|
BUSPIRONE 15 MG TABLET
|
Facility
|
IP
|
$202.10
|
|
|
Service Code
|
NDC 68382018201
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.92 |
| Max. Negotiated Rate |
$181.89 |
| Rate for Payer: Aetna American Axle |
$131.37
|
| Rate for Payer: Aetna Commercial |
$171.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.37
|
| 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 |
$88.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.57
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
IP
|
$76.14
|
|
|
Service Code
|
NDC 16729020312
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$68.53 |
| Rate for Payer: Aetna American Axle |
$49.49
|
| Rate for Payer: Aetna Commercial |
$64.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.49
|
| Rate for Payer: Cash Price |
$60.91
|
| Rate for Payer: Cofinity Commercial |
$53.30
|
| Rate for Payer: Cofinity Commercial |
$65.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.91
|
| Rate for Payer: Healthscope Commercial |
$68.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.72
|
| Rate for Payer: PHP Commercial |
$64.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.49
|
| Rate for Payer: Priority Health SBD |
$47.97
|
| Rate for Payer: UMR Bronson Commercial |
$33.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.10
|
|
|
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
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
NDC 00904689961
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.84 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Aetna American Axle |
$234.65
|
| Rate for Payer: Aetna Commercial |
$306.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.65
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$252.70
|
| Rate for Payer: Cofinity Commercial |
$310.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$252.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.80
|
| Rate for Payer: Healthscope Commercial |
$324.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$252.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.85
|
| Rate for Payer: PHP Commercial |
$306.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.65
|
| Rate for Payer: Priority Health SBD |
$227.43
|
| Rate for Payer: UMR Bronson Commercial |
$158.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.75
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
OP
|
$122.20
|
|
|
Service Code
|
NDC 00093100301
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.21 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna American Axle |
$79.43
|
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna Medicare |
$61.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.43
|
| Rate for Payer: BCBS Complete |
$48.88
|
| 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 |
$45.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
OP
|
$76.14
|
|
|
Service Code
|
NDC 16729020312
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.17 |
| Max. Negotiated Rate |
$68.53 |
| Rate for Payer: Aetna American Axle |
$49.49
|
| Rate for Payer: Aetna Commercial |
$64.72
|
| Rate for Payer: Aetna Medicare |
$38.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.49
|
| Rate for Payer: BCBS Complete |
$30.46
|
| Rate for Payer: Cash Price |
$60.91
|
| Rate for Payer: Cofinity Commercial |
$53.30
|
| Rate for Payer: Cofinity Commercial |
$65.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.91
|
| Rate for Payer: Healthscope Commercial |
$68.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.72
|
| Rate for Payer: PHP Commercial |
$64.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.49
|
| Rate for Payer: Priority Health SBD |
$47.97
|
| Rate for Payer: UMR Bronson Commercial |
$28.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.10
|
|
|
BUSPIRONE 30 MG TABLET
|
Facility
|
OP
|
$431.04
|
|
|
Service Code
|
NDC 51079099420
|
| Hospital Charge Code |
27046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.48 |
| Max. Negotiated Rate |
$387.94 |
| Rate for Payer: Aetna American Axle |
$280.18
|
| Rate for Payer: Aetna Commercial |
$366.38
|
| Rate for Payer: Aetna Medicare |
$215.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.18
|
| Rate for Payer: BCBS Complete |
$172.42
|
| Rate for Payer: Cash Price |
$344.83
|
| Rate for Payer: Cofinity Commercial |
$301.73
|
| Rate for Payer: Cofinity Commercial |
$370.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.83
|
| Rate for Payer: Healthscope Commercial |
$387.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.38
|
| Rate for Payer: PHP Commercial |
$366.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.18
|
| Rate for Payer: Priority Health SBD |
$271.56
|
| Rate for Payer: UMR Bronson Commercial |
$159.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.28
|
|
|
BUSPIRONE 30 MG TABLET
|
Facility
|
IP
|
$253.16
|
|
|
Service Code
|
NDC 00093520006
|
| Hospital Charge Code |
27046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.39 |
| Max. Negotiated Rate |
