Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

MINOXIDIL 2.5 MG TABLET

Facility

$291.40

Service Code	NDC 53489038601
Hospital Charge Code	5115
Hospital Revenue Code	637
Min. Negotiated Rate	$183.58
Max. Negotiated Rate	$262.26
Rate for Payer: Aetna Commercial	$247.69
Rate for Payer: Aetna New Business (MI Preferred)	$189.41
Rate for Payer: Cash Price	$233.12
Rate for Payer: Cofinity Advantage	$203.98
Rate for Payer: Cofinity Commercial	$250.60
Rate for Payer: Encore Health Key Benefits Commercial	$233.12
Rate for Payer: Healthscope Commercial	$262.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$247.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$218.55
Rate for Payer: PHP Commercial	$247.69
Rate for Payer: Priority Health SBD	$183.58

MINOXIDIL 2.5 MG TABLET

Facility

$2.68

Service Code	NDC 68084020411
Hospital Charge Code	5115
Hospital Revenue Code	637
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.41
Rate for Payer: Aetna Commercial	$2.28
Rate for Payer: Aetna Medicare	$1.34
Rate for Payer: Aetna New Business (MI Preferred)	$1.74
Rate for Payer: BCBS Complete	$1.07
Rate for Payer: Cash Price	$2.14
Rate for Payer: Cofinity Advantage	$1.88
Rate for Payer: Cofinity Commercial	$2.30
Rate for Payer: Encore Health Key Benefits Commercial	$2.14
Rate for Payer: Healthscope Commercial	$2.41
Rate for Payer: MI Amish Medical Board Commercial	$2.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.01
Rate for Payer: PHP Commercial	$2.28
Rate for Payer: Priority Health SBD	$1.69
Rate for Payer: UHC All Payor (Choice/PPO)	$1.74
Rate for Payer: UHC Core	$1.40
Rate for Payer: UHC Exchange	$1.05

MINOXIDIL 2.5 MG TABLET

Facility

$267.84

Service Code	NDC 68084020401
Hospital Charge Code	5115
Hospital Revenue Code	637
Min. Negotiated Rate	$168.74
Max. Negotiated Rate	$241.06
Rate for Payer: Aetna Commercial	$227.66
Rate for Payer: Aetna New Business (MI Preferred)	$174.10
Rate for Payer: Cash Price	$214.27
Rate for Payer: Cofinity Advantage	$187.49
Rate for Payer: Cofinity Commercial	$230.34
Rate for Payer: Encore Health Key Benefits Commercial	$214.27
Rate for Payer: Healthscope Commercial	$241.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$227.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$200.88
Rate for Payer: PHP Commercial	$227.66
Rate for Payer: Priority Health SBD	$168.74

MINOXIDIL 2.5 MG TABLET

Facility

$291.40

Service Code	NDC 53489038601
Hospital Charge Code	5115
Hospital Revenue Code	637
Min. Negotiated Rate	$114.52
Max. Negotiated Rate	$262.26
Rate for Payer: Aetna Commercial	$247.69
Rate for Payer: Aetna Medicare	$145.70
Rate for Payer: Aetna New Business (MI Preferred)	$189.41
Rate for Payer: BCBS Complete	$116.56
Rate for Payer: Cash Price	$233.12
Rate for Payer: Cofinity Advantage	$203.98
Rate for Payer: Cofinity Commercial	$250.60
Rate for Payer: Encore Health Key Benefits Commercial	$233.12
Rate for Payer: Healthscope Commercial	$262.26
Rate for Payer: MI Amish Medical Board Commercial	$233.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$247.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$218.55
Rate for Payer: PHP Commercial	$247.69
Rate for Payer: Priority Health SBD	$183.58
Rate for Payer: UHC All Payor (Choice/PPO)	$189.41
Rate for Payer: UHC Core	$151.82
Rate for Payer: UHC Exchange	$114.52

MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$1,259.19

Service Code	NDC 70710115903
Hospital Charge Code	161790
Hospital Revenue Code	637
Min. Negotiated Rate	$793.29
Max. Negotiated Rate	$1,133.27
Rate for Payer: Aetna Commercial	$1,070.31
Rate for Payer: Aetna New Business (MI Preferred)	$818.47
Rate for Payer: Cash Price	$1,007.35
Rate for Payer: Cofinity Advantage	$881.43
Rate for Payer: Cofinity Commercial	$1,082.90
Rate for Payer: Encore Health Key Benefits Commercial	$1,007.35
Rate for Payer: Healthscope Commercial	$1,133.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,070.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$944.39
Rate for Payer: PHP Commercial	$1,070.31
Rate for Payer: Priority Health SBD	$793.29

MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$1,583.86

Service Code	NDC 00469260130
Hospital Charge Code	161790
Hospital Revenue Code	637
Min. Negotiated Rate	$997.83
Max. Negotiated Rate	$1,425.47
Rate for Payer: Aetna Commercial	$1,346.28
Rate for Payer: Aetna New Business (MI Preferred)	$1,029.51
Rate for Payer: Cash Price	$1,267.09
Rate for Payer: Cofinity Advantage	$1,108.70
Rate for Payer: Cofinity Commercial	$1,362.12
Rate for Payer: Encore Health Key Benefits Commercial	$1,267.09
Rate for Payer: Healthscope Commercial	$1,425.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,346.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,187.89
Rate for Payer: PHP Commercial	$1,346.28
Rate for Payer: Priority Health SBD	$997.83

MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$1,583.86

Service Code	NDC 00469260130
Hospital Charge Code	161790
Hospital Revenue Code	637
Min. Negotiated Rate	$622.46
Max. Negotiated Rate	$1,425.47
Rate for Payer: Aetna Commercial	$1,346.28
Rate for Payer: Aetna Medicare	$791.93
Rate for Payer: Aetna New Business (MI Preferred)	$1,029.51
Rate for Payer: BCBS Complete	$633.54
Rate for Payer: Cash Price	$1,267.09
Rate for Payer: Cofinity Advantage	$1,108.70
Rate for Payer: Cofinity Commercial	$1,362.12
Rate for Payer: Encore Health Key Benefits Commercial	$1,267.09
Rate for Payer: Healthscope Commercial	$1,425.47
Rate for Payer: MI Amish Medical Board Commercial	$1,267.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,346.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,187.89
Rate for Payer: PHP Commercial	$1,346.28
Rate for Payer: Priority Health SBD	$997.83
Rate for Payer: UHC All Payor (Choice/PPO)	$1,029.51
Rate for Payer: UHC Core	$825.19
Rate for Payer: UHC Exchange	$622.46

MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$1,259.19

Service Code	NDC 70710115903
Hospital Charge Code	161790
Hospital Revenue Code	637
Min. Negotiated Rate	$494.86
Max. Negotiated Rate	$1,133.27
Rate for Payer: Aetna Commercial	$1,070.31
Rate for Payer: Aetna Medicare	$629.60
Rate for Payer: Aetna New Business (MI Preferred)	$818.47
Rate for Payer: BCBS Complete	$503.68
Rate for Payer: Cash Price	$1,007.35
Rate for Payer: Cofinity Advantage	$881.43
Rate for Payer: Cofinity Commercial	$1,082.90
Rate for Payer: Encore Health Key Benefits Commercial	$1,007.35
Rate for Payer: Healthscope Commercial	$1,133.27
Rate for Payer: MI Amish Medical Board Commercial	$1,007.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,070.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$944.39
Rate for Payer: PHP Commercial	$1,070.31
Rate for Payer: Priority Health SBD	$793.29
Rate for Payer: UHC All Payor (Choice/PPO)	$818.47
Rate for Payer: UHC Core	$656.04
Rate for Payer: UHC Exchange	$494.86

