Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

MIDODRINE 5 MG TABLET

Facility

$3.15

Service Code	NDC 0245-0212-89
Hospital Charge Code	10610
Hospital Revenue Code	637
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$2.84
Rate for Payer: Aetna Commercial	$2.68
Rate for Payer: Aetna New Business (MI Preferred)	$2.05
Rate for Payer: Cash Price	$2.52
Rate for Payer: Cofinity Commercial	$2.20
Rate for Payer: Cofinity Commercial	$2.71
Rate for Payer: Healthscope Commercial	$2.84
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.68
Rate for Payer: PHP Commercial	$2.68
Rate for Payer: Priority Health Cigna Priority Health	$2.20
Rate for Payer: Priority Health SBD	$1.98

MIDODRINE 5 MG TABLET

Facility

$314.45

Service Code	NDC 0245-0212-01
Hospital Charge Code	10610
Hospital Revenue Code	637
Min. Negotiated Rate	$198.10
Max. Negotiated Rate	$283.00
Rate for Payer: Aetna Commercial	$267.28
Rate for Payer: Aetna New Business (MI Preferred)	$204.39
Rate for Payer: Cash Price	$251.56
Rate for Payer: Cofinity Commercial	$220.12
Rate for Payer: Cofinity Commercial	$270.43
Rate for Payer: Healthscope Commercial	$283.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$267.28
Rate for Payer: PHP Commercial	$267.28
Rate for Payer: Priority Health Cigna Priority Health	$220.12
Rate for Payer: Priority Health SBD	$198.10

MIDODRINE 5 MG TABLET

Facility

$217.55

Service Code	NDC 0245-0212-11
Hospital Charge Code	10610
Hospital Revenue Code	637
Min. Negotiated Rate	$137.06
Max. Negotiated Rate	$195.80
Rate for Payer: Aetna Commercial	$184.92
Rate for Payer: Aetna New Business (MI Preferred)	$141.41
Rate for Payer: Cash Price	$174.04
Rate for Payer: Cofinity Commercial	$187.09
Rate for Payer: Cofinity Commercial	$152.28
Rate for Payer: Healthscope Commercial	$195.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$184.92
Rate for Payer: PHP Commercial	$184.92
Rate for Payer: Priority Health Cigna Priority Health	$152.28
Rate for Payer: Priority Health SBD	$137.06

MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK

Facility

$89.97

Service Code	HCPCS J2260
Hospital Charge Code	14961
Hospital Revenue Code	636
Min. Negotiated Rate	$56.68
Max. Negotiated Rate	$80.97
Rate for Payer: Aetna Commercial	$76.47
Rate for Payer: Aetna Commercial	$60.87
Rate for Payer: Aetna Commercial	$70.50
Rate for Payer: Aetna Commercial	$84.72
Rate for Payer: Aetna New Business (MI Preferred)	$53.91
Rate for Payer: Aetna New Business (MI Preferred)	$58.48
Rate for Payer: Aetna New Business (MI Preferred)	$64.79
Rate for Payer: Aetna New Business (MI Preferred)	$46.55
Rate for Payer: Cash Price	$57.29
Rate for Payer: Cash Price	$71.98
Rate for Payer: Cash Price	$79.74
Rate for Payer: Cash Price	$66.35
Rate for Payer: Cofinity Commercial	$50.13
Rate for Payer: Cofinity Commercial	$85.72
Rate for Payer: Cofinity Commercial	$69.77
Rate for Payer: Cofinity Commercial	$77.37
Rate for Payer: Cofinity Commercial	$58.06
Rate for Payer: Cofinity Commercial	$71.33
Rate for Payer: Cofinity Commercial	$62.98
Rate for Payer: Cofinity Commercial	$61.58
Rate for Payer: Healthscope Commercial	$89.70
Rate for Payer: Healthscope Commercial	$64.45
Rate for Payer: Healthscope Commercial	$74.65
Rate for Payer: Healthscope Commercial	$80.97
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$70.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$76.47
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$60.87
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$84.72
Rate for Payer: PHP Commercial	$70.50
Rate for Payer: PHP Commercial	$84.72
Rate for Payer: PHP Commercial	$60.87
Rate for Payer: PHP Commercial	$76.47
Rate for Payer: Priority Health Cigna Priority Health	$69.77
Rate for Payer: Priority Health Cigna Priority Health	$62.98
Rate for Payer: Priority Health Cigna Priority Health	$50.13
Rate for Payer: Priority Health Cigna Priority Health	$58.06
Rate for Payer: Priority Health SBD	$56.68
Rate for Payer: Priority Health SBD	$45.11
Rate for Payer: Priority Health SBD	$52.25
Rate for Payer: Priority Health SBD	$62.79

