|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$180.81
|
|
|
Service Code
|
NDC 00054018813
|
| 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 Advantage |
$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 Commercial |
$153.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.61
|
| Rate for Payer: PHP Commercial |
$153.69
|
| 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
|
OP
|
$420.62
|
|
|
Service Code
|
NDC 00904700906
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.63 |
| Max. Negotiated Rate |
$378.56 |
| Rate for Payer: Aetna American Axle |
$273.40
|
| Rate for Payer: Aetna Commercial |
$357.53
|
| Rate for Payer: Aetna Medicare |
$210.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.40
|
| Rate for Payer: BCBS Complete |
$168.25
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cofinity Advantage |
$294.43
|
| Rate for Payer: Cofinity Commercial |
$361.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.50
|
| Rate for Payer: Healthscope Commercial |
$378.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$336.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.46
|
| Rate for Payer: PHP Commercial |
$357.53
|
| Rate for Payer: Priority Health SBD |
$264.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.40
|
| Rate for Payer: UHC Core |
$219.14
|
| Rate for Payer: UHC Exchange |
$165.30
|
| Rate for Payer: UMR Bronson Commercial |
$155.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.46
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$9.26
|
|
|
Service Code
|
NDC 50268014411
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$8.33 |
| Rate for Payer: Aetna American Axle |
$6.02
|
| Rate for Payer: Aetna Commercial |
$7.87
|
| Rate for Payer: Aetna Medicare |
$4.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.02
|
| Rate for Payer: BCBS Complete |
$3.70
|
| Rate for Payer: Cash Price |
$7.41
|
| Rate for Payer: Cofinity Advantage |
$6.48
|
| Rate for Payer: Cofinity Commercial |
$7.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.41
|
| Rate for Payer: Healthscope Commercial |
$8.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.95
|
| Rate for Payer: PHP Commercial |
$7.87
|
| Rate for Payer: Priority Health SBD |
$5.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.02
|
| Rate for Payer: UHC Core |
$4.82
|
| Rate for Payer: UHC Exchange |
$3.64
|
| Rate for Payer: UMR Bronson Commercial |
$3.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.95
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$217.14
|
|
|
Service Code
|
NDC 65162041603
|
| 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 Advantage |
$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 |
$162.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.85
|
| Rate for Payer: PHP Commercial |
$184.57
|
| 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 |
$162.85
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$420.62
|
|
|
Service Code
|
NDC 00904700906
|
| Hospital Charge Code |
34713
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.07 |
| Max. Negotiated Rate |
$378.56 |
| Rate for Payer: Aetna American Axle |
$273.40
|
| Rate for Payer: Aetna Commercial |
$357.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.40
|
| Rate for Payer: Cash Price |
$336.50
|
| Rate for Payer: Cofinity Advantage |
$294.43
|
| Rate for Payer: Cofinity Commercial |
$361.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.50
|
| Rate for Payer: Healthscope Commercial |
$378.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.46
|
| Rate for Payer: PHP Commercial |
$357.53
|
| Rate for Payer: Priority Health SBD |
$264.99
|
| Rate for Payer: UMR Bronson Commercial |
$185.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.46
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$465.37
|
|
|
Service Code
|
NDC 00093365640
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.19 |
| Max. Negotiated Rate |
$418.83 |
| Rate for Payer: Aetna American Axle |
$302.49
|
| Rate for Payer: Aetna Commercial |
$395.56
|
| Rate for Payer: Aetna Medicare |
$232.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.49
|
| Rate for Payer: BCBS Complete |
$186.15
|
| Rate for Payer: Cash Price |
$372.30
|
| Rate for Payer: Cofinity Advantage |
$325.76
|
| Rate for Payer: Cofinity Commercial |
$400.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.30
|
| Rate for Payer: Healthscope Commercial |
$418.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$372.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.03
|
| Rate for Payer: PHP Commercial |
$395.56
|
| Rate for Payer: Priority Health SBD |
$293.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$302.49
|
| Rate for Payer: UHC Core |
$242.46
|
| Rate for Payer: UHC Exchange |
$182.89
|
| Rate for Payer: UMR Bronson Commercial |
$172.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.03
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
NDC 59011075004
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.05 |
| Max. Negotiated Rate |
$508.50 |
| Rate for Payer: Aetna American Axle |
$367.25
|
| Rate for Payer: Aetna Commercial |
$480.25
|
| Rate for Payer: Aetna Medicare |
$282.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.25
|
| Rate for Payer: BCBS Complete |
$226.00
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cofinity Advantage |
$395.50
|
| Rate for Payer: Cofinity Commercial |
$485.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.00
|
| Rate for Payer: Healthscope Commercial |
$508.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$395.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$452.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$480.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$423.75
