|
MINOXIDIL 10 MG TABLET
|
Facility
|
OP
|
$284.64
|
|
|
Service Code
|
NDC 68084020501
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.18 |
| Max. Negotiated Rate |
$256.18 |
| Rate for Payer: Aetna Commercial |
$241.94
|
| Rate for Payer: Aetna Medicare |
$74.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$88.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$88.95
|
| Rate for Payer: BCBS Complete |
$52.69
|
| Rate for Payer: BCBS MAPPO |
$71.16
|
| Rate for Payer: BCBS Trust/PPO |
$234.00
|
| Rate for Payer: BCN Commercial |
$234.00
|
| Rate for Payer: BCN Medicare Advantage |
$71.16
|
| Rate for Payer: Cash Price |
$227.71
|
| Rate for Payer: Cofinity Commercial |
$244.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.16
|
| Rate for Payer: Healthscope Commercial |
$256.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.48
|
| Rate for Payer: Mclaren Medicaid |
$50.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.72
|
| Rate for Payer: Meridian Medicaid |
$52.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.94
|
| Rate for Payer: Nomi Health Commercial |
$233.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.48
|
| Rate for Payer: PACE Senior Care Partners |
$67.60
|
| Rate for Payer: PACE SWMI |
$71.16
|
| Rate for Payer: PHP Commercial |
$241.94
|
| Rate for Payer: PHP Medicare Advantage |
$71.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$247.64
|
| Rate for Payer: Priority Health Medicare |
$71.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.11
|
| Rate for Payer: Railroad Medicare Medicare |
$71.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.48
|
| Rate for Payer: UHC Core |
$237.67
|
| Rate for Payer: UHC Exchange |
$71.16
|
| Rate for Payer: UHC Medicaid |
$50.18
|
| Rate for Payer: UHC Medicare Advantage |
$71.16
|
| Rate for Payer: UHCCP Medicaid |
$50.18
|
| Rate for Payer: VA VA |
$71.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.48
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$284.64
|
|
|
Service Code
|
NDC 68084020501
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.11 |
| Max. Negotiated Rate |
$256.18 |
| Rate for Payer: Aetna Commercial |
$241.94
|
| Rate for Payer: BCBS Trust/PPO |
$235.08
|
| Rate for Payer: BCN Commercial |
$235.08
|
| Rate for Payer: Cash Price |
$227.71
|
| Rate for Payer: Cofinity Commercial |
$244.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.71
|
| Rate for Payer: Healthscope Commercial |
$256.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.94
|
| Rate for Payer: Nomi Health Commercial |
$233.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.48
|
| Rate for Payer: PHP Commercial |
$241.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$247.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$198.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.48
|
| Rate for Payer: UHC Core |
$237.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.48
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4,751.58
|
|
|
Service Code
|
NDC 00469260190
|
| Hospital Charge Code |
161790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,307.10 |
| Max. Negotiated Rate |
$4,276.42 |
| Rate for Payer: Aetna Commercial |
$4,038.84
|
| Rate for Payer: BCBS Trust/PPO |
$3,924.33
|
| Rate for Payer: BCN Commercial |
$3,924.33
|
| Rate for Payer: Cash Price |
$3,801.26
|
| Rate for Payer: Cofinity Commercial |
$4,086.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,801.26
|
| Rate for Payer: Healthscope Commercial |
$4,276.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,563.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,038.84
|
| Rate for Payer: Nomi Health Commercial |
$3,896.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,563.68
|
| Rate for Payer: PHP Commercial |
$4,038.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,133.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,307.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,181.39
|
| Rate for Payer: UHC Core |
$3,967.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,563.68
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,583.86
|
|
|
Service Code
|
NDC 00469260130
|
| Hospital Charge Code |
161790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,102.37 |
| Max. Negotiated Rate |
$1,425.47 |
| Rate for Payer: Aetna Commercial |
$1,346.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,308.11
|
| Rate for Payer: BCN Commercial |
$1,308.11
|
| Rate for Payer: Cash Price |
$1,267.09
|
| 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: Lakeland Regional Health Systems Commercial |