MINERAL OIL

Facility

$60.28

Service Code	NDC 6332325410
Hospital Charge Code	109056
Hospital Revenue Code	637
Min. Negotiated Rate	$37.98
Max. Negotiated Rate	$54.25
Rate for Payer: Aetna Commercial	$51.24
Rate for Payer: Aetna New Business (MI Preferred)	$39.18
Rate for Payer: Cash Price	$48.22
Rate for Payer: Cofinity Commercial	$42.20
Rate for Payer: Cofinity Commercial	$51.84
Rate for Payer: Healthscope Commercial	$54.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$51.24
Rate for Payer: PHP Commercial	$51.24
Rate for Payer: Priority Health Cigna Priority Health	$42.20
Rate for Payer: Priority Health SBD	$37.98

MINERAL OIL ORAL

Facility

$8.88

Service Code	NDC 96295-10183
Hospital Charge Code	5086
Hospital Revenue Code	637
Min. Negotiated Rate	$5.59
Max. Negotiated Rate	$7.99
Rate for Payer: Aetna Commercial	$7.55
Rate for Payer: Aetna New Business (MI Preferred)	$5.77
Rate for Payer: Cash Price	$7.10
Rate for Payer: Cofinity Commercial	$6.22
Rate for Payer: Cofinity Commercial	$7.64
Rate for Payer: Healthscope Commercial	$7.99
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.55
Rate for Payer: PHP Commercial	$7.55
Rate for Payer: Priority Health Cigna Priority Health	$6.22
Rate for Payer: Priority Health SBD	$5.59

MINOCYCLINE 50 MG CAPSULE

Facility

$234.65

Service Code	NDC 0591-5694-01
Hospital Charge Code	5111
Hospital Revenue Code	637
Min. Negotiated Rate	$147.83
Max. Negotiated Rate	$211.18
Rate for Payer: Aetna Commercial	$199.45
Rate for Payer: Aetna New Business (MI Preferred)	$152.52
Rate for Payer: Cash Price	$187.72
Rate for Payer: Cofinity Commercial	$164.26
Rate for Payer: Cofinity Commercial	$201.80
Rate for Payer: Healthscope Commercial	$211.18
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$199.45
Rate for Payer: PHP Commercial	$199.45
Rate for Payer: Priority Health Cigna Priority Health	$164.26
Rate for Payer: Priority Health SBD	$147.83

MINOR BLADDER PROCEDURES WITH CC

Facility

$29,987.21

Service Code	MS-DRG 663
Min. Negotiated Rate	$10,450.14
Max. Negotiated Rate	$29,987.21
Rate for Payer: Aetna Medicare	$11,440.16
Rate for Payer: Allen County Amish Medical Aid Commercial	$13,750.19
Rate for Payer: Amish Plain Church Group Commercial	$13,750.19
Rate for Payer: BCBS MAPPO	$11,000.15
Rate for Payer: BCBS Trust/PPO	$29,987.21
Rate for Payer: BCN Medicare Advantage	$11,000.15
Rate for Payer: Health Alliance Plan Medicare Advantage	$11,000.15
Rate for Payer: Mclaren Medicare	$11,000.15
Rate for Payer: Meridian Wellcare - Medicare Advantage	$11,550.16
Rate for Payer: MI Amish Medical Board Commercial	$12,650.17
Rate for Payer: PACE Medicare	$10,450.14
Rate for Payer: PACE SWMI	$11,000.15
Rate for Payer: PHP Medicare Advantage	$11,000.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20,936.53
Rate for Payer: Priority Health Medicare	$11,000.15
Rate for Payer: Priority Health Narrow Network	$16,749.22
Rate for Payer: Railroad Medicare Medicare	$11,000.15
Rate for Payer: UHC All Payor (Choice/PPO)	$22,255.59
Rate for Payer: UHC Core	$13,656.24
Rate for Payer: UHC Dual Complete DSNP	$11,000.15
Rate for Payer: UHC Exchange	$14,626.48
Rate for Payer: UHC Medicare Advantage	$11,330.15
Rate for Payer: VA VA	$11,000.15