|
| Rate for Payer: PHP Commercial |
$480.25
|
| Rate for Payer: Priority Health SBD |
$355.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$367.25
|
| Rate for Payer: UHC Core |
$294.37
|
| Rate for Payer: UHC Exchange |
$222.04
|
| Rate for Payer: UMR Bronson Commercial |
$209.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.75
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$127.75
|
|
|
Service Code
|
NDC 50742037201
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.27 |
| Max. Negotiated Rate |
$114.97 |
| Rate for Payer: Aetna American Axle |
$83.04
|
| Rate for Payer: Aetna Commercial |
$108.59
|
| Rate for Payer: Aetna Medicare |
$63.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.04
|
| Rate for Payer: BCBS Complete |
$51.10
|
| Rate for Payer: Cash Price |
$102.20
|
| Rate for Payer: Cofinity Advantage |
$89.42
|
| Rate for Payer: Cofinity Commercial |
$109.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.20
|
| Rate for Payer: Healthscope Commercial |
$114.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$102.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.81
|
| Rate for Payer: PHP Commercial |
$108.59
|
| Rate for Payer: Priority Health SBD |
$80.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.04
|
| Rate for Payer: UHC Core |
$66.56
|
| Rate for Payer: UHC Exchange |
$50.21
|
| Rate for Payer: UMR Bronson Commercial |
$47.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.81
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$465.37
|
|
|
Service Code
|
NDC 00093365640
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.76 |
| Max. Negotiated Rate |
$418.83 |
| Rate for Payer: Aetna American Axle |
$302.49
|
| Rate for Payer: Aetna Commercial |
$395.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.49
|
| Rate for Payer: Cash Price |
$372.30
|
| Rate for Payer: Cofinity Advantage |
$325.76
|
| Rate for Payer: Cofinity Commercial |
$400.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.30
|
| Rate for Payer: Healthscope Commercial |
$418.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$325.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$349.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$395.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$349.03
|
| Rate for Payer: PHP Commercial |
$395.56
|
| Rate for Payer: Priority Health SBD |
$293.18
|
| Rate for Payer: UMR Bronson Commercial |
$204.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$349.03
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$510.98
|
|
|
Service Code
|
NDC 50742037204
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.83 |
| Max. Negotiated Rate |
$459.88 |
| Rate for Payer: Aetna American Axle |
$332.14
|
| Rate for Payer: Aetna Commercial |
$434.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.14
|
| Rate for Payer: Cash Price |
$408.78
|
| Rate for Payer: Cofinity Advantage |
$357.69
|
| Rate for Payer: Cofinity Commercial |
$439.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.78
|
| Rate for Payer: Healthscope Commercial |
$459.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$383.24
|
| Rate for Payer: PHP Commercial |
$434.33
|
| Rate for Payer: Priority Health SBD |
$321.92
|
| Rate for Payer: UMR Bronson Commercial |
$224.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.24
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
NDC 59011075004
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$248.60 |
| Max. Negotiated Rate |
$508.50 |
| Rate for Payer: Aetna American Axle |
$367.25
|
| Rate for Payer: Aetna Commercial |
$480.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.25
|
| Rate for Payer: Cash Price |
$452.00
|
| Rate for Payer: Cofinity Advantage |
$395.50
|
| Rate for Payer: Cofinity Commercial |
$485.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$452.00
|
| Rate for Payer: Healthscope Commercial |
$508.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$395.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$423.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$480.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$423.75
|
| Rate for Payer: PHP Commercial |
$480.25
|
| Rate for Payer: Priority Health SBD |
$355.95
|
| Rate for Payer: UMR Bronson Commercial |
$248.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$423.75
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$650.08
|
|
|
Service Code
|
NDC 69238120202
|
| 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 Advantage |
$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 Commercial |
$552.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$487.56
|
| Rate for Payer: PHP Commercial |
$552.57
|
| 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
|
OP
|
$510.98
|
|
|
Service Code
|
NDC 50742037204
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.06 |
| Max. Negotiated Rate |
$459.88 |
| Rate for Payer: Aetna American Axle |
$332.14
|
| Rate for Payer: Aetna Commercial |
$434.33
|
| Rate for Payer: Aetna Medicare |
$255.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.14
|
| Rate for Payer: BCBS Complete |
$204.39
|
| Rate for Payer: Cash Price |
$408.78
|
| Rate for Payer: Cofinity Advantage |
$357.69
|
| Rate for Payer: Cofinity Commercial |
$439.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$408.78
|
| Rate for Payer: Healthscope Commercial |
$459.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$357.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$383.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$408.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$383.24
|
| Rate for Payer: PHP Commercial |
$434.33
|
