|
BUPRENORPHINE HCL 2 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$386.40
|
|
|
Service Code
|
NDC 00904715404
|
| Hospital Charge Code |
34711
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.56 |
| Max. Negotiated Rate |
$386.40 |
| Rate for Payer: Aetna Commercial |
$347.76
|
| Rate for Payer: Aetna Medicare |
$193.20
|
| Rate for Payer: ASR ASR |
$374.81
|
| Rate for Payer: ASR Commercial |
$374.81
|
| Rate for Payer: BCBS Complete |
$154.56
|
| Rate for Payer: BCBS Trust/PPO |
$316.42
|
| Rate for Payer: BCN Commercial |
$299.58
|
| Rate for Payer: Cash Price |
$309.12
|
| Rate for Payer: Cofinity Commercial |
$363.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.12
|
| Rate for Payer: Healthscope Commercial |
$386.40
|
| Rate for Payer: Healthscope Whirlpool |
$374.81
|
| Rate for Payer: Mclaren Commercial |
$347.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.44
|
| Rate for Payer: Nomi Health Commercial |
$316.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$338.56
|
| Rate for Payer: Priority Health Narrow Network |
$270.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$340.03
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$251.68
|
|
|
Service Code
|
NDC 16729044315
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.59 |
| Max. Negotiated Rate |
$251.68 |
| Rate for Payer: Aetna Commercial |
$226.51
|
| Rate for Payer: ASR ASR |
$244.13
|
| Rate for Payer: ASR Commercial |
$244.13
|
| Rate for Payer: BCBS Trust/PPO |
$205.09
|
| Rate for Payer: BCN Commercial |
$195.13
|
| Rate for Payer: Cash Price |
$201.35
|
| Rate for Payer: Cofinity Commercial |
$236.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.34
|
| Rate for Payer: Healthscope Commercial |
$251.68
|
| Rate for Payer: Healthscope Whirlpool |
$244.13
|
| Rate for Payer: Mclaren Commercial |
$226.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.93
|
| Rate for Payer: Nomi Health Commercial |
$206.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.48
|
|
|
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 |
$538.20 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Aetna Commercial |
$745.20
|
| Rate for Payer: ASR ASR |
$803.16
|
| Rate for Payer: ASR Commercial |
$803.16
|
| Rate for Payer: BCBS Trust/PPO |
$674.74
|
| Rate for Payer: BCN Commercial |
$641.95
|
| 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 |
$828.00
|
| Rate for Payer: Healthscope Whirlpool |
$803.16
|
| 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: Priority Health Cigna Priority Health |
$538.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$728.64
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$615.84
|
|
|
Service Code
|
NDC 00904708461
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.34 |
| Max. Negotiated Rate |
$615.84 |
| Rate for Payer: Aetna Commercial |
$554.26
|
| Rate for Payer: Aetna Medicare |
$307.92
|
| Rate for Payer: ASR ASR |
$597.36
|
| Rate for Payer: ASR Commercial |
$597.36
|
| Rate for Payer: BCBS Complete |
$246.34
|
| Rate for Payer: BCBS Trust/PPO |
$504.31
|
| Rate for Payer: BCN Commercial |
$477.46
|
| 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 |
$615.84
|
| Rate for Payer: Healthscope Whirlpool |
$597.36
|
| 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: Priority Health Cigna Priority Health |
$400.30
|
| Rate for Payer: 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
|
$251.68
|
|
|
Service Code
|
NDC 16729044315
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.67 |
| Max. Negotiated Rate |
$251.68 |
| Rate for Payer: Aetna Commercial |
$226.51
|
| Rate for Payer: Aetna Medicare |
$125.84
|
| Rate for Payer: ASR ASR |
$244.13
|
| Rate for Payer: ASR Commercial |
$244.13
|
| Rate for Payer: BCBS Complete |
$100.67
|
| Rate for Payer: BCBS Trust/PPO |
$206.10
|
| Rate for Payer: BCN Commercial |
$195.13
|
| Rate for Payer: Cash Price |
$201.35
|
| Rate for Payer: Cofinity Commercial |
$236.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.34
|
| Rate for Payer: Healthscope Commercial |
$251.68
|
| Rate for Payer: Healthscope Whirlpool |
$244.13
|
| Rate for Payer: Mclaren Commercial |
$226.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.93
|
| Rate for Payer: Nomi Health Commercial |
$206.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.52
|
| 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
|
$828.00
|
|
|
Service Code
|
NDC 60687031201
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$331.20 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Aetna Commercial |