MINOR BLADDER PROCEDURES WITH MCC

Facility

$48,408.62

Service Code	MS-DRG 662
Min. Negotiated Rate	$20,970.61
Max. Negotiated Rate	$48,408.62
Rate for Payer: Aetna Medicare	$22,957.30
Rate for Payer: Allen County Amish Medical Aid Commercial	$27,592.91
Rate for Payer: Amish Plain Church Group Commercial	$27,592.91
Rate for Payer: BCBS MAPPO	$22,074.33
Rate for Payer: BCBS Trust/PPO	$48,408.62
Rate for Payer: BCN Medicare Advantage	$22,074.33
Rate for Payer: Health Alliance Plan Medicare Advantage	$22,074.33
Rate for Payer: Mclaren Medicare	$22,074.33
Rate for Payer: Meridian Wellcare - Medicare Advantage	$23,178.05
Rate for Payer: MI Amish Medical Board Commercial	$25,385.48
Rate for Payer: PACE Medicare	$20,970.61
Rate for Payer: PACE SWMI	$22,074.33
Rate for Payer: PHP Medicare Advantage	$22,074.33
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$43,002.41
Rate for Payer: Priority Health Medicare	$22,074.33
Rate for Payer: Priority Health Narrow Network	$34,401.93
Rate for Payer: Railroad Medicare Medicare	$22,074.33
Rate for Payer: UHC All Payor (Choice/PPO)	$45,711.66
Rate for Payer: UHC Core	$28,049.11
Rate for Payer: UHC Dual Complete DSNP	$22,074.33
Rate for Payer: UHC Exchange	$30,041.92
Rate for Payer: UHC Medicare Advantage	$22,736.56
Rate for Payer: VA VA	$22,074.33

MINOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility

$21,820.66

Service Code	MS-DRG 664
Min. Negotiated Rate	$7,731.24
Max. Negotiated Rate	$21,820.66
Rate for Payer: Aetna Medicare	$8,463.68
Rate for Payer: Allen County Amish Medical Aid Commercial	$10,172.69
Rate for Payer: Amish Plain Church Group Commercial	$10,172.69
Rate for Payer: BCBS MAPPO	$8,138.15
Rate for Payer: BCBS Trust/PPO	$21,820.66
Rate for Payer: BCN Medicare Advantage	$8,138.15
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,138.15
Rate for Payer: Mclaren Medicare	$8,138.15
Rate for Payer: Meridian Wellcare - Medicare Advantage	$8,545.06
Rate for Payer: MI Amish Medical Board Commercial	$9,358.87
Rate for Payer: PACE Medicare	$7,731.24
Rate for Payer: PACE SWMI	$8,138.15
Rate for Payer: PHP Medicare Advantage	$8,138.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$15,233.88
Rate for Payer: Priority Health Medicare	$8,138.15
Rate for Payer: Priority Health Narrow Network	$12,187.10
Rate for Payer: Railroad Medicare Medicare	$8,138.15
Rate for Payer: UHC All Payor (Choice/PPO)	$16,193.65
Rate for Payer: UHC Core	$9,936.58
Rate for Payer: UHC Dual Complete DSNP	$8,138.15
Rate for Payer: UHC Exchange	$10,642.54
Rate for Payer: UHC Medicare Advantage	$8,382.29
Rate for Payer: VA VA	$8,138.15

