|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
OP
|
$225.15
|
|
|
Service Code
|
NDC 16729020101
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.31 |
| Max. Negotiated Rate |
$202.63 |
| Rate for Payer: Aetna American Axle |
$146.35
|
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna Medicare |
$112.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.35
|
| Rate for Payer: BCBS Complete |
$90.06
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Advantage |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$180.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.86
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health SBD |
$141.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.35
|
| Rate for Payer: UHC Core |
$117.30
|
| Rate for Payer: UHC Exchange |
$88.48
|
| Rate for Payer: UMR Bronson Commercial |
$83.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
OP
|
$298.45
|
|
|
Service Code
|
NDC 72888006301
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.43 |
| Max. Negotiated Rate |
$268.61 |
| Rate for Payer: Aetna American Axle |
$193.99
|
| Rate for Payer: Aetna Commercial |
$253.68
|
| Rate for Payer: Aetna Medicare |
$149.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.99
|
| Rate for Payer: BCBS Complete |
$119.38
|
| Rate for Payer: Cash Price |
$238.76
|
| Rate for Payer: Cofinity Advantage |
$208.91
|
| Rate for Payer: Cofinity Commercial |
$256.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.76
|
| Rate for Payer: Healthscope Commercial |
$268.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$238.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$223.84
|
| Rate for Payer: PHP Commercial |
$253.68
|
| Rate for Payer: Priority Health SBD |
$188.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.99
|
| Rate for Payer: UHC Core |
$155.49
|
| Rate for Payer: UHC Exchange |
$117.29
|
| Rate for Payer: UMR Bronson Commercial |
$110.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.84
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
IP
|
$225.15
|
|
|
Service Code
|
NDC 59651039001
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.07 |
| Max. Negotiated Rate |
$202.63 |
| Rate for Payer: Aetna American Axle |
$146.35
|
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.35
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Advantage |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.86
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health SBD |
$141.84
|
| Rate for Payer: UMR Bronson Commercial |
$99.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
OP
|
$225.15
|
|
|
Service Code
|
NDC 59651039001
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.31 |
| Max. Negotiated Rate |
$202.63 |
| Rate for Payer: Aetna American Axle |
$146.35
|
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna Medicare |
$112.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.35
|
| Rate for Payer: BCBS Complete |
$90.06
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Advantage |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$180.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.86
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health SBD |
$141.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.35
|
| Rate for Payer: UHC Core |
$117.30
|
| Rate for Payer: UHC Exchange |
$88.48
|
| Rate for Payer: UMR Bronson Commercial |
$83.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
OP
|
$225.15
|
|
|
Service Code
|
NDC 68382062301
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.31 |
| Max. Negotiated Rate |
$202.63 |
| Rate for Payer: Aetna American Axle |
$146.35
|
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna Medicare |
$112.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.35
|
| Rate for Payer: BCBS Complete |
$90.06
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Advantage |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$180.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.86
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health SBD |
$141.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.35
|
| Rate for Payer: UHC Core |
$117.30
|
| Rate for Payer: UHC Exchange |
$88.48
|
| Rate for Payer: UMR Bronson Commercial |
$83.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
BUSPIRONE 7.5 MG TABLET
|
Facility
|
IP
|
$225.15
|
|
|
Service Code
|
NDC 68382062301
|
| Hospital Charge Code |
29967
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.07 |
| Max. Negotiated Rate |
$202.63 |
| Rate for Payer: Aetna American Axle |
$146.35
|
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.35
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Advantage |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.86
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health SBD |
$141.84
|
| Rate for Payer: UMR Bronson Commercial |
$99.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$325.50
|
|
|
Service Code
|
NDC 70010014901
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.22 |
| Max. Negotiated Rate |
$292.95 |
