|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 68084020511
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$2.14
|
| 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: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health HMO/PPO |
$2.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.36
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$234.65
|
|
|
Service Code
|
NDC 53489038701
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.52 |
| Max. Negotiated Rate |
$211.18 |
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: BCBS Trust/PPO |
$191.54
|
| Rate for Payer: BCN Commercial |
$181.34
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$211.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Nomi Health Commercial |
$192.41
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.52
|
| Rate for Payer: Priority Health HMO/PPO |
$204.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.49
|
| Rate for Payer: UHC Core |
$195.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 68084020501
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.10 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: BCBS Trust/PPO |
$218.64
|
| Rate for Payer: BCN Commercial |
$206.99
|
| Rate for Payer: Cash Price |
$214.27
|
| 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: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Nomi Health Commercial |
$219.63
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.10
|
| Rate for Payer: Priority Health HMO/PPO |
$233.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.70
|
| Rate for Payer: UHC Core |
$223.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
NDC 68084020511
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Medicare |
$0.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.84
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: BCBS MAPPO |
$0.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.20
|
| Rate for Payer: BCN Commercial |
$2.08
|
| Rate for Payer: BCN Medicare Advantage |
$0.67
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.67
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: PACE Senior Care Partners |
$0.64
|
| Rate for Payer: PACE SWMI |
$0.67
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: PHP Medicare Advantage |
$0.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health HMO/PPO |
$2.33
|
| Rate for Payer: Priority Health Medicare |
$0.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: Railroad Medicare Medicare |
$0.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.36
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.67
|
| Rate for Payer: UHC Exchange |
$0.67
|
| Rate for Payer: UHC Medicare Advantage |
$0.67
|
| Rate for Payer: VA VA |
$0.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
OP
|
$267.84
|
|
|
Service Code
|
NDC 68084020501
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.61 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna Medicare |
$69.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.70
|
| Rate for Payer: BCBS Complete |
$107.14
|
| Rate for Payer: BCBS MAPPO |
$66.96
|
| Rate for Payer: BCBS Trust/PPO |
$220.19
|
| Rate for Payer: BCN Commercial |
$208.25
|
| Rate for Payer: BCN Medicare Advantage |
$66.96
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.96
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Nomi Health Commercial |
$219.63
|
| Rate for Payer: PACE Senior Care Partners |
$63.61
|
| Rate for Payer: PACE SWMI |
$66.96
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: PHP Medicare Advantage |
$66.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.10
|
| Rate for Payer: Priority Health HMO/PPO |
$233.02
|
| Rate for Payer: Priority Health Medicare |
$67.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.45
|
| Rate for Payer: Railroad Medicare Medicare |
$66.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.70
|
| Rate for Payer: UHC Core |
$223.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.96
|
| Rate for Payer: UHC Exchange |
$66.96
|
| Rate for Payer: UHC Medicare Advantage |
$66.96
|
| Rate for Payer: VA VA |
$66.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
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 |
$1,128.50 |
| 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 |
$1,900.63
|
| Rate for Payer: BCBS MAPPO |
$1,187.90
|
| Rate for Payer: BCBS Trust/PPO |
$3,906.27
|
| Rate for Payer: BCN Commercial |
$3,694.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,187.90
|
| 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 |
$1,187.90
|
| Rate for Payer: Healthscope Commercial |
$4,276.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,563.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,247.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,366.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,038.84
|
| Rate for Payer: Nomi Health Commercial |
$3,896.30
|
| Rate for Payer: PACE Senior Care Partners |
$1,128.50
|
| Rate for Payer: PACE SWMI |
$1,187.90
|
| Rate for Payer: PHP Commercial |
$4,038.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,187.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,088.53
|
| Rate for Payer: Priority Health HMO/PPO |
$4,133.87
|
| Rate for Payer: Priority Health Medicare |
$1,199.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,183.56
|
| Rate for Payer: Railroad Medicare Medicare |
$1,187.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,181.39
|
| Rate for Payer: UHC Core |
$3,967.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,187.90
|
| Rate for Payer: UHC Exchange |
$1,187.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,187.90
|
| Rate for Payer: VA VA |
$1,187.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,563.68
|
|
|
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 |
$376.17 |
| 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 |
$633.54
|
| Rate for Payer: BCBS MAPPO |
$395.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,302.09
|
| Rate for Payer: BCN Commercial |
$1,231.45
|
| 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 |
$1,187.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$415.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$455.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,346.28
|
| Rate for Payer: Nomi Health Commercial |
$1,298.77
|
| 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 Cigna Priority Health |
$1,029.51
|
| Rate for Payer: Priority Health HMO/PPO |
$1,377.96
|
| Rate for Payer: Priority Health Medicare |
$399.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,061.19
