|
BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
IP
|
$136.23
|
|
|
Service Code
|
NDC 0591-3540-60
|
| Hospital Charge Code |
18385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.94 |
| Max. Negotiated Rate |
$122.61 |
| Rate for Payer: Aetna American Axle |
$88.55
|
| Rate for Payer: Aetna Commercial |
$115.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.55
|
| Rate for Payer: Cash Price |
$108.98
|
| Rate for Payer: Cofinity Commercial |
$117.16
|
| Rate for Payer: Cofinity Commercial |
$95.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.98
|
| Rate for Payer: Healthscope Commercial |
$122.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.80
|
| Rate for Payer: PHP Commercial |
$115.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.36
|
| Rate for Payer: Priority Health SBD |
$85.82
|
| Rate for Payer: UMR Bronson Commercial |
$59.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.17
|
|
|
BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
IP
|
$180.87
|
|
|
Service Code
|
NDC 0185-0410-60
|
| Hospital Charge Code |
18385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.58 |
| Max. Negotiated Rate |
$162.78 |
| Rate for Payer: Aetna American Axle |
$117.57
|
| Rate for Payer: Aetna Commercial |
$153.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.57
|
| Rate for Payer: Cash Price |
$144.70
|
| Rate for Payer: Cofinity Commercial |
$126.61
|
| Rate for Payer: Cofinity Commercial |
$155.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$144.70
|
| Rate for Payer: Healthscope Commercial |
$162.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$126.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$135.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$153.74
|
| Rate for Payer: PHP Commercial |
$153.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.61
|
| Rate for Payer: Priority Health SBD |
$113.95
|
| Rate for Payer: UMR Bronson Commercial |
$79.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$135.65
|
|
|
BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
IP
|
$239.40
|
|
|
Service Code
|
NDC 0185-0415-60
|
| Hospital Charge Code |
18386
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.34 |
| Max. Negotiated Rate |
$215.46 |
| Rate for Payer: Aetna American Axle |
$155.61
|
| Rate for Payer: Aetna Commercial |
$203.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.61
|
| Rate for Payer: Cash Price |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$167.58
|
| Rate for Payer: Cofinity Commercial |
$205.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$191.52
|
| Rate for Payer: Healthscope Commercial |
$215.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$167.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$179.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$203.49
|
| Rate for Payer: PHP Commercial |
$203.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.58
|
| Rate for Payer: Priority Health SBD |
$150.82
|
| Rate for Payer: UMR Bronson Commercial |
$105.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$179.55
|
|
|
BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
IP
|
$143.07
|
|
|
Service Code
|
NDC 0591-3541-60
|
| Hospital Charge Code |
18386
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.95 |
| Max. Negotiated Rate |
$128.76 |
| Rate for Payer: Aetna American Axle |
$93.00
|
| Rate for Payer: Aetna Commercial |
$121.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.00
|
| Rate for Payer: Cash Price |
$114.46
|
| Rate for Payer: Cofinity Commercial |
$123.04
|
| Rate for Payer: Cofinity Commercial |
$100.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.46
|
| Rate for Payer: Healthscope Commercial |
$128.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$121.61
|
| Rate for Payer: PHP Commercial |
$121.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.15
|
| Rate for Payer: Priority Health SBD |
$90.13
|
| Rate for Payer: UMR Bronson Commercial |
$62.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.30
|
|
|
BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
IP
|
$144.21
|
|
|
Service Code
|
NDC 43598-537-60
|
| Hospital Charge Code |
18386
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.45 |
| Max. Negotiated Rate |
$129.79 |
| Rate for Payer: Aetna American Axle |
$93.74
|
| Rate for Payer: Aetna Commercial |
$122.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.74
|
| Rate for Payer: Cash Price |
$115.37
|
| Rate for Payer: Cofinity Commercial |
$100.95
|
| Rate for Payer: Cofinity Commercial |
$124.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.37
|
| Rate for Payer: Healthscope Commercial |
$129.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.58
|
| Rate for Payer: PHP Commercial |
$122.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.95
|
| Rate for Payer: Priority Health SBD |
$90.85
|
| Rate for Payer: UMR Bronson Commercial |
$63.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.16
