|
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
|
$140.26
|
|
|
Service Code
|
NDC 00904708404
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.90 |
| Max. Negotiated Rate |
$126.23 |
| Rate for Payer: Aetna American Axle |
$91.17
|
| Rate for Payer: Aetna Commercial |
$119.22
|
| Rate for Payer: Aetna Medicare |
$70.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.17
|
| Rate for Payer: BCBS Complete |
$56.10
|
| 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: MI Amish Medical Board Commercial |
$112.21
|
| 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: UHC All Payor (Choice/PPO) |
$91.17
|
| Rate for Payer: UHC Core |
$73.08
|
| Rate for Payer: UHC Exchange |
$55.12
|
| Rate for Payer: UMR Bronson Commercial |
$51.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.19
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$744.96
|
|
|
Service Code
|
NDC 60687078201
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$275.64 |
| Max. Negotiated Rate |
$670.46 |
| Rate for Payer: Aetna American Axle |
$484.22
|
| Rate for Payer: Aetna Commercial |
$633.22
|
| Rate for Payer: Aetna Medicare |
$372.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$484.22
|
| Rate for Payer: BCBS Complete |
$297.98
|
| Rate for Payer: Cash Price |
$595.97
|
| Rate for Payer: Cofinity Advantage |
$521.47
|
| Rate for Payer: Cofinity Commercial |
$640.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$595.97
|
| Rate for Payer: Healthscope Commercial |
$670.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$521.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$558.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$595.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$633.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$558.72
|
| Rate for Payer: PHP Commercial |
$633.22
|
| Rate for Payer: Priority Health SBD |
$469.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$484.22
|
| Rate for Payer: UHC Core |
$388.12
|
| Rate for Payer: UHC Exchange |
$292.77
|
| Rate for Payer: UMR Bronson Commercial |
$275.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$558.72
|
|
|
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
|
$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
|
|
|
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
|
|
|
BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS
|
Facility
|
IP
|
$20,956.96
|
|
|
Service Code
|
APR-DRG 8422
|
| Min. Negotiated Rate |
$19,959.01 |
| Max. Negotiated Rate |
$20,956.96 |
| Rate for Payer: BCBS Complete |
$20,956.96
|
| Rate for Payer: Mclaren Medicaid |
$19,959.01
|
| Rate for Payer: Meridian Medicaid |
$20,956.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$19,959.01
|
| Rate for Payer: UHC Medicaid |
$19,959.01
|
| Rate for Payer: UHCCP Medicaid |
$19,959.01
|
|
|
BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS
|
Facility
|
IP
|
$26,432.12
|
|
|
Service Code
|
APR-DRG 8423
|
| Min. Negotiated Rate |
$25,173.45 |
| Max. Negotiated Rate |
$26,432.12 |
| Rate for Payer: BCBS Complete |
$26,432.12
|
| Rate for Payer: Mclaren Medicaid |
$25,173.45
|
| Rate for Payer: Meridian Medicaid |
$26,432.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$25,173.45
|
| Rate for Payer: UHC Medicaid |
$25,173.45
|
| Rate for Payer: UHCCP Medicaid |
$25,173.45
|
|
|
BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS
|
Facility
|
IP
|
$10,715.46
|
|
|
Service Code
|
APR-DRG 8421
|
| Min. Negotiated Rate |
$10,205.20 |
| Max. Negotiated Rate |
$10,715.46 |
| Rate for Payer: BCBS Complete |
$10,715.46
|
| Rate for Payer: Mclaren Medicaid |
$10,205.20
|
| Rate for Payer: Meridian Medicaid |
$10,715.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,205.20
|
| Rate for Payer: UHC Medicaid |
$10,205.20
|
| Rate for Payer: UHCCP Medicaid |
$10,205.20
|
|
|
BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS
|
Facility
|
IP
|
$100,070.51
|
|
|
Service Code
|
APR-DRG 8424
|
| Min. Negotiated Rate |
$95,305.25 |
| Max. Negotiated Rate |
$100,070.51 |
| Rate for Payer: BCBS Complete |
$100,070.51
|
| Rate for Payer: Mclaren Medicaid |
$95,305.25
|
| Rate for Payer: Meridian Medicaid |
$100,070.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$95,305.25
|
| Rate for Payer: UHC Medicaid |
$95,305.25
|
| Rate for Payer: UHCCP Medicaid |
$95,305.25
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
IP
|
$122.20
|
|
|
Service Code
|
NDC 23155002401
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.77 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna American Axle |
$79.43
|
