|
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 |
$237.11 |
| Max. Negotiated Rate |
$576.76 |
| Rate for Payer: Aetna American Axle |
$416.55
|
| Rate for Payer: Aetna Commercial |
$544.72
|
| Rate for Payer: Aetna Medicare |
$320.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.55
|
| Rate for Payer: BCBS Complete |
$256.34
|
| Rate for Payer: Cash Price |
$512.68
|
| Rate for Payer: Cofinity Commercial |
$448.60
|
| Rate for Payer: Cofinity Commercial |
$551.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$448.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$512.68
|
| Rate for Payer: Healthscope Commercial |
$576.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$448.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$480.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$544.72
|
| Rate for Payer: PHP Commercial |
$544.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.55
|
| Rate for Payer: Priority Health SBD |
$403.74
|
| Rate for Payer: UMR Bronson Commercial |
$237.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$480.64
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$7.86
|
|
|
Service Code
|
NDC 50268014411
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Aetna American Axle |
$5.11
|
| Rate for Payer: Aetna Commercial |
$6.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.11
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cofinity Commercial |
$5.50
|
| Rate for Payer: Cofinity Commercial |
$6.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.29
|
| Rate for Payer: Healthscope Commercial |
$7.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.68
|
| Rate for Payer: PHP Commercial |
$6.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.11
|
| Rate for Payer: Priority Health SBD |
$4.95
|
| Rate for Payer: UMR Bronson Commercial |
$3.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.89
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$180.81
|
|
|
Service Code
|
NDC 00054018813
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.90 |
| Max. Negotiated Rate |
$162.73 |
| Rate for Payer: Aetna American Axle |
$117.53
|
| Rate for Payer: Aetna Commercial |
$153.69
|
| Rate for Payer: Aetna Medicare |
$90.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.53
|
| Rate for Payer: BCBS Complete |
$72.32
|
| Rate for Payer: Cash Price |
$144.65
|
| Rate for Payer: Cofinity Commercial |
$126.57
|
| Rate for Payer: Cofinity Commercial |
$155.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.65
|
| Rate for Payer: Healthscope Commercial |
$162.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.69
|
| Rate for Payer: PHP Commercial |
$153.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.53
|
| Rate for Payer: Priority Health SBD |
$113.91
|
| Rate for Payer: UMR Bronson Commercial |
$66.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.61
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$217.14
|
|
|
Service Code
|
NDC 65162041603
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.54 |
| Max. Negotiated Rate |
$195.43 |
| Rate for Payer: Aetna American Axle |
$141.14
|
| Rate for Payer: Aetna Commercial |
$184.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.14
|
| Rate for Payer: Cash Price |
$173.71
|
| Rate for Payer: Cofinity Commercial |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$186.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.71
|
| Rate for Payer: Healthscope Commercial |
$195.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.57
|
| Rate for Payer: PHP Commercial |
$184.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.14
|
| Rate for Payer: Priority Health SBD |
$136.80
|
| Rate for Payer: UMR Bronson Commercial |
$95.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.85
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$7.86
|
|
|
Service Code
|
NDC 50268014411
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$7.07 |
| Rate for Payer: Aetna American Axle |
$5.11
|
| Rate for Payer: Aetna Commercial |
$6.68
|
| Rate for Payer: Aetna Medicare |
$3.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.11
|
| Rate for Payer: BCBS Complete |
$3.14
|
| Rate for Payer: Cash Price |
$6.29
|
| Rate for Payer: Cofinity Commercial |
$5.50
|
| Rate for Payer: Cofinity Commercial |
$6.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.29
|
| Rate for Payer: Healthscope Commercial |
$7.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.68
|
| Rate for Payer: PHP Commercial |
$6.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.11
|
| Rate for Payer: Priority Health SBD |
$4.95
|
| Rate for Payer: UMR Bronson Commercial |
$2.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.89
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
NDC 59011075004
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.60 |
| Max. Negotiated Rate |
$508.50 |
| Rate for Payer: Aetna American Axle |
$367.25
|
| Rate for Payer: Aetna Commercial |
$480.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.25
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cofinity Commercial |
$395.50
|
| Rate for Payer: Cofinity Commercial |
$485.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$395.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.00
|
| Rate for Payer: Healthscope Commercial |
$508.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$395.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$480.25
|
| Rate for Payer: PHP Commercial |
$480.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.25
|
| Rate for Payer: Priority Health SBD |
$355.95
|
| Rate for Payer: UMR Bronson Commercial |
$248.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.75
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$114.53
|
|
|
Service Code
|
NDC 00093365621
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$103.08 |
| Rate for Payer: Aetna American Axle |
$74.44
|
| Rate for Payer: Aetna Commercial |
$97.35
|
| Rate for Payer: Aetna Medicare |
$57.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.44