| Rate for Payer: Aetna American Axle |
$211.57
|
| Rate for Payer: Aetna Commercial |
$276.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.57
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cofinity Advantage |
$227.85
|
| Rate for Payer: Cofinity Commercial |
$279.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.40
|
| Rate for Payer: Healthscope Commercial |
$292.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.12
|
| Rate for Payer: PHP Commercial |
$276.68
|
| Rate for Payer: Priority Health SBD |
$205.06
|
| Rate for Payer: UMR Bronson Commercial |
$143.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.12
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$735.70
|
|
|
Service Code
|
NDC 00603254421
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$272.21 |
| Max. Negotiated Rate |
$662.13 |
| Rate for Payer: Aetna American Axle |
$478.20
|
| Rate for Payer: Aetna Commercial |
$625.35
|
| Rate for Payer: Aetna Medicare |
$367.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.20
|
| Rate for Payer: BCBS Complete |
$294.28
|
| Rate for Payer: Cash Price |
$588.56
|
| Rate for Payer: Cofinity Advantage |
$514.99
|
| Rate for Payer: Cofinity Commercial |
$632.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.56
|
| Rate for Payer: Healthscope Commercial |
$662.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$514.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$588.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$551.77
|
| Rate for Payer: PHP Commercial |
$625.35
|
| Rate for Payer: Priority Health SBD |
$463.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$478.20
|
| Rate for Payer: UHC Core |
$383.30
|
| Rate for Payer: UHC Exchange |
$289.13
|
| Rate for Payer: UMR Bronson Commercial |
$272.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.77
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$325.50
|
|
|
Service Code
|
NDC 70010014901
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.44 |
| Max. Negotiated Rate |
$292.95 |
| Rate for Payer: Aetna American Axle |
$211.57
|
| Rate for Payer: Aetna Commercial |
$276.68
|
| Rate for Payer: Aetna Medicare |
$162.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.57
|
| Rate for Payer: BCBS Complete |
$130.20
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cofinity Advantage |
$227.85
|
| Rate for Payer: Cofinity Commercial |
$279.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.40
|
| Rate for Payer: Healthscope Commercial |
$292.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$260.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.12
|
| Rate for Payer: PHP Commercial |
$276.68
|
| Rate for Payer: Priority Health SBD |
$205.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.57
|
| Rate for Payer: UHC Core |
$169.59
|
| Rate for Payer: UHC Exchange |
$127.92
|
| Rate for Payer: UMR Bronson Commercial |
$120.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.12
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$3,472.00
|
|
|
Service Code
|
NDC 00603254428
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,527.68 |
| Max. Negotiated Rate |
$3,124.80 |
| Rate for Payer: Aetna American Axle |
$2,256.80
|
| Rate for Payer: Aetna Commercial |
$2,951.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,256.80
|
| Rate for Payer: Cash Price |
$2,777.60
|
| Rate for Payer: Cofinity Advantage |
$2,430.40
|
| Rate for Payer: Cofinity Commercial |
$2,985.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,777.60
|
| Rate for Payer: Healthscope Commercial |
$3,124.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,430.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,604.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,951.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,604.00
|
| Rate for Payer: PHP Commercial |
$2,951.20
|
| Rate for Payer: Priority Health SBD |
$2,187.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,527.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,604.00
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$302.75
|
|
|
Service Code
|
NDC 00527169501
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.21 |
| Max. Negotiated Rate |
$272.48 |
| Rate for Payer: Aetna American Axle |
$196.79
|
| Rate for Payer: Aetna Commercial |
$257.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.79
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: Cofinity Advantage |
$211.93
|
| Rate for Payer: Cofinity Commercial |
$260.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.20
|
| Rate for Payer: Healthscope Commercial |
$272.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.06
|
| Rate for Payer: PHP Commercial |
$257.34
|
| Rate for Payer: Priority Health SBD |
$190.73
|
| Rate for Payer: UMR Bronson Commercial |
$133.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.06
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$735.70
|
|
|
Service Code
|
NDC 00603254421
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$323.71 |
| Max. Negotiated Rate |
$662.13 |
| Rate for Payer: Aetna American Axle |
