|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$140.91
|
|
|
Service Code
|
NDC 50383092493
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$126.82 |
| Rate for Payer: Aetna American Axle |
$91.59
|
| Rate for Payer: Aetna Commercial |
$119.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.59
|
| Rate for Payer: Cash Price |
$112.73
|
| Rate for Payer: Cofinity Commercial |
$121.18
|
| Rate for Payer: Cofinity Commercial |
$98.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.73
|
| Rate for Payer: Healthscope Commercial |
$126.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.77
|
| Rate for Payer: PHP Commercial |
$119.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.59
|
| Rate for Payer: Priority Health SBD |
$88.77
|
| Rate for Payer: UMR Bronson Commercial |
$62.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.68
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$236.81
|
|
|
Service Code
|
NDC 60687048121
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.62 |
| Max. Negotiated Rate |
$213.13 |
| Rate for Payer: Aetna American Axle |
$153.93
|
| Rate for Payer: Aetna Commercial |
$201.29
|
| Rate for Payer: Aetna Medicare |
$118.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.93
|
| Rate for Payer: BCBS Complete |
$94.72
|
| Rate for Payer: Cash Price |
$189.45
|
| Rate for Payer: Cofinity Commercial |
$165.77
|
| Rate for Payer: Cofinity Commercial |
$203.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.45
|
| Rate for Payer: Healthscope Commercial |
$213.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.29
|
| Rate for Payer: PHP Commercial |
$201.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.93
|
| Rate for Payer: Priority Health SBD |
$149.19
|
| Rate for Payer: UMR Bronson Commercial |
$87.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.61
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$386.40
|
|
|
Service Code
|
NDC 00904715404
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.97 |
| Max. Negotiated Rate |
$347.76 |
| Rate for Payer: Aetna American Axle |
$251.16
|
| Rate for Payer: Aetna Commercial |
$328.44
|
| Rate for Payer: Aetna Medicare |
$193.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.16
|
| Rate for Payer: BCBS Complete |
$154.56
|
| Rate for Payer: Cash Price |
$309.12
|
| Rate for Payer: Cofinity Commercial |
$270.48
|
| Rate for Payer: Cofinity Commercial |
$332.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.12
|
| Rate for Payer: Healthscope Commercial |
$347.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.44
|
| Rate for Payer: PHP Commercial |
$328.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.16
|
| Rate for Payer: Priority Health SBD |
$243.43
|
| Rate for Payer: UMR Bronson Commercial |
$142.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.80
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$7.90
|
|
|
Service Code
|
NDC 60687048111
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$7.11 |
| Rate for Payer: Aetna American Axle |
$5.13
|
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.13
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cofinity Commercial |
$5.53
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.32
|
| Rate for Payer: Healthscope Commercial |
$7.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.13
|
| Rate for Payer: Priority Health SBD |
$4.98
|
| Rate for Payer: UMR Bronson Commercial |
$3.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$195.30
|
|
|
Service Code
|
NDC 00054017613
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.26 |
| Max. Negotiated Rate |
$175.77 |
| Rate for Payer: Aetna American Axle |
$126.94
|
| Rate for Payer: Aetna Commercial |
$166.00
|
| Rate for Payer: Aetna Medicare |
$97.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.94
|
| Rate for Payer: BCBS Complete |
$78.12
|
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Cofinity Commercial |
$136.71
|
| Rate for Payer: Cofinity Commercial |
$167.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.24
|
| Rate for Payer: Healthscope Commercial |
$175.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.00
|
| Rate for Payer: PHP Commercial |
$166.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.94
|
| Rate for Payer: Priority Health SBD |
$123.04
|
| Rate for Payer: UMR Bronson Commercial |
$72.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.47
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$386.40
|
|
|
Service Code
|
NDC 00904715404
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.02 |
| Max. Negotiated Rate |
$347.76 |
| Rate for Payer: Aetna American Axle |
$251.16
|
| Rate for Payer: Aetna Commercial |
$328.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.16