$1,187.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,346.28
|
| Rate for Payer: Nomi Health Commercial |
$1,298.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,187.89
|
| Rate for Payer: PHP Commercial |
$1,346.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,377.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,102.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,393.80
|
| Rate for Payer: UHC Core |
$1,322.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,187.89
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4,751.58
|
|
|
Service Code
|
NDC 00469260190
|
| Hospital Charge Code |
161790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$837.70 |
| Max. Negotiated Rate |
$4,276.42 |
| Rate for Payer: Aetna Commercial |
$4,038.84
|
| Rate for Payer: Aetna Medicare |
$1,235.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,484.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,484.87
|
| Rate for Payer: BCBS Complete |
$879.52
|
| Rate for Payer: BCBS MAPPO |
$1,187.89
|
| Rate for Payer: BCBS Trust/PPO |
$3,906.27
|
| Rate for Payer: BCN Commercial |
$3,906.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,187.89
|
| Rate for Payer: Cash Price |
$3,801.26
|
| Rate for Payer: Cofinity Commercial |
$4,086.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,801.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,187.89
|
| Rate for Payer: Healthscope Commercial |
$4,276.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,563.68
|
| Rate for Payer: Mclaren Medicaid |
$837.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,247.29
|
| Rate for Payer: Meridian Medicaid |
$879.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,366.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,306.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,038.84
|
| Rate for Payer: Nomi Health Commercial |
$3,896.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,563.68
|
| Rate for Payer: PACE Senior Care Partners |
$1,128.50
|
| Rate for Payer: PACE SWMI |
$1,187.89
|
| Rate for Payer: PHP Commercial |
$4,038.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,187.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$837.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$4,133.87
|
| Rate for Payer: Priority Health Medicare |
$1,199.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,307.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,187.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,181.39
|
| Rate for Payer: UHC Core |
$3,967.57
|
| Rate for Payer: UHC Exchange |
$1,187.89
|
| Rate for Payer: UHC Medicaid |
$837.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,187.89
|
| Rate for Payer: UHCCP Medicaid |
$837.70
|
| Rate for Payer: VA VA |
$1,187.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,563.68
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3,635.03
|
|
|
Service Code
|
NDC 70710115909
|
| Hospital Charge Code |
161790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$640.86 |
| Max. Negotiated Rate |
$3,271.53 |
| Rate for Payer: Aetna Commercial |
$3,089.78
|
| Rate for Payer: Aetna Medicare |
$945.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,135.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,135.95
|
| Rate for Payer: BCBS Complete |
$672.84
|
| Rate for Payer: BCBS MAPPO |
$908.76
|
| Rate for Payer: BCBS Trust/PPO |
$2,988.36
|
| Rate for Payer: BCN Commercial |
$2,988.36
|
| Rate for Payer: BCN Medicare Advantage |
$908.76
|
| Rate for Payer: Cash Price |
$2,908.02
|
| Rate for Payer: Cofinity Commercial |
$3,126.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,908.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$908.76
|
| Rate for Payer: Healthscope Commercial |
$3,271.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,726.27
|
| Rate for Payer: Mclaren Medicaid |
$640.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$954.20
|
| Rate for Payer: Meridian Medicaid |
$672.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,045.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$999.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,089.78
|
| Rate for Payer: Nomi Health Commercial |
$2,980.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,726.27
|
| Rate for Payer: PACE Senior Care Partners |
$863.32
|
| Rate for Payer: PACE SWMI |
$908.76
|
| Rate for Payer: PHP Commercial |
$3,089.78
|
| Rate for Payer: PHP Medicare Advantage |
$908.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$640.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,162.48
