|
MIRTAZAPINE 30 MG TABLET
|
Facility
|
IP
|
$248.90
|
|
|
Service Code
|
NDC 00378353001
|
| Hospital Charge Code |
17465
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.81 |
| Max. Negotiated Rate |
$224.01 |
| Rate for Payer: Aetna Commercial |
$211.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.78
|
| 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: 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
|
|
|
MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC
|
Facility
|
IP
|
$22,839.19
|
|
|
Service Code
|
MSDRG 640
|
| Min. Negotiated Rate |
$10,355.79 |
| Max. Negotiated Rate |
$22,839.19 |
| Rate for Payer: Aetna Medicare |
$11,336.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,626.04
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,626.04
|
| Rate for Payer: BCBS MAPPO |
$10,900.83
|
| Rate for Payer: BCBS Trust/PPO |
$22,839.19
|
| Rate for Payer: BCN Commercial |
$22,839.19
|
| Rate for Payer: BCN Medicare Advantage |
$10,900.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,900.83
|
| Rate for Payer: Mclaren Medicare |
$10,900.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,445.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,535.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,990.91
|
| Rate for Payer: Nomi Health Commercial |
$17,229.24
|
| Rate for Payer: PACE Medicare |
$10,355.79
|
| Rate for Payer: PACE SWMI |
$10,900.83
|
| Rate for Payer: PHP Medicare Advantage |
$10,900.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$21,532.73
|
| Rate for Payer: Priority Health Medicare |
$10,900.83
|
| Rate for Payer: Priority Health Tiered Network |
$17,226.18
|
| Rate for Payer: Railroad Medicare Medicare |
$10,900.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,770.28
|
| Rate for Payer: UHC Core |
$18,213.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,900.83
|
| Rate for Payer: UHC Exchange |
$14,874.58
|
| Rate for Payer: VA VA |
$10,900.83
|
|
|
MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC
|
Facility
|
IP
|
$12,766.72
|
|
|
Service Code
|
MSDRG 641
|
| Min. Negotiated Rate |
$6,263.44 |
| Max. Negotiated Rate |
$12,766.72 |
| Rate for Payer: Aetna Medicare |
$6,856.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,241.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,241.38
|
| Rate for Payer: BCBS MAPPO |
$6,593.10
|
| Rate for Payer: BCBS Trust/PPO |
$12,766.72
|
| Rate for Payer: BCN Commercial |
$12,766.72
|
| Rate for Payer: BCN Medicare Advantage |
$6,593.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,593.10
|
| Rate for Payer: Mclaren Medicare |
$6,593.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6,922.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,582.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$7,252.41
|
| Rate for Payer: Nomi Health Commercial |
$10,038.78
|
| Rate for Payer: PACE Medicare |
$6,263.44
|
| Rate for Payer: PACE SWMI |
$6,593.10
|
| Rate for Payer: PHP Medicare Advantage |
$6,593.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$12,546.25
|
| Rate for Payer: Priority Health Medicare |
$6,593.10
|
| Rate for Payer: Priority Health Tiered Network |
$10,037.00
|
| Rate for Payer: Railroad Medicare Medicare |
$6,593.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12,684.66
|
| Rate for Payer: UHC Core |
$10,612.31
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$6,593.10
|
| Rate for Payer: UHC Exchange |
$8,666.81
|
| Rate for Payer: VA VA |
$6,593.10
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 68084004011
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Aetna Commercial |
$5.95
|
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.55
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cofinity Advantage |
$4.90
|
| Rate for Payer: Cofinity Commercial |
$6.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.60
|
| Rate for Payer: Healthscope Commercial |
$6.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.25
|
| Rate for Payer: PHP Commercial |
$5.95
|
| Rate for Payer: Priority Health SBD |
$4.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.55
|
| Rate for Payer: UHC Core |
$3.65
|
| Rate for Payer: UHC Exchange |
$2.75
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$355.40
|
|
|
Service Code
|
NDC 59762500702
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.90 |
| Max. Negotiated Rate |
$319.86 |
| Rate for Payer: Aetna Commercial |