MIRABEGRON ER 50 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$1,583.86

Service Code	NDC 00469260230
Hospital Charge Code	161791
Hospital Revenue Code	637
Min. Negotiated Rate	$622.46
Max. Negotiated Rate	$1,425.47
Rate for Payer: Aetna Commercial	$1,346.28
Rate for Payer: Aetna Medicare	$791.93
Rate for Payer: Aetna New Business (MI Preferred)	$1,029.51
Rate for Payer: BCBS Complete	$633.54
Rate for Payer: Cash Price	$1,267.09
Rate for Payer: Cofinity Advantage	$1,108.70
Rate for Payer: Cofinity Commercial	$1,362.12
Rate for Payer: Encore Health Key Benefits Commercial	$1,267.09
Rate for Payer: Healthscope Commercial	$1,425.47
Rate for Payer: MI Amish Medical Board Commercial	$1,267.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,346.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,187.89
Rate for Payer: PHP Commercial	$1,346.28
Rate for Payer: Priority Health SBD	$997.83
Rate for Payer: UHC All Payor (Choice/PPO)	$1,029.51
Rate for Payer: UHC Core	$825.19
Rate for Payer: UHC Exchange	$622.46

MIRABEGRON ER 50 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$1,583.86

Service Code	NDC 00469260230
Hospital Charge Code	161791
Hospital Revenue Code	637
Min. Negotiated Rate	$997.83
Max. Negotiated Rate	$1,425.47
Rate for Payer: Aetna Commercial	$1,346.28
Rate for Payer: Aetna New Business (MI Preferred)	$1,029.51
Rate for Payer: Cash Price	$1,267.09
Rate for Payer: Cofinity Advantage	$1,108.70
Rate for Payer: Cofinity Commercial	$1,362.12
Rate for Payer: Encore Health Key Benefits Commercial	$1,267.09
Rate for Payer: Healthscope Commercial	$1,425.47
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,346.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,187.89
Rate for Payer: PHP Commercial	$1,346.28
Rate for Payer: Priority Health SBD	$997.83

MIRTAZAPINE 15 MG TABLET

Facility

$46.53

Service Code	NDC 13107003134
Hospital Charge Code	17466
Hospital Revenue Code	637
Min. Negotiated Rate	$18.29
Max. Negotiated Rate	$41.88
Rate for Payer: Aetna Commercial	$39.55
Rate for Payer: Aetna Medicare	$23.27
Rate for Payer: Aetna New Business (MI Preferred)	$30.24
Rate for Payer: BCBS Complete	$18.61
Rate for Payer: Cash Price	$37.22
Rate for Payer: Cofinity Advantage	$32.57
Rate for Payer: Cofinity Commercial	$40.02
Rate for Payer: Encore Health Key Benefits Commercial	$37.22
Rate for Payer: Healthscope Commercial	$41.88
Rate for Payer: MI Amish Medical Board Commercial	$37.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.90
Rate for Payer: PHP Commercial	$39.55
Rate for Payer: Priority Health SBD	$29.31
Rate for Payer: UHC All Payor (Choice/PPO)	$30.24
Rate for Payer: UHC Core	$24.24
Rate for Payer: UHC Exchange	$18.29

MIRTAZAPINE 15 MG TABLET

Facility

$401.85

Service Code	NDC 51079008620
Hospital Charge Code	17466
Hospital Revenue Code	637
Min. Negotiated Rate	$157.93
Max. Negotiated Rate	$361.67
Rate for Payer: Aetna Commercial	$341.57
Rate for Payer: Aetna Medicare	$200.93
Rate for Payer: Aetna New Business (MI Preferred)	$261.20
Rate for Payer: BCBS Complete	$160.74
Rate for Payer: Cash Price	$321.48
Rate for Payer: Cofinity Advantage	$281.30
Rate for Payer: Cofinity Commercial	$345.59
Rate for Payer: Encore Health Key Benefits Commercial	$321.48
Rate for Payer: Healthscope Commercial	$361.67
Rate for Payer: MI Amish Medical Board Commercial	$321.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$341.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$301.39
Rate for Payer: PHP Commercial	$341.57
Rate for Payer: Priority Health SBD	$253.17
Rate for Payer: UHC All Payor (Choice/PPO)	$261.20
Rate for Payer: UHC Core	$209.36
Rate for Payer: UHC Exchange	$157.93

