|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL FILM
|
Facility
|
IP
|
$389.13
|
|
|
Service Code
|
NDC 43598057930
|
| Hospital Charge Code |
106176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$291.85 |
| Max. Negotiated Rate |
$389.13 |
| Rate for Payer: Aetna Commercial |
$350.22
|
| Rate for Payer: ASR ASR |
$377.46
|
| Rate for Payer: BCBS Trust/PPO |
$319.55
|
| Rate for Payer: BCN Commercial |
$319.55
|
| Rate for Payer: Cash Price |
$311.30
|
| Rate for Payer: Cofinity Commercial |
$365.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.30
|
| Rate for Payer: Healthscope Commercial |
$377.46
|
| Rate for Payer: Healthscope Whirlpool |
$389.13
|
| Rate for Payer: Mclaren Commercial |
$350.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$330.76
|
| Rate for Payer: Nomi Health Commercial |
$319.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.43
|
|
|
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL FILM
|
Facility
|
OP
|
$12.97
|
|
|
Service Code
|
NDC 43598057901
|
| Hospital Charge Code |
106176
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$12.97 |
| Rate for Payer: Aetna Commercial |
$11.67
|
| Rate for Payer: Aetna Medicare |
$4.80
|
| Rate for Payer: ASR ASR |
$12.58
|
| Rate for Payer: BCBS Complete |
$5.19
|
| Rate for Payer: BCBS Trust/PPO |
$10.69
|
| Rate for Payer: BCN Commercial |
$10.69
|
| Rate for Payer: Cash Price |
$10.38
|
| Rate for Payer: Cofinity Commercial |
$12.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.38
|
| Rate for Payer: Healthscope Commercial |
$12.58
|
| Rate for Payer: Healthscope Whirlpool |
$12.97
|
| Rate for Payer: Mclaren Commercial |
$11.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.03
|
| Rate for Payer: Nomi Health Commercial |
$10.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.37
|
| Rate for Payer: Priority Health Narrow Network |
$9.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.41
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$270.06
|
|
|
Service Code
|
NDC 54018913
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.92 |
| Max. Negotiated Rate |
$270.06 |
| Rate for Payer: Aetna Commercial |
$243.05
|
| Rate for Payer: Aetna Medicare |
$99.92
|
| Rate for Payer: ASR ASR |
$261.96
|
| Rate for Payer: BCBS Complete |
$108.02
|
| Rate for Payer: BCBS Trust/PPO |
$222.66
|
| Rate for Payer: BCN Commercial |
$222.66
|
| Rate for Payer: Cash Price |
$216.05
|
| Rate for Payer: Cofinity Commercial |
$253.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.05
|
| Rate for Payer: Healthscope Commercial |
$261.96
|
| Rate for Payer: Healthscope Whirlpool |
$270.06
|
| Rate for Payer: Mclaren Commercial |
$243.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$216.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.55
|
| Rate for Payer: Nomi Health Commercial |
$221.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$236.63
|
| Rate for Payer: Priority Health Narrow Network |
$189.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.65
|
|
|
BUPRENORPHINE 8 MG-NALOXONE 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$270.06
|
|
|
Service Code
|
NDC 54018913
|
| Hospital Charge Code |
34714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.54 |
| Max. Negotiated Rate |
$270.06 |
| Rate for Payer: Aetna Commercial |
$243.05
|
| Rate for Payer: ASR ASR |
$261.96
|
| Rate for Payer: BCBS Trust/PPO |
$221.77
|
| Rate for Payer: BCN Commercial |
$221.77
|
| Rate for Payer: Cash Price |
$216.05
|
| Rate for Payer: Cofinity Commercial |
$253.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$216.05
|
| Rate for Payer: Healthscope Commercial |
$261.96
|
| Rate for Payer: Healthscope Whirlpool |
$270.06
|
| Rate for Payer: Mclaren Commercial |
$243.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$229.55
|
| Rate for Payer: Nomi Health Commercial |
$221.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$202.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.65
|
|
|
BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$54.47
|
|
|
Service Code
|
HCPCS J0592
|
| Hospital Charge Code |
115937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.85 |
| Max. Negotiated Rate |
$54.47 |