$302.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.01
|
| Rate for Payer: Cash Price |
$284.32
|
| Rate for Payer: Cofinity Advantage |
$248.78
|
| Rate for Payer: Cofinity Commercial |
$305.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.32
|
| Rate for Payer: Healthscope Commercial |
$319.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.55
|
| Rate for Payer: PHP Commercial |
$302.09
|
| Rate for Payer: Priority Health SBD |
$223.90
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$177.41
|
|
|
Service Code
|
NDC 59762500701
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.77 |
| Max. Negotiated Rate |
$159.67 |
| Rate for Payer: Aetna Commercial |
$150.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.32
|
| Rate for Payer: Cash Price |
$141.93
|
| Rate for Payer: Cofinity Advantage |
$124.19
|
| Rate for Payer: Cofinity Commercial |
$152.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.93
|
| Rate for Payer: Healthscope Commercial |
$159.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.06
|
| Rate for Payer: PHP Commercial |
$150.80
|
| Rate for Payer: Priority Health SBD |
$111.77
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
OP
|
$355.40
|
|
|
Service Code
|
NDC 59762500702
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.67 |
| Max. Negotiated Rate |
$319.86 |
| Rate for Payer: Aetna Commercial |
$302.09
|
| Rate for Payer: Aetna Medicare |
$177.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.01
|
| Rate for Payer: BCBS Complete |
$142.16
|
| Rate for Payer: Cash Price |
$284.32
|
| Rate for Payer: Cofinity Advantage |
$248.78
|
| Rate for Payer: Cofinity Commercial |
$305.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.32
|
| Rate for Payer: Healthscope Commercial |
$319.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$284.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$266.55
|
| Rate for Payer: PHP Commercial |
$302.09
|
| Rate for Payer: Priority Health SBD |
$223.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.01
|
| Rate for Payer: UHC Core |
$185.16
|
| Rate for Payer: UHC Exchange |
$139.67
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$699.84
|
|
|
Service Code
|
NDC 68084004001
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$440.90 |
| Max. Negotiated Rate |
$629.86 |
| Rate for Payer: Aetna Commercial |
$594.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.90
|
| Rate for Payer: Cash Price |
$559.87
|
| Rate for Payer: Cofinity Advantage |
$489.89
|
| Rate for Payer: Cofinity Commercial |
$601.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.87
|
| Rate for Payer: Healthscope Commercial |
$629.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$524.88
|
| Rate for Payer: PHP Commercial |
$594.86
|
| Rate for Payer: Priority Health SBD |
$440.90
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 68084004011
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Aetna Commercial |
$5.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.55
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cofinity Advantage |
$4.90
|
| Rate for Payer: Cofinity Commercial |
$6.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.60
|
| Rate for Payer: Healthscope Commercial |
$6.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.25
|
| Rate for Payer: PHP Commercial |
$5.95
|
| Rate for Payer: Priority Health SBD |
$4.41
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$177.12
|
|
|
Service Code
|
NDC 43386016006
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.59 |
| Max. Negotiated Rate |
$159.41 |
| Rate for Payer: Aetna Commercial |
$150.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.13
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cofinity Advantage |
$123.98
|
| Rate for Payer: Cofinity Commercial |
$152.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.70
|
| Rate for Payer: Healthscope Commercial |
$159.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.84
|
| Rate for Payer: PHP Commercial |
$150.55
|
| Rate for Payer: Priority Health SBD |
$111.59
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
OP
|
$699.84
|
|
|
Service Code
|
NDC 68084004001
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$275.04 |
| Max. Negotiated Rate |
$629.86 |
| Rate for Payer: Aetna Commercial |
$594.86
|
| Rate for Payer: Aetna Medicare |
$349.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.90
