|
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
|
IP
|
$368.95
|
|
|
Service Code
|
NDC 72888006301
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.34 |
| Max. Negotiated Rate |
$332.06 |
| Rate for Payer: Aetna American Axle |
$239.82
|
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.82
|
| 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 |
$162.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.71
|
|
|
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
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$735.70
|
|
|
Service Code
|
NDC 00603254421
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$323.71 |
| Max. Negotiated Rate |
$662.13 |
| Rate for Payer: Aetna American Axle |
$478.20
|
| Rate for Payer: Aetna Commercial |
$625.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.20
|
| Rate for Payer: Cash Price |
$588.56
|
| Rate for Payer: Cofinity Commercial |
$514.99
|
| Rate for Payer: Cofinity Commercial |
$632.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$514.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.56
|
| Rate for Payer: Healthscope Commercial |
$662.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$514.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.35
|
| Rate for Payer: PHP Commercial |
$625.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.20
|
| Rate for Payer: Priority Health SBD |
$463.49
|
| Rate for Payer: UMR Bronson Commercial |
$323.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.77
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$434.70
|
|
|
Service Code
|
NDC 00591336901
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.84 |
| Max. Negotiated Rate |
$391.23 |
| Rate for Payer: Aetna American Axle |
$282.56
|
| Rate for Payer: Aetna Commercial |
$369.50
|
| Rate for Payer: Aetna Medicare |
$217.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.56
|
| Rate for Payer: BCBS Complete |
$173.88
|
| Rate for Payer: Cash Price |
$347.76
|
| Rate for Payer: Cofinity Commercial |
$304.29
|
| Rate for Payer: Cofinity Commercial |
$373.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$304.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.76
|
| Rate for Payer: Healthscope Commercial |
$391.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$326.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.50
|
| Rate for Payer: PHP Commercial |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.56
|
| Rate for Payer: Priority Health SBD |
$273.86
|
| Rate for Payer: UMR Bronson Commercial |
$160.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$326.02
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$306.25
|
|
|
Service Code
|
NDC 70010014901
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.31 |
| Max. Negotiated Rate |
$275.62 |
| Rate for Payer: Aetna American Axle |
$199.06
|
| Rate for Payer: Aetna Commercial |
$260.31
|
| Rate for Payer: Aetna Medicare |
$153.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.06
|
| Rate for Payer: BCBS Complete |
$122.50
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cofinity Commercial |
$214.38
|
| Rate for Payer: Cofinity Commercial |
$263.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.00
|
| Rate for Payer: Healthscope Commercial |
$275.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.31
|
| Rate for Payer: PHP Commercial |
$260.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.06
|
| Rate for Payer: Priority Health SBD |
$192.94
|
| Rate for Payer: UMR Bronson Commercial |
$113.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.69
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$10.65
|
|
|
Service Code
|
NDC 68084039611
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$9.59 |
| Rate for Payer: Aetna American Axle |
$6.92
|
| Rate for Payer: Aetna Commercial |
$9.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.92
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cofinity Commercial |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$9.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.52
|
| Rate for Payer: Healthscope Commercial |
$9.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.05
|
| Rate for Payer: PHP Commercial |
$9.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.92
|
| Rate for Payer: Priority Health SBD |
$6.71
|
| Rate for Payer: UMR Bronson Commercial |
$4.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.99
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
NDC 46672005310
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna American Axle |
$95.55
|
| Rate for Payer: Aetna Commercial |
$124.95
|
| Rate for Payer: Aetna Medicare |
$73.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.55
|
| Rate for Payer: BCBS Complete |
$58.80
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Cofinity Commercial |
$126.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.60
|
| Rate for Payer: Healthscope Commercial |
$132.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.95
|
| Rate for Payer: PHP Commercial |
$124.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.55
|
| Rate for Payer: Priority Health SBD |
$92.61
|
| Rate for Payer: UMR Bronson Commercial |
$54.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.25
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
NDC 46672005310
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna American Axle |
$95.55
|
| Rate for Payer: Aetna Commercial |
$124.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.55
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$102.90
|
| Rate for Payer: Cofinity Commercial |
$126.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$102.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.60
|
| Rate for Payer: Healthscope Commercial |
$132.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.95
|
| Rate for Payer: PHP Commercial |
$124.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.55
|