$478.20
|
| Rate for Payer: Aetna Commercial |
$625.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.20
|
| Rate for Payer: Cash Price |
$588.56
|
| Rate for Payer: Cofinity Advantage |
$514.99
|
| Rate for Payer: Cofinity Commercial |
$632.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.56
|
| Rate for Payer: Healthscope Commercial |
$662.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$514.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$551.77
|
| Rate for Payer: PHP Commercial |
$625.35
|
| Rate for Payer: Priority Health SBD |
$463.49
|
| Rate for Payer: UMR Bronson Commercial |
$323.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.77
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$3,472.00
|
|
|
Service Code
|
NDC 00603254428
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,284.64 |
| Max. Negotiated Rate |
$3,124.80 |
| Rate for Payer: Aetna American Axle |
$2,256.80
|
| Rate for Payer: Aetna Commercial |
$2,951.20
|
| Rate for Payer: Aetna Medicare |
$1,736.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,256.80
|
| Rate for Payer: BCBS Complete |
$1,388.80
|
| Rate for Payer: Cash Price |
$2,777.60
|
| Rate for Payer: Cofinity Advantage |
$2,430.40
|
| Rate for Payer: Cofinity Commercial |
$2,985.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,777.60
|
| Rate for Payer: Healthscope Commercial |
$3,124.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,430.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,604.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,777.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,951.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,604.00
|
| Rate for Payer: PHP Commercial |
$2,951.20
|
| Rate for Payer: Priority Health SBD |
$2,187.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,256.80
|
| Rate for Payer: UHC Core |
$1,808.91
|
| Rate for Payer: UHC Exchange |
$1,364.50
|
| Rate for Payer: UMR Bronson Commercial |
$1,284.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,604.00
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
NDC 46672005310
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna American Axle |
$95.55
|
| Rate for Payer: Aetna Commercial |
$124.95
|
| Rate for Payer: Aetna Medicare |
$73.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.55
|
| Rate for Payer: BCBS Complete |
$58.80
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cofinity Advantage |
$102.90
|
| Rate for Payer: Cofinity Commercial |
$126.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.60
|
| Rate for Payer: Healthscope Commercial |
$132.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.25
|
| Rate for Payer: PHP Commercial |
$124.95
|
| Rate for Payer: Priority Health SBD |
$92.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.55
|
| Rate for Payer: UHC Core |
$76.59
|
| Rate for Payer: UHC Exchange |
$57.77
|
| Rate for Payer: UMR Bronson Commercial |
$54.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.25
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
NDC 46672005310
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$132.30 |
| Rate for Payer: Aetna American Axle |
$95.55
|
| Rate for Payer: Aetna Commercial |
$124.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.55
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cofinity Advantage |
$102.90
|
| Rate for Payer: Cofinity Commercial |
$126.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$117.60
|
| Rate for Payer: Healthscope Commercial |
$132.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$102.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$110.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.25
|
| Rate for Payer: PHP Commercial |
$124.95
|
| Rate for Payer: Priority Health SBD |
$92.61
|
| Rate for Payer: UMR Bronson Commercial |
$64.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$110.25
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$434.70
|
|
|
Service Code
|
NDC 00591336901
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.27 |
| Max. Negotiated Rate |
$391.23 |
| Rate for Payer: Aetna American Axle |
$282.56
|
| Rate for Payer: Aetna Commercial |
$369.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.56
|
| Rate for Payer: Cash Price |
$347.76
|
| Rate for Payer: Cofinity Advantage |
$304.29
|
| Rate for Payer: Cofinity Commercial |
$373.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.76
|
| Rate for Payer: Healthscope Commercial |
$391.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$326.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$326.02
|
| Rate for Payer: PHP Commercial |
$369.50
|
| Rate for Payer: Priority Health SBD |
$273.86
|
| Rate for Payer: UMR Bronson Commercial |
$191.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$326.02
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$434.70
|
|
|
Service Code
|
NDC 00591336901
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.84 |
| Max. Negotiated Rate |
$391.23 |
| Rate for Payer: Aetna American Axle |
$282.56
|
| Rate for Payer: Aetna Commercial |