|
| Rate for Payer: Priority Health Medicare |
$917.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,529.98
|
| Rate for Payer: Railroad Medicare Medicare |
$908.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,198.83
|
| Rate for Payer: UHC Core |
$3,035.25
|
| Rate for Payer: UHC Exchange |
$908.76
|
| Rate for Payer: UHC Medicaid |
$640.86
|
| Rate for Payer: UHC Medicare Advantage |
$908.76
|
| Rate for Payer: UHCCP Medicaid |
$640.86
|
| Rate for Payer: VA VA |
$908.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,726.27
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3,635.03
|
|
|
Service Code
|
NDC 70710115909
|
| Hospital Charge Code |
161790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,529.98 |
| Max. Negotiated Rate |
$3,271.53 |
| Rate for Payer: Aetna Commercial |
$3,089.78
|
| Rate for Payer: BCBS Trust/PPO |
$3,002.17
|
| Rate for Payer: BCN Commercial |
$3,002.17
|
| Rate for Payer: Cash Price |
$2,908.02
|
| Rate for Payer: Cofinity Commercial |
$3,126.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,908.02
|
| Rate for Payer: Healthscope Commercial |
$3,271.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,726.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,089.78
|
| Rate for Payer: Nomi Health Commercial |
$2,980.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,726.27
|
| Rate for Payer: PHP Commercial |
$3,089.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3,162.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,529.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,198.83
|
| Rate for Payer: UHC Core |
$3,035.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,726.27
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,583.86
|
|
|
Service Code
|
NDC 00469260130
|
| Hospital Charge Code |
161790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$279.23 |
| Max. Negotiated Rate |
$1,425.47 |
| Rate for Payer: Aetna Commercial |
$1,346.28
|
| Rate for Payer: Aetna Medicare |
$411.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$494.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$494.96
|
| Rate for Payer: BCBS Complete |
$293.17
|
| Rate for Payer: BCBS MAPPO |
$395.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,302.09
|
| Rate for Payer: BCN Commercial |
$1,302.09
|
| Rate for Payer: BCN Medicare Advantage |
$395.96
|
| Rate for Payer: Cash Price |
$1,267.09
|
| Rate for Payer: Cofinity Commercial |
$1,362.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,267.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$395.96
|
| Rate for Payer: Healthscope Commercial |
$1,425.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,187.89
|
| Rate for Payer: Mclaren Medicaid |
$279.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$415.76
|
| Rate for Payer: Meridian Medicaid |
$293.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$455.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$435.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,346.28
|
| Rate for Payer: Nomi Health Commercial |
$1,298.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,187.89
|
| Rate for Payer: PACE Senior Care Partners |
$376.17
|
| Rate for Payer: PACE SWMI |
$395.96
|
| Rate for Payer: PHP Commercial |
$1,346.28
|
| Rate for Payer: PHP Medicare Advantage |
$395.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$279.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,377.96
|
| Rate for Payer: Priority Health Medicare |
$399.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,102.37
|
| Rate for Payer: Railroad Medicare Medicare |
$395.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,393.80
|
| Rate for Payer: UHC Core |
$1,322.52
|
| Rate for Payer: UHC Exchange |
$395.96
|
| Rate for Payer: UHC Medicaid |
$279.23
|
| Rate for Payer: UHC Medicare Advantage |
$395.96
|
| Rate for Payer: UHCCP Medicaid |
$279.23
|
| Rate for Payer: VA VA |
$395.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,187.89
|
|
|
MIRTAZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$440.01
|
|
|
Service Code
|
NDC 00052010630
|
| Hospital Charge Code |
29531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.57 |
| Max. Negotiated Rate |
$396.01 |
| Rate for Payer: Aetna Commercial |
$374.01
|
| Rate for Payer: Aetna Medicare |
$114.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$137.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$137.50
|
| Rate for Payer: BCBS Complete |
$81.45
|
| Rate for Payer: BCBS MAPPO |
$110.00
|
| Rate for Payer: BCBS Trust/PPO |