MIRTAZAPINE 15 MG TABLET

Facility

$4.21

Service Code	NDC 68084011911
Hospital Charge Code	17466
Hospital Revenue Code	637
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$3.79
Rate for Payer: Aetna Commercial	$3.58
Rate for Payer: Aetna Medicare	$2.10
Rate for Payer: Aetna New Business (MI Preferred)	$2.74
Rate for Payer: BCBS Complete	$1.68
Rate for Payer: Cash Price	$3.37
Rate for Payer: Cofinity Advantage	$2.95
Rate for Payer: Cofinity Commercial	$3.62
Rate for Payer: Encore Health Key Benefits Commercial	$3.37
Rate for Payer: Healthscope Commercial	$3.79
Rate for Payer: MI Amish Medical Board Commercial	$3.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.16
Rate for Payer: PHP Commercial	$3.58
Rate for Payer: Priority Health SBD	$2.65
Rate for Payer: UHC All Payor (Choice/PPO)	$2.74
Rate for Payer: UHC Core	$2.19
Rate for Payer: UHC Exchange	$1.65

MIRTAZAPINE 15 MG TABLET

Facility

$420.65

Service Code	NDC 68084011901
Hospital Charge Code	17466
Hospital Revenue Code	637
Min. Negotiated Rate	$165.32
Max. Negotiated Rate	$378.58
Rate for Payer: Aetna Commercial	$357.55
Rate for Payer: Aetna Medicare	$210.32
Rate for Payer: Aetna New Business (MI Preferred)	$273.42
Rate for Payer: BCBS Complete	$168.26
Rate for Payer: Cash Price	$336.52
Rate for Payer: Cofinity Advantage	$294.45
Rate for Payer: Cofinity Commercial	$361.76
Rate for Payer: Encore Health Key Benefits Commercial	$336.52
Rate for Payer: Healthscope Commercial	$378.58
Rate for Payer: MI Amish Medical Board Commercial	$336.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$357.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$315.49
Rate for Payer: PHP Commercial	$357.55
Rate for Payer: Priority Health SBD	$265.01
Rate for Payer: UHC All Payor (Choice/PPO)	$273.42
Rate for Payer: UHC Core	$219.16
Rate for Payer: UHC Exchange	$165.32

MIRTAZAPINE 15 MG TABLET

Facility

$420.65

Service Code	NDC 68084011901
Hospital Charge Code	17466
Hospital Revenue Code	637
Min. Negotiated Rate	$265.01
Max. Negotiated Rate	$378.58
Rate for Payer: Aetna Commercial	$357.55
Rate for Payer: Aetna New Business (MI Preferred)	$273.42
Rate for Payer: Cash Price	$336.52
Rate for Payer: Cofinity Advantage	$294.45
Rate for Payer: Cofinity Commercial	$361.76
Rate for Payer: Encore Health Key Benefits Commercial	$336.52
Rate for Payer: Healthscope Commercial	$378.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$357.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$315.49
Rate for Payer: PHP Commercial	$357.55
Rate for Payer: Priority Health SBD	$265.01

MIRTAZAPINE 15 MG TABLET

Facility

$4.21

Service Code	NDC 68084011911
Hospital Charge Code	17466
Hospital Revenue Code	637
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$3.79
Rate for Payer: Aetna Commercial	$3.58
Rate for Payer: Aetna New Business (MI Preferred)	$2.74
Rate for Payer: Cash Price	$3.37
Rate for Payer: Cofinity Advantage	$2.95
Rate for Payer: Cofinity Commercial	$3.62
Rate for Payer: Encore Health Key Benefits Commercial	$3.37
Rate for Payer: Healthscope Commercial	$3.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.16
Rate for Payer: PHP Commercial	$3.58
Rate for Payer: Priority Health SBD	$2.65

MIRTAZAPINE 15 MG TABLET

Facility

$46.53

Service Code	NDC 13107003134
Hospital Charge Code	17466
Hospital Revenue Code	637
Min. Negotiated Rate	$29.31
Max. Negotiated Rate	$41.88
Rate for Payer: Aetna Commercial	$39.55
Rate for Payer: Aetna New Business (MI Preferred)	$30.24
Rate for Payer: Cash Price	$37.22
Rate for Payer: Cofinity Advantage	$32.57
Rate for Payer: Cofinity Commercial	$40.02
Rate for Payer: Encore Health Key Benefits Commercial	$37.22
Rate for Payer: Healthscope Commercial	$41.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$39.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.90
Rate for Payer: PHP Commercial	$39.55
Rate for Payer: Priority Health SBD	$29.31