|
| Rate for Payer: Cash Price |
$309.12
|
| Rate for Payer: Cofinity Commercial |
$270.48
|
| Rate for Payer: Cofinity Commercial |
$332.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$270.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.12
|
| Rate for Payer: Healthscope Commercial |
$347.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$289.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.44
|
| Rate for Payer: PHP Commercial |
$328.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.16
|
| Rate for Payer: Priority Health SBD |
$243.43
|
| Rate for Payer: UMR Bronson Commercial |
$170.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$289.80
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$140.91
|
|
|
Service Code
|
NDC 50383092493
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.14 |
| Max. Negotiated Rate |
$126.82 |
| Rate for Payer: Aetna American Axle |
$91.59
|
| Rate for Payer: Aetna Commercial |
$119.77
|
| Rate for Payer: Aetna Medicare |
$70.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.59
|
| Rate for Payer: BCBS Complete |
$56.36
|
| Rate for Payer: Cash Price |
$112.73
|
| Rate for Payer: Cofinity Commercial |
$121.18
|
| Rate for Payer: Cofinity Commercial |
$98.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.73
|
| Rate for Payer: Healthscope Commercial |
$126.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.77
|
| Rate for Payer: PHP Commercial |
$119.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.59
|
| Rate for Payer: Priority Health SBD |
$88.77
|
| Rate for Payer: UMR Bronson Commercial |
$52.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.68
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$195.30
|
|
|
Service Code
|
NDC 00054017613
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.93 |
| Max. Negotiated Rate |
$175.77 |
| Rate for Payer: Aetna American Axle |
$126.94
|
| Rate for Payer: Aetna Commercial |
$166.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.94
|
| Rate for Payer: Cash Price |
$156.24
|
| Rate for Payer: Cofinity Commercial |
$136.71
|
| Rate for Payer: Cofinity Commercial |
$167.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$136.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.24
|
| Rate for Payer: Healthscope Commercial |
$175.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.00
|
| Rate for Payer: PHP Commercial |
$166.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.94
|
| Rate for Payer: Priority Health SBD |
$123.04
|
| Rate for Payer: UMR Bronson Commercial |
$85.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.47
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$7.90
|
|
|
Service Code
|
NDC 60687048111
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$7.11 |
| Rate for Payer: Aetna American Axle |
$5.13
|
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.13
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cofinity Commercial |
$5.53
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.32
|
| Rate for Payer: Healthscope Commercial |
$7.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.13
|
| Rate for Payer: Priority Health SBD |
$4.98
|
| Rate for Payer: UMR Bronson Commercial |
$2.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$236.81
|
|
|
Service Code
|
NDC 60687048121
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.20 |
| Max. Negotiated Rate |
$213.13 |
| Rate for Payer: Aetna American Axle |
$153.93
|
| Rate for Payer: Aetna Commercial |
$201.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.93
|
| Rate for Payer: Cash Price |
$189.45
|
| Rate for Payer: Cofinity Commercial |
$165.77
|
| Rate for Payer: Cofinity Commercial |
$203.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$165.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.45
|
| Rate for Payer: Healthscope Commercial |
$213.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.29
|
| Rate for Payer: PHP Commercial |
$201.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.93
|
| Rate for Payer: Priority Health SBD |
$149.19
|
| Rate for Payer: UMR Bronson Commercial |
$104.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.61
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
|
IP
|
$521.76
|
|
|
Service Code
|
NDC 00904663661
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$229.57 |
| Max. Negotiated Rate |
$469.58 |
| Rate for Payer: Aetna American Axle |
$339.14
|
| Rate for Payer: Aetna Commercial |
$443.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.14
|
| Rate for Payer: Cash Price |
$417.41
|
| Rate for Payer: Cofinity Commercial |
$365.23
|
| Rate for Payer: Cofinity Commercial |
$448.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$365.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$417.41