$361.73
|
| Rate for Payer: BCN Commercial |
$361.73
|
| Rate for Payer: BCN Medicare Advantage |
$110.00
|
| Rate for Payer: Cash Price |
$352.01
|
| Rate for Payer: Cofinity Commercial |
$378.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.00
|
| Rate for Payer: Healthscope Commercial |
$396.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.01
|
| Rate for Payer: Mclaren Medicaid |
$77.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.50
|
| Rate for Payer: Meridian Medicaid |
$81.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$121.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.01
|
| Rate for Payer: Nomi Health Commercial |
$360.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$330.01
|
| Rate for Payer: PACE Senior Care Partners |
$104.50
|
| Rate for Payer: PACE SWMI |
$110.00
|
| Rate for Payer: PHP Commercial |
$374.01
|
| Rate for Payer: PHP Medicare Advantage |
$110.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$77.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$382.81
|
| Rate for Payer: Priority Health Medicare |
$111.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$306.25
|
| Rate for Payer: Railroad Medicare Medicare |
$110.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$387.21
|
| Rate for Payer: UHC Core |
$367.41
|
| Rate for Payer: UHC Exchange |
$110.00
|
| Rate for Payer: UHC Medicaid |
$77.57
|
| Rate for Payer: UHC Medicare Advantage |
$110.00
|
| Rate for Payer: UHCCP Medicaid |
$77.57
|
| Rate for Payer: VA VA |
$110.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.01
|
|
|
MIRTAZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$106.02
|
|
|
Service Code
|
NDC 65862002106
|
| Hospital Charge Code |
29531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.79 |
| Max. Negotiated Rate |
$95.42 |
| Rate for Payer: Aetna Commercial |
$90.12
|
| Rate for Payer: BCBS Trust/PPO |
$87.56
|
| Rate for Payer: BCN Commercial |
$87.56
|
| Rate for Payer: Cash Price |
$84.82
|
| Rate for Payer: Cofinity Commercial |
$91.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.82
|
| Rate for Payer: Healthscope Commercial |
$95.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.12
|
| Rate for Payer: Nomi Health Commercial |
$86.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.52
|
| Rate for Payer: PHP Commercial |
$90.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$92.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.30
|
| Rate for Payer: UHC Core |
$88.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.52
|
|
|
MIRTAZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$440.01
|
|
|
Service Code
|
NDC 00052010630
|
| Hospital Charge Code |
29531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$306.25 |
| Max. Negotiated Rate |
$396.01 |
| Rate for Payer: Aetna Commercial |
$374.01
|
| Rate for Payer: BCBS Trust/PPO |
$363.40
|
| Rate for Payer: BCN Commercial |
$363.40
|
| Rate for Payer: Cash Price |
$352.01
|
| Rate for Payer: Cofinity Commercial |
$378.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.01
|
| Rate for Payer: Healthscope Commercial |
$396.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.01
|
| Rate for Payer: Nomi Health Commercial |
$360.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$330.01
|
| Rate for Payer: PHP Commercial |
$374.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$382.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$306.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$387.21
|
| Rate for Payer: UHC Core |
$367.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.01
|
|
|
MIRTAZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$88.01
|
|
|
Service Code
|
NDC 00052010606
|
| Hospital Charge Code |
29531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.52 |
| Max. Negotiated Rate |
$79.21 |
| Rate for Payer: Aetna Commercial |
$74.81
|
| Rate for Payer: Aetna Medicare |
$22.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.50
|
| Rate for Payer: BCBS Complete |
$16.29
|
| Rate for Payer: BCBS MAPPO |
$22.00
|
| Rate for Payer: BCBS Trust/PPO |
$72.35
|
| Rate for Payer: BCN Commercial |
$72.35
|
| Rate for Payer: BCN Medicare Advantage |
$22.00
|
| Rate for Payer: Cash Price |
$70.41
|
| Rate for Payer: Cofinity Commercial |
$75.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.00
|
| Rate for Payer: Healthscope Commercial |
$79.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.01
|
| Rate for Payer: Mclaren Medicaid |
$15.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.10
|
| Rate for Payer: Meridian Medicaid |
