|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$182.93
|
|
|
Service Code
|
NDC 0093-3657-21
|
| Hospital Charge Code |
107661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.49 |
| Max. Negotiated Rate |
$164.64 |
| Rate for Payer: Aetna American Axle |
$118.90
|
| Rate for Payer: Aetna Commercial |
$155.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.90
|
| Rate for Payer: Cash Price |
$146.34
|
| Rate for Payer: Cofinity Commercial |
$128.05
|
| Rate for Payer: Cofinity Commercial |
$157.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.34
|
| Rate for Payer: Healthscope Commercial |
$164.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$128.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$137.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.49
|
| Rate for Payer: PHP Commercial |
$155.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.05
|
| Rate for Payer: Priority Health SBD |
$115.25
|
| Rate for Payer: UMR Bronson Commercial |
$80.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$137.20
|
|
|
BUPRENORPHINE 10 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$731.69
|
|
|
Service Code
|
NDC 0093-3657-40
|
| Hospital Charge Code |
107661
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$321.94 |
| Max. Negotiated Rate |
$658.52 |
| Rate for Payer: Aetna American Axle |
$475.60
|
| Rate for Payer: Aetna Commercial |
$621.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$475.60
|
| Rate for Payer: Cash Price |
$585.35
|
| Rate for Payer: Cofinity Commercial |
$512.18
|
| Rate for Payer: Cofinity Commercial |
$629.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$585.35
|
| Rate for Payer: Healthscope Commercial |
$658.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$512.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$548.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$621.94
|
| Rate for Payer: PHP Commercial |
$621.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$512.18
|
| Rate for Payer: Priority Health SBD |
$460.96
|
| Rate for Payer: UMR Bronson Commercial |
$321.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$548.77
|
|
|
BUPRENORPHINE 20 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$421.04
|
|
|
Service Code
|
NDC 0093-3659-21
|
| Hospital Charge Code |
107662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.26 |
| Max. Negotiated Rate |
$378.94 |
| Rate for Payer: Aetna American Axle |
$273.68
|
| Rate for Payer: Aetna Commercial |
$357.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.68
|
| Rate for Payer: Cash Price |
$336.83
|
| Rate for Payer: Cofinity Commercial |
$294.73
|
| Rate for Payer: Cofinity Commercial |
$362.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.83
|
| Rate for Payer: Healthscope Commercial |
$378.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$357.88
|
| Rate for Payer: PHP Commercial |
$357.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.73
|
| Rate for Payer: Priority Health SBD |
$265.26
|
| Rate for Payer: UMR Bronson Commercial |
$185.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.78
|
|
|
BUPRENORPHINE 20 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$1,684.14
|
|
|
Service Code
|
NDC 0093-3659-40
|
| Hospital Charge Code |
107662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$741.02 |
| Max. Negotiated Rate |
$1,515.73 |
| Rate for Payer: Aetna American Axle |
$1,094.69
|
| Rate for Payer: Aetna Commercial |
$1,431.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,094.69
|
| Rate for Payer: Cash Price |
$1,347.31
|
| Rate for Payer: Cofinity Commercial |
$1,178.90
|
| Rate for Payer: Cofinity Commercial |
$1,448.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,347.31
|
| Rate for Payer: Healthscope Commercial |
$1,515.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,178.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,263.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,431.52
|
| Rate for Payer: PHP Commercial |
$1,431.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,178.90
|
| Rate for Payer: Priority Health SBD |
$1,061.01
|
| Rate for Payer: UMR Bronson Commercial |
$741.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,263.10
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$626.15
|
|
|
Service Code
|
NDC 0904-7009-06
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$275.51 |
| Max. Negotiated Rate |
$563.54 |
| Rate for Payer: Aetna American Axle |
$407.00
|
| Rate for Payer: Aetna Commercial |
$532.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$407.00
|
| Rate for Payer: Cash Price |
$500.92
|
| Rate for Payer: Cofinity Commercial |
$438.30
|
| Rate for Payer: Cofinity Commercial |
$538.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$500.92
|