$745.20
|
| Rate for Payer: Aetna Medicare |
$414.00
|
| Rate for Payer: ASR ASR |
$803.16
|
| Rate for Payer: ASR Commercial |
$803.16
|
| Rate for Payer: BCBS Complete |
$331.20
|
| Rate for Payer: BCBS Trust/PPO |
$678.05
|
| Rate for Payer: BCN Commercial |
$641.95
|
| 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 |
$828.00
|
| Rate for Payer: Healthscope Whirlpool |
$803.16
|
| 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: Priority Health Cigna Priority Health |
$538.20
|
| Rate for Payer: 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
|
OP
|
$8.28
|
|
|
Service Code
|
NDC 60687031211
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: Aetna Medicare |
$4.14
|
| Rate for Payer: ASR ASR |
$8.03
|
| Rate for Payer: ASR Commercial |
$8.03
|
| Rate for Payer: BCBS Complete |
$3.31
|
| Rate for Payer: BCBS Trust/PPO |
$6.78
|
| Rate for Payer: BCN Commercial |
$6.42
|
| 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 |
$8.28
|
| Rate for Payer: Healthscope Whirlpool |
$8.03
|
| Rate for Payer: Mclaren Commercial |
$7.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.04
|
| Rate for Payer: Nomi Health Commercial |
$6.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.38
|
| Rate for Payer: 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
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$177.66
|
|
|
Service Code
|
NDC 68180031909
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.48 |
| Max. Negotiated Rate |
$177.66 |
| Rate for Payer: Aetna Commercial |
$159.89
|
| Rate for Payer: ASR ASR |
$172.33
|
| Rate for Payer: ASR Commercial |
$172.33
|
| Rate for Payer: BCBS Trust/PPO |
$144.78
|
| Rate for Payer: BCN Commercial |
$137.74
|
| Rate for Payer: Cash Price |
$142.13
|
| Rate for Payer: Cofinity Commercial |
$167.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.13
|
| Rate for Payer: Healthscope Commercial |
$177.66
|
| Rate for Payer: Healthscope Whirlpool |
$172.33
|
| Rate for Payer: Mclaren Commercial |
$159.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.01
|
| Rate for Payer: Nomi Health Commercial |
$145.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$156.34
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$8.28
|
|
|
Service Code
|
NDC 60687031211
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.38 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: Aetna Commercial |
$7.45
|
| Rate for Payer: ASR ASR |
$8.03
|
| Rate for Payer: ASR Commercial |
$8.03
|
| Rate for Payer: BCBS Trust/PPO |
$6.75
|
| Rate for Payer: BCN Commercial |
$6.42
|
| 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 |
$8.28
|
| Rate for Payer: Healthscope Whirlpool |
$8.03
|
| Rate for Payer: Mclaren Commercial |
$7.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.04
|
| Rate for Payer: Nomi Health Commercial |
$6.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.29
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
OP
|
$177.66
|
|
|
Service Code
|
NDC 68180031909
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.06 |
| Max. Negotiated Rate |
$177.66 |
| Rate for Payer: Aetna Commercial |
$159.89
|
| Rate for Payer: Aetna Medicare |
$88.83
|
| Rate for Payer: ASR ASR |
$172.33
|
| Rate for Payer: ASR Commercial |
$172.33
|
| Rate for Payer: BCBS Complete |
$71.06
|
| Rate for Payer: BCBS Trust/PPO |
$145.49
|
| Rate for Payer: BCN Commercial |
$137.74
|
| Rate for Payer: Cash Price |
$142.13
|
| Rate for Payer: Cofinity Commercial |
$167.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.13
|
| Rate for Payer: Healthscope Commercial |
$177.66
|
| Rate for Payer: Healthscope Whirlpool |
$172.33
|
| Rate for Payer: Mclaren Commercial |
$159.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.01
|
| Rate for Payer: Nomi Health Commercial |
$145.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.67
|
| Rate for Payer: Priority Health Narrow Network |
$124.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$156.34
|
|
|
BUPROPION HCL XL 150 MG 24 HR TABLET, EXTENDED RELEASE
|
Facility
|
IP
|
$615.84
|
|
|
Service Code
|
NDC 00904708461
|
| Hospital Charge Code |
36775
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$400.30 |
| Max. Negotiated Rate |
$615.84 |
| Rate for Payer: Aetna Commercial |
$554.26
|
| Rate for Payer: ASR ASR |
$597.36
|
| Rate for Payer: ASR Commercial |
$597.36
|
| Rate for Payer: BCBS Trust/PPO |
$501.85
|
| Rate for Payer: BCN Commercial |