| Rate for Payer: Aetna Commercial |
$49.02
|
| Rate for Payer: Aetna Commercial |
$56.50
|
| Rate for Payer: ASR ASR |
$60.90
|
| Rate for Payer: ASR ASR |
$52.83
|
| Rate for Payer: BCBS Trust/PPO |
$51.56
|
| Rate for Payer: BCBS Trust/PPO |
$44.73
|
| Rate for Payer: BCN Commercial |
$51.56
|
| Rate for Payer: BCN Commercial |
$44.73
|
| Rate for Payer: Cash Price |
$50.22
|
| Rate for Payer: Cash Price |
$43.57
|
| Rate for Payer: Cofinity Commercial |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$59.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.57
|
| Rate for Payer: Healthscope Commercial |
$52.83
|
| Rate for Payer: Healthscope Commercial |
$60.90
|
| Rate for Payer: Healthscope Whirlpool |
$62.78
|
| Rate for Payer: Healthscope Whirlpool |
$54.47
|
| Rate for Payer: Mclaren Commercial |
$56.50
|
| Rate for Payer: Mclaren Commercial |
$49.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.30
|
| Rate for Payer: Nomi Health Commercial |
$51.48
|
| Rate for Payer: Nomi Health Commercial |
$44.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.25
|
|
|
BUPRENORPHINE HCL 0.3 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$62.78
|
|
|
Service Code
|
HCPCS J0592
|
| Hospital Charge Code |
115937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$62.78 |
| Rate for Payer: Aetna Commercial |
$56.50
|
| Rate for Payer: Aetna Commercial |
$49.02
|
| Rate for Payer: Aetna Medicare |
$20.15
|
| Rate for Payer: Aetna Medicare |
$23.23
|
| Rate for Payer: ASR ASR |
$60.90
|
| Rate for Payer: ASR ASR |
$52.83
|
| Rate for Payer: BCBS Complete |
$21.79
|
| Rate for Payer: BCBS Complete |
$25.11
|
| Rate for Payer: BCBS Trust/PPO |
$51.76
|
| Rate for Payer: BCBS Trust/PPO |
$44.91
|
| Rate for Payer: BCN Commercial |
$44.91
|
| Rate for Payer: BCN Commercial |
$51.76
|
| Rate for Payer: Cash Price |
$50.22
|
| Rate for Payer: Cash Price |
$43.57
|
| Rate for Payer: Cash Price |
$50.22
|
| Rate for Payer: Cash Price |
$43.57
|
| Rate for Payer: Cofinity Commercial |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$59.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$43.57
|
| Rate for Payer: Healthscope Commercial |
$60.90
|
| Rate for Payer: Healthscope Commercial |
$52.83
|
| Rate for Payer: Healthscope Whirlpool |
$62.78
|
| Rate for Payer: Healthscope Whirlpool |
$54.47
|
| Rate for Payer: Mclaren Commercial |
$56.50
|
| Rate for Payer: Mclaren Commercial |
$49.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.36
|
| Rate for Payer: Nomi Health Commercial |
$44.66
|
| Rate for Payer: Nomi Health Commercial |
$51.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.37
|
| Rate for Payer: Priority Health Narrow Network |
$3.50
|
| Rate for Payer: Priority Health Narrow Network |
$3.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.25
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$150.15
|
|
|
Service Code
|
NDC 72888018230
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.56 |
| Max. Negotiated Rate |
$150.15 |
| Rate for Payer: Aetna Commercial |
$135.13
|
| Rate for Payer: Aetna Medicare |
$55.56
|
| Rate for Payer: ASR ASR |
$145.65
|
| Rate for Payer: BCBS Complete |
$60.06
|
| Rate for Payer: BCBS Trust/PPO |
$123.80
|
| Rate for Payer: BCN Commercial |
$123.80
|
| Rate for Payer: Cash Price |
$120.12
|
| Rate for Payer: Cofinity Commercial |
$141.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.12
|
| Rate for Payer: Healthscope Commercial |
$145.65
|
| Rate for Payer: Healthscope Whirlpool |
$150.15
|
| Rate for Payer: Mclaren Commercial |
$135.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.63
|
| Rate for Payer: Nomi Health Commercial |
$123.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$131.56
|
| Rate for Payer: Priority Health Narrow Network |
$105.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.13
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$200.55
|
|
|
Service Code
|
NDC 54017613
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.41 |
| Max. Negotiated Rate |
$200.55 |
| Rate for Payer: Aetna Commercial |
$180.50
|
| Rate for Payer: ASR ASR |
$194.53
|
| Rate for Payer: BCBS Trust/PPO |
$164.69
|
| Rate for Payer: BCN Commercial |
$164.69
|
