|
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
|
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
|
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 SR 100 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
OP
|
$131.10
|
|
|
Service Code
|
NDC 00591354060
|
| Hospital Charge Code |
18385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$117.99 |
| Rate for Payer: Aetna American Axle |
$85.22
|
| Rate for Payer: Aetna Commercial |
$111.44
|
| Rate for Payer: Aetna Medicare |
$65.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.22
|
| Rate for Payer: BCBS Complete |
$52.44
|
| Rate for Payer: Cash Price |
$104.88
|
| Rate for Payer: Cofinity Advantage |
$91.77
|
| Rate for Payer: Cofinity Commercial |
$112.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.88
|
| Rate for Payer: Healthscope Commercial |
$117.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.33
|
| Rate for Payer: PHP Commercial |
$111.44
|
| Rate for Payer: Priority Health SBD |
$82.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.22
|
| Rate for Payer: UHC Core |
$68.30
|
| Rate for Payer: UHC Exchange |
$51.52
|
| Rate for Payer: UMR Bronson Commercial |
$48.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.33
|
|
|
BUPROPION HCL SR 100 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
IP
|
$131.10
|
|
|
Service Code
|
NDC 00591354060
|
| Hospital Charge Code |
18385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.68 |
| Max. Negotiated Rate |
$117.99 |
| Rate for Payer: Aetna American Axle |
$85.22
|
| Rate for Payer: Aetna Commercial |
$111.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$85.22
|
| Rate for Payer: Cash Price |
$104.88
|
| Rate for Payer: Cofinity Advantage |
$91.77
|
| Rate for Payer: Cofinity Commercial |
$112.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.88
|
| Rate for Payer: Healthscope Commercial |
$117.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$98.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$98.33
|
| Rate for Payer: PHP Commercial |
$111.44
|
| Rate for Payer: Priority Health SBD |
$82.59
|
| Rate for Payer: UMR Bronson Commercial |
$57.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$98.33
|
|
|
BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
IP
|
$144.21
|
|
|
Service Code
|
NDC 43598053760
|
| 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 Advantage |
$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 Commercial |
$122.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.16
|
| Rate for Payer: PHP Commercial |
$122.58
|
| 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 SR 150 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
OP
|
$143.07
|
|
|
Service Code
|
NDC 00591354160
|
| Hospital Charge Code |
18386
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.94 |
| Max. Negotiated Rate |
$128.76 |
| Rate for Payer: Aetna American Axle |
$93.00
|
| Rate for Payer: Aetna Commercial |
$121.61
|
| Rate for Payer: Aetna Medicare |
$71.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.00
|
| Rate for Payer: BCBS Complete |
$57.23
|
| Rate for Payer: Cash Price |
$114.46
|
| Rate for Payer: Cofinity Advantage |
$100.15
|
| Rate for Payer: Cofinity Commercial |
$123.04
|
| 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: MI Amish Medical Board Commercial |
$114.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$121.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.30
|
| Rate for Payer: PHP Commercial |
$121.61
|
| Rate for Payer: Priority Health SBD |
$90.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.00
|
| Rate for Payer: UHC Core |
$74.54
|
| Rate for Payer: UHC Exchange |
$56.23
|
| Rate for Payer: UMR Bronson Commercial |
$52.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.30
|
|
|
BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
IP
|
$143.07
|
|
|
Service Code
|
NDC 00591354160
|
| 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 Advantage |
$100.15
|
| Rate for Payer: Cofinity Commercial |
$123.04
|
| 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 Commercial |
$121.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.30
|
| Rate for Payer: PHP Commercial |
$121.61
|
| 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
|
OP
|
$144.21
|
|
|
Service Code
|
NDC 43598053760
|
| Hospital Charge Code |
18386
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.36 |
| Max. Negotiated Rate |
$129.79 |
| Rate for Payer: Aetna American Axle |
$93.74
|
| Rate for Payer: Aetna Commercial |
$122.58
|
| Rate for Payer: Aetna Medicare |
$72.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.74
|
| Rate for Payer: BCBS Complete |
$57.68
|
| Rate for Payer: Cash Price |
$115.37
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$115.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$108.16
|
| Rate for Payer: PHP Commercial |
$122.58
|
| Rate for Payer: Priority Health SBD |
$90.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.74
|
| Rate for Payer: UHC Core |
$75.13
|
| Rate for Payer: UHC Exchange |
$56.67
|