|
| Rate for Payer: BCBS Complete |
$45.81
|
| Rate for Payer: Cash Price |
$91.62
|
| Rate for Payer: Cofinity Commercial |
$80.17
|
| Rate for Payer: Cofinity Commercial |
$98.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.62
|
| Rate for Payer: Healthscope Commercial |
$103.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.35
|
| Rate for Payer: PHP Commercial |
$97.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.44
|
| Rate for Payer: Priority Health SBD |
$72.15
|
| Rate for Payer: UMR Bronson Commercial |
$42.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.90
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$650.08
|
|
|
Service Code
|
NDC 69238120202
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.53 |
| Max. Negotiated Rate |
$585.07 |
| Rate for Payer: Aetna American Axle |
$422.55
|
| Rate for Payer: Aetna Commercial |
$552.57
|
| Rate for Payer: Aetna Medicare |
$325.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.55
|
| Rate for Payer: BCBS Complete |
$260.03
|
| Rate for Payer: Cash Price |
$520.06
|
| Rate for Payer: Cofinity Commercial |
$455.06
|
| Rate for Payer: Cofinity Commercial |
$559.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$455.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.06
|
| Rate for Payer: Healthscope Commercial |
$585.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$487.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.57
|
| Rate for Payer: PHP Commercial |
$552.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.55
|
| Rate for Payer: Priority Health SBD |
$409.55
|
| Rate for Payer: UMR Bronson Commercial |
$240.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$487.56
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$458.11
|
|
|
Service Code
|
NDC 00093365640
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.57 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna American Axle |
$297.77
|
| Rate for Payer: Aetna Commercial |
$389.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.77
|
| Rate for Payer: Cash Price |
$366.49
|
| Rate for Payer: Cofinity Commercial |
$320.68
|
| Rate for Payer: Cofinity Commercial |
$393.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.49
|
| Rate for Payer: Healthscope Commercial |
$412.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.39
|
| Rate for Payer: PHP Commercial |
$389.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.77
|
| Rate for Payer: Priority Health SBD |
$288.61
|
| Rate for Payer: UMR Bronson Commercial |
$201.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.58
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$650.08
|
|
|
Service Code
|
NDC 69238120202
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.04 |
| Max. Negotiated Rate |
$585.07 |
| Rate for Payer: Aetna American Axle |
$422.55
|
| Rate for Payer: Aetna Commercial |
$552.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.55
|
| Rate for Payer: Cash Price |
$520.06
|
| Rate for Payer: Cofinity Commercial |
$455.06
|
| Rate for Payer: Cofinity Commercial |
$559.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$455.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.06
|
| Rate for Payer: Healthscope Commercial |
$585.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$487.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.57
|
| Rate for Payer: PHP Commercial |
$552.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.55
|
| Rate for Payer: Priority Health SBD |
$409.55
|
| Rate for Payer: UMR Bronson Commercial |
$286.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$487.56
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
NDC 59011075004
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.05 |
| Max. Negotiated Rate |
$508.50 |
| Rate for Payer: Aetna American Axle |
$367.25
|
| Rate for Payer: Aetna Commercial |
$480.25
|
| Rate for Payer: Aetna Medicare |
$282.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.25
|
| Rate for Payer: BCBS Complete |
$226.00
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cofinity Commercial |
$395.50
|
| Rate for Payer: Cofinity Commercial |
$485.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$395.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.00
|
| Rate for Payer: Healthscope Commercial |
$508.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$395.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$480.25
|
| Rate for Payer: PHP Commercial |
$480.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.25
|
| Rate for Payer: Priority Health SBD |
$355.95
|
| Rate for Payer: UMR Bronson Commercial |
$209.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.75
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$458.11
|
|
|
Service Code
|
NDC 00093365640
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.50 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna American Axle |
$297.77
|
| Rate for Payer: Aetna Commercial |
$389.39
|
| Rate for Payer: Aetna Medicare |
$229.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.77
|
| Rate for Payer: BCBS Complete |
$183.24
|
| Rate for Payer: Cash Price |
$366.49
|
| Rate for Payer: Cofinity Commercial |
$320.68
|
| Rate for Payer: Cofinity Commercial |
$393.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.49
|
| Rate for Payer: Healthscope Commercial |
$412.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.39
|
| Rate for Payer: PHP Commercial |
$389.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.77
|
| Rate for Payer: Priority Health SBD |
$288.61
|
| Rate for Payer: UMR Bronson Commercial |
$169.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.58
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$114.53
|
|
|
Service Code
|
NDC 00093365621
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$103.08 |
| Rate for Payer: Aetna American Axle |
$74.44
|
| Rate for Payer: Aetna Commercial |
$97.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.44
|
| Rate for Payer: Cash Price |
$91.62
|