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$93.77
|
|
|
Service Code
|
NDC 68180-319-06
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.26 |
| Max. Negotiated Rate |
$84.39 |
| Rate for Payer: Aetna American Axle |
$60.95
|
| Rate for Payer: Aetna Commercial |
$79.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.95
|
| Rate for Payer: Cash Price |
$75.02
|
| Rate for Payer: Cofinity Commercial |
$65.64
|
| Rate for Payer: Cofinity Commercial |
$80.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.02
|
| Rate for Payer: Healthscope Commercial |
$84.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.70
|
| Rate for Payer: PHP Commercial |
$79.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.64
|
| Rate for Payer: Priority Health SBD |
$59.08
|
| Rate for Payer: UMR Bronson Commercial |
$41.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.33
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$112.86
|
|
|
Service Code
|
NDC 43598-655-30
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$101.57 |
| Rate for Payer: Aetna American Axle |
$73.36
|
| Rate for Payer: Aetna Commercial |
$95.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.36
|
| Rate for Payer: Cash Price |
$90.29
|
| Rate for Payer: Cofinity Commercial |
$79.00
|
| Rate for Payer: Cofinity Commercial |
$97.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.29
|
| Rate for Payer: Healthscope Commercial |
$101.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.93
|
| Rate for Payer: PHP Commercial |
$95.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.00
|
| Rate for Payer: Priority Health SBD |
$71.10
|
| Rate for Payer: UMR Bronson Commercial |
$49.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.64
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$6.70
|
|
|
Service Code
|
NDC 60687-312-11
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$6.03 |
| Rate for Payer: Aetna American Axle |
$4.36
|
| Rate for Payer: Aetna Commercial |
$5.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.36
|
| Rate for Payer: Cash Price |
$5.36
|
| Rate for Payer: Cofinity Commercial |
$4.69
|
| Rate for Payer: Cofinity Commercial |
$5.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.36
|
| Rate for Payer: Healthscope Commercial |
$6.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.70
|
| Rate for Payer: PHP Commercial |
$5.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.69
|
| Rate for Payer: Priority Health SBD |
$4.22
|
| Rate for Payer: UMR Bronson Commercial |
$2.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.02
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$137.96
|
|
|
Service Code
|
NDC 0904-7084-04
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.70 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: Aetna American Axle |
$89.67
|
| Rate for Payer: Aetna Commercial |
$117.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.67
|
| Rate for Payer: Cash Price |
$110.37
|
| Rate for Payer: Cofinity Commercial |
$118.65
|
| Rate for Payer: Cofinity Commercial |
$96.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.37
|
| Rate for Payer: Healthscope Commercial |
$124.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.27
|
| Rate for Payer: PHP Commercial |
$117.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.57
|
| Rate for Payer: Priority Health SBD |
$86.91
|
| Rate for Payer: UMR Bronson Commercial |
$60.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.47
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$134.21
|
|
|
Service Code
|
NDC 70436-010-04
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.05 |
| Max. Negotiated Rate |
$120.79 |
| Rate for Payer: Aetna American Axle |
$87.24
|
| Rate for Payer: Aetna Commercial |
$114.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.24
|
| Rate for Payer: Cash Price |
$107.37
|
| Rate for Payer: Cofinity Commercial |
$115.42
|
| Rate for Payer: Cofinity Commercial |
$93.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.37
|
| Rate for Payer: Healthscope Commercial |
$120.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.08
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.95
|
| Rate for Payer: Priority Health SBD |
$84.55
|
| Rate for Payer: UMR Bronson Commercial |
$59.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.66
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$64.70
|
|
|
Service Code
|
NDC 60429-933-30
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.47 |
| Max. Negotiated Rate |
$58.23 |
| Rate for Payer: Aetna American Axle |
$42.06
|
| Rate for Payer: Aetna Commercial |
$55.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.06
|
| Rate for Payer: Cash Price |
$51.76
|
| Rate for Payer: Cofinity Commercial |
$45.29
|
| Rate for Payer: Cofinity Commercial |
$55.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.76
|
| Rate for Payer: Healthscope Commercial |
$58.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$45.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$55.00