| Rate for Payer: Priority Health SBD |
$92.61
|
| Rate for Payer: UMR Bronson Commercial |
$64.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.25
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$3,472.00
|
|
|
Service Code
|
NDC 00603254428
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,284.64 |
| Max. Negotiated Rate |
$3,124.80 |
| Rate for Payer: Aetna American Axle |
$2,256.80
|
| Rate for Payer: Aetna Commercial |
$2,951.20
|
| Rate for Payer: Aetna Medicare |
$1,736.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,256.80
|
| Rate for Payer: BCBS Complete |
$1,388.80
|
| Rate for Payer: Cash Price |
$2,777.60
|
| Rate for Payer: Cofinity Commercial |
$2,430.40
|
| Rate for Payer: Cofinity Commercial |
$2,985.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,430.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,777.60
|
| Rate for Payer: Healthscope Commercial |
$3,124.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,430.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,604.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,951.20
|
| Rate for Payer: PHP Commercial |
$2,951.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.80
|
| Rate for Payer: Priority Health SBD |
$2,187.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,284.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,604.00
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$302.75
|
|
|
Service Code
|
NDC 00527169501
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.21 |
| Max. Negotiated Rate |
$272.48 |
| Rate for Payer: Aetna American Axle |
$196.79
|
| Rate for Payer: Aetna Commercial |
$257.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.79
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: Cofinity Commercial |
$211.93
|
| Rate for Payer: Cofinity Commercial |
$260.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.20
|
| Rate for Payer: Healthscope Commercial |
$272.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.34
|
| Rate for Payer: PHP Commercial |
$257.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.79
|
| Rate for Payer: Priority Health SBD |
$190.73
|
| Rate for Payer: UMR Bronson Commercial |
$133.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.06
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$10.65
|
|
|
Service Code
|
NDC 68084039611
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$9.59 |
| Rate for Payer: Aetna American Axle |
$6.92
|
| Rate for Payer: Aetna Commercial |
$9.05
|
| Rate for Payer: Aetna Medicare |
$5.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.92
|
| Rate for Payer: BCBS Complete |
$4.26
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cofinity Commercial |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$9.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.52
|
| Rate for Payer: Healthscope Commercial |
$9.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.05
|
| Rate for Payer: PHP Commercial |
$9.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.92
|
| Rate for Payer: Priority Health SBD |
$6.71
|
| Rate for Payer: UMR Bronson Commercial |
$3.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.99
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$302.75
|
|
|
Service Code
|
NDC 00527169501
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.02 |
| Max. Negotiated Rate |
$272.48 |
| Rate for Payer: Aetna American Axle |
$196.79
|
| Rate for Payer: Aetna Commercial |
$257.34
|
| Rate for Payer: Aetna Medicare |
$151.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.79
|
| Rate for Payer: BCBS Complete |
$121.10
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: Cofinity Commercial |
$211.93
|
| Rate for Payer: Cofinity Commercial |
$260.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$211.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.20
|
| Rate for Payer: Healthscope Commercial |
$272.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.34
|
| Rate for Payer: PHP Commercial |
$257.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.79
|
| Rate for Payer: Priority Health SBD |
$190.73
|
| Rate for Payer: UMR Bronson Commercial |
$112.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.06
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$3,472.00
|
|
|
Service Code
|
NDC 00603254428
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,527.68 |
| Max. Negotiated Rate |
$3,124.80 |
| Rate for Payer: Aetna American Axle |
$2,256.80
|
| Rate for Payer: Aetna Commercial |
$2,951.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,256.80
|
| Rate for Payer: Cash Price |
$2,777.60
|
| Rate for Payer: Cofinity Commercial |
$2,430.40
|
| Rate for Payer: Cofinity Commercial |
$2,985.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,430.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,777.60
|
| Rate for Payer: Healthscope Commercial |
$3,124.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,430.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,604.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,951.20
|
| Rate for Payer: PHP Commercial |
$2,951.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,256.80
|
| Rate for Payer: Priority Health SBD |
$2,187.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,527.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,604.00
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$735.70
|
|
|
Service Code
|
NDC 00603254421
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$272.21 |
| Max. Negotiated Rate |
$662.13 |
| Rate for Payer: Aetna American Axle |
$478.20
|
| Rate for Payer: Aetna Commercial |
$625.35
|
| Rate for Payer: Aetna Medicare |
$367.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.20
|
| Rate for Payer: BCBS Complete |
$294.28
|
| Rate for Payer: Cash Price |
$588.56
|
| Rate for Payer: Cofinity Commercial |
$514.99
|
| Rate for Payer: Cofinity Commercial |