| Rate for Payer: Cofinity Commercial |
$80.17
|
| Rate for Payer: Cofinity Commercial |
$98.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$80.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.62
|
| Rate for Payer: Healthscope Commercial |
$103.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$97.35
|
| Rate for Payer: PHP Commercial |
$97.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.44
|
| Rate for Payer: Priority Health SBD |
$72.15
|
| Rate for Payer: UMR Bronson Commercial |
$50.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.90
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$531.38
|
|
|
Service Code
|
NDC 60687063765
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$196.61 |
| Max. Negotiated Rate |
$478.24 |
| Rate for Payer: Aetna American Axle |
$345.40
|
| Rate for Payer: Aetna Commercial |
$451.67
|
| Rate for Payer: Aetna Medicare |
$265.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.40
|
| Rate for Payer: BCBS Complete |
$212.55
|
| Rate for Payer: Cash Price |
$425.10
|
| Rate for Payer: Cofinity Commercial |
$371.97
|
| Rate for Payer: Cofinity Commercial |
$456.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$371.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.10
|
| Rate for Payer: Healthscope Commercial |
$478.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$371.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.67
|
| Rate for Payer: PHP Commercial |
$451.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.40
|
| Rate for Payer: Priority Health SBD |
$334.77
|
| Rate for Payer: UMR Bronson Commercial |
$196.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.54
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$263.55
|
|
|
Service Code
|
NDC 00054018913
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.96 |
| Max. Negotiated Rate |
$237.19 |
| Rate for Payer: Aetna American Axle |
$171.31
|
| Rate for Payer: Aetna Commercial |
$224.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.31
|
| Rate for Payer: Cash Price |
$210.84
|
| Rate for Payer: Cofinity Commercial |
$184.49
|
| Rate for Payer: Cofinity Commercial |
$226.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.84
|
| Rate for Payer: Healthscope Commercial |
$237.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.02
|
| Rate for Payer: PHP Commercial |
$224.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.31
|
| Rate for Payer: Priority Health SBD |
$166.04
|
| Rate for Payer: UMR Bronson Commercial |
$115.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.66
|
|
|
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 |
$180.66 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Aetna American Axle |
$317.38
|
| Rate for Payer: Aetna Commercial |
$415.04
|
| Rate for Payer: Aetna Medicare |
$244.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.38
|
| Rate for Payer: BCBS Complete |
$195.31
|
| Rate for Payer: Cash Price |
$390.62
|
| Rate for Payer: Cofinity Commercial |
$341.80
|
| Rate for Payer: Cofinity Commercial |
$419.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$341.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.62
|
| Rate for Payer: Healthscope Commercial |
$439.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$341.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.04
|
| Rate for Payer: PHP Commercial |
$415.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.38
|
| Rate for Payer: Priority Health SBD |
$307.62
|
| Rate for Payer: UMR Bronson Commercial |
$180.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.21
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$388.29
|
|
|
Service Code
|
NDC 65162041503
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.85 |
| Max. Negotiated Rate |
$349.46 |
| Rate for Payer: Aetna American Axle |
$252.39
|
| Rate for Payer: Aetna Commercial |
$330.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.39
|
| Rate for Payer: Cash Price |
$310.63
|
| Rate for Payer: Cofinity Commercial |
$271.80
|
| Rate for Payer: Cofinity Commercial |
$333.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$271.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.63
|
| Rate for Payer: Healthscope Commercial |
$349.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.05
|
| Rate for Payer: PHP Commercial |
$330.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.39
|
| Rate for Payer: Priority Health SBD |
$244.62
|
| Rate for Payer: UMR Bronson Commercial |
$170.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.22
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$10.63
|
|
|
Service Code
|
NDC 60687063711
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna American Axle |
$6.91
|
| Rate for Payer: Aetna Commercial |
$9.04
|
| Rate for Payer: Aetna Medicare |
$5.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.91
|
| Rate for Payer: BCBS Complete |
$4.25
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cofinity Commercial |
$7.44
|
| Rate for Payer: Cofinity Commercial |
$9.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.50
|
| Rate for Payer: Healthscope Commercial |
$9.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.04
|
| Rate for Payer: PHP Commercial |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.91
|
| Rate for Payer: Priority Health SBD |
$6.70
|
| Rate for Payer: UMR Bronson Commercial |
$3.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.97
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$531.38
|
|
|
Service Code
|
NDC 60687063765
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.81 |
| Max. Negotiated Rate |
$478.24 |
| Rate for Payer: Aetna American Axle |
$345.40
|
| Rate for Payer: Aetna Commercial |
$451.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$345.40
|
| Rate for Payer: Cash Price |
$425.10
|
| Rate for Payer: Cofinity Commercial |
$371.97
|
| Rate for Payer: Cofinity Commercial |
$456.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$371.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$425.10
|