|
| Rate for Payer: BCBS Complete |
$279.94
|
| Rate for Payer: Cash Price |
$559.87
|
| Rate for Payer: Cofinity Advantage |
$489.89
|
| Rate for Payer: Cofinity Commercial |
$601.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.87
|
| Rate for Payer: Healthscope Commercial |
$629.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$559.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$524.88
|
| Rate for Payer: PHP Commercial |
$594.86
|
| Rate for Payer: Priority Health SBD |
$440.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$454.90
|
| Rate for Payer: UHC Core |
$364.62
|
| Rate for Payer: UHC Exchange |
$275.04
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
OP
|
$177.12
|
|
|
Service Code
|
NDC 43386016006
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.61 |
| Max. Negotiated Rate |
$159.41 |
| Rate for Payer: Aetna Commercial |
$150.55
|
| Rate for Payer: Aetna Medicare |
$88.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.13
|
| Rate for Payer: BCBS Complete |
$70.85
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cofinity Advantage |
$123.98
|
| Rate for Payer: Cofinity Commercial |
$152.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.70
|
| Rate for Payer: Healthscope Commercial |
$159.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$132.84
|
| Rate for Payer: PHP Commercial |
$150.55
|
| Rate for Payer: Priority Health SBD |
$111.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.13
|
| Rate for Payer: UHC Core |
$92.28
|
| Rate for Payer: UHC Exchange |
$69.61
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
OP
|
$177.41
|
|
|
Service Code
|
NDC 59762500701
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.72 |
| Max. Negotiated Rate |
$159.67 |
| Rate for Payer: Aetna Commercial |
$150.80
|
| Rate for Payer: Aetna Medicare |
$88.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.32
|
| Rate for Payer: BCBS Complete |
$70.96
|
| Rate for Payer: Cash Price |
$141.93
|
| Rate for Payer: Cofinity Advantage |
$124.19
|
| Rate for Payer: Cofinity Commercial |
$152.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.93
|
| Rate for Payer: Healthscope Commercial |
$159.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.06
|
| Rate for Payer: PHP Commercial |
$150.80
|
| Rate for Payer: Priority Health SBD |
$111.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.32
|
| Rate for Payer: UHC Core |
$92.43
|
| Rate for Payer: UHC Exchange |
$69.72
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$2,022.79
|
|
|
Service Code
|
NDC 00025146131
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,274.36 |
| Max. Negotiated Rate |
$1,820.51 |
| Rate for Payer: Aetna Commercial |
$1,719.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,314.81
|
| Rate for Payer: Cash Price |
$1,618.23
|
| Rate for Payer: Cofinity Advantage |
$1,415.95
|
| Rate for Payer: Cofinity Commercial |
$1,739.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,618.23
|
| Rate for Payer: Healthscope Commercial |
$1,820.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,719.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,517.09
|
| Rate for Payer: PHP Commercial |
$1,719.37
|
| Rate for Payer: Priority Health SBD |
$1,274.36
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
OP
|
$431.04
|
|
|
Service Code
|
NDC 59762500802
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.40 |
| Max. Negotiated Rate |
$387.94 |
| Rate for Payer: Aetna Commercial |
$366.38
|
| Rate for Payer: Aetna Medicare |
$215.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.18
|
| Rate for Payer: BCBS Complete |
$172.42
|
| Rate for Payer: Cash Price |
$344.83
|
| Rate for Payer: Cofinity Advantage |
$301.73
|
| Rate for Payer: Cofinity Commercial |
$370.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.83
|
| Rate for Payer: Healthscope Commercial |
$387.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$344.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.28
|
| Rate for Payer: PHP Commercial |
$366.38
|
| Rate for Payer: Priority Health SBD |
$271.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.18
|
| Rate for Payer: UHC Core |
$224.57
|
| Rate for Payer: UHC Exchange |
$169.40
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$390.72
|
|
|
Service Code
|
NDC 70954044420
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$246.15 |
