPO |
$294.68
|
| Rate for Payer: BCN Commercial |
$278.98
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$310.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.80
|
| Rate for Payer: Healthscope Commercial |
$324.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.85
|
| Rate for Payer: Nomi Health Commercial |
$296.02
|
| Rate for Payer: PHP Commercial |
$306.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.65
|
| Rate for Payer: Priority Health HMO/PPO |
$314.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.68
|
| Rate for Payer: UHC Core |
$301.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.75
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
NDC 00904689961
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.74 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Aetna Commercial |
$306.85
|
| Rate for Payer: Aetna Medicare |
$93.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$112.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$112.81
|
| Rate for Payer: BCBS Complete |
$144.40
|
| Rate for Payer: BCBS MAPPO |
$90.25
|
| Rate for Payer: BCBS Trust/PPO |
$296.78
|
| Rate for Payer: BCN Commercial |
$280.68
|
| Rate for Payer: BCN Medicare Advantage |
$90.25
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$310.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.25
|
| Rate for Payer: Healthscope Commercial |
$324.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$94.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$103.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.85
|
| Rate for Payer: Nomi Health Commercial |
$296.02
|
| Rate for Payer: PACE Senior Care Partners |
$85.74
|
| Rate for Payer: PACE SWMI |
$90.25
|
| Rate for Payer: PHP Commercial |
$306.85
|
| Rate for Payer: PHP Medicare Advantage |
$90.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.65
|
| Rate for Payer: Priority Health HMO/PPO |
$314.07
|
| Rate for Payer: Priority Health Medicare |
$91.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.87
|
| Rate for Payer: Railroad Medicare Medicare |
$90.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.68
|
| Rate for Payer: UHC Core |
$301.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.25
|
| Rate for Payer: UHC Exchange |
$90.25
|
| Rate for Payer: UHC Medicare Advantage |
$90.25
|
| Rate for Payer: VA VA |
$90.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.75
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
OP
|
$122.20
|
|
|
Service Code
|
NDC 00093100301
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.02 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna Medicare |
$31.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$38.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$38.19
|
| Rate for Payer: BCBS Complete |
$48.88
|
| Rate for Payer: BCBS MAPPO |
$30.55
|
| Rate for Payer: BCBS Trust/PPO |
$100.46
|
| Rate for Payer: BCN Commercial |
$95.01
|
| Rate for Payer: BCN Medicare Advantage |
$30.55
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.55
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: Nomi Health Commercial |
$100.20
|
| Rate for Payer: PACE Senior Care Partners |
$29.02
|
| Rate for Payer: PACE SWMI |
$30.55
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: PHP Medicare Advantage |
$30.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.43
|
| Rate for Payer: Priority Health HMO/PPO |
$106.31
|
| Rate for Payer: Priority Health Medicare |
$30.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.87
|
| Rate for Payer: Railroad Medicare Medicare |
$30.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.54
|
| Rate for Payer: UHC Core |
$102.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.55
|
| Rate for Payer: UHC Exchange |
$30.55
|
| Rate for Payer: UHC Medicare Advantage |
$30.55
|
| Rate for Payer: VA VA |
$30.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
OP
|
$455.05
|
|
|
Service Code
|
NDC 51079096020
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.07 |
| Max. Negotiated Rate |
$409.54 |
| Rate for Payer: Aetna Commercial |
$386.79
|
| Rate for Payer: Aetna Medicare |
$118.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$142.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$142.20
|
| Rate for Payer: BCBS Complete |
$182.02
|
| Rate for Payer: BCBS MAPPO |
$113.76
|
| Rate for Payer: BCBS Trust/PPO |
$374.10
|
| Rate for Payer: BCN Commercial |
$353.80
|
| Rate for Payer: BCN Medicare Advantage |
$113.76
|
| Rate for Payer: Cash Price |
$364.04
|
| Rate for Payer: Cofinity Commercial |
$391.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.76
|
| Rate for Payer: Healthscope Commercial |
$409.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$341.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$119.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$386.79
|
| Rate for Payer: Nomi Health Commercial |
$373.14
|
| Rate for Payer: PACE Senior Care Partners |
$108.07
|
| Rate for Payer: PACE SWMI |
$113.76
|
| Rate for Payer: PHP Commercial |
$386.79
|
| Rate for Payer: PHP Medicare Advantage |
$113.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.78
|
| Rate for Payer: Priority Health HMO/PPO |