| Rate for Payer: Cash Price |
$160.44
|
| Rate for Payer: Cofinity Commercial |
$188.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.44
|
| Rate for Payer: Healthscope Commercial |
$194.53
|
| Rate for Payer: Healthscope Whirlpool |
$200.55
|
| Rate for Payer: Mclaren Commercial |
$180.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.47
|
| Rate for Payer: Nomi Health Commercial |
$164.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.48
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$394.38
|
|
|
Service Code
|
NDC 904715404
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$295.79 |
| Max. Negotiated Rate |
$394.38 |
| Rate for Payer: Aetna Commercial |
$354.94
|
| Rate for Payer: ASR ASR |
$382.55
|
| Rate for Payer: BCBS Trust/PPO |
$323.86
|
| Rate for Payer: BCN Commercial |
$323.86
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cofinity Commercial |
$370.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.50
|
| Rate for Payer: Healthscope Commercial |
$382.55
|
| Rate for Payer: Healthscope Whirlpool |
$394.38
|
| Rate for Payer: Mclaren Commercial |
$354.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.22
|
| Rate for Payer: Nomi Health Commercial |
$323.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$347.05
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$200.55
|
|
|
Service Code
|
NDC 54017613
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$200.55 |
| Rate for Payer: Aetna Commercial |
$180.50
|
| Rate for Payer: Aetna Medicare |
$74.20
|
| Rate for Payer: ASR ASR |
$194.53
|
| Rate for Payer: BCBS Complete |
$80.22
|
| Rate for Payer: BCBS Trust/PPO |
$165.35
|
| Rate for Payer: BCN Commercial |
$165.35
|
| Rate for Payer: Cash Price |
$160.44
|
| Rate for Payer: Cofinity Commercial |
$188.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.44
|
| Rate for Payer: Healthscope Commercial |
$194.53
|
| Rate for Payer: Healthscope Whirlpool |
$200.55
|
| Rate for Payer: Mclaren Commercial |
$180.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$160.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.47
|
| Rate for Payer: Nomi Health Commercial |
$164.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$175.72
|
| Rate for Payer: Priority Health Narrow Network |
$140.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$176.48
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$394.38
|
|
|
Service Code
|
NDC 904715404
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$145.92 |
| Max. Negotiated Rate |
$394.38 |
| Rate for Payer: Aetna Commercial |
$354.94
|
| Rate for Payer: Aetna Medicare |
$145.92
|
| Rate for Payer: ASR ASR |
$382.55
|
| Rate for Payer: BCBS Complete |
$157.75
|
| Rate for Payer: BCBS Trust/PPO |
$325.17
|
| Rate for Payer: BCN Commercial |
$325.17
|
| Rate for Payer: Cash Price |
$315.50
|
| Rate for Payer: Cofinity Commercial |
$370.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$315.50
|
| Rate for Payer: Healthscope Commercial |
$382.55
|
| Rate for Payer: Healthscope Whirlpool |
$394.38
|
| Rate for Payer: Mclaren Commercial |
$354.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$315.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$335.22
|
| Rate for Payer: Nomi Health Commercial |
$323.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$295.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$345.56
|
| Rate for Payer: Priority Health Narrow Network |
$276.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$347.05
|
|
|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$150.15
|
|
|
Service Code
|
NDC 72888018230
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.61 |
| Max. Negotiated Rate |
$150.15 |
| Rate for Payer: Aetna Commercial |
$135.13
|
| Rate for Payer: ASR ASR |
$145.65
|
| Rate for Payer: BCBS Trust/PPO |
$123.30
|
| Rate for Payer: BCN Commercial |
$123.30
|
| Rate for Payer: Cash Price |
$120.12
|
| Rate for Payer: Cofinity Commercial |
$141.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$120.12
|
| Rate for Payer: Healthscope Commercial |
$145.65
|
| Rate for Payer: Healthscope Whirlpool |
$150.15
|
| Rate for Payer: Mclaren Commercial |
$135.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$127.63