$16.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.81
|
| Rate for Payer: Nomi Health Commercial |
$72.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.01
|
| Rate for Payer: PACE Senior Care Partners |
$20.90
|
| Rate for Payer: PACE SWMI |
$22.00
|
| Rate for Payer: PHP Commercial |
$74.81
|
| Rate for Payer: PHP Medicare Advantage |
$22.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.57
|
| Rate for Payer: Priority Health Medicare |
$22.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.25
|
| Rate for Payer: Railroad Medicare Medicare |
$22.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.45
|
| Rate for Payer: UHC Core |
$73.49
|
| Rate for Payer: UHC Exchange |
$22.00
|
| Rate for Payer: UHC Medicaid |
$15.52
|
| Rate for Payer: UHC Medicare Advantage |
$22.00
|
| Rate for Payer: UHCCP Medicaid |
$15.52
|
| Rate for Payer: VA VA |
$22.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.01
|
|
|
MIRTAZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$106.02
|
|
|
Service Code
|
NDC 65862002106
|
| Hospital Charge Code |
29531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.69 |
| Max. Negotiated Rate |
$95.42 |
| Rate for Payer: Aetna Commercial |
$90.12
|
| Rate for Payer: Aetna Medicare |
$27.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.13
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.13
|
| Rate for Payer: BCBS Complete |
$19.62
|
| Rate for Payer: BCBS MAPPO |
$26.50
|
| Rate for Payer: BCBS Trust/PPO |
$87.16
|
| Rate for Payer: BCN Commercial |
$87.16
|
| Rate for Payer: BCN Medicare Advantage |
$26.50
|
| Rate for Payer: Cash Price |
$84.82
|
| Rate for Payer: Cofinity Commercial |
$91.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.50
|
| Rate for Payer: Healthscope Commercial |
$95.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.52
|
| Rate for Payer: Mclaren Medicaid |
$18.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.83
|
| Rate for Payer: Meridian Medicaid |
$19.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.12
|
| Rate for Payer: Nomi Health Commercial |
$86.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.52
|
| Rate for Payer: PACE Senior Care Partners |
$25.18
|
| Rate for Payer: PACE SWMI |
$26.50
|
| Rate for Payer: PHP Commercial |
$90.12
|
| Rate for Payer: PHP Medicare Advantage |
$26.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$92.24
|
| Rate for Payer: Priority Health Medicare |
$26.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.79
|
| Rate for Payer: Railroad Medicare Medicare |
$26.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.30
|
| Rate for Payer: UHC Core |
$88.53
|
| Rate for Payer: UHC Exchange |
$26.50
|
| Rate for Payer: UHC Medicaid |
$18.69
|
| Rate for Payer: UHC Medicare Advantage |
$26.50
|
| Rate for Payer: UHCCP Medicaid |
$18.69
|
| Rate for Payer: VA VA |
$26.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.52
|
|
|
MIRTAZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$88.01
|
|
|
Service Code
|
NDC 00052010606
|
| Hospital Charge Code |
29531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$79.21 |
| Rate for Payer: Aetna Commercial |
$74.81
|
| Rate for Payer: BCBS Trust/PPO |
$72.69
|
| Rate for Payer: BCN Commercial |
$72.69
|
| Rate for Payer: Cash Price |
$70.41
|
| Rate for Payer: Cofinity Commercial |
$75.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.41
|
| Rate for Payer: Healthscope Commercial |
$79.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.81
|
| Rate for Payer: Nomi Health Commercial |
$72.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.01
|
| Rate for Payer: PHP Commercial |
$74.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$76.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$77.45
|
| Rate for Payer: UHC Core |
$73.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.01
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$420.65
|
|
|
Service Code
|
NDC 68084011901
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.16 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: Aetna Medicare |
$109.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.45
|
| Rate for Payer: BCBS Complete |
$77.86
|
| Rate for Payer: BCBS MAPPO |
$105.16
|
| Rate for Payer: BCBS Trust/PPO |
$345.82
|
| Rate for Payer: BCN Commercial |
$345.82
|
| Rate for Payer: BCN Medicare Advantage |
$105.16
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Commercial |
$361.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.16
|
| Rate for Payer: Healthscope Commercial |