| Rate for Payer: Healthscope Commercial |
$563.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$438.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$469.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$532.23
|
| Rate for Payer: PHP Commercial |
$532.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.30
|
| Rate for Payer: Priority Health SBD |
$394.47
|
| Rate for Payer: UMR Bronson Commercial |
$275.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$469.61
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$180.81
|
|
|
Service Code
|
NDC 0054-0188-13
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$162.73 |
| Rate for Payer: Aetna American Axle |
$117.53
|
| Rate for Payer: Aetna Commercial |
$153.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.53
|
| Rate for Payer: Cash Price |
$144.65
|
| Rate for Payer: Cofinity Commercial |
$126.57
|
| Rate for Payer: Cofinity Commercial |
$155.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.65
|
| Rate for Payer: Healthscope Commercial |
$162.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.69
|
| Rate for Payer: PHP Commercial |
$153.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.57
|
| Rate for Payer: Priority Health SBD |
$113.91
|
| Rate for Payer: UMR Bronson Commercial |
$79.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.61
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$217.14
|
|
|
Service Code
|
NDC 65162-416-03
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.54 |
| Max. Negotiated Rate |
$195.43 |
| Rate for Payer: Aetna American Axle |
$141.14
|
| Rate for Payer: Aetna Commercial |
$184.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.14
|
| Rate for Payer: Cash Price |
$173.71
|
| Rate for Payer: Cofinity Commercial |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$186.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$173.71
|
| Rate for Payer: Healthscope Commercial |
$195.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$152.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$184.57
|
| Rate for Payer: PHP Commercial |
$184.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.00
|
| Rate for Payer: Priority Health SBD |
$136.80
|
| Rate for Payer: UMR Bronson Commercial |
$95.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.86
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$650.08
|
|
|
Service Code
|
NDC 69238-1202-2
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.04 |
| Max. Negotiated Rate |
$585.07 |
| Rate for Payer: Aetna American Axle |
$422.55
|
| Rate for Payer: Aetna Commercial |
$552.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.55
|
| Rate for Payer: Cash Price |
$520.06
|
| Rate for Payer: Cofinity Commercial |
$455.06
|
| Rate for Payer: Cofinity Commercial |
$559.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.06
|
| Rate for Payer: Healthscope Commercial |
$585.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$455.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$487.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.57
|
| Rate for Payer: PHP Commercial |
$552.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.06
|
| Rate for Payer: Priority Health SBD |
$409.55
|
| Rate for Payer: UMR Bronson Commercial |
$286.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$487.56
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$986.88
|
|
|
Service Code
|
NDC 59011-750-04
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$434.23 |
| Max. Negotiated Rate |
$888.19 |
| Rate for Payer: Aetna American Axle |
$641.47
|
| Rate for Payer: Aetna Commercial |
$838.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$641.47
|
| Rate for Payer: Cash Price |
$789.50
|
| Rate for Payer: Cofinity Commercial |
$690.82
|
| Rate for Payer: Cofinity Commercial |
$848.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$789.50
|
| Rate for Payer: Healthscope Commercial |
$888.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$690.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$740.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$838.85
|
| Rate for Payer: PHP Commercial |
$838.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$690.82
|
| Rate for Payer: Priority Health SBD |
$621.73
|
| Rate for Payer: UMR Bronson Commercial |
$434.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$740.16
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$112.98
|
|
|
Service Code
|
NDC 0093-3656-21
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.71 |
| Max. Negotiated Rate |
$101.68 |
| Rate for Payer: Aetna American Axle |
$73.44
|
| Rate for Payer: Aetna Commercial |
$96.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.44
|
| Rate for Payer: Cash Price |
$90.38
|
| Rate for Payer: Cofinity Commercial |
$79.09
|