|
| Rate for Payer: Healthscope Commercial |
$469.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$365.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$391.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.50
|
| Rate for Payer: PHP Commercial |
$443.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.14
|
| Rate for Payer: Priority Health SBD |
$328.71
|
| Rate for Payer: UMR Bronson Commercial |
$229.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$391.32
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
|
OP
|
$521.76
|
|
|
Service Code
|
NDC 00904663661
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.05 |
| Max. Negotiated Rate |
$469.58 |
| Rate for Payer: Aetna American Axle |
$339.14
|
| Rate for Payer: Aetna Commercial |
$443.50
|
| Rate for Payer: Aetna Medicare |
$260.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.14
|
| Rate for Payer: BCBS Complete |
$208.70
|
| Rate for Payer: Cash Price |
$417.41
|
| Rate for Payer: Cofinity Commercial |
$365.23
|
| Rate for Payer: Cofinity Commercial |
$448.71
|
| Rate for Payer: Cofinity Medicare Advantage |
$365.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$417.41
|
| Rate for Payer: Healthscope Commercial |
$469.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$365.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$391.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$443.50
|
| Rate for Payer: PHP Commercial |
$443.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$339.14
|
| Rate for Payer: Priority Health SBD |
$328.71
|
| Rate for Payer: UMR Bronson Commercial |
$193.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$391.32
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
IP
|
$4.53
|
|
|
Service Code
|
NDC 51079094301
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna American Axle |
$2.94
|
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.94
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Cofinity Commercial |
$3.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.62
|
| Rate for Payer: Healthscope Commercial |
$4.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.85
|
| Rate for Payer: PHP Commercial |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.94
|
| Rate for Payer: Priority Health SBD |
$2.85
|
| Rate for Payer: UMR Bronson Commercial |
$1.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.40
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
OP
|
$452.16
|
|
|
Service Code
|
NDC 51079094320
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.30 |
| Max. Negotiated Rate |
$406.94 |
| Rate for Payer: Aetna American Axle |
$293.90
|
| Rate for Payer: Aetna Commercial |
$384.34
|
| Rate for Payer: Aetna Medicare |
$226.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.90
|
| Rate for Payer: BCBS Complete |
$180.86
|
| Rate for Payer: Cash Price |
$361.73
|
| Rate for Payer: Cofinity Commercial |
$316.51
|
| Rate for Payer: Cofinity Commercial |
$388.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$316.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.73
|
| Rate for Payer: Healthscope Commercial |
$406.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.34
|
| Rate for Payer: PHP Commercial |
$384.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.90
|
| Rate for Payer: Priority Health SBD |
$284.86
|
| Rate for Payer: UMR Bronson Commercial |
$167.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.12
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
IP
|
$452.16
|
|
|
Service Code
|
NDC 51079094320
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.95 |
| Max. Negotiated Rate |
$406.94 |
| Rate for Payer: Aetna American Axle |
$293.90
|
| Rate for Payer: Aetna Commercial |
$384.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.90
|
| Rate for Payer: Cash Price |
$361.73
|
| Rate for Payer: Cofinity Commercial |
$316.51
|
| Rate for Payer: Cofinity Commercial |
$388.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$316.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.73
|
| Rate for Payer: Healthscope Commercial |
$406.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.34
|
| Rate for Payer: PHP Commercial |
$384.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.90
|
| Rate for Payer: Priority Health SBD |
$284.86
|
| Rate for Payer: UMR Bronson Commercial |
$198.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.12
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
OP
|
$414.72
|
|
|
Service Code
|
NDC 00904663561
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.45 |
| Max. Negotiated Rate |
$373.25 |
| Rate for Payer: Aetna American Axle |
$269.57
|
| Rate for Payer: Aetna Commercial |