$477.46
|
| 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 |
$615.84
|
| Rate for Payer: Healthscope Whirlpool |
$597.36
|
| 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: Priority Health Cigna Priority Health |
$400.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$541.94
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
IP
|
$251.45
|
|
|
Service Code
|
NDC 51079098520
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.44 |
| Max. Negotiated Rate |
$251.45 |
| Rate for Payer: Aetna Commercial |
$226.31
|
| Rate for Payer: ASR ASR |
$243.91
|
| Rate for Payer: ASR Commercial |
$243.91
|
| Rate for Payer: BCBS Trust/PPO |
$204.91
|
| Rate for Payer: BCN Commercial |
$194.95
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Commercial |
$236.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Healthscope Commercial |
$251.45
|
| Rate for Payer: Healthscope Whirlpool |
$243.91
|
| Rate for Payer: Mclaren Commercial |
$226.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Nomi Health Commercial |
$206.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.28
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
OP
|
$251.45
|
|
|
Service Code
|
NDC 51079098520
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.58 |
| Max. Negotiated Rate |
$251.45 |
| Rate for Payer: Aetna Commercial |
$226.31
|
| Rate for Payer: Aetna Medicare |
$125.72
|
| Rate for Payer: ASR ASR |
$243.91
|
| Rate for Payer: ASR Commercial |
$243.91
|
| Rate for Payer: BCBS Complete |
$100.58
|
| Rate for Payer: BCBS Trust/PPO |
$205.91
|
| Rate for Payer: BCN Commercial |
$194.95
|
| Rate for Payer: Cash Price |
$201.16
|
| Rate for Payer: Cofinity Commercial |
$236.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$201.16
|
| Rate for Payer: Healthscope Commercial |
$251.45
|
| Rate for Payer: Healthscope Whirlpool |
$243.91
|
| Rate for Payer: Mclaren Commercial |
$226.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$213.73
|
| Rate for Payer: Nomi Health Commercial |
$206.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.32
|
| Rate for Payer: Priority Health Narrow Network |
$176.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.28
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
OP
|
$209.15
|
|
|
Service Code
|
NDC 00904712261
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.66 |
| Max. Negotiated Rate |
$209.15 |
| Rate for Payer: Aetna Commercial |
$188.24
|
| Rate for Payer: Aetna Medicare |
$104.58
|
| Rate for Payer: ASR ASR |
$202.88
|
| Rate for Payer: ASR Commercial |
$202.88
|
| Rate for Payer: BCBS Complete |
$83.66
|
| Rate for Payer: BCBS Trust/PPO |
$171.27
|
| Rate for Payer: BCN Commercial |
$162.15
|
| Rate for Payer: Cash Price |
$167.32
|
| Rate for Payer: Cofinity Commercial |
$196.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.32
|
| Rate for Payer: Healthscope Commercial |
$209.15
|
| Rate for Payer: Healthscope Whirlpool |
$202.88
|
| Rate for Payer: Mclaren Commercial |
$188.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.78
|
| Rate for Payer: Nomi Health Commercial |
$171.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.26
|
| Rate for Payer: Priority Health Narrow Network |
$146.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.05
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
NDC 23155002301
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.10 |
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: ASR ASR |
$91.18
|
| Rate for Payer: ASR Commercial |
$91.18
|
| Rate for Payer: BCBS Trust/PPO |
$76.60
|
| Rate for Payer: BCN Commercial |
$72.88
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cofinity Commercial |
$88.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.20
|
| Rate for Payer: Healthscope Commercial |
$94.00
|
| Rate for Payer: Healthscope Whirlpool |
$91.18
|
| Rate for Payer: Mclaren Commercial |
$84.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.90
|
| Rate for Payer: Nomi Health Commercial |
$77.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.72
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
NDC 23155002301
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$94.00 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Medicare |
$47.00
|
| Rate for Payer: ASR ASR |
$91.18
|
| Rate for Payer: ASR Commercial |
$91.18
|
| Rate for Payer: BCBS Complete |
$37.60
|
| Rate for Payer: BCBS Trust/PPO |
$76.98
|
| Rate for Payer: BCN Commercial |
$72.88