MIRTAZAPINE 15 MG TABLET

Facility

$401.85

Service Code	NDC 51079008620
Hospital Charge Code	17466
Hospital Revenue Code	637
Min. Negotiated Rate	$253.17
Max. Negotiated Rate	$361.67
Rate for Payer: Aetna Commercial	$341.57
Rate for Payer: Aetna New Business (MI Preferred)	$261.20
Rate for Payer: Cash Price	$321.48
Rate for Payer: Cofinity Advantage	$281.30
Rate for Payer: Cofinity Commercial	$345.59
Rate for Payer: Encore Health Key Benefits Commercial	$321.48
Rate for Payer: Healthscope Commercial	$361.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$341.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$301.39
Rate for Payer: PHP Commercial	$341.57
Rate for Payer: Priority Health SBD	$253.17

MIRTAZAPINE 30 MG TABLET

Facility

$467.65

Service Code	NDC 68084012011
Hospital Charge Code	17465
Hospital Revenue Code	637
Min. Negotiated Rate	$294.62
Max. Negotiated Rate	$420.88
Rate for Payer: Aetna Commercial	$397.50
Rate for Payer: Aetna New Business (MI Preferred)	$303.97
Rate for Payer: Cash Price	$374.12
Rate for Payer: Cofinity Advantage	$327.36
Rate for Payer: Cofinity Commercial	$402.18
Rate for Payer: Encore Health Key Benefits Commercial	$374.12
Rate for Payer: Healthscope Commercial	$420.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$397.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$350.74
Rate for Payer: PHP Commercial	$397.50
Rate for Payer: Priority Health SBD	$294.62

MIRTAZAPINE 30 MG TABLET

Facility

$354.85

Service Code	NDC 63739009910
Hospital Charge Code	17465
Hospital Revenue Code	637
Min. Negotiated Rate	$223.56
Max. Negotiated Rate	$319.37
Rate for Payer: Aetna Commercial	$301.62
Rate for Payer: Aetna New Business (MI Preferred)	$230.65
Rate for Payer: Cash Price	$283.88
Rate for Payer: Cofinity Advantage	$248.40
Rate for Payer: Cofinity Commercial	$305.17
Rate for Payer: Encore Health Key Benefits Commercial	$283.88
Rate for Payer: Healthscope Commercial	$319.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$301.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$266.14
Rate for Payer: PHP Commercial	$301.62
Rate for Payer: Priority Health SBD	$223.56

MIRTAZAPINE 30 MG TABLET

Facility

$248.90

Service Code	NDC 00378353001
Hospital Charge Code	17465
Hospital Revenue Code	637
Min. Negotiated Rate	$97.82
Max. Negotiated Rate	$224.01
Rate for Payer: Aetna Commercial	$211.56
Rate for Payer: Aetna Medicare	$124.45
Rate for Payer: Aetna New Business (MI Preferred)	$161.78
Rate for Payer: BCBS Complete	$99.56
Rate for Payer: Cash Price	$199.12
Rate for Payer: Cofinity Advantage	$174.23
Rate for Payer: Cofinity Commercial	$214.05
Rate for Payer: Encore Health Key Benefits Commercial	$199.12
Rate for Payer: Healthscope Commercial	$224.01
Rate for Payer: MI Amish Medical Board Commercial	$199.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$211.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$186.68
Rate for Payer: PHP Commercial	$211.56
Rate for Payer: Priority Health SBD	$156.81
Rate for Payer: UHC All Payor (Choice/PPO)	$161.78
Rate for Payer: UHC Core	$129.68
Rate for Payer: UHC Exchange	$97.82