|
| Rate for Payer: Nomi Health Commercial |
$123.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$112.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$132.13
|
|
|
BUPROPION HCL 150 MG TABLET,12 HR SUSTAINED-RELEASE(SMOKING DETERRENT)
|
Facility
|
IP
|
$172.71
|
|
|
Service Code
|
NDC 43598086360
|
| Hospital Charge Code |
179212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.53 |
| Max. Negotiated Rate |
$172.71 |
| Rate for Payer: Aetna Commercial |
$155.44
|
| Rate for Payer: ASR ASR |
$167.53
|
| Rate for Payer: BCBS Trust/PPO |
$141.83
|
| Rate for Payer: BCN Commercial |
$141.83
|
| Rate for Payer: Cash Price |
$138.17
|
| Rate for Payer: Cofinity Commercial |
$162.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.17
|
| Rate for Payer: Healthscope Commercial |
$167.53
|
| Rate for Payer: Healthscope Whirlpool |
$172.71
|
| Rate for Payer: Mclaren Commercial |
$155.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.80
|
| Rate for Payer: Nomi Health Commercial |
$141.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$151.98
|
|
|
BUPROPION HCL 150 MG TABLET,12 HR SUSTAINED-RELEASE(SMOKING DETERRENT)
|
Facility
|
OP
|
$172.71
|
|
|
Service Code
|
NDC 43598086360
|
| Hospital Charge Code |
179212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$172.71 |
| Rate for Payer: Aetna Commercial |
$155.44
|
| Rate for Payer: Aetna Medicare |
$63.90
|
| Rate for Payer: ASR ASR |
$167.53
|
| Rate for Payer: BCBS Complete |
$69.08
|
| Rate for Payer: BCBS Trust/PPO |
$142.40
|
| Rate for Payer: BCN Commercial |
$142.40
|
| Rate for Payer: Cash Price |
$138.17
|
| Rate for Payer: Cofinity Commercial |
$162.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.17
|
| Rate for Payer: Healthscope Commercial |
$167.53
|
| Rate for Payer: Healthscope Whirlpool |
$172.71
|
| Rate for Payer: Mclaren Commercial |
$155.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$138.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$146.80
|
| Rate for Payer: Nomi Health Commercial |
$141.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$151.33
|
| Rate for Payer: Priority Health Narrow Network |
$121.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$151.98
|
|
|
BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
NDC 50228017505
|
| Hospital Charge Code |
18386
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.29 |
| Max. Negotiated Rate |
$517.00 |
| Rate for Payer: Aetna Commercial |
$465.30
|
| Rate for Payer: Aetna Medicare |
$191.29
|
| Rate for Payer: ASR ASR |
$501.49
|
| Rate for Payer: BCBS Complete |
$206.80
|
| Rate for Payer: BCBS Trust/PPO |
$426.27
|
| Rate for Payer: BCN Commercial |
$426.27
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$485.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.60
|
| Rate for Payer: Healthscope Commercial |
$501.49
|
| Rate for Payer: Healthscope Whirlpool |
$517.00
|
| Rate for Payer: Mclaren Commercial |
$465.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$413.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.45
|
| Rate for Payer: Nomi Health Commercial |
$423.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$453.00
|
| Rate for Payer: Priority Health Narrow Network |
$362.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$454.96
|
|
|
BUPROPION HCL SR 150 MG TABLET,12 HR SUSTAINED-RELEASE
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
NDC 50228017505
|
| Hospital Charge Code |
18386
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$387.75 |
| Max. Negotiated Rate |
$517.00 |
| Rate for Payer: Aetna Commercial |
$465.30
|
| Rate for Payer: ASR ASR |
$501.49
|
| Rate for Payer: BCBS Trust/PPO |
$424.56
|
| Rate for Payer: BCN Commercial |
$424.56
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$485.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.60
|
| Rate for Payer: Healthscope Commercial |
$501.49
|
| Rate for Payer: Healthscope Whirlpool |
$517.00
|
| Rate for Payer: Mclaren Commercial |
$465.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.45
|
| Rate for Payer: Nomi Health Commercial |
$423.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$454.96
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$251.69