$352.51
|
| Rate for Payer: Aetna Medicare |
$207.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.57
|
| Rate for Payer: BCBS Complete |
$165.89
|
| Rate for Payer: Cash Price |
$331.78
|
| Rate for Payer: Cofinity Commercial |
$290.30
|
| Rate for Payer: Cofinity Commercial |
$356.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.78
|
| Rate for Payer: Healthscope Commercial |
$373.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.51
|
| Rate for Payer: PHP Commercial |
$352.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.57
|
| Rate for Payer: Priority Health SBD |
$261.27
|
| Rate for Payer: UMR Bronson Commercial |
$153.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.04
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
OP
|
$4.53
|
|
|
Service Code
|
NDC 51079094301
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna American Axle |
$2.94
|
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna Medicare |
$2.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.94
|
| Rate for Payer: BCBS Complete |
$1.81
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Cofinity Commercial |
$3.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.62
|
| Rate for Payer: Healthscope Commercial |
$4.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.85
|
| Rate for Payer: PHP Commercial |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.94
|
| Rate for Payer: Priority Health SBD |
$2.85
|
| Rate for Payer: UMR Bronson Commercial |
$1.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.40
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
IP
|
$414.72
|
|
|
Service Code
|
NDC 00904663561
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.48 |
| Max. Negotiated Rate |
$373.25 |
| Rate for Payer: Aetna American Axle |
$269.57
|
| Rate for Payer: Aetna Commercial |
$352.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.57
|
| Rate for Payer: Cash Price |
$331.78
|
| Rate for Payer: Cofinity Commercial |
$290.30
|
| Rate for Payer: Cofinity Commercial |
$356.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$290.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$331.78
|
| Rate for Payer: Healthscope Commercial |
$373.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$290.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$352.51
|
| Rate for Payer: PHP Commercial |
$352.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.57
|
| Rate for Payer: Priority Health SBD |
$261.27
|
| Rate for Payer: UMR Bronson Commercial |
$182.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.04
|
|
|
BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
OP
|
$180.87
|
|
|
Service Code
|
NDC 00185041060
|
| Hospital Charge Code |
18385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.92 |
| Max. Negotiated Rate |
$162.78 |
| Rate for Payer: Aetna American Axle |
$117.57
|
| Rate for Payer: Aetna Commercial |
$153.74
|
| Rate for Payer: Aetna Medicare |
$90.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.57
|
| Rate for Payer: BCBS Complete |
$72.35
|
| Rate for Payer: Cash Price |
$144.70
|
| Rate for Payer: Cofinity Commercial |
$126.61
|
| Rate for Payer: Cofinity Commercial |
$155.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.70
|
| Rate for Payer: Healthscope Commercial |
$162.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.74
|
| Rate for Payer: PHP Commercial |
$153.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.57
|
| Rate for Payer: Priority Health SBD |
$113.95
|
| Rate for Payer: UMR Bronson Commercial |
$66.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.65
|
|
|
BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
OP
|
$136.23
|
|
|
Service Code
|
NDC 00591354060
|
| Hospital Charge Code |
18385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.41 |
| Max. Negotiated Rate |
$122.61 |
| Rate for Payer: Aetna American Axle |
$88.55
|
| Rate for Payer: Aetna Commercial |
$115.80
|
| Rate for Payer: Aetna Medicare |
$68.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.55
|
| Rate for Payer: BCBS Complete |
$54.49
|
| Rate for Payer: Cash Price |
$108.98
|
| Rate for Payer: Cofinity Commercial |
$117.16
|
| Rate for Payer: Cofinity Commercial |
$95.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.98
|
| Rate for Payer: Healthscope Commercial |
$122.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.80
|
| Rate for Payer: PHP Commercial |
$115.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.55
|
| Rate for Payer: Priority Health SBD |
$85.82
|
| Rate for Payer: UMR Bronson Commercial |
$50.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.17
|
|
|
BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
IP
|
$136.23
|
|
|
Service Code
|
NDC 00591354060
|
