|
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
|
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 HCL 0.3 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$49.26
|
|
|
Service Code
|
HCPCS J0592
|
| Hospital Charge Code |
115937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.67 |
| Max. Negotiated Rate |
$44.33 |
| Rate for Payer: Aetna American Axle |
$32.02
|
| Rate for Payer: Aetna American Axle |
$40.81
|
| Rate for Payer: Aetna Commercial |
$41.87
|
| Rate for Payer: Aetna Commercial |
$53.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.81
|
| Rate for Payer: Cash Price |
$39.41
|
| Rate for Payer: Cash Price |
$50.23
|
| Rate for Payer: Cofinity Advantage |
$43.95
|
| Rate for Payer: Cofinity Advantage |
$34.48
|
| Rate for Payer: Cofinity Commercial |
$54.00
|
| Rate for Payer: Cofinity Commercial |
$42.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.23
|
| Rate for Payer: Healthscope Commercial |
$44.33
|
| Rate for Payer: Healthscope Commercial |
$56.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.09
|
| Rate for Payer: PHP Commercial |
$41.87
|
| Rate for Payer: PHP Commercial |
$53.37
|
| Rate for Payer: Priority Health SBD |
$39.56
|
| Rate for Payer: Priority Health SBD |
$31.03
|
| Rate for Payer: UMR Bronson Commercial |
$21.67
|
| Rate for Payer: UMR Bronson Commercial |
$27.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.09
|
|
|
BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$49.26
|
|
|
Service Code
|
HCPCS J0592
|
| Hospital Charge Code |
115937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$44.33 |
| Rate for Payer: Aetna American Axle |
$32.02
|
| Rate for Payer: Aetna American Axle |
$40.81
|
| Rate for Payer: Aetna Commercial |
$41.87
|
| Rate for Payer: Aetna Commercial |
$53.37
|
| Rate for Payer: Aetna Medicare |
$24.63
|
| Rate for Payer: Aetna Medicare |
$31.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.81
|
| Rate for Payer: BCBS Complete |
$25.12
|
| Rate for Payer: BCBS Complete |
$19.70
|
| Rate for Payer: BCBS Trust/PPO |
$13.65
|
| Rate for Payer: BCBS Trust/PPO |
$13.65
|
| Rate for Payer: BCN Commercial |
$13.65
|
| Rate for Payer: BCN Commercial |
$13.65
|
| Rate for Payer: Cash Price |
$39.41
|
| Rate for Payer: Cash Price |
$50.23
|
| Rate for Payer: Cash Price |
$39.41
|
| Rate for Payer: Cash Price |
$50.23
|
| Rate for Payer: Cofinity Advantage |
$34.48
|
| Rate for Payer: Cofinity Advantage |
$43.95
|
| Rate for Payer: Cofinity Commercial |
$42.36
|
| Rate for Payer: Cofinity Commercial |
$54.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.23
|
| Rate for Payer: Healthscope Commercial |
$44.33
|
| Rate for Payer: Healthscope Commercial |
$56.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$34.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$43.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.95
|
| Rate for Payer: PHP Commercial |
$41.87
|
| Rate for Payer: PHP Commercial |
$53.37
|
| Rate for Payer: Priority Health SBD |
$31.03
|
| Rate for Payer: Priority Health SBD |
$39.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.95
|
| Rate for Payer: UHC Core |
$6.95
|
| Rate for Payer: UHC Core |
$6.95
|
| Rate for Payer: UHC Exchange |
$6.95
|
| Rate for Payer: UHC Exchange |
$6.95
|
| Rate for Payer: UMR Bronson Commercial |
$18.23
|
| Rate for Payer: UMR Bronson Commercial |
$23.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.09
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$394.38
|
|
|
Service Code
|
NDC 00904715404
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.53 |
| Max. Negotiated Rate |
$354.94 |
| Rate for Payer: Aetna American Axle |
$256.35
|
| Rate for Payer: Aetna Commercial |
$335.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.35
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cofinity Advantage |
$276.07
|
| Rate for Payer: Cofinity Commercial |
$339.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.50
|
| Rate for Payer: Healthscope Commercial |
$354.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.79
|
| Rate for Payer: PHP Commercial |
$335.22
|
| Rate for Payer: Priority Health SBD |
$248.46
|
| Rate for Payer: UMR Bronson Commercial |
$173.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.79
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$8.06
|
|
|
Service Code
|
NDC 60687048111
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$7.25 |
| Rate for Payer: Aetna American Axle |
$5.24
|
| Rate for Payer: Aetna Commercial |