$227.84 |
| Rate for Payer: Aetna American Axle |
$164.55
|
| Rate for Payer: Aetna Commercial |
$215.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.55
|
| Rate for Payer: Cash Price |
$202.53
|
| Rate for Payer: Cofinity Commercial |
$177.21
|
| Rate for Payer: Cofinity Commercial |
$217.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.53
|
| Rate for Payer: Healthscope Commercial |
$227.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.19
|
| Rate for Payer: PHP Commercial |
$215.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.55
|
| Rate for Payer: Priority Health SBD |
$159.49
|
| Rate for Payer: UMR Bronson Commercial |
$111.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.87
|
|
|
BUSPIRONE 30 MG TABLET
|
Facility
|
IP
|
$176.13
|
|
|
Service Code
|
NDC 68382018314
|
| Hospital Charge Code |
27046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.50 |
| Max. Negotiated Rate |
$158.52 |
| Rate for Payer: Aetna American Axle |
$114.48
|
| Rate for Payer: Aetna Commercial |
$149.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.48
|
| Rate for Payer: Cash Price |
$140.90
|
| Rate for Payer: Cofinity Commercial |
$123.29
|
| Rate for Payer: Cofinity Commercial |
$151.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.90
|
| Rate for Payer: Healthscope Commercial |
$158.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.71
|
| Rate for Payer: PHP Commercial |
$149.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.48
|
| Rate for Payer: Priority Health SBD |
$110.96
|
| Rate for Payer: UMR Bronson Commercial |
$77.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.10
|
|
|
BUSPIRONE 30 MG TABLET
|
Facility
|
OP
|
$253.16
|
|
|
Service Code
|
NDC 00093520006
|
| Hospital Charge Code |
27046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.67 |
| Max. Negotiated Rate |
$227.84 |
| Rate for Payer: Aetna American Axle |
$164.55
|
| Rate for Payer: Aetna Commercial |
$215.19
|
| Rate for Payer: Aetna Medicare |
$126.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.55
|
| Rate for Payer: BCBS Complete |
$101.26
|
| Rate for Payer: Cash Price |
$202.53
|
| Rate for Payer: Cofinity Commercial |
$177.21
|
| Rate for Payer: Cofinity Commercial |
$217.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$177.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.53
|
| Rate for Payer: Healthscope Commercial |
$227.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$189.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$215.19
|
| Rate for Payer: PHP Commercial |
$215.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.55
|
| Rate for Payer: Priority Health SBD |
$159.49
|
| Rate for Payer: UMR Bronson Commercial |
$93.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.87
|
|
|
BUSPIRONE 30 MG TABLET
|
Facility
|
OP
|
$132.81
|
|
|
Service Code
|
NDC 24689093306
|
| Hospital Charge Code |
27046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$119.53 |
| Rate for Payer: Aetna American Axle |
$86.33
|
| Rate for Payer: Aetna Commercial |
$112.89
|
| Rate for Payer: Aetna Medicare |
$66.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.33
|
| Rate for Payer: BCBS Complete |
$53.12
|
| Rate for Payer: Cash Price |
$106.25
|
| Rate for Payer: Cofinity Commercial |
$114.22
|
| Rate for Payer: Cofinity Commercial |
$92.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.25
|
| Rate for Payer: Healthscope Commercial |
$119.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.89
|
| Rate for Payer: PHP Commercial |
$112.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.33
|
| Rate for Payer: Priority Health SBD |
$83.67
|
| Rate for Payer: UMR Bronson Commercial |
$49.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.61
|
|
|
BUSPIRONE 30 MG TABLET
|
Facility
|
OP
|
$4.32
|
|
|
Service Code
|
NDC 51079099401
|
| Hospital Charge Code |
27046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna American Axle |
$2.81
|
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Aetna Medicare |
$2.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.81
|
| Rate for Payer: BCBS Complete |
$1.73
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.67
|
| Rate for Payer: PHP Commercial |
$3.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health SBD |
$2.72
|
| Rate for Payer: UMR Bronson Commercial |
$1.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.24
|
|
|
BUSPIRONE 30 MG TABLET
|
Facility
|
IP
|
$132.81
|
|
|
Service Code
|
NDC 24689093306
|
| Hospital Charge Code |
27046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.44 |
| Max. Negotiated Rate |
$119.53 |
| Rate for Payer: Aetna American Axle |
$86.33
|
| Rate for Payer: Aetna Commercial |
$112.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$86.33
|
| Rate for Payer: Cash Price |
$106.25
|
| Rate for Payer: Cofinity Commercial |
$114.22
|
| Rate for Payer: Cofinity Commercial |
$92.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$92.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$106.25