$378.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.49
|
| Rate for Payer: Mclaren Medicaid |
$74.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.42
|
| Rate for Payer: Meridian Medicaid |
$77.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$115.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.55
|
| Rate for Payer: Nomi Health Commercial |
$344.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.49
|
| Rate for Payer: PACE Senior Care Partners |
$99.90
|
| Rate for Payer: PACE SWMI |
$105.16
|
| Rate for Payer: PHP Commercial |
$357.55
|
| Rate for Payer: PHP Medicare Advantage |
$105.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$365.97
|
| Rate for Payer: Priority Health Medicare |
$106.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.77
|
| Rate for Payer: Railroad Medicare Medicare |
$105.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.17
|
| Rate for Payer: UHC Core |
$351.24
|
| Rate for Payer: UHC Exchange |
$105.16
|
| Rate for Payer: UHC Medicaid |
$74.16
|
| Rate for Payer: UHC Medicare Advantage |
$105.16
|
| Rate for Payer: UHCCP Medicaid |
$74.16
|
| Rate for Payer: VA VA |
$105.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.49
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$4.02
|
|
|
Service Code
|
NDC 51079008601
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: BCBS Trust/PPO |
$3.32
|
| Rate for Payer: BCN Commercial |
$3.32
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cofinity Commercial |
$3.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.22
|
| Rate for Payer: Healthscope Commercial |
$3.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.42
|
| Rate for Payer: Nomi Health Commercial |
$3.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.02
|
| Rate for Payer: PHP Commercial |
$3.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.54
|
| Rate for Payer: UHC Core |
$3.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.02
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$4.21
|
|
|
Service Code
|
NDC 68084011911
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Aetna Commercial |
$3.58
|
| Rate for Payer: BCBS Trust/PPO |
$3.48
|
| Rate for Payer: BCN Commercial |
$3.48
|
| Rate for Payer: Cash Price |
$3.37
|
| 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: Lakeland Regional Health Systems Commercial |
$3.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.58
|
| Rate for Payer: Nomi Health Commercial |
$3.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.16
|
| Rate for Payer: PHP Commercial |
$3.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.70
|
| Rate for Payer: UHC Core |
$3.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.16
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$364.25
|
|
|
Service Code
|
NDC 00904651961
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$253.52 |
| Max. Negotiated Rate |
$327.82 |
| Rate for Payer: Aetna Commercial |
$309.61
|
| Rate for Payer: BCBS Trust/PPO |
$300.83
|
| Rate for Payer: BCN Commercial |
$300.83
|
| Rate for Payer: Cash Price |
$291.40
|
| Rate for Payer: Cofinity Commercial |
$313.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.40
|
| Rate for Payer: Healthscope Commercial |
$327.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.61
|
| Rate for Payer: Nomi Health Commercial |
$298.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.19
|
| Rate for Payer: PHP Commercial |
$309.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$316.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.54
|
| Rate for Payer: UHC Core |
$304.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.19
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$420.65
|
|
|
Service Code
|
NDC 68084011901
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$292.77 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: BCBS Trust/PPO |
$347.41
|
| Rate for Payer: BCN Commercial |
$347.41
|
| Rate for Payer: Cash Price |
$336.52
|
| 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: Lakeland Regional Health Systems Commercial |
$315.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.55
|
| Rate for Payer: Nomi Health Commercial |
$344.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.49
|
| Rate for Payer: PHP Commercial |
$357.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$365.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$370.17
|
| Rate for Payer: UHC Core |
$351.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.49
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$4.21
|
|
|