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cofinity Commercial |
$88.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$75.20
|
| Rate for Payer: Healthscope Commercial |
$94.00
|
| Rate for Payer: Healthscope Whirlpool |
$91.18
|
| Rate for Payer: Mclaren Commercial |
$84.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.90
|
| Rate for Payer: Nomi Health Commercial |
$77.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.36
|
| Rate for Payer: Priority Health Narrow Network |
$65.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$82.72
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
IP
|
$2.52
|
|
|
Service Code
|
NDC 51079098501
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Aetna Commercial |
$2.27
|
| Rate for Payer: ASR ASR |
$2.44
|
| Rate for Payer: ASR Commercial |
$2.44
|
| Rate for Payer: BCBS Trust/PPO |
$2.05
|
| Rate for Payer: BCN Commercial |
$1.95
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: Cofinity Commercial |
$2.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.02
|
| Rate for Payer: Healthscope Commercial |
$2.52
|
| Rate for Payer: Healthscope Whirlpool |
$2.44
|
| Rate for Payer: Mclaren Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.14
|
| Rate for Payer: Nomi Health Commercial |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.22
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
IP
|
$209.15
|
|
|
Service Code
|
NDC 00904712261
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.95 |
| Max. Negotiated Rate |
$209.15 |
| Rate for Payer: Aetna Commercial |
$188.24
|
| Rate for Payer: ASR ASR |
$202.88
|
| Rate for Payer: ASR Commercial |
$202.88
|
| Rate for Payer: BCBS Trust/PPO |
$170.44
|
| Rate for Payer: BCN Commercial |
$162.15
|
| Rate for Payer: Cash Price |
$167.32
|
| Rate for Payer: Cofinity Commercial |
$196.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.32
|
| Rate for Payer: Healthscope Commercial |
$209.15
|
| Rate for Payer: Healthscope Whirlpool |
$202.88
|
| Rate for Payer: Mclaren Commercial |
$188.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$177.78
|
| Rate for Payer: Nomi Health Commercial |
$171.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$184.05
|
|
|
BUSPIRONE 5 MG TABLET
|
Facility
|
OP
|
$2.52
|
|
|
Service Code
|
NDC 51079098501
|
| Hospital Charge Code |
9324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$2.52 |
| Rate for Payer: Aetna Commercial |
$2.27
|
| Rate for Payer: Aetna Medicare |
$1.26
|
| Rate for Payer: ASR ASR |
$2.44
|
| Rate for Payer: ASR Commercial |
$2.44
|
| Rate for Payer: BCBS Complete |
$1.01
|
| Rate for Payer: BCBS Trust/PPO |
$2.06
|
| Rate for Payer: BCN Commercial |
$1.95
|
| Rate for Payer: Cash Price |
$2.01
|
| Rate for Payer: Cofinity Commercial |
$2.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.02
|
| Rate for Payer: Healthscope Commercial |
$2.52
|
| Rate for Payer: Healthscope Whirlpool |
$2.44
|
| Rate for Payer: Mclaren Commercial |
$2.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.14
|
| Rate for Payer: Nomi Health Commercial |
$2.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.21
|
| Rate for Payer: Priority Health Narrow Network |
$1.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.22
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$306.25
|
|
|
Service Code
|
NDC 70010014901
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.06 |
| Max. Negotiated Rate |
$306.25 |
| Rate for Payer: Aetna Commercial |
$275.62
|
| Rate for Payer: ASR ASR |
$297.06
|
| Rate for Payer: ASR Commercial |
$297.06
|
| Rate for Payer: BCBS Trust/PPO |
$249.56
|
| Rate for Payer: BCN Commercial |
$237.44
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cofinity Commercial |
$287.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.00
|
| Rate for Payer: Healthscope Commercial |
$306.25
|
| Rate for Payer: Healthscope Whirlpool |
$297.06
|
| Rate for Payer: Mclaren Commercial |
$275.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.31
|
| Rate for Payer: Nomi Health Commercial |
$251.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$269.50
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$371.35
|
|
|
Service Code
|
NDC 00904693806
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.54 |
| Max. Negotiated Rate |
$371.35 |
| Rate for Payer: Aetna Commercial |
$334.21
|
| Rate for Payer: Aetna Medicare |
$185.68
|
| Rate for Payer: ASR ASR |
$360.21
|
| Rate for Payer: ASR Commercial |
$360.21
|
| Rate for Payer: BCBS Complete |