|
|
|
Service Code
|
NDC 16729044315
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$188.76 |
| Max. Negotiated Rate |
$251.69 |
| Rate for Payer: Aetna Commercial |
$226.52
|
| Rate for Payer: ASR ASR |
$244.13
|
| Rate for Payer: BCBS Trust/PPO |
$206.68
|
| Rate for Payer: BCN Commercial |
$206.68
|
| Rate for Payer: Cash Price |
$201.35
|
| Rate for Payer: Cofinity Commercial |
$236.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.35
|
| Rate for Payer: Healthscope Commercial |
$244.13
|
| Rate for Payer: Healthscope Whirlpool |
$251.69
|
| Rate for Payer: Mclaren Commercial |
$226.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.93
|
| Rate for Payer: Nomi Health Commercial |
$206.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.48
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$615.84
|
|
|
Service Code
|
NDC 904708461
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$461.88 |
| Max. Negotiated Rate |
$615.84 |
| Rate for Payer: Aetna Commercial |
$554.26
|
| Rate for Payer: ASR ASR |
$597.36
|
| Rate for Payer: BCBS Trust/PPO |
$505.73
|
| Rate for Payer: BCN Commercial |
$505.73
|
| Rate for Payer: Cash Price |
$492.67
|
| Rate for Payer: Cofinity Commercial |
$578.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.67
|
| Rate for Payer: Healthscope Commercial |
$597.36
|
| Rate for Payer: Healthscope Whirlpool |
$615.84
|
| Rate for Payer: Mclaren Commercial |
$554.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.46
|
| Rate for Payer: Nomi Health Commercial |
$504.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$461.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$541.94
|
|
|
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 |
$271.25 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna Commercial |
$325.50
|
| Rate for Payer: ASR ASR |
$350.82
|
| Rate for Payer: BCBS Trust/PPO |
$297.00
|
| Rate for Payer: BCN Commercial |
$297.00
|
| Rate for Payer: Cash Price |
$289.33
|
| Rate for Payer: Cofinity Commercial |
$339.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.33
|
| Rate for Payer: Healthscope Commercial |
$350.82
|
| Rate for Payer: Healthscope Whirlpool |
$361.67
|
| Rate for Payer: Mclaren Commercial |
$325.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.42
|
| Rate for Payer: Nomi Health Commercial |
$296.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$318.27
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$251.69
|
|
|
Service Code
|
NDC 16729044315
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.12 |
| Max. Negotiated Rate |
$251.69 |
| Rate for Payer: Aetna Commercial |
$226.52
|
| Rate for Payer: Aetna Medicare |
$93.12
|
| Rate for Payer: ASR ASR |
$244.13
|
| Rate for Payer: BCBS Complete |
$100.67
|
| Rate for Payer: BCBS Trust/PPO |
$207.51
|
| Rate for Payer: BCN Commercial |
$207.51
|
| Rate for Payer: Cash Price |
$201.35
|
| Rate for Payer: Cofinity Commercial |
$236.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.35
|
| Rate for Payer: Healthscope Commercial |
$244.13
|
| Rate for Payer: Healthscope Whirlpool |
$251.69
|
| Rate for Payer: Mclaren Commercial |
$226.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.93
|
| Rate for Payer: Nomi Health Commercial |
$206.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$188.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$220.53
|
| Rate for Payer: Priority Health Narrow Network |
$176.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.48
|
|
|
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 |
$361.67 |
| Rate for Payer: Aetna Commercial |
$325.50
|
| Rate for Payer: Aetna Medicare |
$133.82
|
| Rate for Payer: ASR ASR |
$350.82
|
| Rate for Payer: BCBS Complete |
$144.67
|
| Rate for Payer: BCBS Trust/PPO |
$298.19
|
| Rate for Payer: BCN Commercial |
$298.19
|
| Rate for Payer: Cash Price |
$289.33
|
| Rate for Payer: Cofinity Commercial |
$339.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$289.33
|
| Rate for Payer: Healthscope Commercial |
$350.82
|
| Rate for Payer: Healthscope Whirlpool |
$361.67
|
| Rate for Payer: Mclaren Commercial |
$325.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$289.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$307.42