$6.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.24
|
| Rate for Payer: Cash Price |
$6.45
|
| Rate for Payer: Cofinity Advantage |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.45
|
| Rate for Payer: Healthscope Commercial |
$7.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.04
|
| Rate for Payer: PHP Commercial |
$6.85
|
| Rate for Payer: Priority Health SBD |
$5.08
|
| Rate for Payer: UMR Bronson Commercial |
$3.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.04
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$203.70
|
|
|
Service Code
|
NDC 42858050103
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.37 |
| Max. Negotiated Rate |
$183.33 |
| Rate for Payer: Aetna American Axle |
$132.41
|
| Rate for Payer: Aetna Commercial |
$173.15
|
| Rate for Payer: Aetna Medicare |
$101.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.41
|
| Rate for Payer: BCBS Complete |
$81.48
|
| Rate for Payer: Cash Price |
$162.96
|
| Rate for Payer: Cofinity Advantage |
$142.59
|
| Rate for Payer: Cofinity Commercial |
$175.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.96
|
| Rate for Payer: Healthscope Commercial |
$183.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.78
|
| Rate for Payer: PHP Commercial |
$173.15
|
| Rate for Payer: Priority Health SBD |
$128.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.41
|
| Rate for Payer: UHC Core |
$106.13
|
| Rate for Payer: UHC Exchange |
$80.05
|
| Rate for Payer: UMR Bronson Commercial |
$75.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.78
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$140.91
|
|
|
Service Code
|
NDC 50383092493
|
| 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 Advantage |
$98.64
|
| Rate for Payer: Cofinity Commercial |
$121.18
|
| 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 Commercial |
$119.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.68
|
| Rate for Payer: PHP Commercial |
$119.77
|
| 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
|
$203.70
|
|
|
Service Code
|
NDC 42858050103
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.63 |
| Max. Negotiated Rate |
$183.33 |
| Rate for Payer: Aetna American Axle |
$132.41
|
| Rate for Payer: Aetna Commercial |
$173.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.41
|
| Rate for Payer: Cash Price |
$162.96
|
| Rate for Payer: Cofinity Advantage |
$142.59
|
| Rate for Payer: Cofinity Commercial |
$175.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.96
|
| Rate for Payer: Healthscope Commercial |
$183.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.78
|
| Rate for Payer: PHP Commercial |
$173.15
|
| Rate for Payer: Priority Health SBD |
$128.33
|
| Rate for Payer: UMR Bronson Commercial |
$89.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.78
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$394.38
|
|
|
Service Code
|
NDC 00904715404
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.92 |
| Max. Negotiated Rate |
$354.94 |
| Rate for Payer: Aetna American Axle |
$256.35
|
| Rate for Payer: Aetna Commercial |
$335.22
|
| Rate for Payer: Aetna Medicare |
$197.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.35
|
| Rate for Payer: BCBS Complete |
$157.75
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cofinity Advantage |
$276.07
|
| Rate for Payer: Cofinity Commercial |
$339.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.50
|
| Rate for Payer: Healthscope Commercial |
$354.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$276.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$295.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$315.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.79
|
| Rate for Payer: PHP Commercial |
$335.22
|
| Rate for Payer: Priority Health SBD |
$248.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$256.35
|
| Rate for Payer: UHC Core |
$205.47
|
| Rate for Payer: UHC Exchange |
$154.99
|
| Rate for Payer: UMR Bronson Commercial |
$145.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$295.79
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$140.91
|
|
|
Service Code
|
NDC 50383092493
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.14 |
| Max. Negotiated Rate |
$126.82 |
| Rate for Payer: Aetna American Axle |
$91.59
|
| Rate for Payer: Aetna Commercial |
$119.77
|
| Rate for Payer: Aetna Medicare |
$70.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.59
|
| Rate for Payer: BCBS Complete |
$56.36
|
| Rate for Payer: Cash Price |
$112.73