$148.54
|
| Rate for Payer: BCBS Trust/PPO |
$304.10
|
| Rate for Payer: BCN Commercial |
$287.91
|
| Rate for Payer: Cash Price |
$297.08
|
| Rate for Payer: Cofinity Commercial |
$349.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.08
|
| Rate for Payer: Healthscope Commercial |
$371.35
|
| Rate for Payer: Healthscope Whirlpool |
$360.21
|
| Rate for Payer: Mclaren Commercial |
$334.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$315.65
|
| Rate for Payer: Nomi Health Commercial |
$304.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$325.38
|
| Rate for Payer: Priority Health Narrow Network |
$260.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$326.79
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$8.01
|
|
|
Service Code
|
NDC 50268055311
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$8.01 |
| Rate for Payer: Aetna Commercial |
$7.21
|
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: ASR ASR |
$7.77
|
| Rate for Payer: ASR Commercial |
$7.77
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS Trust/PPO |
$6.56
|
| Rate for Payer: BCN Commercial |
$6.21
|
| Rate for Payer: Cash Price |
$6.41
|
| Rate for Payer: Cofinity Commercial |
$7.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.41
|
| Rate for Payer: Healthscope Commercial |
$8.01
|
| Rate for Payer: Healthscope Whirlpool |
$7.77
|
| Rate for Payer: Mclaren Commercial |
$7.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.81
|
| Rate for Payer: Nomi Health Commercial |
$6.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.02
|
| Rate for Payer: Priority Health Narrow Network |
$5.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.05
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
OP
|
$240.24
|
|
|
Service Code
|
NDC 50268055313
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.10 |
| Max. Negotiated Rate |
$240.24 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Medicare |
$120.12
|
| Rate for Payer: ASR ASR |
$233.03
|
| Rate for Payer: ASR Commercial |
$233.03
|
| Rate for Payer: BCBS Complete |
$96.10
|
| Rate for Payer: BCBS Trust/PPO |
$196.73
|
| Rate for Payer: BCN Commercial |
$186.26
|
| Rate for Payer: Cash Price |
$192.19
|
| Rate for Payer: Cofinity Commercial |
$225.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.19
|
| Rate for Payer: Healthscope Commercial |
$240.24
|
| Rate for Payer: Healthscope Whirlpool |
$233.03
|
| Rate for Payer: Mclaren Commercial |
$216.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.20
|
| Rate for Payer: Nomi Health Commercial |
$197.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$210.50
|
| Rate for Payer: Priority Health Narrow Network |
$168.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.41
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$8.01
|
|
|
Service Code
|
NDC 50268055311
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$8.01 |
| Rate for Payer: Aetna Commercial |
$7.21
|
| Rate for Payer: ASR ASR |
$7.77
|
| Rate for Payer: ASR Commercial |
$7.77
|
| Rate for Payer: BCBS Trust/PPO |
$6.53
|
| Rate for Payer: BCN Commercial |
$6.21
|
| Rate for Payer: Cash Price |
$6.41
|
| Rate for Payer: Cofinity Commercial |
$7.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.41
|
| Rate for Payer: Healthscope Commercial |
$8.01
|
| Rate for Payer: Healthscope Whirlpool |
$7.77
|
| Rate for Payer: Mclaren Commercial |
$7.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.81
|
| Rate for Payer: Nomi Health Commercial |
$6.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.05
|
|
|
BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50 MG-325 MG-40 MG TABLET
|
Facility
|
IP
|
$240.24
|
|
|
Service Code
|
NDC 50268055313
|
| Hospital Charge Code |
8958
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.16 |
| Max. Negotiated Rate |
$240.24 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: ASR ASR |
$233.03
|
| Rate for Payer: ASR Commercial |
$233.03
|
| Rate for Payer: BCBS Trust/PPO |
$195.77
|
| Rate for Payer: BCN Commercial |
$186.26
|
| Rate for Payer: Cash Price |
$192.19
|
| Rate for Payer: Cofinity Commercial |
$225.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.19
|
| Rate for Payer: Healthscope Commercial |
$240.24
|
| Rate for Payer: Healthscope Whirlpool |
$233.03
|
| Rate for Payer: Mclaren Commercial |
$216.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.20
|
| Rate for Payer: Nomi Health Commercial |
$197.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.41
|
|