| Rate for Payer: Cofinity Commercial |
$97.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.38
|
| Rate for Payer: Healthscope Commercial |
$101.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$96.03
|
| Rate for Payer: PHP Commercial |
$96.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.09
|
| Rate for Payer: Priority Health SBD |
$71.18
|
| Rate for Payer: UMR Bronson Commercial |
$49.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.74
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$451.91
|
|
|
Service Code
|
NDC 0093-3656-40
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.84 |
| Max. Negotiated Rate |
$406.72 |
| Rate for Payer: Aetna American Axle |
$293.74
|
| Rate for Payer: Aetna Commercial |
$384.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.74
|
| Rate for Payer: Cash Price |
$361.53
|
| Rate for Payer: Cofinity Commercial |
$316.34
|
| Rate for Payer: Cofinity Commercial |
$388.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.53
|
| Rate for Payer: Healthscope Commercial |
$406.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$338.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$384.12
|
| Rate for Payer: PHP Commercial |
$384.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.34
|
| Rate for Payer: Priority Health SBD |
$284.70
|
| Rate for Payer: UMR Bronson Commercial |
$198.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$338.93
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$10.13
|
|
|
Service Code
|
NDC 60687-637-11
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Aetna American Axle |
$6.58
|
| Rate for Payer: Aetna Commercial |
$8.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.58
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cofinity Commercial |
$7.09
|
| Rate for Payer: Cofinity Commercial |
$8.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.10
|
| Rate for Payer: Healthscope Commercial |
$9.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.61
|
| Rate for Payer: PHP Commercial |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.09
|
| Rate for Payer: Priority Health SBD |
$6.38
|
| Rate for Payer: UMR Bronson Commercial |
$4.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.60
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$263.55
|
|
|
Service Code
|
NDC 0054-0189-13
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.96 |
| Max. Negotiated Rate |
$237.20 |
| Rate for Payer: Aetna American Axle |
$171.31
|
| Rate for Payer: Aetna Commercial |
$224.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.31
|
| Rate for Payer: Cash Price |
$210.84
|
| Rate for Payer: Cofinity Commercial |
$184.48
|
| Rate for Payer: Cofinity Commercial |
$226.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$210.84
|
| Rate for Payer: Healthscope Commercial |
$237.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$184.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$197.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$224.02
|
| Rate for Payer: PHP Commercial |
$224.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.48
|
| Rate for Payer: Priority Health SBD |
$166.04
|
| Rate for Payer: UMR Bronson Commercial |
$115.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$197.66
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$506.22
|
|
|
Service Code
|
NDC 60687-637-65
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.74 |
| Max. Negotiated Rate |
$455.60 |
| Rate for Payer: Aetna American Axle |
$329.04
|
| Rate for Payer: Aetna Commercial |
$430.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.04
|
| Rate for Payer: Cash Price |
$404.98
|
| Rate for Payer: Cofinity Commercial |
$354.35
|
| Rate for Payer: Cofinity Commercial |
$435.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$404.98
|
| Rate for Payer: Healthscope Commercial |
$455.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$354.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$379.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$430.29
|
| Rate for Payer: PHP Commercial |
$430.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$354.35
|
| Rate for Payer: Priority Health SBD |
$318.92
|
| Rate for Payer: UMR Bronson Commercial |
$222.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$379.66
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$388.29
|
|
|
Service Code
|
NDC 65162-415-03
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.85 |
| Max. Negotiated Rate |
$349.46 |
| Rate for Payer: Aetna American Axle |
$252.39
|
| Rate for Payer: Aetna Commercial |
$330.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.39
|
| Rate for Payer: Cash Price |
$310.63
|
| Rate for Payer: Cofinity Commercial |
$271.80
|
| Rate for Payer: Cofinity Commercial |