|
| Rate for Payer: PHP Commercial |
$55.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.29
|
| Rate for Payer: Priority Health SBD |
$40.76
|
| Rate for Payer: UMR Bronson Commercial |
$28.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.52
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$351.09
|
|
|
Service Code
|
NDC 0115-6811-10
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.48 |
| Max. Negotiated Rate |
$315.98 |
| Rate for Payer: Aetna American Axle |
$228.21
|
| Rate for Payer: Aetna Commercial |
$298.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.21
|
| Rate for Payer: Cash Price |
$280.87
|
| Rate for Payer: Cofinity Commercial |
$245.76
|
| Rate for Payer: Cofinity Commercial |
$301.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$280.87
|
| Rate for Payer: Healthscope Commercial |
$315.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$245.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$263.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$298.43
|
| Rate for Payer: PHP Commercial |
$298.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.76
|
| Rate for Payer: Priority Health SBD |
$221.19
|
| Rate for Payer: UMR Bronson Commercial |
$154.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$263.32
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$669.60
|
|
|
Service Code
|
NDC 60687-312-01
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$294.62 |
| Max. Negotiated Rate |
$602.64 |
| Rate for Payer: Aetna American Axle |
$435.24
|
| Rate for Payer: Aetna Commercial |
$569.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.24
|
| Rate for Payer: Cash Price |
$535.68
|
| Rate for Payer: Cofinity Commercial |
$468.72
|
| Rate for Payer: Cofinity Commercial |
$575.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$535.68
|
| Rate for Payer: Healthscope Commercial |
$602.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$468.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$502.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$569.16
|
| Rate for Payer: PHP Commercial |
$569.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.72
|
| Rate for Payer: Priority Health SBD |
$421.85
|
| Rate for Payer: UMR Bronson Commercial |
$294.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$502.20
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
IP
|
$96.35
|
|
|
Service Code
|
NDC 16729-202-01
|
| 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: 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 Multiplan/Beech St/PHCS |
$81.90
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.44
|
| 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
|
$77.55
|
|
|
Service Code
|
NDC 23155-024-01
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$69.80 |
| Rate for Payer: Aetna American Axle |
$50.41
|
| Rate for Payer: Aetna Commercial |
$65.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.41
|
| Rate for Payer: Cash Price |
$62.04
|
| Rate for Payer: Cofinity Commercial |
$54.28
|
| Rate for Payer: Cofinity Commercial |
$66.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.04
|
| Rate for Payer: Healthscope Commercial |
$69.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.92
|
| Rate for Payer: PHP Commercial |
$65.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.28
|
| Rate for Payer: Priority Health SBD |
$48.86
|
| Rate for Payer: UMR Bronson Commercial |
$34.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.16
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
IP
|
$481.75
|
|
|
Service Code
|
NDC 16729-202-16
|
| 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: 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 Multiplan/Beech St/PHCS |
$409.49
|
| Rate for Payer: PHP Commercial |
$409.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$337.22
|
| 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 15 MG TABLET
|
Facility
|
IP
|
$108.10
|
|
|
Service Code
|
NDC 0093-1003-01
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.56 |
| Max. Negotiated Rate |
$97.29 |
| Rate for Payer: Aetna American Axle |
$70.26
|
| Rate for Payer: Aetna Commercial |
$91.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.26
|
| Rate for Payer: Cash Price |
$86.48
|
| Rate for Payer: Cofinity Commercial |
$75.67
|
| Rate for Payer: Cofinity Commercial |
$92.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.48
|
| Rate for Payer: Healthscope Commercial |
$97.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$75.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$91.88
|
| Rate for Payer: PHP Commercial |
$91.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.67
|
| Rate for Payer: Priority Health SBD |
$68.10
|
| Rate for Payer: UMR Bronson Commercial |
$47.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.08
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
IP
|
$76.14
|
|
|
Service Code
|
NDC 16729-203-12
|