$369.50
|
| Rate for Payer: Aetna Medicare |
$217.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.56
|
| Rate for Payer: BCBS Complete |
$173.88
|
| Rate for Payer: Cash Price |
$347.76
|
| Rate for Payer: Cofinity Advantage |
$304.29
|
| Rate for Payer: Cofinity Commercial |
$373.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.76
|
| Rate for Payer: Healthscope Commercial |
$391.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$326.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$347.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$326.02
|
| Rate for Payer: PHP Commercial |
$369.50
|
| Rate for Payer: Priority Health SBD |
$273.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$282.56
|
| Rate for Payer: UHC Core |
$226.48
|
| Rate for Payer: UHC Exchange |
$170.84
|
| Rate for Payer: UMR Bronson Commercial |
$160.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$326.02
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$302.75
|
|
|
Service Code
|
NDC 00527169501
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.02 |
| Max. Negotiated Rate |
$272.48 |
| Rate for Payer: Aetna American Axle |
$196.79
|
| Rate for Payer: Aetna Commercial |
$257.34
|
| Rate for Payer: Aetna Medicare |
$151.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.79
|
| Rate for Payer: BCBS Complete |
$121.10
|
| Rate for Payer: Cash Price |
$242.20
|
| Rate for Payer: Cofinity Advantage |
$211.93
|
| Rate for Payer: Cofinity Commercial |
$260.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.20
|
| Rate for Payer: Healthscope Commercial |
$272.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$211.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.06
|
| Rate for Payer: PHP Commercial |
$257.34
|
| Rate for Payer: Priority Health SBD |
$190.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.79
|
| Rate for Payer: UHC Core |
$157.73
|
| Rate for Payer: UHC Exchange |
$118.98
|
| Rate for Payer: UMR Bronson Commercial |
$112.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.06
|
|
|
BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE
|
Facility
|
IP
|
$712.60
|
|
|
Service Code
|
NDC 00591321901
|
| Hospital Charge Code |
8922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$313.54 |
| Max. Negotiated Rate |
$641.34 |
| Rate for Payer: Aetna American Axle |
$463.19
|
| Rate for Payer: Aetna Commercial |
$605.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.19
|
| Rate for Payer: Cash Price |
$570.08
|
| Rate for Payer: Cofinity Advantage |
$498.82
|
| Rate for Payer: Cofinity Commercial |
$612.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.08
|
| Rate for Payer: Healthscope Commercial |
$641.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$498.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$605.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$534.45
|
| Rate for Payer: PHP Commercial |
$605.71
|
| Rate for Payer: Priority Health SBD |
$448.94
|
| Rate for Payer: UMR Bronson Commercial |
$313.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.45
|
|
|
BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE
|
Facility
|
OP
|
$712.60
|
|
|
Service Code
|
NDC 00591321901
|
| Hospital Charge Code |
8922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$263.66 |
| Max. Negotiated Rate |
$641.34 |
| Rate for Payer: Aetna American Axle |
$463.19
|
| Rate for Payer: Aetna Commercial |
$605.71
|
| Rate for Payer: Aetna Medicare |
$356.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.19
|
| Rate for Payer: BCBS Complete |
$285.04
|
| Rate for Payer: Cash Price |
$570.08
|
| Rate for Payer: Cofinity Advantage |
$498.82
|
| Rate for Payer: Cofinity Commercial |
$612.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.08
|
| Rate for Payer: Healthscope Commercial |
$641.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$498.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$570.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$605.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$534.45
|
| Rate for Payer: PHP Commercial |
$605.71
|
| Rate for Payer: Priority Health SBD |
$448.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$463.19
|
| Rate for Payer: UHC Core |
$371.26
|
| Rate for Payer: UHC Exchange |
$280.05
|
| Rate for Payer: UMR Bronson Commercial |
$263.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.45
|
|
|
BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE
|
Facility
|
IP
|
$712.60
|
|
|
Service Code
|
NDC 00527155201
|
| Hospital Charge Code |
8922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$313.54 |
| Max. Negotiated Rate |
$641.34 |
| Rate for Payer: Aetna American Axle |
$463.19
|
| Rate for Payer: Aetna Commercial |
$605.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.19
|
| Rate for Payer: Cash Price |
$570.08
|
| Rate for Payer: Cofinity Advantage |
$498.82
|
| Rate for Payer: Cofinity Commercial |
$612.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.08
|
| Rate for Payer: Healthscope Commercial |