$333.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.63
|
| Rate for Payer: Healthscope Commercial |
$349.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$291.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$330.05
|
| Rate for Payer: PHP Commercial |
$330.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.80
|
| Rate for Payer: Priority Health SBD |
$244.62
|
| Rate for Payer: UMR Bronson Commercial |
$170.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$291.22
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$482.04
|
|
|
Service Code
|
NDC 0904-7010-06
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$212.10 |
| Max. Negotiated Rate |
$433.84 |
| Rate for Payer: Aetna American Axle |
$313.33
|
| Rate for Payer: Aetna Commercial |
$409.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.33
|
| Rate for Payer: Cash Price |
$385.63
|
| Rate for Payer: Cofinity Commercial |
$337.43
|
| Rate for Payer: Cofinity Commercial |
$414.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.63
|
| Rate for Payer: Healthscope Commercial |
$433.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$409.73
|
| Rate for Payer: PHP Commercial |
$409.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.43
|
| Rate for Payer: Priority Health SBD |
$303.69
|
| Rate for Payer: UMR Bronson Commercial |
$212.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.53
|
|
|
BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$62.79
|
|
|
Service Code
|
HCPCS J0592
|
| Hospital Charge Code |
115937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$56.51 |
| Rate for Payer: Aetna American Axle |
$40.81
|
| Rate for Payer: Aetna Commercial |
$53.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.81
|
| Rate for Payer: Cash Price |
$50.23
|
| Rate for Payer: Cofinity Commercial |
$43.95
|
| Rate for Payer: Cofinity Commercial |
$54.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.23
|
| Rate for Payer: Healthscope Commercial |
$56.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.37
|
| Rate for Payer: PHP Commercial |
$53.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.95
|
| Rate for Payer: Priority Health SBD |
$39.56
|
| Rate for Payer: UMR Bronson Commercial |
$27.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.09
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$140.91
|
|
|
Service Code
|
NDC 50383-924-93
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$126.82 |
| Rate for Payer: Aetna American Axle |
$91.59
|
| Rate for Payer: Aetna Commercial |
$119.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.59
|
| Rate for Payer: Cash Price |
$112.73
|
| Rate for Payer: Cofinity Commercial |
$121.18
|
| Rate for Payer: Cofinity Commercial |
$98.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.73
|
| Rate for Payer: Healthscope Commercial |
$126.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.77
|
| Rate for Payer: PHP Commercial |
$119.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.64
|
| Rate for Payer: Priority Health SBD |
$88.77
|
| Rate for Payer: UMR Bronson Commercial |
$62.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.68
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$192.15
|
|
|
Service Code
|
NDC 0054-0176-13
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.55 |
| Max. Negotiated Rate |
$172.94 |
| Rate for Payer: Aetna American Axle |
$124.90
|
| Rate for Payer: Aetna Commercial |
$163.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.90
|
| Rate for Payer: Cash Price |
$153.72
|
| Rate for Payer: Cofinity Commercial |
$134.50
|
| Rate for Payer: Cofinity Commercial |
$165.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$153.72
|
| Rate for Payer: Healthscope Commercial |
$172.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.33
|
| Rate for Payer: PHP Commercial |
$163.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.50
|
| Rate for Payer: Priority Health SBD |
$121.05
|
| Rate for Payer: UMR Bronson Commercial |
$84.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.11
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$13.29
|
|
|
Service Code
|
NDC 60687-481-11
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$11.96 |
| Rate for Payer: Aetna American Axle |
$8.64
|
| Rate for Payer: Aetna Commercial |
$11.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.64
|
| Rate for Payer: Cash Price |
$10.63
|
| Rate for Payer: Cofinity Commercial |
$11.43
|
| Rate for Payer: Cofinity Commercial |
$9.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.63
|
| Rate for Payer: Healthscope Commercial |
$11.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.30
|
| Rate for Payer: PHP Commercial |
$11.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.30
|
| Rate for Payer: Priority Health SBD |
$8.37
|