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.43
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Advantage |
$85.54
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.65
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health SBD |
$76.99
|
| Rate for Payer: UMR Bronson Commercial |
$53.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
OP
|
$481.75
|
|
|
Service Code
|
NDC 16729020216
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.25 |
| Max. Negotiated Rate |
$433.57 |
| Rate for Payer: Aetna American Axle |
$313.14
|
| Rate for Payer: Aetna Commercial |
$409.49
|
| Rate for Payer: Aetna Medicare |
$240.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.14
|
| Rate for Payer: BCBS Complete |
$192.70
|
| Rate for Payer: Cash Price |
$385.40
|
| Rate for Payer: Cofinity Advantage |
$337.23
|
| Rate for Payer: Cofinity Commercial |
$414.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.40
|
| Rate for Payer: Healthscope Commercial |
$433.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$385.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$361.31
|
| Rate for Payer: PHP Commercial |
$409.49
|
| Rate for Payer: Priority Health SBD |
$303.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$313.14
|
| Rate for Payer: UHC Core |
$250.99
|
| Rate for Payer: UHC Exchange |
$189.33
|
| Rate for Payer: UMR Bronson Commercial |
$178.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.31
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
OP
|
$122.20
|
|
|
Service Code
|
NDC 23155002401
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.21 |
| Max. Negotiated Rate |
$109.98 |
| Rate for Payer: Aetna American Axle |
$79.43
|
| Rate for Payer: Aetna Commercial |
$103.87
|
| Rate for Payer: Aetna Medicare |
$61.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.43
|
| Rate for Payer: BCBS Complete |
$48.88
|
| Rate for Payer: Cash Price |
$97.76
|
| Rate for Payer: Cofinity Advantage |
$85.54
|
| Rate for Payer: Cofinity Commercial |
$105.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.76
|
| Rate for Payer: Healthscope Commercial |
$109.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.65
|
| Rate for Payer: PHP Commercial |
$103.87
|
| Rate for Payer: Priority Health SBD |
$76.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.43
|
| Rate for Payer: UHC Core |
$63.67
|
| Rate for Payer: UHC Exchange |
$48.02
|
| Rate for Payer: UMR Bronson Commercial |
$45.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.65
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
OP
|
$96.35
|
|
|
Service Code
|
NDC 16729020201
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.65 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Aetna American Axle |
$62.63
|
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna Medicare |
$48.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.63
|
| Rate for Payer: BCBS Complete |
$38.54
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Advantage |
$67.44
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Healthscope Commercial |
$86.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.26
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health SBD |
$60.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.63
|
| Rate for Payer: UHC Core |
$50.20
|
| Rate for Payer: UHC Exchange |
$37.87
|
| Rate for Payer: UMR Bronson Commercial |
$35.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.26
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
IP
|
$96.35
|
|
|
Service Code
|
NDC 16729020201
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.39 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Aetna American Axle |
$62.63
|
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.63
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Advantage |
$67.44
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Healthscope Commercial |
$86.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.26
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health SBD |
$60.70
|
| Rate for Payer: UMR Bronson Commercial |
$42.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.26
|
|
|
BUSPIRONE 10 MG TABLET
|
Facility
|
IP
|
$481.75
|
|
|
Service Code
|
NDC 16729020216
|
| Hospital Charge Code |
9323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$211.97 |
| Max. Negotiated Rate |
$433.57 |
| Rate for Payer: Aetna American Axle |
$313.14
|
| Rate for Payer: Aetna Commercial |
$409.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.14
|
| Rate for Payer: Cash Price |
$385.40
|
| Rate for Payer: Cofinity Advantage |