|
| Rate for Payer: Cofinity Advantage |
$98.64
|
| Rate for Payer: Cofinity Commercial |
$121.18
|
| 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: MI Amish Medical Board Commercial |
$112.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.68
|
| Rate for Payer: PHP Commercial |
$119.77
|
| Rate for Payer: Priority Health SBD |
$88.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.59
|
| Rate for Payer: UHC Core |
$73.41
|
| Rate for Payer: UHC Exchange |
$55.38
|
| Rate for Payer: UMR Bronson Commercial |
$52.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.68
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$200.55
|
|
|
Service Code
|
NDC 00054017613
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.24 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Aetna American Axle |
$130.36
|
| Rate for Payer: Aetna Commercial |
$170.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.36
|
| Rate for Payer: Cash Price |
$160.44
|
| Rate for Payer: Cofinity Advantage |
$140.38
|
| Rate for Payer: Cofinity Commercial |
$172.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.44
|
| Rate for Payer: Healthscope Commercial |
$180.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.41
|
| Rate for Payer: PHP Commercial |
$170.47
|
| Rate for Payer: Priority Health SBD |
$126.35
|
| Rate for Payer: UMR Bronson Commercial |
$88.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.41
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$8.06
|
|
|
Service Code
|
NDC 60687048111
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$7.25 |
| Rate for Payer: Aetna American Axle |
$5.24
|
| Rate for Payer: Aetna Commercial |
$6.85
|
| Rate for Payer: Aetna Medicare |
$4.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.24
|
| Rate for Payer: BCBS Complete |
$3.22
|
| Rate for Payer: Cash Price |
$6.45
|
| Rate for Payer: Cofinity Advantage |
$5.64
|
| Rate for Payer: Cofinity Commercial |
$6.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.45
|
| Rate for Payer: Healthscope Commercial |
$7.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.04
|
| Rate for Payer: PHP Commercial |
$6.85
|
| Rate for Payer: Priority Health SBD |
$5.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.24
|
| Rate for Payer: UHC Core |
$4.20
|
| Rate for Payer: UHC Exchange |
$3.17
|
| Rate for Payer: UMR Bronson Commercial |
$2.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.04
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$241.73
|
|
|
Service Code
|
NDC 60687048121
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.36 |
| Max. Negotiated Rate |
$217.56 |
| Rate for Payer: Aetna American Axle |
$157.12
|
| Rate for Payer: Aetna Commercial |
$205.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.12
|
| Rate for Payer: Cash Price |
$193.38
|
| Rate for Payer: Cofinity Advantage |
$169.21
|
| Rate for Payer: Cofinity Commercial |
$207.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.38
|
| Rate for Payer: Healthscope Commercial |
$217.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.30
|
| Rate for Payer: PHP Commercial |
$205.47
|
| Rate for Payer: Priority Health SBD |
$152.29
|
| Rate for Payer: UMR Bronson Commercial |
$106.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.30
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$241.73
|
|
|
Service Code
|
NDC 60687048121
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.44 |
| Max. Negotiated Rate |
$217.56 |
| Rate for Payer: Aetna American Axle |
$157.12
|
| Rate for Payer: Aetna Commercial |
$205.47
|
| Rate for Payer: Aetna Medicare |
$120.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.12
|
| Rate for Payer: BCBS Complete |
$96.69
|
| Rate for Payer: Cash Price |
$193.38
|
| Rate for Payer: Cofinity Advantage |
$169.21
|
| Rate for Payer: Cofinity Commercial |
$207.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.38
|
| Rate for Payer: Healthscope Commercial |
$217.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$193.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$181.30
|
| Rate for Payer: PHP Commercial |
$205.47
|
| Rate for Payer: Priority Health SBD |
$152.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.12
|
| Rate for Payer: UHC Core |
$125.94
|
| Rate for Payer: UHC Exchange |
$95.00
|
| Rate for Payer: UMR Bronson Commercial |
$89.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.30
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$200.55
|
|
|
Service Code
|
NDC 00054017613