| Rate for Payer: Healthscope Commercial |
$478.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$371.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$398.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$451.67
|
| Rate for Payer: PHP Commercial |
$451.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.40
|
| Rate for Payer: Priority Health SBD |
$334.77
|
| Rate for Payer: UMR Bronson Commercial |
$233.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$398.54
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$263.55
|
|
|
Service Code
|
NDC 00054018913
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.51 |
| Max. Negotiated Rate |
$237.19 |
| Rate for Payer: Aetna American Axle |
$171.31
|
| Rate for Payer: Aetna Commercial |
$224.02
|
| Rate for Payer: Aetna Medicare |
$131.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.31
|
| Rate for Payer: BCBS Complete |
$105.42
|
| Rate for Payer: Cash Price |
$210.84
|
| Rate for Payer: Cofinity Commercial |
$184.49
|
| Rate for Payer: Cofinity Commercial |
$226.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.84
|
| Rate for Payer: Healthscope Commercial |
$237.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$224.02
|
| Rate for Payer: PHP Commercial |
$224.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.31
|
| Rate for Payer: Priority Health SBD |
$166.04
|
| Rate for Payer: UMR Bronson Commercial |
$97.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.66
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$10.63
|
|
|
Service Code
|
NDC 60687063711
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna American Axle |
$6.91
|
| Rate for Payer: Aetna Commercial |
$9.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.91
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cofinity Commercial |
$7.44
|
| Rate for Payer: Cofinity Commercial |
$9.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.50
|
| Rate for Payer: Healthscope Commercial |
$9.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.04
|
| Rate for Payer: PHP Commercial |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.91
|
| Rate for Payer: Priority Health SBD |
$6.70
|
| Rate for Payer: UMR Bronson Commercial |
$4.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.97
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$388.29
|
|
|
Service Code
|
NDC 65162041503
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.67 |
| Max. Negotiated Rate |
$349.46 |
| Rate for Payer: Aetna American Axle |
$252.39
|
| Rate for Payer: Aetna Commercial |
$330.05
|
| Rate for Payer: Aetna Medicare |
$194.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.39
|
| Rate for Payer: BCBS Complete |
$155.32
|
| Rate for Payer: Cash Price |
$310.63
|
| Rate for Payer: Cofinity Commercial |
$271.80
|
| Rate for Payer: Cofinity Commercial |
$333.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$271.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.63
|
| Rate for Payer: Healthscope Commercial |
$349.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.05
|
| Rate for Payer: PHP Commercial |
$330.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.39
|
| Rate for Payer: Priority Health SBD |
$244.62
|
| Rate for Payer: UMR Bronson Commercial |
$143.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.22
|
|
|
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 |
$214.84 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Aetna American Axle |
$317.38
|
| Rate for Payer: Aetna Commercial |
$415.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.38
|
| Rate for Payer: Cash Price |
$390.62
|
| Rate for Payer: Cofinity Commercial |
$341.80
|
| Rate for Payer: Cofinity Commercial |
$419.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$341.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.62
|
| Rate for Payer: Healthscope Commercial |
$439.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$341.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.04
|
| Rate for Payer: PHP Commercial |
$415.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.38
|
| Rate for Payer: Priority Health SBD |
$307.62
|
| Rate for Payer: UMR Bronson Commercial |
$214.84
|
| 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 |
$23.23 |
| Max. Negotiated Rate |
$56.51 |
| Rate for Payer: Aetna American Axle |
$40.81
|
| Rate for Payer: Aetna Commercial |
$53.37
|
| Rate for Payer: Aetna Medicare |
$31.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.81
|
| Rate for Payer: BCBS Complete |
$25.12
|
| Rate for Payer: Cash Price |
$50.23
|
| Rate for Payer: Cofinity Commercial |
$43.95
|
| Rate for Payer: Cofinity Commercial |
$54.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.23
|
| Rate for Payer: Healthscope Commercial |
$56.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.37
|
| Rate for Payer: PHP Commercial |
$53.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.81
|
| Rate for Payer: Priority Health SBD |
$39.56
|
| Rate for Payer: UMR Bronson Commercial |
$23.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.09
|
|
|
BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$62.79
|
|
|
Service Code
|
HCPCS J0592
|
| Hospital Charge Code |
115937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$56.51 |
| Rate for Payer: Aetna American Axle |
$40.81
|
| Rate for Payer: Aetna Commercial |
$53.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.81
|
| Rate for Payer: Cash Price |
$50.23
|
| Rate for Payer: Cofinity Commercial |
$43.95
|
| Rate for Payer: Cofinity Commercial |
$54.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$43.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.23
|
| Rate for Payer: Healthscope Commercial |
$56.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.37
|
| Rate for Payer: PHP Commercial |
$53.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.81
|
| Rate for Payer: Priority Health SBD |
$39.56
|
| Rate for Payer: UMR Bronson Commercial |
$27.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.09
|
|