MINOR SKIN DISORDERS WITH MCC

Facility

$24,475.50

Service Code	MS-DRG 606
Min. Negotiated Rate	$11,317.66
Max. Negotiated Rate	$24,475.50
Rate for Payer: Aetna Medicare	$12,389.86
Rate for Payer: Allen County Amish Medical Aid Commercial	$14,891.66
Rate for Payer: Amish Plain Church Group Commercial	$14,891.66
Rate for Payer: BCBS MAPPO	$11,913.33
Rate for Payer: BCBS Trust/PPO	$24,475.50
Rate for Payer: BCN Medicare Advantage	$11,913.33
Rate for Payer: Health Alliance Plan Medicare Advantage	$11,913.33
Rate for Payer: Mclaren Medicare	$11,913.33
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12,509.00
Rate for Payer: MI Amish Medical Board Commercial	$13,700.33
Rate for Payer: PACE Medicare	$11,317.66
Rate for Payer: PACE SWMI	$11,913.33
Rate for Payer: PHP Medicare Advantage	$11,913.33
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$22,756.10
Rate for Payer: Priority Health Medicare	$11,913.33
Rate for Payer: Priority Health Narrow Network	$18,204.88
Rate for Payer: Railroad Medicare Medicare	$11,913.33
Rate for Payer: UHC All Payor (Choice/PPO)	$24,189.79
Rate for Payer: UHC Core	$14,843.09
Rate for Payer: UHC Dual Complete DSNP	$11,913.33
Rate for Payer: UHC Exchange	$15,897.65
Rate for Payer: UHC Medicare Advantage	$12,270.73
Rate for Payer: VA VA	$11,913.33

MINOR SKIN DISORDERS WITHOUT MCC

Facility

$13,629.45

Service Code	MS-DRG 607
Min. Negotiated Rate	$6,581.14
Max. Negotiated Rate	$13,629.45
Rate for Payer: Aetna Medicare	$7,204.62
Rate for Payer: Allen County Amish Medical Aid Commercial	$8,659.40
Rate for Payer: Amish Plain Church Group Commercial	$8,659.40
Rate for Payer: BCBS MAPPO	$6,927.52
Rate for Payer: BCBS Trust/PPO	$11,822.73
Rate for Payer: BCN Medicare Advantage	$6,927.52
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,927.52
Rate for Payer: Mclaren Medicare	$6,927.52
Rate for Payer: Meridian Wellcare - Medicare Advantage	$7,273.90
Rate for Payer: MI Amish Medical Board Commercial	$7,966.65
Rate for Payer: PACE Medicare	$6,581.14
Rate for Payer: PACE SWMI	$6,927.52
Rate for Payer: PHP Medicare Advantage	$6,927.52
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$12,821.65
Rate for Payer: Priority Health Medicare	$6,927.52
Rate for Payer: Priority Health Narrow Network	$10,257.32
Rate for Payer: Railroad Medicare Medicare	$6,927.52
Rate for Payer: UHC All Payor (Choice/PPO)	$13,629.45
Rate for Payer: UHC Core	$8,363.16
Rate for Payer: UHC Dual Complete DSNP	$6,927.52
Rate for Payer: UHC Exchange	$8,957.34
Rate for Payer: UHC Medicare Advantage	$7,135.35
Rate for Payer: VA VA	$6,927.52

MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC

Facility

$27,169.87

Service Code	MS-DRG 345
Min. Negotiated Rate	$11,008.41
Max. Negotiated Rate	$27,169.87
Rate for Payer: Aetna Medicare	$12,051.31
Rate for Payer: Allen County Amish Medical Aid Commercial	$14,484.75
Rate for Payer: Amish Plain Church Group Commercial	$14,484.75
Rate for Payer: BCBS MAPPO	$11,587.80
Rate for Payer: BCBS Trust/PPO	$27,169.87
Rate for Payer: BCN Medicare Advantage	$11,587.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$11,587.80
Rate for Payer: Mclaren Medicare	$11,587.80
Rate for Payer: Meridian Wellcare - Medicare Advantage	$12,167.19
Rate for Payer: MI Amish Medical Board Commercial	$13,325.97
Rate for Payer: PACE Medicare	$11,008.41
Rate for Payer: PACE SWMI	$11,587.80
Rate for Payer: PHP Medicare Advantage	$11,587.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$22,107.49
Rate for Payer: Priority Health Medicare	$11,587.80
Rate for Payer: Priority Health Narrow Network	$17,685.99
Rate for Payer: Railroad Medicare Medicare	$11,587.80
Rate for Payer: UHC All Payor (Choice/PPO)	$23,500.31
Rate for Payer: UHC Core	$14,420.02
Rate for Payer: UHC Dual Complete DSNP	$11,587.80
Rate for Payer: UHC Exchange	$15,444.52
Rate for Payer: UHC Medicare Advantage	$11,935.43
Rate for Payer: VA VA	$11,587.80

MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC

Facility

$47,216.24

Service Code	MS-DRG 344
Min. Negotiated Rate	$19,217.09
Max. Negotiated Rate	$47,216.24
Rate for Payer: Aetna Medicare	$21,037.66
Rate for Payer: Allen County Amish Medical Aid Commercial	$25,285.65
Rate for Payer: Amish Plain Church Group Commercial	$25,285.65
Rate for Payer: BCBS MAPPO	$20,228.52
Rate for Payer: BCBS Trust/PPO	$47,216.24
Rate for Payer: BCN Medicare Advantage	$20,228.52
Rate for Payer: Health Alliance Plan Medicare Advantage	$20,228.52
Rate for Payer: Mclaren Medicare	$20,228.52
Rate for Payer: Meridian Wellcare - Medicare Advantage	$21,239.95
Rate for Payer: MI Amish Medical Board Commercial	$23,262.80
Rate for Payer: PACE Medicare	$19,217.09
Rate for Payer: PACE SWMI	$20,228.52
Rate for Payer: PHP Medicare Advantage	$20,228.52
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$39,324.52
Rate for Payer: Priority Health Medicare	$20,228.52
Rate for Payer: Priority Health Narrow Network	$31,459.62
Rate for Payer: Railroad Medicare Medicare	$20,228.52
Rate for Payer: UHC All Payor (Choice/PPO)	$41,802.06
Rate for Payer: UHC Core	$25,650.14
Rate for Payer: UHC Dual Complete DSNP	$20,228.52
Rate for Payer: UHC Exchange	$27,472.51
Rate for Payer: UHC Medicare Advantage	$20,835.38
Rate for Payer: VA VA	$20,228.52

MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC

Facility

$25,292.38

Service Code	MS-DRG 346
Min. Negotiated Rate	$9,278.85
Max. Negotiated Rate	$25,292.38
Rate for Payer: Aetna Medicare	$10,157.90
Rate for Payer: Allen County Amish Medical Aid Commercial	$12,209.01
Rate for Payer: Amish Plain Church Group Commercial	$12,209.01
Rate for Payer: BCBS MAPPO	$9,767.21
Rate for Payer: BCBS Trust/PPO	$25,292.38
Rate for Payer: BCN Medicare Advantage	$9,767.21
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,767.21
Rate for Payer: Mclaren Medicare	$9,767.21
Rate for Payer: Meridian Wellcare - Medicare Advantage	$10,255.57
Rate for Payer: MI Amish Medical Board Commercial	$11,232.29
Rate for Payer: PACE Medicare	$9,278.85
Rate for Payer: PACE SWMI	$9,767.21
Rate for Payer: PHP Medicare Advantage	$9,767.21
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$18,479.83
Rate for Payer: Priority Health Medicare	$9,767.21
Rate for Payer: Priority Health Narrow Network	$14,783.86
Rate for Payer: Railroad Medicare Medicare	$9,767.21
Rate for Payer: UHC All Payor (Choice/PPO)	$19,644.10
Rate for Payer: UHC Core	$12,053.81
Rate for Payer: UHC Dual Complete DSNP	$9,767.21
Rate for Payer: UHC Exchange	$12,910.20
Rate for Payer: UHC Medicare Advantage	$10,060.23
Rate for Payer: VA VA	$9,767.21