$395.89
|
| Rate for Payer: Priority Health Medicare |
$114.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$304.88
|
| Rate for Payer: Railroad Medicare Medicare |
$113.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$400.44
|
| Rate for Payer: UHC Core |
$379.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$113.76
|
| Rate for Payer: UHC Exchange |
$113.76
|
| Rate for Payer: UHC Medicare Advantage |
$113.76
|
| Rate for Payer: VA VA |
$113.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$341.29
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
IP
|
$455.05
|
|
|
Service Code
|
NDC 51079096020
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$295.78 |
| Max. Negotiated Rate |
$409.54 |
| Rate for Payer: Aetna Commercial |
$386.79
|
| Rate for Payer: BCBS Trust/PPO |
$371.46
|
| Rate for Payer: BCN Commercial |
$351.66
|
| Rate for Payer: Cash Price |
$364.04
|
| Rate for Payer: Cofinity Commercial |
$391.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$364.04
|
| Rate for Payer: Healthscope Commercial |
$409.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$341.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$386.79
|
| Rate for Payer: Nomi Health Commercial |
$373.14
|
| Rate for Payer: PHP Commercial |
$386.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.78
|
| Rate for Payer: Priority Health HMO/PPO |
$395.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$304.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$400.44
|
| Rate for Payer: UHC Core |
$379.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$341.29
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
NDC 23155002301
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna Commercial |
$79.90
|
| Rate for Payer: BCBS Trust/PPO |
$76.73
|
| Rate for Payer: BCN Commercial |
$72.64
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cofinity Commercial |
$80.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.20
|
| Rate for Payer: Healthscope Commercial |
$84.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.90
|
| Rate for Payer: Nomi Health Commercial |
$77.08
|
| Rate for Payer: PHP Commercial |
$79.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
| Rate for Payer: Priority Health HMO/PPO |
$81.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.72
|
| Rate for Payer: UHC Core |
$78.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.50
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
OP
|
$2.52
|
|
|
Service Code
|
NDC 51079098501
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna Commercial |
$2.14
|
| Rate for Payer: Aetna Medicare |
$0.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.79
|
| Rate for Payer: BCBS Complete |
$1.01
|
| Rate for Payer: BCBS MAPPO |
$0.63
|
| Rate for Payer: BCBS Trust/PPO |
$2.07
|
| Rate for Payer: BCN Commercial |
$1.96
|
| Rate for Payer: BCN Medicare Advantage |
$0.63
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.63
|
| Rate for Payer: Healthscope Commercial |
$2.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.14
|
| Rate for Payer: Nomi Health Commercial |
$2.07
|
| Rate for Payer: PACE Senior Care Partners |
$0.60
|
| Rate for Payer: PACE SWMI |
$0.63
|
| Rate for Payer: PHP Commercial |
$2.14
|
| Rate for Payer: PHP Medicare Advantage |
$0.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health HMO/PPO |
$2.19
|
| Rate for Payer: Priority Health Medicare |
$0.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.69
|
| Rate for Payer: Railroad Medicare Medicare |
$0.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.22
|
| Rate for Payer: UHC Core |
$2.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.63
|
| Rate for Payer: UHC Exchange |
$0.63
|
| Rate for Payer: UHC Medicare Advantage |
$0.63
|
| Rate for Payer: VA VA |
$0.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.89
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
IP
|
$2.52
|
|
|
Service Code
|
NDC 51079098501
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna Commercial |
$2.14
|
| Rate for Payer: BCBS Trust/PPO |
$2.06
|
| Rate for Payer: BCN Commercial |
$1.95
|
| Rate for Payer: Cash Price |
$2.02
|
| Rate for Payer: Cofinity Commercial |
$2.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.02
|
| Rate for Payer: Healthscope Commercial |
$2.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.14
|
| Rate for Payer: Nomi Health Commercial |
$2.07
|
| Rate for Payer: PHP Commercial |
$2.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health HMO/PPO |
$2.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.22
|
| Rate for Payer: UHC Core |
$2.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.89
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
NDC 23155002301
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.32 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna Commercial |
$79.90
|
| Rate for Payer: Aetna Medicare |
$24.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.38
|
| Rate for Payer: BCBS Complete |
$37.60
|
| Rate for Payer: BCBS MAPPO |
$23.50
|
| Rate for Payer: BCBS Trust/PPO |
$77.28
|
| Rate for Payer: BCN Commercial |
$73.08
|
| Rate for Payer: BCN Medicare Advantage |