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Aetna American Axle |
$130.36
|
| Rate for Payer: Aetna Commercial |
$170.47
|
| Rate for Payer: Aetna Medicare |
$100.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.36
|
| Rate for Payer: BCBS Complete |
$80.22
|
| Rate for Payer: Cash Price |
$160.44
|
| Rate for Payer: Cofinity Advantage |
$140.38
|
| Rate for Payer: Cofinity Commercial |
$172.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.44
|
| Rate for Payer: Healthscope Commercial |
$180.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.41
|
| Rate for Payer: PHP Commercial |
$170.47
|
| Rate for Payer: Priority Health SBD |
$126.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.36
|
| Rate for Payer: UHC Core |
$104.49
|
| Rate for Payer: UHC Exchange |
$78.82
|
| Rate for Payer: UMR Bronson Commercial |
$74.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.41
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
|
IP
|
$289.05
|
|
|
Service Code
|
NDC 62332012731
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.18 |
| Max. Negotiated Rate |
$260.14 |
| Rate for Payer: Aetna American Axle |
$187.88
|
| Rate for Payer: Aetna Commercial |
$245.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.88
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Advantage |
$202.34
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$260.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.79
|
| Rate for Payer: PHP Commercial |
$245.69
|
| Rate for Payer: Priority Health SBD |
$182.10
|
| Rate for Payer: UMR Bronson Commercial |
$127.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.79
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
|
OP
|
$518.40
|
|
|
Service Code
|
NDC 00904663661
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.81 |
| Max. Negotiated Rate |
$466.56 |
| Rate for Payer: Aetna American Axle |
$336.96
|
| Rate for Payer: Aetna Commercial |
$440.64
|
| Rate for Payer: Aetna Medicare |
$259.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.96
|
| Rate for Payer: BCBS Complete |
$207.36
|
| Rate for Payer: Cash Price |
$414.72
|
| Rate for Payer: Cofinity Advantage |
$362.88
|
| Rate for Payer: Cofinity Commercial |
$445.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.72
|
| Rate for Payer: Healthscope Commercial |
$466.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$362.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$388.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$414.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.80
|
| Rate for Payer: PHP Commercial |
$440.64
|
| Rate for Payer: Priority Health SBD |
$326.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$336.96
|
| Rate for Payer: UHC Core |
$270.09
|
| Rate for Payer: UHC Exchange |
$203.73
|
| Rate for Payer: UMR Bronson Commercial |
$191.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$388.80
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
|
OP
|
$289.05
|
|
|
Service Code
|
NDC 62332012731
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.95 |
| Max. Negotiated Rate |
$260.14 |
| Rate for Payer: Aetna American Axle |
$187.88
|
| Rate for Payer: Aetna Commercial |
$245.69
|
| Rate for Payer: Aetna Medicare |
$144.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.88
|
| Rate for Payer: BCBS Complete |
$115.62
|
| Rate for Payer: Cash Price |
$231.24
|
| Rate for Payer: Cofinity Advantage |
$202.34
|
| Rate for Payer: Cofinity Commercial |
$248.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$231.24
|
| Rate for Payer: Healthscope Commercial |
$260.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$202.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$216.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$231.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$245.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.79
|
| Rate for Payer: PHP Commercial |
$245.69
|
| Rate for Payer: Priority Health SBD |
$182.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.88
|
| Rate for Payer: UHC Core |
$150.60
|
| Rate for Payer: UHC Exchange |
$113.60
|
| Rate for Payer: UMR Bronson Commercial |
$106.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$216.79
|
|
|
BUPROPION HCL 100 MG TABLET
|
Facility
|
IP
|
$518.40
|
|
|
Service Code
|
NDC 00904663661
|
| Hospital Charge Code |
9321
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.10 |
| Max. Negotiated Rate |
$466.56 |
| Rate for Payer: Aetna American Axle |
$336.96
|
| Rate for Payer: Aetna Commercial |