| Rate for Payer: UMR Bronson Commercial |
$53.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.16
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$8.28
|
|
|
Service Code
|
NDC 60687031211
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Aetna American Axle |
$5.38
|
| Rate for Payer: Aetna Commercial |
$7.04
|
| Rate for Payer: Aetna Medicare |
$4.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.38
|
| Rate for Payer: BCBS Complete |
$3.31
|
| Rate for Payer: Cash Price |
$6.62
|
| Rate for Payer: Cofinity Advantage |
$5.80
|
| Rate for Payer: Cofinity Commercial |
$7.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.62
|
| Rate for Payer: Healthscope Commercial |
$7.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.21
|
| Rate for Payer: PHP Commercial |
$7.04
|
| Rate for Payer: Priority Health SBD |
$5.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.38
|
| Rate for Payer: UHC Core |
$4.31
|
| Rate for Payer: UHC Exchange |
$3.25
|
| Rate for Payer: UMR Bronson Commercial |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.21
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$140.26
|
|
|
Service Code
|
NDC 00904708404
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.71 |
| Max. Negotiated Rate |
$126.23 |
| Rate for Payer: Aetna American Axle |
$91.17
|
| Rate for Payer: Aetna Commercial |
$119.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.17
|
| Rate for Payer: Cash Price |
$112.21
|
| Rate for Payer: Cofinity Advantage |
$98.18
|
| Rate for Payer: Cofinity Commercial |
$120.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.21
|
| Rate for Payer: Healthscope Commercial |
$126.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.19
|
| Rate for Payer: PHP Commercial |
$119.22
|
| Rate for Payer: Priority Health SBD |
$88.36
|
| Rate for Payer: UMR Bronson Commercial |
$61.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.19
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$78.96
|
|
|
Service Code
|
NDC 50228014430
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.22 |
| Max. Negotiated Rate |
$71.06 |
| Rate for Payer: Aetna American Axle |
$51.32
|
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna Medicare |
$39.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.32
|
| Rate for Payer: BCBS Complete |
$31.58
|
| Rate for Payer: Cash Price |
$63.17
|
| Rate for Payer: Cofinity Advantage |
$55.27
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.17
|
| Rate for Payer: Healthscope Commercial |
$71.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.22
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: Priority Health SBD |
$49.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.32
|
| Rate for Payer: UHC Core |
$41.14
|
| Rate for Payer: UHC Exchange |
$31.03
|
| Rate for Payer: UMR Bronson Commercial |
$29.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.22
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$110.58
|
|
|
Service Code
|
NDC 43598065530
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.66 |
| Max. Negotiated Rate |
$99.52 |
| Rate for Payer: Aetna American Axle |
$71.88
|
| Rate for Payer: Aetna Commercial |
$93.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.88
|
| Rate for Payer: Cash Price |
$88.46
|
| Rate for Payer: Cofinity Advantage |
$77.41
|
| Rate for Payer: Cofinity Commercial |
$95.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.46
|
| Rate for Payer: Healthscope Commercial |
$99.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.94
|
| Rate for Payer: PHP Commercial |
$93.99
|
| Rate for Payer: Priority Health SBD |
$69.67
|
| Rate for Payer: UMR Bronson Commercial |
$48.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.94
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$7.45
|
|
|
Service Code
|
NDC 60687078211
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$6.71 |
| Rate for Payer: Aetna American Axle |
$4.84
|
| Rate for Payer: Aetna Commercial |
$6.33
|
| Rate for Payer: Aetna Medicare |
$3.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.84
|
| Rate for Payer: BCBS Complete |
$2.98
|
| Rate for Payer: Cash Price |
$5.96
|
| Rate for Payer: Cofinity Advantage |
$5.21
|
| Rate for Payer: Cofinity Commercial |
$6.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.96
|
| Rate for Payer: Healthscope Commercial |
$6.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.59
|
| Rate for Payer: PHP Commercial |
$6.33
|
| Rate for Payer: Priority Health SBD |
$4.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.84
|
| Rate for Payer: UHC Core |
$3.88
|
| Rate for Payer: UHC Exchange |
$2.93
|
| Rate for Payer: UMR Bronson Commercial |
$2.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.59
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$110.58
|
|
|
Service Code
|
NDC 43598065530
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.91 |
| Max. Negotiated Rate |
$99.52 |
| Rate for Payer: Aetna American Axle |
$71.88
|
| Rate for Payer: Aetna Commercial |
$93.99
|
| Rate for Payer: Aetna Medicare |
