|
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
|
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
|
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 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
|
$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 |
$2.26
|
| 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
|
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 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 |
$68.12
|
| 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 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 150 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
OP
|
$144.21
|
|
|
Service Code
|
NDC 43598053760
|
| Hospital Charge Code |
18386
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.36 |
| Max. Negotiated Rate |
$129.79 |
| Rate for Payer: Aetna American Axle |
$93.74
|
| Rate for Payer: Aetna Commercial |
$122.58
|
| Rate for Payer: Aetna Medicare |
$72.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.74
|
| Rate for Payer: BCBS Complete |
$57.68
|
| 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 |
$53.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.16
|
|
|
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
|
OP
|
$239.40
|
|
|
Service Code
|
NDC 00185041560
|
| Hospital Charge Code |
18386
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.58 |
| Max. Negotiated Rate |
$215.46 |
| Rate for Payer: Aetna American Axle |
$155.61
|
| Rate for Payer: Aetna Commercial |
$203.49
|
| Rate for Payer: Aetna Medicare |
$119.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.61
|
| Rate for Payer: BCBS Complete |
$95.76
|
| Rate for Payer: Cash Price |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$167.58
|
| Rate for Payer: Cofinity Commercial |
$205.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.52
|
| Rate for Payer: Healthscope Commercial |
$215.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.49
|
| Rate for Payer: PHP Commercial |
$203.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.61
|
| Rate for Payer: Priority Health SBD |
$150.82
|
| Rate for Payer: UMR Bronson Commercial |
$88.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.55
|
|
|
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 |
$71.54
|
| 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
|
$239.40
|
|
|
Service Code
|
NDC 00185041560
|
| Hospital Charge Code |
18386
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.34 |
| Max. Negotiated Rate |
$215.46 |
| Rate for Payer: Aetna American Axle |
$155.61
|
| Rate for Payer: Aetna Commercial |
$203.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.61
|
| Rate for Payer: Cash Price |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$167.58
|
| Rate for Payer: Cofinity Commercial |
$205.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$167.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.52
|
| Rate for Payer: Healthscope Commercial |
$215.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$203.49
|
| Rate for Payer: PHP Commercial |
$203.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.61
|
| Rate for Payer: Priority Health SBD |
$150.82
|
| Rate for Payer: UMR Bronson Commercial |
$105.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.55
|
|
|
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
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$134.21
|
|
|
Service Code
|
NDC 70436001004
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.05 |
| Max. Negotiated Rate |
$120.79 |
| Rate for Payer: Aetna American Axle |
$87.24
|
| Rate for Payer: Aetna Commercial |
$114.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.24
|
| Rate for Payer: Cash Price |
$107.37
|
| Rate for Payer: Cofinity Commercial |
$115.42
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.37
|
| Rate for Payer: Healthscope Commercial |
$120.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.08
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.24
|
| Rate for Payer: Priority Health SBD |
$84.55
|
| Rate for Payer: UMR Bronson Commercial |
$59.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.66
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$140.26
|
|
|
Service Code
|
NDC 00904708404
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.90 |
| Max. Negotiated Rate |
$126.23 |
| Rate for Payer: Aetna American Axle |
$91.17
|
| Rate for Payer: Aetna Commercial |
$119.22
|
| Rate for Payer: Aetna Medicare |
$70.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.17
|
| Rate for Payer: BCBS Complete |
$56.10
|
| Rate for Payer: Cash Price |
$112.21
|
| Rate for Payer: Cofinity Commercial |
$120.62
|
| Rate for Payer: Cofinity Commercial |
$98.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$98.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.21
|
| Rate for Payer: Healthscope Commercial |
$126.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.22
|
| Rate for Payer: PHP Commercial |
$119.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.17
|
| Rate for Payer: Priority Health SBD |
$88.36
|
| Rate for Payer: UMR Bronson Commercial |
$51.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.20
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
NDC 60687031201
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$364.32 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Aetna American Axle |
$538.20
|
| Rate for Payer: Aetna Commercial |
$703.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$538.20
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cofinity Commercial |
$579.60
|
| Rate for Payer: Cofinity Commercial |
$712.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$579.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$662.40
|
| Rate for Payer: Healthscope Commercial |
$745.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$579.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$621.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$703.80
|
| Rate for Payer: PHP Commercial |