| Rate for Payer: UMR Bronson Commercial |
$5.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.97
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$398.58
|
|
|
Service Code
|
NDC 60687-481-21
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.38 |
| Max. Negotiated Rate |
$358.72 |
| Rate for Payer: Aetna American Axle |
$259.08
|
| Rate for Payer: Aetna Commercial |
$338.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.08
|
| Rate for Payer: Cash Price |
$318.86
|
| Rate for Payer: Cofinity Commercial |
$279.01
|
| Rate for Payer: Cofinity Commercial |
$342.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.86
|
| Rate for Payer: Healthscope Commercial |
$358.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$279.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$338.79
|
| Rate for Payer: PHP Commercial |
$338.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.01
|
| Rate for Payer: Priority Health SBD |
$251.11
|
| Rate for Payer: UMR Bronson Commercial |
$175.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.94
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
|
IP
|
$510.72
|
|
|
Service Code
|
NDC 0904-6636-61
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.72 |
| Max. Negotiated Rate |
$459.65 |
| Rate for Payer: Aetna American Axle |
$331.97
|
| Rate for Payer: Aetna Commercial |
$434.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.97
|
| Rate for Payer: Cash Price |
$408.58
|
| Rate for Payer: Cofinity Commercial |
$357.50
|
| Rate for Payer: Cofinity Commercial |
$439.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.58
|
| Rate for Payer: Healthscope Commercial |
$459.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$434.11
|
| Rate for Payer: PHP Commercial |
$434.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$357.50
|
| Rate for Payer: Priority Health SBD |
$321.75
|
| Rate for Payer: UMR Bronson Commercial |
$224.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.04
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
IP
|
$405.60
|
|
|
Service Code
|
NDC 0904-6635-61
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.46 |
| Max. Negotiated Rate |
$365.04 |
| Rate for Payer: Aetna American Axle |
$263.64
|
| Rate for Payer: Aetna Commercial |
$344.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.64
|
| Rate for Payer: Cash Price |
$324.48
|
| Rate for Payer: Cofinity Commercial |
$283.92
|
| Rate for Payer: Cofinity Commercial |
$348.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$324.48
|
| Rate for Payer: Healthscope Commercial |
$365.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$283.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$344.76
|
| Rate for Payer: PHP Commercial |
$344.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.92
|
| Rate for Payer: Priority Health SBD |
$255.53
|
| Rate for Payer: UMR Bronson Commercial |
$178.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.20
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
IP
|
$452.16
|
|
|
Service Code
|
NDC 51079-943-20
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.95 |
| Max. Negotiated Rate |
$406.94 |
| Rate for Payer: Aetna American Axle |
$293.90
|
| Rate for Payer: Aetna Commercial |
$384.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.90
|
| Rate for Payer: Cash Price |
$361.73
|
| Rate for Payer: Cofinity Commercial |
$316.51
|
| Rate for Payer: Cofinity Commercial |
$388.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.73
|
| Rate for Payer: Healthscope Commercial |
$406.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$316.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$384.34
|
| Rate for Payer: PHP Commercial |
$384.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$316.51
|
| Rate for Payer: Priority Health SBD |
$284.86
|
| Rate for Payer: UMR Bronson Commercial |
$198.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.12
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
IP
|
$4.53
|
|
|
Service Code
|
NDC 51079-943-01
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.99 |
| Max. Negotiated Rate |
$4.08 |
| Rate for Payer: Aetna American Axle |
$2.94
|
| Rate for Payer: Aetna Commercial |
$3.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.94
|
| Rate for Payer: Cash Price |
$3.62
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Cofinity Commercial |
$3.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.62
|
| Rate for Payer: Healthscope Commercial |
$4.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.85
|
| Rate for Payer: PHP Commercial |
$3.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.17
|
| Rate for Payer: Priority Health SBD |
$2.85
|
| Rate for Payer: UMR Bronson Commercial |
$1.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.40
|
|