$641.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$498.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$605.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$534.45
|
| Rate for Payer: PHP Commercial |
$605.71
|
| Rate for Payer: Priority Health SBD |
$448.94
|
| Rate for Payer: UMR Bronson Commercial |
$313.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.45
|
|
|
BUTALBITAL-ASPIRIN-CAFFEINE 50 MG-325 MG-40 MG CAPSULE
|
Facility
|
OP
|
$712.60
|
|
|
Service Code
|
NDC 00527155201
|
| Hospital Charge Code |
8922
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$263.66 |
| Max. Negotiated Rate |
$641.34 |
| Rate for Payer: Aetna American Axle |
$463.19
|
| Rate for Payer: Aetna Commercial |
$605.71
|
| Rate for Payer: Aetna Medicare |
$356.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$463.19
|
| Rate for Payer: BCBS Complete |
$285.04
|
| Rate for Payer: Cash Price |
$570.08
|
| Rate for Payer: Cofinity Advantage |
$498.82
|
| Rate for Payer: Cofinity Commercial |
$612.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.08
|
| Rate for Payer: Healthscope Commercial |
$641.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$498.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$570.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$605.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$534.45
|
| Rate for Payer: PHP Commercial |
$605.71
|
| Rate for Payer: Priority Health SBD |
$448.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$463.19
|
| Rate for Payer: UHC Core |
$371.26
|
| Rate for Payer: UHC Exchange |
$280.05
|
| Rate for Payer: UMR Bronson Commercial |
$263.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.45
|
|
|
BUTORPHANOL 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$74.66
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
9333
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.85 |
| Max. Negotiated Rate |
$67.19 |
| Rate for Payer: Aetna American Axle |
$48.53
|
| Rate for Payer: Aetna Commercial |
$63.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.53
|
| Rate for Payer: Cash Price |
$59.73
|
| Rate for Payer: Cofinity Advantage |
$52.26
|
| Rate for Payer: Cofinity Commercial |
$64.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.73
|
| Rate for Payer: Healthscope Commercial |
$67.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.99
|
| Rate for Payer: PHP Commercial |
$63.46
|
| Rate for Payer: Priority Health SBD |
$47.04
|
| Rate for Payer: UMR Bronson Commercial |
$32.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.99
|
|
|
BUTORPHANOL 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$74.66
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
9333
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$67.19 |
| Rate for Payer: Aetna American Axle |
$48.53
|
| Rate for Payer: Aetna Commercial |
$63.46
|
| Rate for Payer: Aetna Medicare |
$37.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.53
|
| Rate for Payer: BCBS Complete |
$29.86
|
| Rate for Payer: BCBS Trust/PPO |
$17.95
|
| Rate for Payer: BCN Commercial |
$17.95
|
| Rate for Payer: Cash Price |
$59.73
|
| Rate for Payer: Cash Price |
$59.73
|
| Rate for Payer: Cofinity Advantage |
$52.26
|
| Rate for Payer: Cofinity Commercial |
$64.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.73
|
| Rate for Payer: Healthscope Commercial |
$67.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.99
|
| Rate for Payer: PHP Commercial |
$63.46
|
| Rate for Payer: Priority Health SBD |
$47.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.14
|
| Rate for Payer: UHC Core |
$9.14
|
| Rate for Payer: UHC Exchange |
$9.14
|
| Rate for Payer: UMR Bronson Commercial |
$27.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.99
|
|
|
BUTYLATED HYDROXYTOLUENE POWDER
|
Facility
|
OP
|
$359.55
|
|
|
Service Code
|
NDC 38779006505
|
| Hospital Charge Code |
17041
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.03 |
| Max. Negotiated Rate |
$323.60 |
| Rate for Payer: Aetna American Axle |
$233.71
|
| Rate for Payer: Aetna Commercial |
$305.62
|
| Rate for Payer: Aetna Medicare |
$179.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$233.71
|
| Rate for Payer: BCBS Complete |
$143.82
|
| Rate for Payer: Cash Price |
$287.64
|
| Rate for Payer: Cofinity Advantage |
$251.69
|
| Rate for Payer: Cofinity Commercial |
$309.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$287.64
|
| Rate for Payer: Healthscope Commercial |
$323.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$251.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$269.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$287.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$305.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$269.66
|
| Rate for Payer: PHP Commercial |
$305.62
|
| Rate for Payer: Priority Health SBD |
$226.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$233.71
|
| Rate for Payer: UHC Core |
$187.33
|
| Rate for Payer: UHC Exchange |
$141.30
|
| Rate for Payer: UMR Bronson Commercial |
$133.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$269.66
|
|