| 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: 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 Multiplan/Beech St/PHCS |
$64.72
|
| Rate for Payer: PHP Commercial |
$64.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health SBD |
$47.97
|
| Rate for Payer: UMR Bronson Commercial |
$33.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.10
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
IP
|
$202.10
|
|
|
Service Code
|
NDC 68382-182-01
|
| 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: 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 Multiplan/Beech St/PHCS |
$171.78
|
| Rate for Payer: PHP Commercial |
$171.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.47
|
| 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 30 MG TABLET
|
Facility
|
IP
|
$173.85
|
|
|
Service Code
|
NDC 68382-183-14
|
| Hospital Charge Code |
27046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.49 |
| Max. Negotiated Rate |
$156.46 |
| Rate for Payer: Aetna American Axle |
$113.00
|
| Rate for Payer: Aetna Commercial |
$147.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.00
|
| Rate for Payer: Cash Price |
$139.08
|
| Rate for Payer: Cofinity Commercial |
$121.70
|
| Rate for Payer: Cofinity Commercial |
$149.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.08
|
| Rate for Payer: Healthscope Commercial |
$156.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.77
|
| Rate for Payer: PHP Commercial |
$147.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.70
|
| Rate for Payer: Priority Health SBD |
$109.53
|
| Rate for Payer: UMR Bronson Commercial |
$76.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.39
|
|
|
BUSPIRONE 30 MG TABLET
|
Facility
|
IP
|
$405.60
|
|
|
Service Code
|
NDC 51079-994-20
|
| Hospital Charge Code |
27046
|
|
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
|
|
|
BUSPIRONE 30 MG TABLET
|
Facility
|
IP
|
$290.88
|
|
|
Service Code
|
NDC 24689-933-06
|
| Hospital Charge Code |
27046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.99 |
| Max. Negotiated Rate |
$261.79 |
| Rate for Payer: Aetna American Axle |
$189.07
|
| Rate for Payer: Aetna Commercial |
$247.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.07
|
| Rate for Payer: Cash Price |
$232.70
|
| Rate for Payer: Cofinity Commercial |
$203.62
|
| Rate for Payer: Cofinity Commercial |
$250.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$232.70
|
| Rate for Payer: Healthscope Commercial |
$261.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$247.25
|
| Rate for Payer: PHP Commercial |
$247.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$203.62
|
| Rate for Payer: Priority Health SBD |
$183.25
|
| Rate for Payer: UMR Bronson Commercial |
$127.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.16
|
|
|
BUSPIRONE 30 MG TABLET
|
Facility
|
IP
|
$253.16
|
|
|
Service Code
|
NDC 0093-5200-06
|
| 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: 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 Multiplan/Beech St/PHCS |
$215.19
|
| Rate for Payer: PHP Commercial |
$215.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.21
|
| Rate for Payer: Priority Health SBD |
$159.49
|
| Rate for Payer: UMR Bronson Commercial |
$111.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$189.87
|
|
|
BUSPIRONE 30 MG TABLET
|
Facility
|
IP
|
$4.06
|
|
|
Service Code
|
NDC 51079-994-01
|
| Hospital Charge Code |
27046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$3.65 |
| Rate for Payer: Aetna American Axle |
$2.64
|
| Rate for Payer: Aetna Commercial |
$3.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.64
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$2.84
|
| Rate for Payer: Cofinity Commercial |
$3.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.25
|
| Rate for Payer: Healthscope Commercial |
$3.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.45
|
| Rate for Payer: PHP Commercial |
$3.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.84
|
| Rate for Payer: Priority Health SBD |
$2.56
|
| Rate for Payer: UMR Bronson Commercial |
$1.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.04
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
IP
|
$105.75
|
|
|
Service Code
|
NDC 59651-389-01
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.53 |
| Max. Negotiated Rate |
$95.18 |
| Rate for Payer: Aetna American Axle |
$68.74
|
| Rate for Payer: Aetna Commercial |
$89.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.74
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cofinity Commercial |
$74.02
|
| Rate for Payer: Cofinity Commercial |
$90.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.60
|
| Rate for Payer: Healthscope Commercial |
$95.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$89.89
|
| Rate for Payer: PHP Commercial |
$89.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.02
|
| Rate for Payer: Priority Health SBD |
$66.62
|
| Rate for Payer: UMR Bronson Commercial |
$46.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.31
|
|