| Hospital Charge Code |
18385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.94 |
| Max. Negotiated Rate |
$122.61 |
| Rate for Payer: Aetna American Axle |
$88.55
|
| Rate for Payer: Aetna Commercial |
$115.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.55
|
| Rate for Payer: Cash Price |
$108.98
|
| Rate for Payer: Cofinity Commercial |
$117.16
|
| Rate for Payer: Cofinity Commercial |
$95.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.98
|
| Rate for Payer: Healthscope Commercial |
$122.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.80
|
| Rate for Payer: PHP Commercial |
$115.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.55
|
| Rate for Payer: Priority Health SBD |
$85.82
|
| Rate for Payer: UMR Bronson Commercial |
$59.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.17
|
|
|
BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
IP
|
$180.87
|
|
|
Service Code
|
NDC 00185041060
|
| Hospital Charge Code |
18385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.58 |
| Max. Negotiated Rate |
$162.78 |
| Rate for Payer: Aetna American Axle |
$117.57
|
| Rate for Payer: Aetna Commercial |
$153.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.57
|
| Rate for Payer: Cash Price |
$144.70
|
| Rate for Payer: Cofinity Commercial |
$126.61
|
| Rate for Payer: Cofinity Commercial |
$155.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$126.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.70
|
| Rate for Payer: Healthscope Commercial |
$162.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.74
|
| Rate for Payer: PHP Commercial |
$153.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.57
|
| Rate for Payer: Priority Health SBD |
$113.95
|
| Rate for Payer: UMR Bronson Commercial |
$79.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.65
|
|
|
BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
OP
|
$143.07
|
|
|
Service Code
|
NDC 00591354160
|
| Hospital Charge Code |
18386
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.94 |
| Max. Negotiated Rate |
$128.76 |
| Rate for Payer: Aetna American Axle |
$93.00
|
| Rate for Payer: Aetna Commercial |
$121.61
|
| Rate for Payer: Aetna Medicare |
$71.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.00
|
| Rate for Payer: BCBS Complete |
$57.23
|
| Rate for Payer: Cash Price |
$114.46
|
| Rate for Payer: Cofinity Commercial |
$100.15
|
| Rate for Payer: Cofinity Commercial |
$123.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.46
|
| Rate for Payer: Healthscope Commercial |
$128.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.61
|
| Rate for Payer: PHP Commercial |
$121.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.00
|
| Rate for Payer: Priority Health SBD |
$90.13
|
| Rate for Payer: UMR Bronson Commercial |
$52.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.30
|
|
|
BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
IP
|
$144.21
|
|
|
Service Code
|
NDC 43598053760
|
| Hospital Charge Code |
18386
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.45 |
| Max. Negotiated Rate |
$129.79 |
| Rate for Payer: Aetna American Axle |
$93.74
|
| Rate for Payer: Aetna Commercial |
$122.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.74
|
| Rate for Payer: Cash Price |
$115.37
|
| Rate for Payer: Cofinity Commercial |
$100.95
|
| Rate for Payer: Cofinity Commercial |
$124.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.37
|
| Rate for Payer: Healthscope Commercial |
$129.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.58
|
| Rate for Payer: PHP Commercial |
$122.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.74
|
| Rate for Payer: Priority Health SBD |
$90.85
|
| Rate for Payer: UMR Bronson Commercial |
$63.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.16
|
|
|
BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
IP
|
$143.07
|
|
|
Service Code
|
NDC 00591354160
|
| Hospital Charge Code |
18386
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.95 |
| Max. Negotiated Rate |
$128.76 |
| Rate for Payer: Aetna American Axle |
$93.00
|
| Rate for Payer: Aetna Commercial |
$121.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.00
|
| Rate for Payer: Cash Price |
$114.46
|
| Rate for Payer: Cofinity Commercial |
$100.15
|
| Rate for Payer: Cofinity Commercial |
$123.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.46
|
| Rate for Payer: Healthscope Commercial |
$128.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.61
|
| Rate for Payer: PHP Commercial |
$121.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.00
|
| Rate for Payer: Priority Health SBD |
$90.13
|
| Rate for Payer: UMR Bronson Commercial |
$62.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.30
|
|