$440.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.96
|
| Rate for Payer: Cash Price |
$414.72
|
| Rate for Payer: Cofinity Advantage |
$362.88
|
| Rate for Payer: Cofinity Commercial |
$445.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$414.72
|
| Rate for Payer: Healthscope Commercial |
$466.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$362.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$388.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$388.80
|
| Rate for Payer: PHP Commercial |
$440.64
|
| Rate for Payer: Priority Health SBD |
$326.59
|
| Rate for Payer: UMR Bronson Commercial |
$228.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$388.80
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
OP
|
$408.48
|
|
|
Service Code
|
NDC 00904663561
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.14 |
| Max. Negotiated Rate |
$367.63 |
| Rate for Payer: Aetna American Axle |
$265.51
|
| Rate for Payer: Aetna Commercial |
$347.21
|
| Rate for Payer: Aetna Medicare |
$204.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.51
|
| Rate for Payer: BCBS Complete |
$163.39
|
| Rate for Payer: Cash Price |
$326.78
|
| Rate for Payer: Cofinity Advantage |
$285.94
|
| Rate for Payer: Cofinity Commercial |
$351.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.78
|
| Rate for Payer: Healthscope Commercial |
$367.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$326.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$306.36
|
| Rate for Payer: PHP Commercial |
$347.21
|
| Rate for Payer: Priority Health SBD |
$257.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.51
|
| Rate for Payer: UHC Core |
$212.82
|
| Rate for Payer: UHC Exchange |
$160.53
|
| Rate for Payer: UMR Bronson Commercial |
$151.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.36
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
OP
|
$452.16
|
|
|
Service Code
|
NDC 51079094320
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.30 |
| Max. Negotiated Rate |
$406.94 |
| Rate for Payer: Aetna American Axle |
$293.90
|
| Rate for Payer: Aetna Commercial |
$384.34
|
| Rate for Payer: Aetna Medicare |
$226.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.90
|
| Rate for Payer: BCBS Complete |
$180.86
|
| Rate for Payer: Cash Price |
$361.73
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$361.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.12
|
| Rate for Payer: PHP Commercial |
$384.34
|
| Rate for Payer: Priority Health SBD |
$284.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.90
|
| Rate for Payer: UHC Core |
$235.58
|
| Rate for Payer: UHC Exchange |
$177.70
|
| Rate for Payer: UMR Bronson Commercial |
$167.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.12
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
IP
|
$4.53
|
|
|
Service Code
|
NDC 51079094301
|
| 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 Advantage |
$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 Commercial |
$3.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.40
|
| Rate for Payer: PHP Commercial |
$3.85
|
| 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
|
|
|
BUPROPION HCL 75 MG TABLET
|
Facility
|
IP
|
$452.16
|
|
|
Service Code
|
NDC 51079094320
|
| 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 Advantage |
$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 Commercial |
$384.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.12
|
| Rate for Payer: PHP Commercial |
$384.34
|
| 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
|
$408.48
|
|
|
Service Code
|
NDC 00904663561
|
| Hospital Charge Code |
9322
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.73 |
| Max. Negotiated Rate |
$367.63 |
| Rate for Payer: Aetna American Axle |
$265.51
|
| Rate for Payer: Aetna Commercial |
$347.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.51
|
| Rate for Payer: Cash Price |
$326.78
|
| Rate for Payer: Cofinity Advantage |
$285.94
|
| Rate for Payer: Cofinity Commercial |
$351.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.78
|
| Rate for Payer: Healthscope Commercial |
$367.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$285.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$347.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$306.36
|
| Rate for Payer: PHP Commercial |
$347.21
|
| Rate for Payer: Priority Health SBD |
$257.34
|
| Rate for Payer: UMR Bronson Commercial |
$179.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.36
|
|