$55.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.88
|
| Rate for Payer: BCBS Complete |
$44.23
|
| Rate for Payer: Cash Price |
$88.46
|
| Rate for Payer: Cofinity Advantage |
$77.41
|
| Rate for Payer: Cofinity Commercial |
$95.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.46
|
| Rate for Payer: Healthscope Commercial |
$99.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.94
|
| Rate for Payer: PHP Commercial |
$93.99
|
| Rate for Payer: Priority Health SBD |
$69.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.88
|
| Rate for Payer: UHC Core |
$57.61
|
| Rate for Payer: UHC Exchange |
$43.46
|
| Rate for Payer: UMR Bronson Commercial |
$40.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.94
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
NDC 60687031201
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$306.36 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Aetna American Axle |
$538.20
|
| Rate for Payer: Aetna Commercial |
$703.80
|
| Rate for Payer: Aetna Medicare |
$414.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$538.20
|
| Rate for Payer: BCBS Complete |
$331.20
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cofinity Advantage |
$579.60
|
| Rate for Payer: Cofinity Commercial |
$712.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$662.40
|
| Rate for Payer: Healthscope Commercial |
$745.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$579.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$621.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$662.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$703.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$621.00
|
| Rate for Payer: PHP Commercial |
$703.80
|
| Rate for Payer: Priority Health SBD |
$521.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$538.20
|
| Rate for Payer: UHC Core |
$431.39
|
| Rate for Payer: UHC Exchange |
$325.40
|
| Rate for Payer: UMR Bronson Commercial |
$306.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$621.00
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$361.67
|
|
|
Service Code
|
NDC 68180031909
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.82 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna American Axle |
$235.09
|
| Rate for Payer: Aetna Commercial |
$307.42
|
| Rate for Payer: Aetna Medicare |
$180.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.09
|
| Rate for Payer: BCBS Complete |
$144.67
|
| Rate for Payer: Cash Price |
$289.34
|
| Rate for Payer: Cofinity Advantage |
$253.17
|
| Rate for Payer: Cofinity Commercial |
$311.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.34
|
| Rate for Payer: Healthscope Commercial |
$325.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$289.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.25
|
| Rate for Payer: PHP Commercial |
$307.42
|
| Rate for Payer: Priority Health SBD |
$227.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.09
|
| Rate for Payer: UHC Core |
$188.43
|
| Rate for Payer: UHC Exchange |
$142.14
|
| Rate for Payer: UMR Bronson Commercial |
$133.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.25
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$134.21
|
|
|
Service Code
|
NDC 70436001004
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.66 |
| Max. Negotiated Rate |
$120.79 |
| Rate for Payer: Aetna American Axle |
$87.24
|
| Rate for Payer: Aetna Commercial |
$114.08
|
| Rate for Payer: Aetna Medicare |
$67.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.24
|
| Rate for Payer: BCBS Complete |
$53.68
|
| Rate for Payer: Cash Price |
$107.37
|
| Rate for Payer: Cofinity Advantage |
$93.95
|
| Rate for Payer: Cofinity Commercial |
$115.42
|
| 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: MI Amish Medical Board Commercial |
$107.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.66
|
| Rate for Payer: PHP Commercial |
$114.08
|
| Rate for Payer: Priority Health SBD |
$84.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.24
|
| Rate for Payer: UHC Core |
$69.92
|
| Rate for Payer: UHC Exchange |
$52.74
|
| Rate for Payer: UMR Bronson Commercial |
$49.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.66
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$361.67
|
|
|
Service Code
|
NDC 68180031909
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.13 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna American Axle |
$235.09
|
| Rate for Payer: Aetna Commercial |
$307.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.09
|
| Rate for Payer: Cash Price |
$289.34
|
| Rate for Payer: Cofinity Advantage |
$253.17
|
| Rate for Payer: Cofinity Commercial |
$311.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.34
|
| Rate for Payer: Healthscope Commercial |
$325.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$253.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$271.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.25
|
| Rate for Payer: PHP Commercial |
$307.42
|
| Rate for Payer: Priority Health SBD |
$227.85
|
| Rate for Payer: UMR Bronson Commercial |