Service Code
|
NDC 68084011911
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Aetna Commercial |
$3.58
|
| Rate for Payer: Aetna Medicare |
$1.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.32
|
| Rate for Payer: BCBS Complete |
$0.78
|
| Rate for Payer: BCBS MAPPO |
$1.05
|
| Rate for Payer: BCBS Trust/PPO |
$3.46
|
| Rate for Payer: BCN Commercial |
$3.46
|
| Rate for Payer: BCN Medicare Advantage |
$1.05
|
| Rate for Payer: Cash Price |
$3.37
|
| Rate for Payer: Cofinity Commercial |
$3.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.05
|
| Rate for Payer: Healthscope Commercial |
$3.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.16
|
| Rate for Payer: Mclaren Medicaid |
$0.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.11
|
| Rate for Payer: Meridian Medicaid |
$0.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.58
|
| Rate for Payer: Nomi Health Commercial |
$3.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.16
|
| Rate for Payer: PACE Senior Care Partners |
$1.00
|
| Rate for Payer: PACE SWMI |
$1.05
|
| Rate for Payer: PHP Commercial |
$3.58
|
| Rate for Payer: PHP Medicare Advantage |
$1.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.66
|
| Rate for Payer: Priority Health Medicare |
$1.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.70
|
| Rate for Payer: UHC Core |
$3.52
|
| Rate for Payer: UHC Exchange |
$1.05
|
| Rate for Payer: UHC Medicaid |
$0.74
|
| Rate for Payer: UHC Medicare Advantage |
$1.05
|
| Rate for Payer: UHCCP Medicaid |
$0.74
|
| Rate for Payer: VA VA |
$1.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.16
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$364.25
|
|
|
Service Code
|
NDC 00904651961
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.22 |
| Max. Negotiated Rate |
$327.82 |
| Rate for Payer: Aetna Commercial |
$309.61
|
| Rate for Payer: Aetna Medicare |
$94.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$113.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$113.83
|
| Rate for Payer: BCBS Complete |
$67.42
|
| Rate for Payer: BCBS MAPPO |
$91.06
|
| Rate for Payer: BCBS Trust/PPO |
$299.45
|
| Rate for Payer: BCN Commercial |
$299.45
|
| Rate for Payer: BCN Medicare Advantage |
$91.06
|
| Rate for Payer: Cash Price |
$291.40
|
| Rate for Payer: Cofinity Commercial |
$313.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.06
|
| Rate for Payer: Healthscope Commercial |
$327.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.19
|
| Rate for Payer: Mclaren Medicaid |
$64.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.62
|
| Rate for Payer: Meridian Medicaid |
$67.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$104.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$100.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.61
|
| Rate for Payer: Nomi Health Commercial |
$298.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.19
|
| Rate for Payer: PACE Senior Care Partners |
$86.51
|
| Rate for Payer: PACE SWMI |
$91.06
|
| Rate for Payer: PHP Commercial |
$309.61
|
| Rate for Payer: PHP Medicare Advantage |
$91.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$316.90
|
| Rate for Payer: Priority Health Medicare |
$91.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$253.52
|
| Rate for Payer: Railroad Medicare Medicare |
$91.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$320.54
|
| Rate for Payer: UHC Core |
$304.15
|
| Rate for Payer: UHC Exchange |
$91.06
|
| Rate for Payer: UHC Medicaid |
$64.22
|
| Rate for Payer: UHC Medicare Advantage |
$91.06
|
| Rate for Payer: UHCCP Medicaid |
$64.22
|
| Rate for Payer: VA VA |
$91.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.19
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$46.53
|
|
|
Service Code
|
NDC 13107003134
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$41.88 |
| Rate for Payer: Aetna Commercial |
$39.55
|
| Rate for Payer: Aetna Medicare |
$12.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.54
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS MAPPO |
$11.63
|
| Rate for Payer: BCBS Trust/PPO |
$38.25
|
| Rate for Payer: BCN Commercial |
$38.25
|
| Rate for Payer: BCN Medicare Advantage |
$11.63
|
| Rate for Payer: Cash Price |
$37.22
|
| Rate for Payer: Cofinity Commercial |
$40.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.63
|
| Rate for Payer: Healthscope Commercial |
$41.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.90
|
| Rate for Payer: Mclaren Medicaid |
$8.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.21
|
