|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$182.93
|
|
|
Service Code
|
NDC 00093365721
|
| Hospital Charge Code |
107661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.49 |
| Max. Negotiated Rate |
$164.64 |
| Rate for Payer: Aetna American Axle |
$118.90
|
| Rate for Payer: Aetna Commercial |
$155.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.90
|
| Rate for Payer: Cash Price |
$146.34
|
| Rate for Payer: Cofinity Commercial |
$128.05
|
| Rate for Payer: Cofinity Commercial |
$157.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.34
|
| Rate for Payer: Healthscope Commercial |
$164.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.49
|
| Rate for Payer: PHP Commercial |
$155.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.90
|
| Rate for Payer: Priority Health SBD |
$115.25
|
| Rate for Payer: UMR Bronson Commercial |
$80.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.20
|
|
|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$731.69
|
|
|
Service Code
|
NDC 00093365740
|
| Hospital Charge Code |
107661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.73 |
| Max. Negotiated Rate |
$658.52 |
| Rate for Payer: Aetna American Axle |
$475.60
|
| Rate for Payer: Aetna Commercial |
$621.94
|
| Rate for Payer: Aetna Medicare |
$365.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$475.60
|
| Rate for Payer: BCBS Complete |
$292.68
|
| Rate for Payer: Cash Price |
$585.35
|
| Rate for Payer: Cofinity Commercial |
$512.18
|
| Rate for Payer: Cofinity Commercial |
$629.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$512.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$585.35
|
| Rate for Payer: Healthscope Commercial |
$658.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$512.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$548.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$621.94
|
| Rate for Payer: PHP Commercial |
$621.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$475.60
|
| Rate for Payer: Priority Health SBD |
$460.96
|
| Rate for Payer: UMR Bronson Commercial |
$270.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$548.77
|
|
|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$182.93
|
|
|
Service Code
|
NDC 00093365721
|
| Hospital Charge Code |
107661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.68 |
| Max. Negotiated Rate |
$164.64 |
| Rate for Payer: Aetna American Axle |
$118.90
|
| Rate for Payer: Aetna Commercial |
$155.49
|
| Rate for Payer: Aetna Medicare |
$91.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.90
|
| Rate for Payer: BCBS Complete |
$73.17
|
| Rate for Payer: Cash Price |
$146.34
|
| Rate for Payer: Cofinity Commercial |
$128.05
|
| Rate for Payer: Cofinity Commercial |
$157.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$128.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.34
|
| Rate for Payer: Healthscope Commercial |
$164.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.49
|
| Rate for Payer: PHP Commercial |
$155.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.90
|
| Rate for Payer: Priority Health SBD |
$115.25
|
| Rate for Payer: UMR Bronson Commercial |
$67.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.20
|
|
|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$731.69
|
|
|
Service Code
|
NDC 00093365740
|
| Hospital Charge Code |
107661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$321.94 |
| Max. Negotiated Rate |
$658.52 |
| Rate for Payer: Aetna American Axle |
$475.60
|
| Rate for Payer: Aetna Commercial |
$621.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$475.60
|
| Rate for Payer: Cash Price |
$585.35
|
| Rate for Payer: Cofinity Commercial |
$512.18
|
| Rate for Payer: Cofinity Commercial |
$629.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$512.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$585.35
|
| Rate for Payer: Healthscope Commercial |
$658.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$512.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$548.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$621.94
|
| Rate for Payer: PHP Commercial |
$621.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$475.60
|
| Rate for Payer: Priority Health SBD |
$460.96
|
| Rate for Payer: UMR Bronson Commercial |
$321.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$548.77
|
|
|
BUPRENORPHINE 20 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$428.58
|
|
|
Service Code
|
NDC 00093365921
|
| Hospital Charge Code |
107662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.58 |
| Max. Negotiated Rate |
$385.72 |
| Rate for Payer: Aetna American Axle |
$278.58
|
| Rate for Payer: Aetna Commercial |
$364.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.58
|
| Rate for Payer: Cash Price |
$342.86
|
| Rate for Payer: Cofinity Commercial |
$300.01
|
| Rate for Payer: Cofinity Commercial |
$368.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.86
|
| Rate for Payer: Healthscope Commercial |
$385.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.29
|
| Rate for Payer: PHP Commercial |
$364.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.58
|
| Rate for Payer: Priority Health SBD |
$270.01
|
| Rate for Payer: UMR Bronson Commercial |
$188.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.44
|
|
|
BUPRENORPHINE 20 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$1,714.29
|
|
|
Service Code
|
NDC 00093365940
|
| Hospital Charge Code |
107662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$754.29 |
| Max. Negotiated Rate |
$1,542.86 |
| Rate for Payer: Aetna American Axle |
$1,114.29
|
| Rate for Payer: Aetna Commercial |
$1,457.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,114.29
|
| Rate for Payer: Cash Price |
$1,371.43
|
| Rate for Payer: Cofinity Commercial |
$1,200.00
|
| Rate for Payer: Cofinity Commercial |
$1,474.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,200.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,371.43
|
| Rate for Payer: Healthscope Commercial |
$1,542.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,200.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,285.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,457.15
|
| Rate for Payer: PHP Commercial |
$1,457.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,114.29
|
| Rate for Payer: Priority Health SBD |
$1,080.00
|
| Rate for Payer: UMR Bronson Commercial |
$754.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,285.72
|
|
|
BUPRENORPHINE 20 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$428.58
|
|
|
Service Code
|
NDC 00093365921
|
| Hospital Charge Code |
107662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.57 |
| Max. Negotiated Rate |
$385.72 |