| Max. Negotiated Rate |
$351.65 |
| Rate for Payer: Aetna Commercial |
$332.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.97
|
| Rate for Payer: Cash Price |
$312.58
|
| Rate for Payer: Cofinity Advantage |
$273.50
|
| Rate for Payer: Cofinity Commercial |
$336.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.58
|
| Rate for Payer: Healthscope Commercial |
$351.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$293.04
|
| Rate for Payer: PHP Commercial |
$332.11
|
| Rate for Payer: Priority Health SBD |
$246.15
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
OP
|
$797.72
|
|
|
Service Code
|
NDC 60687074601
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$313.50 |
| Max. Negotiated Rate |
$717.95 |
| Rate for Payer: Aetna Commercial |
$678.06
|
| Rate for Payer: Aetna Medicare |
$398.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$518.52
|
| Rate for Payer: BCBS Complete |
$319.09
|
| Rate for Payer: Cash Price |
$638.18
|
| Rate for Payer: Cofinity Advantage |
$558.40
|
| Rate for Payer: Cofinity Commercial |
$686.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$638.18
|
| Rate for Payer: Healthscope Commercial |
$717.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$638.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$678.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$598.29
|
| Rate for Payer: PHP Commercial |
$678.06
|
| Rate for Payer: Priority Health SBD |
$502.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$518.52
|
| Rate for Payer: UHC Core |
$415.61
|
| Rate for Payer: UHC Exchange |
$313.50
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$797.72
|
|
|
Service Code
|
NDC 60687074601
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$502.56 |
| Max. Negotiated Rate |
$717.95 |
| Rate for Payer: Aetna Commercial |
$678.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$518.52
|
| Rate for Payer: Cash Price |
$638.18
|
| Rate for Payer: Cofinity Advantage |
$558.40
|
| Rate for Payer: Cofinity Commercial |
$686.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$638.18
|
| Rate for Payer: Healthscope Commercial |
$717.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$678.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$598.29
|
| Rate for Payer: PHP Commercial |
$678.06
|
| Rate for Payer: Priority Health SBD |
$502.56
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
OP
|
$390.72
|
|
|
Service Code
|
NDC 70954044420
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.55 |
| Max. Negotiated Rate |
$351.65 |
| Rate for Payer: Aetna Commercial |
$332.11
|
| Rate for Payer: Aetna Medicare |
$195.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.97
|
| Rate for Payer: BCBS Complete |
$156.29
|
| Rate for Payer: Cash Price |
$312.58
|
| Rate for Payer: Cofinity Advantage |
$273.50
|
| Rate for Payer: Cofinity Commercial |
$336.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$312.58
|
| Rate for Payer: Healthscope Commercial |
$351.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$312.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$293.04
|
| Rate for Payer: PHP Commercial |
$332.11
|
| Rate for Payer: Priority Health SBD |
$246.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$253.97
|
| Rate for Payer: UHC Core |
$203.57
|
| Rate for Payer: UHC Exchange |
$153.55
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
OP
|
$431.04
|
|
|
Service Code
|
NDC 43386016101
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.40 |
| Max. Negotiated Rate |
$387.94 |
| Rate for Payer: Aetna Commercial |
$366.38
|
| Rate for Payer: Aetna Medicare |
$215.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.18
|
| Rate for Payer: BCBS Complete |
$172.42
|
| Rate for Payer: Cash Price |
$344.83
|
| Rate for Payer: Cofinity Advantage |
$301.73
|
| Rate for Payer: Cofinity Commercial |
$370.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.83
|
| Rate for Payer: Healthscope Commercial |
$387.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$344.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.28
|
| Rate for Payer: PHP Commercial |
$366.38
|
| Rate for Payer: Priority Health SBD |
$271.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.18
|
| Rate for Payer: UHC Core |
$224.57
|
| Rate for Payer: UHC Exchange |
$169.40
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
OP
|
$7.95
|
|
|
Service Code
|
NDC 68084004111