MINOXIDIL 2.5 MG TABLET

Facility

$305.50

Service Code	NDC 53489-386-01
Hospital Charge Code	5115
Hospital Revenue Code	637
Min. Negotiated Rate	$192.46
Max. Negotiated Rate	$274.95
Rate for Payer: Aetna Commercial	$259.68
Rate for Payer: Aetna New Business (MI Preferred)	$198.58
Rate for Payer: Cash Price	$244.40
Rate for Payer: Cofinity Commercial	$213.85
Rate for Payer: Cofinity Commercial	$262.73
Rate for Payer: Healthscope Commercial	$274.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$259.68
Rate for Payer: PHP Commercial	$259.68
Rate for Payer: Priority Health Cigna Priority Health	$213.85
Rate for Payer: Priority Health SBD	$192.46

MINOXIDIL 2.5 MG TABLET

Facility

$4.60

Service Code	NDC 68084-204-11
Hospital Charge Code	5115
Hospital Revenue Code	637
Min. Negotiated Rate	$2.90
Max. Negotiated Rate	$4.14
Rate for Payer: Aetna Commercial	$3.91
Rate for Payer: Aetna New Business (MI Preferred)	$2.99
Rate for Payer: Cash Price	$3.68
Rate for Payer: Cofinity Commercial	$3.22
Rate for Payer: Cofinity Commercial	$3.96
Rate for Payer: Healthscope Commercial	$4.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$3.91
Rate for Payer: PHP Commercial	$3.91
Rate for Payer: Priority Health Cigna Priority Health	$3.22
Rate for Payer: Priority Health SBD	$2.90

MINOXIDIL 2.5 MG TABLET

Facility

$459.80

Service Code	NDC 68084-204-01
Hospital Charge Code	5115
Hospital Revenue Code	637
Min. Negotiated Rate	$289.67
Max. Negotiated Rate	$413.82
Rate for Payer: Aetna Commercial	$390.83
Rate for Payer: Aetna New Business (MI Preferred)	$298.87
Rate for Payer: Cash Price	$367.84
Rate for Payer: Cofinity Commercial	$321.86
Rate for Payer: Cofinity Commercial	$395.43
Rate for Payer: Healthscope Commercial	$413.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$390.83
Rate for Payer: PHP Commercial	$390.83
Rate for Payer: Priority Health Cigna Priority Health	$321.86
Rate for Payer: Priority Health SBD	$289.67

MINOXIDIL 2.5 MG TABLET

Facility

$462.95

Service Code	NDC 0591-5642-01
Hospital Charge Code	5115
Hospital Revenue Code	637
Min. Negotiated Rate	$291.66
Max. Negotiated Rate	$416.66
Rate for Payer: Aetna Commercial	$393.51
Rate for Payer: Aetna New Business (MI Preferred)	$300.92
Rate for Payer: Cash Price	$370.36
Rate for Payer: Cofinity Commercial	$324.06
Rate for Payer: Cofinity Commercial	$398.14
Rate for Payer: Healthscope Commercial	$416.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$393.51
Rate for Payer: PHP Commercial	$393.51
Rate for Payer: Priority Health Cigna Priority Health	$324.06
Rate for Payer: Priority Health SBD	$291.66

MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$1,537.80

Service Code	NDC 0469-2601-30
Hospital Charge Code	161790
Hospital Revenue Code	637
Min. Negotiated Rate	$968.81
Max. Negotiated Rate	$1,384.02
Rate for Payer: Aetna Commercial	$1,307.13
Rate for Payer: Aetna New Business (MI Preferred)	$999.57
Rate for Payer: Cash Price	$1,230.24
Rate for Payer: Cofinity Commercial	$1,076.46
Rate for Payer: Cofinity Commercial	$1,322.51
Rate for Payer: Healthscope Commercial	$1,384.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,307.13
Rate for Payer: PHP Commercial	$1,307.13
Rate for Payer: Priority Health Cigna Priority Health	$1,076.46
Rate for Payer: Priority Health SBD	$968.81