$337.23
|
| Rate for Payer: Cofinity Commercial |
$414.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$385.40
|
| Rate for Payer: Healthscope Commercial |
$433.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$337.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$361.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$409.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$361.31
|
| Rate for Payer: PHP Commercial |
$409.49
|
| Rate for Payer: Priority Health SBD |
$303.50
|
| Rate for Payer: UMR Bronson Commercial |
$211.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$361.31
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
IP
|
$366.70
|
|
|
Service Code
|
NDC 00904689961
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.35 |
| Max. Negotiated Rate |
$330.03 |
| Rate for Payer: Aetna American Axle |
$238.35
|
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.35
|
| Rate for Payer: Cash Price |
$293.36
|
| Rate for Payer: Cofinity Advantage |
$256.69
|
| Rate for Payer: Cofinity Commercial |
$315.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.36
|
| Rate for Payer: Healthscope Commercial |
$330.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$275.02
|
| Rate for Payer: PHP Commercial |
$311.69
|
| Rate for Payer: Priority Health SBD |
$231.02
|
| Rate for Payer: UMR Bronson Commercial |
$161.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.02
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
OP
|
$366.70
|
|
|
Service Code
|
NDC 00904689961
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.68 |
| Max. Negotiated Rate |
$330.03 |
| Rate for Payer: Aetna American Axle |
$238.35
|
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna Medicare |
$183.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.35
|
| Rate for Payer: BCBS Complete |
$146.68
|
| Rate for Payer: Cash Price |
$293.36
|
| Rate for Payer: Cofinity Advantage |
$256.69
|
| Rate for Payer: Cofinity Commercial |
$315.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.36
|
| Rate for Payer: Healthscope Commercial |
$330.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$256.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$275.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$293.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$275.02
|
| Rate for Payer: PHP Commercial |
$311.69
|
| Rate for Payer: Priority Health SBD |
$231.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.35
|
| Rate for Payer: UHC Core |
$191.05
|
| Rate for Payer: UHC Exchange |
$144.11
|
| Rate for Payer: UMR Bronson Commercial |
$135.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$275.02
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
IP
|
$195.05
|
|
|
Service Code
|
NDC 68382018201
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.82 |
| Max. Negotiated Rate |
$175.54 |
| Rate for Payer: Aetna American Axle |
$126.78
|
| Rate for Payer: Aetna Commercial |
$165.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.78
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cofinity Advantage |
$136.53
|
| Rate for Payer: Cofinity Commercial |
$167.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$175.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.29
|
| Rate for Payer: PHP Commercial |
$165.79
|
| Rate for Payer: Priority Health SBD |
$122.88
|
| Rate for Payer: UMR Bronson Commercial |
$85.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.29
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
IP
|
$4.03
|
|
|
Service Code
|
NDC 60687082311
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Aetna American Axle |
$2.62
|
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.62
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cofinity Advantage |
$2.82
|
| Rate for Payer: Cofinity Commercial |
$3.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.22
|
| Rate for Payer: Healthscope Commercial |
$3.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.02
|
| Rate for Payer: PHP Commercial |
$3.43
|
| Rate for Payer: Priority Health SBD |
$2.54
|
| Rate for Payer: UMR Bronson Commercial |
$1.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.02
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
OP
|
$402.80
|
|
|
Service Code
|
NDC 60687082301
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.04 |
| Max. Negotiated Rate |
$362.52 |
| Rate for Payer: Aetna American Axle |
$261.82
|
| Rate for Payer: Aetna Commercial |
$342.38
|
| Rate for Payer: Aetna Medicare |
$201.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.82