$632.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$514.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.56
|
| Rate for Payer: Healthscope Commercial |
$662.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$514.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.35
|
| Rate for Payer: PHP Commercial |
$625.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.20
|
| Rate for Payer: Priority Health SBD |
$463.49
|
| Rate for Payer: UMR Bronson Commercial |
$272.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.77
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$306.25
|
|
|
Service Code
|
NDC 70010014901
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.75 |
| Max. Negotiated Rate |
$275.62 |
| Rate for Payer: Aetna American Axle |
$199.06
|
| Rate for Payer: Aetna Commercial |
$260.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.06
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cofinity Commercial |
$214.38
|
| Rate for Payer: Cofinity Commercial |
$263.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$214.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.00
|
| Rate for Payer: Healthscope Commercial |
$275.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$214.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.31
|
| Rate for Payer: PHP Commercial |
$260.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.06
|
| Rate for Payer: Priority Health SBD |
$192.94
|
| Rate for Payer: UMR Bronson Commercial |
$134.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.69
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$434.70
|
|
|
Service Code
|
NDC 00591336901
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.27 |
| Max. Negotiated Rate |
$391.23 |
| Rate for Payer: Aetna American Axle |
$282.56
|
| Rate for Payer: Aetna Commercial |
$369.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.56
|
| Rate for Payer: Cash Price |
$347.76
|
| Rate for Payer: Cofinity Commercial |
$304.29
|
| Rate for Payer: Cofinity Commercial |
$373.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$304.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.76
|
| Rate for Payer: Healthscope Commercial |
$391.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$326.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.50
|
| Rate for Payer: PHP Commercial |
$369.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.56
|
| Rate for Payer: Priority Health SBD |
$273.86
|
| Rate for Payer: UMR Bronson Commercial |
$191.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$326.02
|
|
|
BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE
|
Facility
|
OP
|
$712.60
|
|
|
Service Code
|
NDC 00527155201
|
| Hospital Charge Code |
8922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$263.66 |
| Max. Negotiated Rate |
$641.34 |
| Rate for Payer: Aetna American Axle |
$463.19
|
| Rate for Payer: Aetna Commercial |
$605.71
|
| Rate for Payer: Aetna Medicare |
$356.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.19
|
| Rate for Payer: BCBS Complete |
$285.04
|
| Rate for Payer: Cash Price |
$570.08
|
| Rate for Payer: Cofinity Commercial |
$498.82
|
| Rate for Payer: Cofinity Commercial |
$612.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$498.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.08
|
| Rate for Payer: Healthscope Commercial |
$641.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$498.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$605.71
|
| Rate for Payer: PHP Commercial |
$605.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$463.19
|
| Rate for Payer: Priority Health SBD |
$448.94
|
| Rate for Payer: UMR Bronson Commercial |
$263.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.45
|
|
|
BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE
|
Facility
|
IP
|
$712.60
|
|
|
Service Code
|
NDC 00591321901
|
| Hospital Charge Code |
8922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$313.54 |
| Max. Negotiated Rate |
$641.34 |
| Rate for Payer: Aetna American Axle |
$463.19
|
| Rate for Payer: Aetna Commercial |
$605.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.19
|
| Rate for Payer: Cash Price |
$570.08
|
| Rate for Payer: Cofinity Commercial |
$498.82
|
| Rate for Payer: Cofinity Commercial |
$612.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$498.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.08
|
| Rate for Payer: Healthscope Commercial |
$641.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$498.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$605.71
|
| Rate for Payer: PHP Commercial |
$605.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$463.19
|
| Rate for Payer: Priority Health SBD |
$448.94
|
| Rate for Payer: UMR Bronson Commercial |
$313.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.45
|
|
|
BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE
|
Facility
|
OP
|
$712.60
|
|
|
Service Code
|
NDC 00591321901
|
| Hospital Charge Code |
8922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$263.66 |
| Max. Negotiated Rate |
$641.34 |
| Rate for Payer: Aetna American Axle |
$463.19
|
| Rate for Payer: Aetna Commercial |
$605.71
|
| Rate for Payer: Aetna Medicare |
$356.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.19
|
| Rate for Payer: BCBS Complete |
$285.04
|
| Rate for Payer: Cash Price |
$570.08
|
| Rate for Payer: Cofinity Commercial |
$498.82
|
| Rate for Payer: Cofinity Commercial |
$612.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$498.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.08
|
| Rate for Payer: Healthscope Commercial |
$641.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$498.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$605.71
|
| Rate for Payer: PHP Commercial |
$605.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$463.19
|
| Rate for Payer: Priority Health SBD |
$448.94
|
| Rate for Payer: UMR Bronson Commercial |
$263.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.45
|
|
|
BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE
|
Facility
|
IP
|
$712.60
|
|
|
Service Code
|
NDC 00527155201
|
| Hospital Charge Code |
8922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$313.54 |
| Max. Negotiated Rate |
$641.34 |
| Rate for Payer: Aetna American Axle |
$463.19
|
| Rate for Payer: Aetna Commercial |
$605.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.19
|
| Rate for Payer: Cash Price |
$570.08
|
| Rate for Payer: Cofinity Commercial |
$498.82
|
| Rate for Payer: Cofinity Commercial |
$612.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$498.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.08
|
| Rate for Payer: Healthscope Commercial |
$641.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$498.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$605.71
|
| Rate for Payer: PHP Commercial |
$605.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$463.19
|
| Rate for Payer: Priority Health SBD |
$448.94
|
| Rate for Payer: UMR Bronson Commercial |
$313.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.45
|
|
|
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOPICAL SPRAY
|
Facility
|
OP
|
$434.49
|
|
|
Service Code
|
NDC 10223020103
|
| Hospital Charge Code |
9328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.76 |
| Max. Negotiated Rate |
$391.04 |
| Rate for Payer: Aetna American Axle |
$282.42
|
| Rate for Payer: Aetna Commercial |
$369.32
|
| Rate for Payer: Aetna Medicare |
$217.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.42
|
| Rate for Payer: BCBS Complete |
$173.80
|
| Rate for Payer: Cash Price |
$347.59
|
| Rate for Payer: Cofinity Commercial |
$304.14
|
| Rate for Payer: Cofinity Commercial |
$373.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$304.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.59
|
| Rate for Payer: Healthscope Commercial |
$391.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.32
|
| Rate for Payer: PHP Commercial |
$369.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.42
|
| Rate for Payer: Priority Health SBD |
$273.73
|
| Rate for Payer: UMR Bronson Commercial |
$160.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.87
|
|
|
BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOPICAL SPRAY
|
Facility
|
IP
|
$434.49
|
|
|
Service Code
|
NDC 10223020103
|
| Hospital Charge Code |
9328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.18 |
| Max. Negotiated Rate |
$391.04 |
| Rate for Payer: Aetna American Axle |
$282.42
|
| Rate for Payer: Aetna Commercial |
$369.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.42
|
| Rate for Payer: Cash Price |
$347.59
|
| Rate for Payer: Cofinity Commercial |
$304.14
|
| Rate for Payer: Cofinity Commercial |
$373.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$304.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.59
|
| Rate for Payer: Healthscope Commercial |
$391.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.32
|
| Rate for Payer: PHP Commercial |
$369.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.42
|
| Rate for Payer: Priority Health SBD |
$273.73
|
| Rate for Payer: UMR Bronson Commercial |
$191.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.87
|
|
|
BUTORPHANOL 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$14.75
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
9333
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Aetna American Axle |
$9.59
|
| Rate for Payer: Aetna American Axle |
$22.97
|
| Rate for Payer: Aetna Commercial |
$12.54
|
| Rate for Payer: Aetna Commercial |
$30.04
|
| Rate for Payer: Aetna Medicare |
$7.38
|
| Rate for Payer: Aetna Medicare |
$17.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.97
|
| Rate for Payer: BCBS Complete |
$14.14
|
| Rate for Payer: BCBS Complete |
$5.90
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Cofinity Commercial |
$12.69
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$30.39
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.27
|
| Rate for Payer: Healthscope Commercial |
$31.81
|
| Rate for Payer: Healthscope Commercial |
$13.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.04
|
| Rate for Payer: PHP Commercial |
$30.04
|
| Rate for Payer: PHP Commercial |
$12.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.97
|
| Rate for Payer: Priority Health SBD |
$22.26
|
| Rate for Payer: Priority Health SBD |
$9.29
|
| Rate for Payer: UMR Bronson Commercial |
$5.46
|
| Rate for Payer: UMR Bronson Commercial |
$13.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.06
|
|
|
BUTORPHANOL 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$14.75
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
9333
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.49 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Aetna American Axle |
$9.59
|
| Rate for Payer: Aetna American Axle |
$22.97
|
| Rate for Payer: Aetna Commercial |
$12.54
|
| Rate for Payer: Aetna Commercial |
$30.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.97
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Cofinity Commercial |
$30.39
|
| Rate for Payer: Cofinity Commercial |
$24.74
|
| Rate for Payer: Cofinity Commercial |
$10.32
|
| Rate for Payer: Cofinity Commercial |
$12.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$24.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.27
|
| Rate for Payer: Healthscope Commercial |
$13.28
|
| Rate for Payer: Healthscope Commercial |
$31.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$24.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.54
|
| Rate for Payer: PHP Commercial |
$30.04
|
| Rate for Payer: PHP Commercial |
$12.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.97
|
| Rate for Payer: Priority Health SBD |
$9.29
|
| Rate for Payer: Priority Health SBD |
$22.26
|
| Rate for Payer: UMR Bronson Commercial |
$6.49
|
| Rate for Payer: UMR Bronson Commercial |
$15.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.50
|
|