| Rate for Payer: Priority Health SBD |
$321.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$332.14
|
| Rate for Payer: UHC Core |
$266.22
|
| Rate for Payer: UHC Exchange |
$200.82
|
| Rate for Payer: UMR Bronson Commercial |
$189.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$383.24
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$127.75
|
|
|
Service Code
|
NDC 50742037201
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.21 |
| Max. Negotiated Rate |
$114.97 |
| Rate for Payer: Aetna American Axle |
$83.04
|
| Rate for Payer: Aetna Commercial |
$108.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.04
|
| Rate for Payer: Cash Price |
$102.20
|
| Rate for Payer: Cofinity Advantage |
$89.42
|
| Rate for Payer: Cofinity Commercial |
$109.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.20
|
| Rate for Payer: Healthscope Commercial |
$114.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$95.81
|
| Rate for Payer: PHP Commercial |
$108.59
|
| Rate for Payer: Priority Health SBD |
$80.48
|
| Rate for Payer: UMR Bronson Commercial |
$56.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.81
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$116.35
|
|
|
Service Code
|
NDC 00093365621
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.05 |
| Max. Negotiated Rate |
$104.72 |
| Rate for Payer: Aetna American Axle |
$75.63
|
| Rate for Payer: Aetna Commercial |
$98.90
|
| Rate for Payer: Aetna Medicare |
$58.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.63
|
| Rate for Payer: BCBS Complete |
$46.54
|
| Rate for Payer: Cash Price |
$93.08
|
| Rate for Payer: Cofinity Advantage |
$81.44
|
| Rate for Payer: Cofinity Commercial |
$100.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.08
|
| Rate for Payer: Healthscope Commercial |
$104.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.26
|
| Rate for Payer: PHP Commercial |
$98.90
|
| Rate for Payer: Priority Health SBD |
$73.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.63
|
| Rate for Payer: UHC Core |
$60.62
|
| Rate for Payer: UHC Exchange |
$45.73
|
| Rate for Payer: UMR Bronson Commercial |
$43.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.26
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
IP
|
$116.35
|
|
|
Service Code
|
NDC 00093365621
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$104.72 |
| Rate for Payer: Aetna American Axle |
$75.63
|
| Rate for Payer: Aetna Commercial |
$98.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.63
|
| Rate for Payer: Cash Price |
$93.08
|
| Rate for Payer: Cofinity Advantage |
$81.44
|
| Rate for Payer: Cofinity Commercial |
$100.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.08
|
| Rate for Payer: Healthscope Commercial |
$104.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.26
|
| Rate for Payer: PHP Commercial |
$98.90
|
| Rate for Payer: Priority Health SBD |
$73.30
|
| Rate for Payer: UMR Bronson Commercial |
$51.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.26
|
|
|
BUPRENORPHINE 5 MCG/HOUR WEEKLY TRANSDERMAL PATCH
|
Facility
|
OP
|
$650.08
|
|
|
Service Code
|
NDC 69238120202
|
| Hospital Charge Code |
107660
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.53 |
| Max. Negotiated Rate |
$585.07 |
| Rate for Payer: Aetna American Axle |
$422.55
|
| Rate for Payer: Aetna Commercial |
$552.57
|
| Rate for Payer: Aetna Medicare |
$325.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$422.55
|
| Rate for Payer: BCBS Complete |
$260.03
|
| Rate for Payer: Cash Price |
$520.06
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$520.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$552.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$487.56
|
| Rate for Payer: PHP Commercial |
$552.57
|
| Rate for Payer: Priority Health SBD |
$409.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$422.55
|
| Rate for Payer: UHC Core |
$338.69
|
| Rate for Payer: UHC Exchange |
$255.48
|
| Rate for Payer: UMR Bronson Commercial |
$240.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$487.56
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$270.06
|
|
|
Service Code
|
NDC 00054018913
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.83 |
| Max. Negotiated Rate |
$243.05 |
| Rate for Payer: Aetna American Axle |
$175.54
|
| Rate for Payer: Aetna Commercial |
$229.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.54
|
| Rate for Payer: Cash Price |
$216.05
|
| Rate for Payer: Cofinity Advantage |
$189.04
|
| Rate for Payer: Cofinity Commercial |
$232.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.05
|
| Rate for Payer: Healthscope Commercial |
$243.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.54
|
| Rate for Payer: PHP Commercial |
$229.55
|
| Rate for Payer: Priority Health SBD |
$170.14
|
| Rate for Payer: UMR Bronson Commercial |
$118.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.54
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$538.20
|
|
|
Service Code
|
NDC 60687063765
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$236.81 |
| Max. Negotiated Rate |
$484.38 |
| Rate for Payer: Aetna American Axle |
$349.83
|
| Rate for Payer: Aetna Commercial |
$457.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$349.83
|
| Rate for Payer: Cash Price |
$430.56
|
| Rate for Payer: Cofinity Advantage |
$376.74
|
| Rate for Payer: Cofinity Commercial |
$462.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$430.56
|
| Rate for Payer: Healthscope Commercial |
$484.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$376.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$403.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$457.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$403.65