$23.50
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cofinity Commercial |
$80.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.50
|
| Rate for Payer: Healthscope Commercial |
$84.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.90
|
| Rate for Payer: Nomi Health Commercial |
$77.08
|
| Rate for Payer: PACE Senior Care Partners |
$22.32
|
| Rate for Payer: PACE SWMI |
$23.50
|
| Rate for Payer: PHP Commercial |
$79.90
|
| Rate for Payer: PHP Medicare Advantage |
$23.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
| Rate for Payer: Priority Health HMO/PPO |
$81.78
|
| Rate for Payer: Priority Health Medicare |
$23.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.98
|
| Rate for Payer: Railroad Medicare Medicare |
$23.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.72
|
| Rate for Payer: UHC Core |
$78.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.50
|
| Rate for Payer: UHC Exchange |
$23.50
|
| Rate for Payer: UHC Medicare Advantage |
$23.50
|
| Rate for Payer: VA VA |
$23.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.50
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
OP
|
$65.80
|
|
|
Service Code
|
NDC 16729020001
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$59.22 |
| Rate for Payer: Aetna Commercial |
$55.93
|
| Rate for Payer: Aetna Medicare |
$17.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.56
|
| Rate for Payer: BCBS Complete |
$26.32
|
| Rate for Payer: BCBS MAPPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$54.09
|
| Rate for Payer: BCN Commercial |
$51.16
|
| Rate for Payer: BCN Medicare Advantage |
$16.45
|
| Rate for Payer: Cash Price |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$56.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.45
|
| Rate for Payer: Healthscope Commercial |
$59.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.93
|
| Rate for Payer: Nomi Health Commercial |
$53.96
|
| Rate for Payer: PACE Senior Care Partners |
$15.63
|
| Rate for Payer: PACE SWMI |
$16.45
|
| Rate for Payer: PHP Commercial |
$55.93
|
| Rate for Payer: PHP Medicare Advantage |
$16.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.77
|
| Rate for Payer: Priority Health HMO/PPO |
$57.25
|
| Rate for Payer: Priority Health Medicare |
$16.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$44.09
|
| Rate for Payer: Railroad Medicare Medicare |
$16.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.90
|
| Rate for Payer: UHC Core |
$54.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.45
|
| Rate for Payer: UHC Exchange |
$16.45
|
| Rate for Payer: UHC Medicare Advantage |
$16.45
|
| Rate for Payer: VA VA |
$16.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.35
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
IP
|
$209.15
|
|
|
Service Code
|
NDC 00904712261
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.95 |
| Max. Negotiated Rate |
$188.24 |
| Rate for Payer: Aetna Commercial |
$177.78
|
| Rate for Payer: BCBS Trust/PPO |
$170.73
|
| Rate for Payer: BCN Commercial |
$161.63
|
| Rate for Payer: Cash Price |
$167.32
|
| Rate for Payer: Cofinity Commercial |
$179.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.32
|
| Rate for Payer: Healthscope Commercial |
$188.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.78
|
| Rate for Payer: Nomi Health Commercial |
$171.50
|
| Rate for Payer: PHP Commercial |
$177.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.95
|
| Rate for Payer: Priority Health HMO/PPO |
$181.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$140.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$184.05
|
| Rate for Payer: UHC Core |
$174.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.86
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
OP
|
$105.75
|
|
|
Service Code
|
NDC 68382018001
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.12 |
| Max. Negotiated Rate |
$95.18 |
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna Medicare |
$27.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.05
|
| Rate for Payer: BCBS Complete |
$42.30
|
| Rate for Payer: BCBS MAPPO |
$26.44
|
| Rate for Payer: BCBS Trust/PPO |
$86.94
|
| Rate for Payer: BCN Commercial |
$82.22
|
| Rate for Payer: BCN Medicare Advantage |
$26.44
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.44
|
| Rate for Payer: Healthscope Commercial |
$95.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: Nomi Health Commercial |
$86.72
|
| Rate for Payer: PACE Senior Care Partners |
$25.12
|
| Rate for Payer: PACE SWMI |
$26.44
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: PHP Medicare Advantage |
$26.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health HMO/PPO |
$92.00
|
| Rate for Payer: Priority Health Medicare |
$26.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.85
|
| Rate for Payer: Railroad Medicare Medicare |
$26.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.06
|
| Rate for Payer: UHC Core |
$88.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.44
|
| Rate for Payer: UHC Exchange |
$26.44
|
| Rate for Payer: UHC Medicare Advantage |
$26.44
|
| Rate for Payer: VA VA |
$26.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