MIRTAZAPINE 30 MG TABLET

Facility

$467.65

Service Code	NDC 68084012001
Hospital Charge Code	17465
Hospital Revenue Code	637
Min. Negotiated Rate	$294.62
Max. Negotiated Rate	$420.88
Rate for Payer: Aetna Commercial	$397.50
Rate for Payer: Aetna New Business (MI Preferred)	$303.97
Rate for Payer: Cash Price	$374.12
Rate for Payer: Cofinity Advantage	$327.36
Rate for Payer: Cofinity Commercial	$402.18
Rate for Payer: Encore Health Key Benefits Commercial	$374.12
Rate for Payer: Healthscope Commercial	$420.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$397.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$350.74
Rate for Payer: PHP Commercial	$397.50
Rate for Payer: Priority Health SBD	$294.62

MIRTAZAPINE 30 MG TABLET

Facility

$467.65

Service Code	NDC 68084012011
Hospital Charge Code	17465
Hospital Revenue Code	637
Min. Negotiated Rate	$183.79
Max. Negotiated Rate	$420.88
Rate for Payer: Aetna Commercial	$397.50
Rate for Payer: Aetna Medicare	$233.82
Rate for Payer: Aetna New Business (MI Preferred)	$303.97
Rate for Payer: BCBS Complete	$187.06
Rate for Payer: Cash Price	$374.12
Rate for Payer: Cofinity Advantage	$327.36
Rate for Payer: Cofinity Commercial	$402.18
Rate for Payer: Encore Health Key Benefits Commercial	$374.12
Rate for Payer: Healthscope Commercial	$420.88
Rate for Payer: MI Amish Medical Board Commercial	$374.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$397.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$350.74
Rate for Payer: PHP Commercial	$397.50
Rate for Payer: Priority Health SBD	$294.62
Rate for Payer: UHC All Payor (Choice/PPO)	$303.97
Rate for Payer: UHC Core	$243.65
Rate for Payer: UHC Exchange	$183.79

MIRTAZAPINE 30 MG TABLET

Facility

$354.85

Service Code	NDC 63739009910
Hospital Charge Code	17465
Hospital Revenue Code	637
Min. Negotiated Rate	$139.46
Max. Negotiated Rate	$319.37
Rate for Payer: Aetna Commercial	$301.62
Rate for Payer: Aetna Medicare	$177.43
Rate for Payer: Aetna New Business (MI Preferred)	$230.65
Rate for Payer: BCBS Complete	$141.94
Rate for Payer: Cash Price	$283.88
Rate for Payer: Cofinity Advantage	$248.40
Rate for Payer: Cofinity Commercial	$305.17
Rate for Payer: Encore Health Key Benefits Commercial	$283.88
Rate for Payer: Healthscope Commercial	$319.37
Rate for Payer: MI Amish Medical Board Commercial	$283.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$301.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$266.14
Rate for Payer: PHP Commercial	$301.62
Rate for Payer: Priority Health SBD	$223.56
Rate for Payer: UHC All Payor (Choice/PPO)	$230.65
Rate for Payer: UHC Core	$184.88
Rate for Payer: UHC Exchange	$139.46

MIRTAZAPINE 30 MG TABLET

Facility

$467.65

Service Code	NDC 68084012001
Hospital Charge Code	17465
Hospital Revenue Code	637
Min. Negotiated Rate	$183.79
Max. Negotiated Rate	$420.88
Rate for Payer: Aetna Commercial	$397.50
Rate for Payer: Aetna Medicare	$233.82
Rate for Payer: Aetna New Business (MI Preferred)	$303.97
Rate for Payer: BCBS Complete	$187.06
Rate for Payer: Cash Price	$374.12
Rate for Payer: Cofinity Advantage	$327.36
Rate for Payer: Cofinity Commercial	$402.18
Rate for Payer: Encore Health Key Benefits Commercial	$374.12
Rate for Payer: Healthscope Commercial	$420.88
Rate for Payer: MI Amish Medical Board Commercial	$374.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$397.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$350.74
Rate for Payer: PHP Commercial	$397.50
Rate for Payer: Priority Health SBD	$294.62
Rate for Payer: UHC All Payor (Choice/PPO)	$303.97
Rate for Payer: UHC Core	$243.65
Rate for Payer: UHC Exchange	$183.79

Know your out-of-pocket cost for care.

All Charges