|
| Rate for Payer: Healthscope Commercial |
$119.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$92.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$99.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.89
|
| Rate for Payer: PHP Commercial |
$112.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.33
|
| Rate for Payer: Priority Health SBD |
$83.67
|
| Rate for Payer: UMR Bronson Commercial |
$58.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$99.61
|
|
|
BUSPIRONE 30 MG TABLET
|
Facility
|
IP
|
$4.32
|
|
|
Service Code
|
NDC 51079099401
|
| Hospital Charge Code |
27046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$3.89 |
| Rate for Payer: Aetna American Axle |
$2.81
|
| Rate for Payer: Aetna Commercial |
$3.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.81
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Commercial |
$3.02
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.67
|
| Rate for Payer: PHP Commercial |
$3.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.81
|
| Rate for Payer: Priority Health SBD |
$2.72
|
| Rate for Payer: UMR Bronson Commercial |
$1.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.24
|
|
|
BUSPIRONE 30 MG TABLET
|
Facility
|
OP
|
$176.13
|
|
|
Service Code
|
NDC 68382018314
|
| Hospital Charge Code |
27046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$158.52 |
| Rate for Payer: Aetna American Axle |
$114.48
|
| Rate for Payer: Aetna Commercial |
$149.71
|
| Rate for Payer: Aetna Medicare |
$88.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.48
|
| Rate for Payer: BCBS Complete |
$70.45
|
| Rate for Payer: Cash Price |
$140.90
|
| Rate for Payer: Cofinity Commercial |
$123.29
|
| Rate for Payer: Cofinity Commercial |
$151.47
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.90
|
| Rate for Payer: Healthscope Commercial |
$158.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.71
|
| Rate for Payer: PHP Commercial |
$149.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.48
|
| Rate for Payer: Priority Health SBD |
$110.96
|
| Rate for Payer: UMR Bronson Commercial |
$65.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.10
|
|
|
BUSPIRONE 30 MG TABLET
|
Facility
|
IP
|
$431.04
|
|
|
Service Code
|
NDC 51079099420
|
| Hospital Charge Code |
27046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.66 |
| Max. Negotiated Rate |
$387.94 |
| Rate for Payer: Aetna American Axle |
$280.18
|
| Rate for Payer: Aetna Commercial |
$366.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.18
|
| Rate for Payer: Cash Price |
$344.83
|
| Rate for Payer: Cofinity Commercial |
$301.73
|
| Rate for Payer: Cofinity Commercial |
$370.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.83
|
| Rate for Payer: Healthscope Commercial |
$387.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.38
|
| Rate for Payer: PHP Commercial |
$366.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.18
|
| Rate for Payer: Priority Health SBD |
$271.56
|
| Rate for Payer: UMR Bronson Commercial |
$189.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.28
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
OP
|
$119.85
|
|
|
Service Code
|
NDC 00093005301
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna American Axle |
$77.90
|
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna Medicare |
$59.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: BCBS Complete |
$47.94
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Cofinity Commercial |
$83.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.87
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.90
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UMR Bronson Commercial |
$44.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.89
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
OP
|
$105.75
|
|
|
Service Code
|
NDC 59651038901
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.13 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna American Axle |
$68.74
|
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna Medicare |
$52.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: BCBS Complete |
$42.30
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$74.03
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UMR Bronson Commercial |
$39.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
IP
|
$65.80
|
|
|
Service Code
|
NDC 16729020001
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.95 |
| Max. Negotiated Rate |
$59.22 |
| Rate for Payer: Aetna American Axle |
$42.77
|
| Rate for Payer: Aetna Commercial |
$55.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.77
|
| Rate for Payer: Cash Price |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$56.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.64
|
| Rate for Payer: Healthscope Commercial |
$59.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.93
|
| Rate for Payer: PHP Commercial |
$55.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.77