|
| Rate for Payer: PHP Commercial |
$457.47
|
| Rate for Payer: Priority Health SBD |
$339.07
|
| Rate for Payer: UMR Bronson Commercial |
$236.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$403.65
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$488.28
|
|
|
Service Code
|
NDC 00904701006
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.66 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Aetna American Axle |
$317.38
|
| Rate for Payer: Aetna Commercial |
$415.04
|
| Rate for Payer: Aetna Medicare |
$244.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.38
|
| Rate for Payer: BCBS Complete |
$195.31
|
| Rate for Payer: Cash Price |
$390.62
|
| Rate for Payer: Cofinity Advantage |
$341.80
|
| Rate for Payer: Cofinity Commercial |
$419.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.62
|
| Rate for Payer: Healthscope Commercial |
$439.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$341.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$390.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$366.21
|
| Rate for Payer: PHP Commercial |
$415.04
|
| Rate for Payer: Priority Health SBD |
$307.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.38
|
| Rate for Payer: UHC Core |
$254.39
|
| Rate for Payer: UHC Exchange |
$191.89
|
| Rate for Payer: UMR Bronson Commercial |
$180.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.21
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$10.77
|
|
|
Service Code
|
NDC 60687063711
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Aetna American Axle |
$7.00
|
| Rate for Payer: Aetna Commercial |
$9.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.00
|
| Rate for Payer: Cash Price |
$8.62
|
| Rate for Payer: Cofinity Advantage |
$7.54
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.62
|
| Rate for Payer: Healthscope Commercial |
$9.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.08
|
| Rate for Payer: PHP Commercial |
$9.15
|
| Rate for Payer: Priority Health SBD |
$6.79
|
| Rate for Payer: UMR Bronson Commercial |
$4.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.08
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$270.06
|
|
|
Service Code
|
NDC 00054018913
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.92 |
| Max. Negotiated Rate |
$243.05 |
| Rate for Payer: Aetna American Axle |
$175.54
|
| Rate for Payer: Aetna Commercial |
$229.55
|
| Rate for Payer: Aetna Medicare |
$135.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$175.54
|
| Rate for Payer: BCBS Complete |
$108.02
|
| Rate for Payer: Cash Price |
$216.05
|
| Rate for Payer: Cofinity Advantage |
$189.04
|
| Rate for Payer: Cofinity Commercial |
$232.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.05
|
| Rate for Payer: Healthscope Commercial |
$243.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$189.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.54
|
| Rate for Payer: PHP Commercial |
$229.55
|
| Rate for Payer: Priority Health SBD |
$170.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.54
|
| Rate for Payer: UHC Core |
$140.70
|
| Rate for Payer: UHC Exchange |
$106.13
|
| Rate for Payer: UMR Bronson Commercial |
$99.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.54
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$10.77
|
|
|
Service Code
|
NDC 60687063711
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$9.69 |
| Rate for Payer: Aetna American Axle |
$7.00
|
| Rate for Payer: Aetna Commercial |
$9.15
|
| Rate for Payer: Aetna Medicare |
$5.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.00
|
| Rate for Payer: BCBS Complete |
$4.31
|
| Rate for Payer: Cash Price |
$8.62
|
| Rate for Payer: Cofinity Advantage |
$7.54
|
| Rate for Payer: Cofinity Commercial |
$9.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.62
|
| Rate for Payer: Healthscope Commercial |
$9.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.08
|
| Rate for Payer: PHP Commercial |
$9.15
|
| Rate for Payer: Priority Health SBD |
$6.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.00
|
| Rate for Payer: UHC Core |
$5.61
|
| Rate for Payer: UHC Exchange |
$4.23
|
| Rate for Payer: UMR Bronson Commercial |
$3.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.08
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$488.28
|
|
|
Service Code
|
NDC 00904701006
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$214.84 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Aetna American Axle |
$317.38
|
| Rate for Payer: Aetna Commercial |
$415.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.38
|
| Rate for Payer: Cash Price |
$390.62
|
| Rate for Payer: Cofinity Advantage |
$341.80
|
| Rate for Payer: Cofinity Commercial |
$419.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$390.62
|
| Rate for Payer: Healthscope Commercial |
$439.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$341.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$366.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$415.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$366.21
|
| Rate for Payer: PHP Commercial |
$415.04
|
| Rate for Payer: Priority Health SBD |
$307.62
|
| Rate for Payer: UMR Bronson Commercial |
$214.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$366.21
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$388.29
|
|
|
Service Code
|
NDC 65162041503
|
| 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 Advantage |
$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 Commercial |
$330.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.22
|
| Rate for Payer: PHP Commercial |
$330.05
|
| 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
|
|