| Rate for Payer: Aetna American Axle |
$278.58
|
| Rate for Payer: Aetna Commercial |
$364.29
|
| Rate for Payer: Aetna Medicare |
$214.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.58
|
| Rate for Payer: BCBS Complete |
$171.43
|
| Rate for Payer: Cash Price |
$342.86
|
| Rate for Payer: Cofinity Commercial |
$300.01
|
| Rate for Payer: Cofinity Commercial |
$368.58
|
| Rate for Payer: Cofinity Medicare Advantage |
$300.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.86
|
| Rate for Payer: Healthscope Commercial |
$385.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$300.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$321.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$364.29
|
| Rate for Payer: PHP Commercial |
$364.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.58
|
| Rate for Payer: Priority Health SBD |
$270.01
|
| Rate for Payer: UMR Bronson Commercial |
$158.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$321.44
|
|
|
BUPRENORPHINE 20 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$1,714.29
|
|
|
Service Code
|
NDC 00093365940
|
| Hospital Charge Code |
107662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$634.29 |
| Max. Negotiated Rate |
$1,542.86 |
| Rate for Payer: Aetna American Axle |
$1,114.29
|
| Rate for Payer: Aetna Commercial |
$1,457.15
|
| Rate for Payer: Aetna Medicare |
$857.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,114.29
|
| Rate for Payer: BCBS Complete |
$685.72
|
| Rate for Payer: Cash Price |
$1,371.43
|
| Rate for Payer: Cofinity Commercial |
$1,200.00
|
| Rate for Payer: Cofinity Commercial |
$1,474.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,200.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,371.43
|
| Rate for Payer: Healthscope Commercial |
$1,542.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,200.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,285.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,457.15
|
| Rate for Payer: PHP Commercial |
$1,457.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,114.29
|
| Rate for Payer: Priority Health SBD |
$1,080.00
|
| Rate for Payer: UMR Bronson Commercial |
$634.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,285.72
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$217.14
|
|
|
Service Code
|
NDC 65162041603
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.34 |
| Max. Negotiated Rate |
$195.43 |
| Rate for Payer: Aetna American Axle |
$141.14
|
| Rate for Payer: Aetna Commercial |
$184.57
|
| Rate for Payer: Aetna Medicare |
$108.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.14
|
| Rate for Payer: BCBS Complete |
$86.86
|
| 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 |
$162.86
|
| 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 |
$80.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.86
|
|
|
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 |
$5.90
|
| 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 |
$5.90
|
|
|
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 |
$90.40
|
| 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 |
$162.86
|
| 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 |
$162.86
|
|
|
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 |
$5.90
|
| 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 |
$5.90
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$392.73
|
|
|
Service Code
|
NDC 50268014415
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.31 |
| Max. Negotiated Rate |
$353.46 |
| Rate for Payer: Aetna American Axle |
$255.27
|
| Rate for Payer: Aetna Commercial |
$333.82
|
| Rate for Payer: Aetna Medicare |
$196.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.27
|
| Rate for Payer: BCBS Complete |
$157.09
|
| Rate for Payer: Cash Price |
$314.18
|
| Rate for Payer: Cofinity Commercial |
$274.91
|
| Rate for Payer: Cofinity Commercial |
$337.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.18
|
| Rate for Payer: Healthscope Commercial |
$353.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.82
|
| Rate for Payer: PHP Commercial |
$333.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.27
|
| Rate for Payer: Priority Health SBD |
$247.42
|
| Rate for Payer: UMR Bronson Commercial |
$145.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.55
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$640.85
|
|
|
Service Code
|
NDC 00904700906
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$281.97 |
| Max. Negotiated Rate |
$576.76 |
| Rate for Payer: Aetna American Axle |
$416.55
|
| Rate for Payer: Aetna Commercial |
$544.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$416.55
|
| 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 |
$281.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$480.64
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$180.81
|
|
|
Service Code
|
NDC 00054018813
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$162.73 |
| Rate for Payer: Aetna American Axle |
$117.53
|
| Rate for Payer: Aetna Commercial |
$153.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.53
|
| 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 |
$79.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.61
|
|
|
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 |
$320.42
|
| 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
|
$392.73
|
|
|
Service Code
|
NDC 50268014415
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$353.46 |
| Rate for Payer: Aetna American Axle |
$255.27
|
| Rate for Payer: Aetna Commercial |
$333.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$255.27
|
| Rate for Payer: Cash Price |
$314.18
|
| Rate for Payer: Cofinity Commercial |
$274.91
|
| Rate for Payer: Cofinity Commercial |
$337.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$274.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$314.18
|
| Rate for Payer: Healthscope Commercial |
$353.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$274.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.82
|
| Rate for Payer: PHP Commercial |
$333.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.27
|
| Rate for Payer: Priority Health SBD |
$247.42
|
| Rate for Payer: UMR Bronson Commercial |
$172.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.55
|
|
|
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
|
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 |
$57.26
|
| 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
|
$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
|
$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
|
$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
|
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
|
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
|
|
