|
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 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
|
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
|
$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
|
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
|
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
|
$263.55
|
|
|
Service Code
|
NDC 00054018913
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.96 |
| Max. Negotiated Rate |
$237.20 |
| 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 |
$184.48
|
| Rate for Payer: Cofinity Commercial |
$226.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.84
|
| Rate for Payer: Healthscope Commercial |
$237.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.48
|
| 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
|
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 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 |
$194.14
|
| 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
|
OP
|
$263.55
|
|
|
Service Code
|
NDC 00054018913
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.51 |
| Max. Negotiated Rate |
$237.20 |
| 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 |
$184.48
|
| Rate for Payer: Cofinity Commercial |
$226.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$184.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.84
|
| Rate for Payer: Healthscope Commercial |
$237.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.48
|
| 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
|
$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 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 |
$10.85 |
| 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 |
$31.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.81
|
| Rate for Payer: BCBS Complete |
$25.12
|
| Rate for Payer: BCBS Trust/PPO |
$10.85
|
| Rate for Payer: BCN Commercial |
$10.85
|
| Rate for Payer: Cash Price |
$50.23
|
| 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
|
|
|
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
|
|
|
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 |
$5.14
|
| Rate for Payer: Aetna Commercial |
$6.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.14
|
| 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 |
$6.72
|
| Rate for Payer: PHP Commercial |
$6.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.14
|
| 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
|
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
|
$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
|
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 |
$146.48
|
| 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 |
$146.48
|
|
|
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 |
$146.48
|
| 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 |
$146.48
|
|
|
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 |
$118.40
|
| 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
|
$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 |
$70.46
|
| 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
|
$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
|
$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 |
$5.14
|
| Rate for Payer: Aetna Commercial |
$6.72
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.14
|
| 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 |
$6.72
|
| Rate for Payer: PHP Commercial |
$6.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.14
|
| 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
|
|
|
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 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
|
|