$159.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$271.25
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
NDC 60687031201
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$364.32 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Aetna American Axle |
$538.20
|
| Rate for Payer: Aetna Commercial |
$703.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$538.20
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cofinity Advantage |
$579.60
|
| Rate for Payer: Cofinity Commercial |
$712.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$662.40
|
| Rate for Payer: Healthscope Commercial |
$745.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$579.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$621.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$703.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$621.00
|
| Rate for Payer: PHP Commercial |
$703.80
|
| Rate for Payer: Priority Health SBD |
$521.64
|
| Rate for Payer: UMR Bronson Commercial |
$364.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$621.00
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$8.28
|
|
|
Service Code
|
NDC 60687031211
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Aetna American Axle |
$5.38
|
| Rate for Payer: Aetna Commercial |
$7.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.38
|
| Rate for Payer: Cash Price |
$6.62
|
| Rate for Payer: Cofinity Advantage |
$5.80
|
| Rate for Payer: Cofinity Commercial |
$7.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.62
|
| Rate for Payer: Healthscope Commercial |
$7.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.21
|
| Rate for Payer: PHP Commercial |
$7.04
|
| Rate for Payer: Priority Health SBD |
$5.22
|
| Rate for Payer: UMR Bronson Commercial |
$3.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.21
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$109.28
|
|
|
Service Code
|
NDC 16571086203
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.43 |
| Max. Negotiated Rate |
$98.35 |
| Rate for Payer: Aetna American Axle |
$71.03
|
| Rate for Payer: Aetna Commercial |
$92.89
|
| Rate for Payer: Aetna Medicare |
$54.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.03
|
| Rate for Payer: BCBS Complete |
$43.71
|
| Rate for Payer: Cash Price |
$87.42
|
| Rate for Payer: Cofinity Advantage |
$76.50
|
| Rate for Payer: Cofinity Commercial |
$93.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.42
|
| Rate for Payer: Healthscope Commercial |
$98.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.96
|
| Rate for Payer: PHP Commercial |
$92.89
|
| Rate for Payer: Priority Health SBD |
$68.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.03
|
| Rate for Payer: UHC Core |
$56.93
|
| Rate for Payer: UHC Exchange |
$42.95
|
| Rate for Payer: UMR Bronson Commercial |
$40.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.96
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$134.21
|
|
|
Service Code
|
NDC 70436001004
|
| 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 Advantage |
$93.95
|
| Rate for Payer: Cofinity Commercial |
$115.42
|
| 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 Commercial |
$114.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.66
|
| Rate for Payer: PHP Commercial |
$114.08
|
| 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
|
$120.56
|
|
|
Service Code
|
NDC 68180031906
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.05 |
| Max. Negotiated Rate |
$108.50 |
| Rate for Payer: Aetna American Axle |
$78.36
|
| Rate for Payer: Aetna Commercial |
$102.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.36
|
| Rate for Payer: Cash Price |
$96.45
|
| Rate for Payer: Cofinity Advantage |
$84.39
|
| Rate for Payer: Cofinity Commercial |
$103.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$96.45
|
| Rate for Payer: Healthscope Commercial |
$108.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$84.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$90.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$90.42
|
| Rate for Payer: PHP Commercial |
$102.48
|
| Rate for Payer: Priority Health SBD |
$75.95
|
| Rate for Payer: UMR Bronson Commercial |
$53.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$90.42
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$7.45
|
|
|
Service Code
|
NDC 60687078211
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$6.71 |
| Rate for Payer: Aetna American Axle |
$4.84
|
| Rate for Payer: Aetna Commercial |
$6.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.84
|
| Rate for Payer: Cash Price |
$5.96
|
| Rate for Payer: Cofinity Advantage |
$5.21
|
| Rate for Payer: Cofinity Commercial |
$6.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.96
|
| Rate for Payer: Healthscope Commercial |
$6.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.59
|
| Rate for Payer: PHP Commercial |
$6.33
|
| Rate for Payer: Priority Health SBD |
$4.69
|
| Rate for Payer: UMR Bronson Commercial |
$3.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.59
|
|
