|
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
|
$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 |
$105.20
|
| 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 |
$61.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.20
|
|
|
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 |
$71.38
|
| 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 |
$35.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.38
|
|
|
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
|
|
|
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
|
IP
|
$124.55
|
|
|
Service Code
|
NDC 23155002401
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$112.10 |
| 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 |
$87.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$112.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.18
|
| 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
|
$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 |
$48.18
|
| 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
|
OP
|
$124.55
|
|
|
Service Code
|
NDC 23155002401
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.08 |
| Max. Negotiated Rate |
$112.10 |
| Rate for Payer: Aetna American Axle |
$80.96
|
| Rate for Payer: Aetna Commercial |
$105.87
|
| Rate for Payer: Aetna Medicare |
$62.28
|
| 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 |
$87.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$112.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.18
|
| 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
|
$481.75
|
|
|
Service Code
|
NDC 16729020216
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.97 |
| Max. Negotiated Rate |
$433.58 |
| 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 |
$337.22
|
| Rate for Payer: Cofinity Commercial |
$414.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.40
|
| Rate for Payer: Healthscope Commercial |
$433.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.22
|
| 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
|
$481.75
|
|
|
Service Code
|
NDC 16729020216
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.25 |
| Max. Negotiated Rate |
$433.58 |
| 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 |
$337.22
|
| Rate for Payer: Cofinity Commercial |
$414.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$337.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.40
|
| Rate for Payer: Healthscope Commercial |
$433.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.22
|
| 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
|
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 |
$131.36
|
| Rate for Payer: Aetna Commercial |
$171.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.36
|
| 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 |
$151.58
|
| 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 |
$131.36
|
| 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 |
$151.58
|
|
|
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
|
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
|
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
|
$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 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 |
$131.36
|
| Rate for Payer: Aetna Commercial |
$171.78
|
| Rate for Payer: Aetna Medicare |
$101.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.36
|
| 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 |
$151.58
|
| 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 |
$131.36
|
| 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 |
$151.58
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
NDC 00904689961
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.57 |
| Max. Negotiated Rate |
$324.90 |
| Rate for Payer: Aetna American Axle |
$234.65
|
| Rate for Payer: Aetna Commercial |
$306.85
|
| Rate for Payer: Aetna Medicare |
$180.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$234.65
|
| Rate for Payer: BCBS Complete |
$144.40
|
| 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 |
$133.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.75
|
|
|
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 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
|
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 |
$66.40
|
| 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
|
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 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
|
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: 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
|
| 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
|
|
|
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
|
|