|
| Rate for Payer: Priority Health SBD |
$41.45
|
| Rate for Payer: UMR Bronson Commercial |
$28.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.35
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
OP
|
$65.80
|
|
|
Service Code
|
NDC 16729020001
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.35 |
| Max. Negotiated Rate |
$59.22 |
| Rate for Payer: Aetna American Axle |
$42.77
|
| Rate for Payer: Aetna Commercial |
$55.93
|
| Rate for Payer: Aetna Medicare |
$32.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.77
|
| Rate for Payer: BCBS Complete |
$26.32
|
| Rate for Payer: Cash Price |
$52.64
|
| Rate for Payer: Cofinity Commercial |
$46.06
|
| Rate for Payer: Cofinity Commercial |
$56.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$46.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.64
|
| Rate for Payer: Healthscope Commercial |
$59.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$46.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$49.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$55.93
|
| Rate for Payer: PHP Commercial |
$55.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.77
|
| Rate for Payer: Priority Health SBD |
$41.45
|
| Rate for Payer: UMR Bronson Commercial |
$24.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$49.35
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
IP
|
$105.75
|
|
|
Service Code
|
NDC 59651038901
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.53 |
| Max. Negotiated Rate |
$95.17 |
| Rate for Payer: Aetna American Axle |
$68.74
|
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$74.03
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.17
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.74
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UMR Bronson Commercial |
$46.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
IP
|
$119.85
|
|
|
Service Code
|
NDC 00093005301
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.73 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna American Axle |
$77.90
|
| Rate for Payer: Aetna Commercial |
$101.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.90
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cofinity Commercial |
$103.07
|
| Rate for Payer: Cofinity Commercial |
$83.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$83.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.88
|
| Rate for Payer: Healthscope Commercial |
$107.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$83.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$89.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$101.87
|
| Rate for Payer: PHP Commercial |
$101.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.90
|
| Rate for Payer: Priority Health SBD |
$75.51
|
| Rate for Payer: UMR Bronson Commercial |
$52.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$89.89
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
OP
|
$225.15
|
|
|
Service Code
|
NDC 64380078706
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.31 |
| Max. Negotiated Rate |
$202.63 |
| Rate for Payer: Aetna American Axle |
$146.35
|
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna Medicare |
$112.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.35
|
| Rate for Payer: BCBS Complete |
$90.06
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.35
|
| Rate for Payer: Priority Health SBD |
$141.84
|
| Rate for Payer: UMR Bronson Commercial |
$83.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
OP
|
$225.15
|
|
|
Service Code
|
NDC 16729020101
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.31 |
| Max. Negotiated Rate |
$202.63 |
| Rate for Payer: Aetna American Axle |
$146.35
|
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna Medicare |
$112.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.35
|
| Rate for Payer: BCBS Complete |
$90.06
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.35
|
| Rate for Payer: Priority Health SBD |
$141.84
|
| Rate for Payer: UMR Bronson Commercial |
$83.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
OP
|
$368.95
|
|
|
Service Code
|
NDC 72888006301
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.51 |
| Max. Negotiated Rate |
$332.06 |
| Rate for Payer: Aetna American Axle |
$239.82
|
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: Aetna Medicare |
$184.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.82
|
| Rate for Payer: BCBS Complete |
$147.58
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Commercial |
$258.26
|
| Rate for Payer: Cofinity Commercial |
$317.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$258.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$258.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: PHP Commercial |
$313.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$239.82
|
| Rate for Payer: Priority Health SBD |
$232.44
|
| Rate for Payer: UMR Bronson Commercial |
$136.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.71
|
|