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Aetna Commercial |
$6.76
|
| Rate for Payer: Aetna Medicare |
$3.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.17
|
| Rate for Payer: BCBS Complete |
$3.18
|
| Rate for Payer: Cash Price |
$6.36
|
| Rate for Payer: Cofinity Advantage |
$5.57
|
| Rate for Payer: Cofinity Commercial |
$6.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.36
|
| Rate for Payer: Healthscope Commercial |
$7.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.96
|
| Rate for Payer: PHP Commercial |
$6.76
|
| Rate for Payer: Priority Health SBD |
$5.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.17
|
| Rate for Payer: UHC Core |
$4.14
|
| Rate for Payer: UHC Exchange |
$3.12
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
OP
|
$2,022.79
|
|
|
Service Code
|
NDC 00025146131
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$794.96 |
| Max. Negotiated Rate |
$1,820.51 |
| Rate for Payer: Aetna Commercial |
$1,719.37
|
| Rate for Payer: Aetna Medicare |
$1,011.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,314.81
|
| Rate for Payer: BCBS Complete |
$809.12
|
| Rate for Payer: Cash Price |
$1,618.23
|
| Rate for Payer: Cofinity Advantage |
$1,415.95
|
| Rate for Payer: Cofinity Commercial |
$1,739.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,618.23
|
| Rate for Payer: Healthscope Commercial |
$1,820.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,618.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,719.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,517.09
|
| Rate for Payer: PHP Commercial |
$1,719.37
|
| Rate for Payer: Priority Health SBD |
$1,274.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,314.81
|
| Rate for Payer: UHC Core |
$1,053.87
|
| Rate for Payer: UHC Exchange |
$794.96
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$431.04
|
|
|
Service Code
|
NDC 43386016101
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$271.56 |
| Max. Negotiated Rate |
$387.94 |
| Rate for Payer: Aetna Commercial |
$366.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.18
|
| Rate for Payer: Cash Price |
$344.83
|
| Rate for Payer: Cofinity Advantage |
$301.73
|
| Rate for Payer: Cofinity Commercial |
$370.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.83
|
| Rate for Payer: Healthscope Commercial |
$387.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$323.28
|
| Rate for Payer: PHP Commercial |
$366.38
|
| Rate for Payer: Priority Health SBD |
$271.56
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
OP
|
$794.88
|
|
|
Service Code
|
NDC 68084004101
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$312.39 |
| Max. Negotiated Rate |
$715.39 |
| Rate for Payer: Aetna Commercial |
$675.65
|
| Rate for Payer: Aetna Medicare |
$397.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$516.67
|
| Rate for Payer: BCBS Complete |
$317.95
|
| Rate for Payer: Cash Price |
$635.90
|
| Rate for Payer: Cofinity Advantage |
$556.42
|
| Rate for Payer: Cofinity Commercial |
$683.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$635.90
|
| Rate for Payer: Healthscope Commercial |
$715.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$635.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$675.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$596.16
|
| Rate for Payer: PHP Commercial |
$675.65
|
| Rate for Payer: Priority Health SBD |
$500.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$516.67
|
| Rate for Payer: UHC Core |
$414.13
|
| Rate for Payer: UHC Exchange |
$312.39
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
OP
|
$7.98
|
|
|
Service Code
|
NDC 60687074611
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$7.18 |
| Rate for Payer: Aetna Commercial |
$6.78
|
| Rate for Payer: Aetna Medicare |
$3.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.19
|
| Rate for Payer: BCBS Complete |
$3.19
|
| Rate for Payer: Cash Price |
$6.38
|
| Rate for Payer: Cofinity Advantage |
$5.59
|
| Rate for Payer: Cofinity Commercial |
$6.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.38
|
| Rate for Payer: Healthscope Commercial |
$7.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.99
|
| Rate for Payer: PHP Commercial |
$6.78
|
| Rate for Payer: Priority Health SBD |
$5.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.19
|
| Rate for Payer: UHC Core |
$4.16
|
| Rate for Payer: UHC Exchange |
$3.14
|
|