|
| Rate for Payer: BCBS Complete |
$161.12
|
| Rate for Payer: Cash Price |
$322.24
|
| Rate for Payer: Cofinity Advantage |
$281.96
|
| Rate for Payer: Cofinity Commercial |
$346.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$322.24
|
| Rate for Payer: Healthscope Commercial |
$362.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$302.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$322.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$342.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$302.10
|
| Rate for Payer: PHP Commercial |
$342.38
|
| Rate for Payer: Priority Health SBD |
$253.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$261.82
|
| Rate for Payer: UHC Core |
$209.86
|
| Rate for Payer: UHC Exchange |
$158.30
|
| Rate for Payer: UMR Bronson Commercial |
$149.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$302.10
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
IP
|
$76.14
|
|
|
Service Code
|
NDC 16729020312
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.50 |
| Max. Negotiated Rate |
$68.53 |
| Rate for Payer: Aetna American Axle |
$49.49
|
| Rate for Payer: Aetna Commercial |
$64.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.49
|
| Rate for Payer: Cash Price |
$60.91
|
| Rate for Payer: Cofinity Advantage |
$53.30
|
| Rate for Payer: Cofinity Commercial |
$65.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.91
|
| Rate for Payer: Healthscope Commercial |
$68.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.10
|
| Rate for Payer: PHP Commercial |
$64.72
|
| Rate for Payer: Priority Health SBD |
$47.97
|
| Rate for Payer: UMR Bronson Commercial |
$33.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.10
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
OP
|
$124.55
|
|
|
Service Code
|
NDC 00093100301
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.08 |
| Max. Negotiated Rate |
$112.09 |
| Rate for Payer: Aetna American Axle |
$80.96
|
| Rate for Payer: Aetna Commercial |
$105.87
|
| Rate for Payer: Aetna Medicare |
$62.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.96
|
| Rate for Payer: BCBS Complete |
$49.82
|
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Cofinity Advantage |
$87.19
|
| Rate for Payer: Cofinity Commercial |
$107.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$112.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.41
|
| Rate for Payer: PHP Commercial |
$105.87
|
| Rate for Payer: Priority Health SBD |
$78.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.96
|
| Rate for Payer: UHC Core |
$64.89
|
| Rate for Payer: UHC Exchange |
$48.95
|
| Rate for Payer: UMR Bronson Commercial |
$46.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.41
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
IP
|
$124.55
|
|
|
Service Code
|
NDC 00093100301
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$112.09 |
| Rate for Payer: Aetna American Axle |
$80.96
|
| Rate for Payer: Aetna Commercial |
$105.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.96
|
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Cofinity Advantage |
$87.19
|
| Rate for Payer: Cofinity Commercial |
$107.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$112.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.41
|
| Rate for Payer: PHP Commercial |
$105.87
|
| Rate for Payer: Priority Health SBD |
$78.47
|
| Rate for Payer: UMR Bronson Commercial |
$54.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.41
|
|
|
BUSPIRONE 15 MG TABLET
|
Facility
|
OP
|
$76.14
|
|
|
Service Code
|
NDC 16729020312
|
| Hospital Charge Code |
17464
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.17 |
| Max. Negotiated Rate |
$68.53 |
| Rate for Payer: Aetna American Axle |
$49.49
|
| Rate for Payer: Aetna Commercial |
$64.72
|
| Rate for Payer: Aetna Medicare |
$38.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.49
|
| Rate for Payer: BCBS Complete |
$30.46
|
| Rate for Payer: Cash Price |
$60.91
|
| Rate for Payer: Cofinity Advantage |
$53.30
|
| Rate for Payer: Cofinity Commercial |
$65.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.91
|
| Rate for Payer: Healthscope Commercial |
$68.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.10
|
| Rate for Payer: PHP Commercial |
$64.72
|
| Rate for Payer: Priority Health SBD |
$47.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.49
|
| Rate for Payer: UHC Core |
$39.67
|
| Rate for Payer: UHC Exchange |
$29.92
|
| Rate for Payer: UMR Bronson Commercial |
$28.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.10
|
|