MIRABEGRON ER 50 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$1,537.80

Service Code	NDC 0469-2602-30
Hospital Charge Code	161791
Hospital Revenue Code	637
Min. Negotiated Rate	$968.81
Max. Negotiated Rate	$1,384.02
Rate for Payer: Aetna Commercial	$1,307.13
Rate for Payer: Aetna New Business (MI Preferred)	$999.57
Rate for Payer: Cash Price	$1,230.24
Rate for Payer: Cofinity Commercial	$1,076.46
Rate for Payer: Cofinity Commercial	$1,322.51
Rate for Payer: Healthscope Commercial	$1,384.02
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,307.13
Rate for Payer: PHP Commercial	$1,307.13
Rate for Payer: Priority Health Cigna Priority Health	$1,076.46
Rate for Payer: Priority Health SBD	$968.81

MIRTAZAPINE 15 MG TABLET

Facility

$350.15

Service Code	NDC 51079-086-20
Hospital Charge Code	17466
Hospital Revenue Code	637
Min. Negotiated Rate	$220.59
Max. Negotiated Rate	$315.14
Rate for Payer: Aetna Commercial	$297.63
Rate for Payer: Aetna New Business (MI Preferred)	$227.60
Rate for Payer: Cash Price	$280.12
Rate for Payer: Cofinity Commercial	$245.10
Rate for Payer: Cofinity Commercial	$301.13
Rate for Payer: Healthscope Commercial	$315.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$297.63
Rate for Payer: PHP Commercial	$297.63
Rate for Payer: Priority Health Cigna Priority Health	$245.10
Rate for Payer: Priority Health SBD	$220.59

MIRTAZAPINE 15 MG TABLET

Facility

$37.37

Service Code	NDC 13107-031-34
Hospital Charge Code	17466
Hospital Revenue Code	637
Min. Negotiated Rate	$23.54
Max. Negotiated Rate	$33.63
Rate for Payer: Aetna Commercial	$31.76
Rate for Payer: Aetna New Business (MI Preferred)	$24.29
Rate for Payer: Cash Price	$29.90
Rate for Payer: Cofinity Commercial	$26.16
Rate for Payer: Cofinity Commercial	$32.14
Rate for Payer: Healthscope Commercial	$33.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$31.76
Rate for Payer: PHP Commercial	$31.76
Rate for Payer: Priority Health Cigna Priority Health	$26.16
Rate for Payer: Priority Health SBD	$23.54

MIRTAZAPINE 15 MG TABLET

Facility

$195.70

Service Code	NDC 68084-119-01
Hospital Charge Code	17466
Hospital Revenue Code	637
Min. Negotiated Rate	$123.29
Max. Negotiated Rate	$176.13
Rate for Payer: Aetna Commercial	$166.34
Rate for Payer: Aetna New Business (MI Preferred)	$127.20
Rate for Payer: Cash Price	$156.56
Rate for Payer: Cofinity Commercial	$136.99
Rate for Payer: Cofinity Commercial	$168.30
Rate for Payer: Healthscope Commercial	$176.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$166.34
Rate for Payer: PHP Commercial	$166.34
Rate for Payer: Priority Health Cigna Priority Health	$136.99
Rate for Payer: Priority Health SBD	$123.29

MIRTAZAPINE 15 MG TABLET

Facility

$195.70

Service Code	NDC 68084-119-11
Hospital Charge Code	17466
Hospital Revenue Code	637
Min. Negotiated Rate	$123.29
Max. Negotiated Rate	$176.13
Rate for Payer: Aetna Commercial	$166.34
Rate for Payer: Aetna New Business (MI Preferred)	$127.20
Rate for Payer: Cash Price	$156.56
Rate for Payer: Cofinity Commercial	$136.99
Rate for Payer: Cofinity Commercial	$168.30
Rate for Payer: Healthscope Commercial	$176.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$166.34
Rate for Payer: PHP Commercial	$166.34
Rate for Payer: Priority Health Cigna Priority Health	$136.99
Rate for Payer: Priority Health SBD	$123.29

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