|
| Rate for Payer: Nomi Health Commercial |
$296.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$271.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$316.89
|
| Rate for Payer: Priority Health Narrow Network |
$253.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$318.27
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$615.84
|
|
|
Service Code
|
NDC 904708461
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$227.86 |
| Max. Negotiated Rate |
$615.84 |
| Rate for Payer: Aetna Commercial |
$554.26
|
| Rate for Payer: Aetna Medicare |
$227.86
|
| Rate for Payer: ASR ASR |
$597.36
|
| Rate for Payer: BCBS Complete |
$246.34
|
| Rate for Payer: BCBS Trust/PPO |
$507.76
|
| Rate for Payer: BCN Commercial |
$507.76
|
| Rate for Payer: Cash Price |
$492.67
|
| Rate for Payer: Cofinity Commercial |
$578.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$492.67
|
| Rate for Payer: Healthscope Commercial |
$597.36
|
| Rate for Payer: Healthscope Whirlpool |
$615.84
|
| Rate for Payer: Mclaren Commercial |
$554.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$492.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$523.46
|
| Rate for Payer: Nomi Health Commercial |
$504.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$461.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$539.60
|
| Rate for Payer: Priority Health Narrow Network |
$431.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$541.94
|
|
|
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 |
$828.00 |
| Rate for Payer: Aetna Commercial |
$745.20
|
| Rate for Payer: Aetna Medicare |
$306.36
|
| Rate for Payer: ASR ASR |
$803.16
|
| Rate for Payer: BCBS Complete |
$331.20
|
| Rate for Payer: BCBS Trust/PPO |
$682.69
|
| Rate for Payer: BCN Commercial |
$682.69
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cofinity Commercial |
$778.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$662.40
|
| Rate for Payer: Healthscope Commercial |
$803.16
|
| Rate for Payer: Healthscope Whirlpool |
$828.00
|
| Rate for Payer: Mclaren Commercial |
$745.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$662.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$703.80
|
| Rate for Payer: Nomi Health Commercial |
$678.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$621.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$725.49
|
| Rate for Payer: Priority Health Narrow Network |
$580.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$728.64
|
|
|
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 |
$621.00 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Aetna Commercial |
$745.20
|
| Rate for Payer: ASR ASR |
$803.16
|
| Rate for Payer: BCBS Trust/PPO |
$679.95
|
| Rate for Payer: BCN Commercial |
$679.95
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cofinity Commercial |
$778.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$662.40
|
| Rate for Payer: Healthscope Commercial |
$803.16
|
| Rate for Payer: Healthscope Whirlpool |
$828.00
|
| Rate for Payer: Mclaren Commercial |
$745.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$703.80
|
| Rate for Payer: Nomi Health Commercial |
$678.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$621.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$728.64
|
|
|
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 |
$8.28 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Aetna Medicare |
$3.06
|
| Rate for Payer: ASR ASR |
$8.03
|
| Rate for Payer: BCBS Complete |
$3.31
|
| Rate for Payer: BCBS Trust/PPO |
$6.83
|
| Rate for Payer: BCN Commercial |
$6.83
|
| Rate for Payer: Cash Price |
$6.62
|
| Rate for Payer: Cofinity Commercial |
$7.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.62
|
| Rate for Payer: Healthscope Commercial |
$8.03
|
| Rate for Payer: Healthscope Whirlpool |
$8.28
|
| Rate for Payer: Mclaren Commercial |
$7.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.04
|
| Rate for Payer: Nomi Health Commercial |
$6.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.25
|
| Rate for Payer: Priority Health Narrow Network |
$5.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.29
|
|