| Rate for Payer: Meridian Medicaid |
$8.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.38
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.55
|
| Rate for Payer: Nomi Health Commercial |
$38.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.90
|
| Rate for Payer: PACE Senior Care Partners |
$11.05
|
| Rate for Payer: PACE SWMI |
$11.63
|
| Rate for Payer: PHP Commercial |
$39.55
|
| Rate for Payer: PHP Medicare Advantage |
$11.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.48
|
| Rate for Payer: Priority Health Medicare |
$11.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.38
|
| Rate for Payer: Railroad Medicare Medicare |
$11.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.95
|
| Rate for Payer: UHC Core |
$38.85
|
| Rate for Payer: UHC Exchange |
$11.63
|
| Rate for Payer: UHC Medicaid |
$8.20
|
| Rate for Payer: UHC Medicare Advantage |
$11.63
|
| Rate for Payer: UHCCP Medicaid |
$8.20
|
| Rate for Payer: VA VA |
$11.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.90
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$401.85
|
|
|
Service Code
|
NDC 51079008620
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$279.69 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna Commercial |
$341.57
|
| Rate for Payer: BCBS Trust/PPO |
$331.89
|
| Rate for Payer: BCN Commercial |
$331.89
|
| Rate for Payer: Cash Price |
$321.48
|
| 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: Lakeland Regional Health Systems Commercial |
$301.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.57
|
| Rate for Payer: Nomi Health Commercial |
$329.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$301.39
|
| Rate for Payer: PHP Commercial |
$341.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$349.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$279.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.63
|
| Rate for Payer: UHC Core |
$335.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.39
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$46.53
|
|
|
Service Code
|
NDC 13107003134
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$41.88 |
| Rate for Payer: Aetna Commercial |
$39.55
|
| Rate for Payer: BCBS Trust/PPO |
$38.43
|
| Rate for Payer: BCN Commercial |
$38.43
|
| Rate for Payer: Cash Price |
$37.22
|
| 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: Lakeland Regional Health Systems Commercial |
$34.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.55
|
| Rate for Payer: Nomi Health Commercial |
$38.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.90
|
| Rate for Payer: PHP Commercial |
$39.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.95
|
| Rate for Payer: UHC Core |
$38.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.90
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$4.02
|
|
|
Service Code
|
NDC 51079008601
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Aetna Commercial |
$3.42
|
| Rate for Payer: Aetna Medicare |
$1.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.26
|
| Rate for Payer: BCBS Complete |
$0.74
|
| Rate for Payer: BCBS MAPPO |
$1.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.30
|
| Rate for Payer: BCN Commercial |
$3.30
|
| Rate for Payer: BCN Medicare Advantage |
$1.00
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Cofinity Commercial |
$3.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.00
|
| Rate for Payer: Healthscope Commercial |
$3.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.02
|
| Rate for Payer: Mclaren Medicaid |
$0.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.06
|
| Rate for Payer: Meridian Medicaid |
$0.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.42
|
| Rate for Payer: Nomi Health Commercial |
$3.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.02
|
| Rate for Payer: PACE Senior Care Partners |
$0.95
|
| Rate for Payer: PACE SWMI |
$1.00
|
| Rate for Payer: PHP Commercial |
$3.42
|
| Rate for Payer: PHP Medicare Advantage |
$1.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$3.50
|
| Rate for Payer: Priority Health Medicare |
$1.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.80
|
| Rate for Payer: Railroad Medicare Medicare |
$1.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.54
|
| Rate for Payer: UHC Core |
$3.36
|
| Rate for Payer: UHC Exchange |
$1.00
|
| Rate for Payer: UHC Medicaid |
$0.71
|
| Rate for Payer: UHC Medicare Advantage |
$1.00
|
| Rate for Payer: UHCCP Medicaid |
$0.71
|
| Rate for Payer: VA VA |
$1.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.02
|
|