$703.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$538.20
|
| Rate for Payer: Priority Health SBD |
$521.64
|
| Rate for Payer: UMR Bronson Commercial |
$364.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$621.00
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$95.18
|
|
|
Service Code
|
NDC 68180031906
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.88 |
| Max. Negotiated Rate |
$85.66 |
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna Commercial |
$80.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: Cash Price |
$76.14
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$81.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$66.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.14
|
| Rate for Payer: Healthscope Commercial |
$85.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$66.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$80.90
|
| Rate for Payer: PHP Commercial |
$80.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.87
|
| Rate for Payer: Priority Health SBD |
$59.96
|
| Rate for Payer: UMR Bronson Commercial |
$41.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.38
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$112.86
|
|
|
Service Code
|
NDC 43598065530
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.76 |
| Max. Negotiated Rate |
$101.57 |
| Rate for Payer: Aetna American Axle |
$73.36
|
| Rate for Payer: Aetna Commercial |
$95.93
|
| Rate for Payer: Aetna Medicare |
$56.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.36
|
| Rate for Payer: BCBS Complete |
$45.14
|
| Rate for Payer: Cash Price |
$90.29
|
| Rate for Payer: Cofinity Commercial |
$79.00
|
| Rate for Payer: Cofinity Commercial |
$97.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.29
|
| Rate for Payer: Healthscope Commercial |
$101.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.93
|
| Rate for Payer: PHP Commercial |
$95.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.36
|
| Rate for Payer: Priority Health SBD |
$71.10
|
| Rate for Payer: UMR Bronson Commercial |
$41.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.64
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
NDC 60687031201
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$306.36 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Aetna American Axle |
$538.20
|
| Rate for Payer: Aetna Commercial |
$703.80
|
| Rate for Payer: Aetna Medicare |
$414.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$538.20
|
| Rate for Payer: BCBS Complete |
$331.20
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cofinity Commercial |
$579.60
|
| Rate for Payer: Cofinity Commercial |
$712.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$579.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$662.40
|
| Rate for Payer: Healthscope Commercial |
$745.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$579.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$621.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$703.80
|
| Rate for Payer: PHP Commercial |
$703.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$538.20
|
| Rate for Payer: Priority Health SBD |
$521.64
|
| Rate for Payer: UMR Bronson Commercial |
$306.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$621.00
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$177.66
|
|
|
Service Code
|
NDC 68180031909
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.73 |
| Max. Negotiated Rate |
$159.89 |
| Rate for Payer: Aetna American Axle |
$115.48
|
| Rate for Payer: Aetna Commercial |
$151.01
|
| Rate for Payer: Aetna Medicare |
$88.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.48
|
| Rate for Payer: BCBS Complete |
$71.06
|
| Rate for Payer: Cash Price |
$142.13
|
| Rate for Payer: Cofinity Commercial |
$124.36
|
| Rate for Payer: Cofinity Commercial |
$152.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.13
|
| Rate for Payer: Healthscope Commercial |
$159.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.01
|
| Rate for Payer: PHP Commercial |
$151.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.48
|
| Rate for Payer: Priority Health SBD |
$111.93
|
| Rate for Payer: UMR Bronson Commercial |
$65.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.24
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$8.28
|
|
|
Service Code
|
NDC 60687031211
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Aetna American Axle |
$5.38
|
| Rate for Payer: Aetna Commercial |
$7.04
|
| Rate for Payer: Aetna Medicare |
$4.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.38
|
| Rate for Payer: BCBS Complete |
$3.31
|
| Rate for Payer: Cash Price |
$6.62
|
| Rate for Payer: Cofinity Commercial |
$5.80
|
| Rate for Payer: Cofinity Commercial |
$7.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.62
|
| Rate for Payer: Healthscope Commercial |
$7.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.04
|
| Rate for Payer: PHP Commercial |
$7.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.38
|
| Rate for Payer: Priority Health SBD |
$5.22
|
| Rate for Payer: UMR Bronson Commercial |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.21
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$177.66
|
|
|
Service Code
|
NDC 68180031909
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.17 |
| Max. Negotiated Rate |
$159.89 |
| Rate for Payer: Aetna American Axle |
$115.48
|
| Rate for Payer: Aetna Commercial |
$151.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.48
|
| Rate for Payer: Cash Price |
$142.13
|
| Rate for Payer: Cofinity Commercial |
$124.36
|
| Rate for Payer: Cofinity Commercial |
$152.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.13
|
| Rate for Payer: Healthscope Commercial |
$159.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.01
|
| Rate for Payer: PHP Commercial |
$151.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.48
|
| Rate for Payer: Priority Health SBD |
$111.93
|
| Rate for Payer: UMR Bronson Commercial |
$78.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.24
|
|
