|
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 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 XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$8.28
|
|
|
Service Code
|
NDC 60687031211
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Aetna American Axle |
$5.38
|
| Rate for Payer: Aetna Commercial |
$7.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.38
|
| 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 |
$3.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.21
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$140.26
|
|
|
Service Code
|
NDC 00904708404
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.71 |
| Max. Negotiated Rate |
$126.23 |
| Rate for Payer: Aetna American Axle |
$91.17
|
| Rate for Payer: Aetna Commercial |
$119.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.17
|
| 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 |
$105.19
|
| 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 |
$61.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.19
|
|
|
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
|
$112.86
|
|
|
Service Code
|
NDC 43598065530
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$101.57 |
| Rate for Payer: Aetna American Axle |
$73.36
|
| Rate for Payer: Aetna Commercial |
$95.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.36
|
| 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 |
$49.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.64
|
|
|
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 |
$133.25
|
| 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 |
$133.25
|
|
|
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 |
$133.25
|
| 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 |
$133.25
|
|
|
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 |
$71.39
|
| 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 |
$71.39
|
|
|
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
|
$95.18
|
|
|
Service Code
|
NDC 68180031906
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.22 |
| Max. Negotiated Rate |
$85.66 |
| Rate for Payer: Aetna American Axle |
$61.87
|
| Rate for Payer: Aetna Commercial |
$80.90
|
| Rate for Payer: Aetna Medicare |
$47.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.87
|
| Rate for Payer: BCBS Complete |
$38.07
|
| 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 |
$71.39
|
| 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 |
$35.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.39
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$134.21
|
|
|
Service Code
|
NDC 70436001004
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$120.79 |
| Rate for Payer: Aetna American Axle |
$87.24
|
| Rate for Payer: Aetna Commercial |
$114.08
|
| Rate for Payer: Aetna Medicare |
$67.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.24
|
| Rate for Payer: BCBS Complete |
$53.68
|
| 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 |
$49.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.66
|
|
|
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
|
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 |
$105.19
|
| 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 |
$105.19
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
IP
|
$481.75
|
|
|
Service Code
|
NDC 16729020216
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.97 |
| Max. Negotiated Rate |
$433.57 |
| Rate for Payer: Aetna American Axle |
$313.14
|
| Rate for Payer: Aetna Commercial |
$409.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.14
|
| Rate for Payer: Cash Price |
$385.40
|
| Rate for Payer: Cofinity Commercial |
$337.23
|
| Rate for Payer: Cofinity Commercial |
$414.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.40
|
| Rate for Payer: Healthscope Commercial |
$433.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.49
|
| Rate for Payer: PHP Commercial |
$409.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: Priority Health SBD |
$303.50
|
| Rate for Payer: UMR Bronson Commercial |
$211.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.31
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
OP
|
$96.35
|
|
|
Service Code
|
NDC 16729020201
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.65 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Aetna American Axle |
$62.63
|
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna Medicare |
$48.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.63
|
| Rate for Payer: BCBS Complete |
$38.54
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Commercial |
$67.44
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Healthscope Commercial |
$86.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.63
|
| Rate for Payer: Priority Health SBD |
$60.70
|
| Rate for Payer: UMR Bronson Commercial |
$35.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.26
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
IP
|
$124.55
|
|
|
Service Code
|
NDC 23155002401
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$112.09 |
| Rate for Payer: Aetna American Axle |
$80.96
|
| Rate for Payer: Aetna Commercial |
$105.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.96
|
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Cofinity Commercial |
$107.11
|
| Rate for Payer: Cofinity Commercial |
$87.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$112.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.87
|
| Rate for Payer: PHP Commercial |
$105.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.96
|
| Rate for Payer: Priority Health SBD |
$78.47
|
| Rate for Payer: UMR Bronson Commercial |
$54.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.41
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
OP
|
$124.55
|
|
|
Service Code
|
NDC 23155002401
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.08 |
| Max. Negotiated Rate |
$112.09 |
| Rate for Payer: Aetna American Axle |
$80.96
|
| Rate for Payer: Aetna Commercial |
$105.87
|
| Rate for Payer: Aetna Medicare |
$62.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.96
|
| Rate for Payer: BCBS Complete |
$49.82
|
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Cofinity Commercial |
$107.11
|
| Rate for Payer: Cofinity Commercial |
$87.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$112.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.87
|
| Rate for Payer: PHP Commercial |
$105.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.96
|
| Rate for Payer: Priority Health SBD |
$78.47
|
| Rate for Payer: UMR Bronson Commercial |
$46.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.41
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
IP
|
$96.35
|
|
|
Service Code
|
NDC 16729020201
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.39 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Aetna American Axle |
$62.63
|
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.63
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Commercial |
$67.44
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Healthscope Commercial |
$86.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.63
|
| Rate for Payer: Priority Health SBD |
$60.70
|
| Rate for Payer: UMR Bronson Commercial |
$42.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.26
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
OP
|
$481.75
|
|
|
Service Code
|
NDC 16729020216
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.25 |
| Max. Negotiated Rate |
$433.57 |
| Rate for Payer: Aetna American Axle |
$313.14
|
| Rate for Payer: Aetna Commercial |
$409.49
|
| Rate for Payer: Aetna Medicare |
$240.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.14
|
| Rate for Payer: BCBS Complete |
$192.70
|
| Rate for Payer: Cash Price |
$385.40
|
| Rate for Payer: Cofinity Commercial |
$337.23
|
| Rate for Payer: Cofinity Commercial |
$414.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.40
|
| Rate for Payer: Healthscope Commercial |
$433.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.49
|
| Rate for Payer: PHP Commercial |
$409.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.14
|
| Rate for Payer: Priority Health SBD |
$303.50
|
| Rate for Payer: UMR Bronson Commercial |
$178.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.31
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
OP
|
$202.10
|
|
|
Service Code
|
NDC 68382018201
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.78 |
| Max. Negotiated Rate |
$181.89 |
| Rate for Payer: Aetna American Axle |
$131.37
|
| Rate for Payer: Aetna Commercial |
$171.78
|
| Rate for Payer: Aetna Medicare |
$101.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.37
|
| Rate for Payer: BCBS Complete |
$80.84
|
| Rate for Payer: Cash Price |
$161.68
|
| Rate for Payer: Cofinity Commercial |
$141.47
|
| Rate for Payer: Cofinity Commercial |
$173.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.68
|
| Rate for Payer: Healthscope Commercial |
$181.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$171.78
|
| Rate for Payer: PHP Commercial |
$171.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.37
|
| Rate for Payer: Priority Health SBD |
$127.32
|
| Rate for Payer: UMR Bronson Commercial |
$74.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.57
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
IP
|
$122.20
|
|
|
Service Code
|
NDC 00093100301
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.77 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna American Axle |
$79.43
|
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.43
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Cofinity Commercial |
$85.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.43
|
| Rate for Payer: Priority Health SBD |
$76.99
|
| Rate for Payer: UMR Bronson Commercial |
$53.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