|
| 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 Dual Complete DSNP |
$395.96
|
| Rate for Payer: UHC Exchange |
$395.96
|
| Rate for Payer: UHC Medicare Advantage |
$395.96
|
| Rate for Payer: VA VA |
$395.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,187.90
|
|
|
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 |
$3,088.53 |
| Max. Negotiated Rate |
$4,276.42 |
| Rate for Payer: Aetna Commercial |
$4,038.84
|
| Rate for Payer: BCBS Trust/PPO |
$3,878.71
|
| Rate for Payer: BCN Commercial |
$3,672.02
|
| 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: PHP Commercial |
$4,038.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,088.53
|
| Rate for Payer: Priority Health HMO/PPO |
$4,133.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,183.56
|
| 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 |
$1,029.51 |
| Max. Negotiated Rate |
$1,425.47 |
| Rate for Payer: Aetna Commercial |
$1,346.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,292.90
|
| Rate for Payer: BCN Commercial |
$1,224.01
|
| 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 |
$1,187.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,346.28
|
| Rate for Payer: Nomi Health Commercial |
$1,298.77
|
| Rate for Payer: PHP Commercial |
$1,346.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,029.51
|
| Rate for Payer: Priority Health HMO/PPO |
$1,377.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,061.19
|
| 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 |
$1,187.90
|
|
|
MIRTAZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$103.74
|
|
|
Service Code
|
NDC 65862002106
|
| Hospital Charge Code |
29531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.43 |
| Max. Negotiated Rate |
$93.37 |
| Rate for Payer: Aetna Commercial |
$88.18
|
| Rate for Payer: BCBS Trust/PPO |
$84.68
|
| Rate for Payer: BCN Commercial |
$80.17
|
| Rate for Payer: Cash Price |
$82.99
|
| Rate for Payer: Cofinity Commercial |
$89.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.99
|
| Rate for Payer: Healthscope Commercial |
$93.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.18
|
| Rate for Payer: Nomi Health Commercial |
$85.07
|
| Rate for Payer: PHP Commercial |
$88.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.43
|
| Rate for Payer: Priority Health HMO/PPO |
$90.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.29
|
| Rate for Payer: UHC Core |
$86.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.80
|
|
|
MIRTAZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$103.74
|
|
|
Service Code
|
NDC 65862002106
|
| Hospital Charge Code |
29531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$93.37 |
| Rate for Payer: Aetna Commercial |
$88.18
|
| Rate for Payer: Aetna Medicare |
$26.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$32.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$32.42
|
| Rate for Payer: BCBS Complete |
$41.50
|
| Rate for Payer: BCBS MAPPO |
$25.94
|
| Rate for Payer: BCBS Trust/PPO |
$85.28
|
| Rate for Payer: BCN Commercial |
$80.66
|
| Rate for Payer: BCN Medicare Advantage |
$25.94
|
| Rate for Payer: Cash Price |
$82.99
|
| Rate for Payer: Cofinity Commercial |
$89.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.94
|
| Rate for Payer: Healthscope Commercial |
$93.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$88.18
|
| Rate for Payer: Nomi Health Commercial |
$85.07
|
| Rate for Payer: PACE Senior Care Partners |
$24.64
|
| Rate for Payer: PACE SWMI |
$25.94
|
| Rate for Payer: PHP Commercial |
$88.18
|
| Rate for Payer: PHP Medicare Advantage |
$25.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.43
|
| Rate for Payer: Priority Health HMO/PPO |
$90.25
|
| Rate for Payer: Priority Health Medicare |
$26.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.51
|
| Rate for Payer: Railroad Medicare Medicare |
$25.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.29
|
| Rate for Payer: UHC Core |
$86.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.94
|
| Rate for Payer: UHC Exchange |
$25.94
|
| Rate for Payer: UHC Medicare Advantage |
$25.94
|
| Rate for Payer: VA VA |
$25.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.80
|
|
|
MIRTAZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$88.01
|
|
|
Service Code
|
NDC 00052010606
|
| Hospital Charge Code |
29531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.90 |
| 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 |
$35.20
|
| Rate for Payer: BCBS MAPPO |
$22.00
|
| Rate for Payer: BCBS Trust/PPO |
$72.35
|
| Rate for Payer: BCN Commercial |
$68.43
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.81
|
| Rate for Payer: Nomi Health Commercial |
$72.17
|
| 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 Cigna Priority Health |
$57.21
|
| Rate for Payer: Priority Health HMO/PPO |
$76.57
|
| Rate for Payer: Priority Health Medicare |
$22.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.97
|
| 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 Dual Complete DSNP |
$22.00
|
| Rate for Payer: UHC Exchange |
$22.00
|
| Rate for Payer: UHC Medicare Advantage |
$22.00
|
| Rate for Payer: VA VA |
$22.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.01
|
|
|
MIRTAZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$440.01
|
|
|
Service Code
|
NDC 00052010630
|
| Hospital Charge Code |
29531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$286.01 |
| Max. Negotiated Rate |
$396.01 |
| Rate for Payer: Aetna Commercial |
$374.01
|
| Rate for Payer: BCBS Trust/PPO |
$359.18
|
| Rate for Payer: BCN Commercial |
$340.04
|
| 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: PHP Commercial |
$374.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.01
|
| Rate for Payer: Priority Health HMO/PPO |
$382.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$294.81
|
| 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
|
IP
|
$88.01
|
|
|
Service Code
|
NDC 00052010606
|
| Hospital Charge Code |
29531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.21 |
| Max. Negotiated Rate |
$79.21 |
| Rate for Payer: Aetna Commercial |
$74.81
|
| Rate for Payer: BCBS Trust/PPO |
$71.84
|
| Rate for Payer: BCN Commercial |
$68.01
|
| 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: PHP Commercial |
$74.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.21
|
| Rate for Payer: Priority Health HMO/PPO |
$76.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.97
|
| 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 DISINTEGRATING TABLET
|
Facility
|
OP
|
$440.01
|
|
|
Service Code
|
NDC 00052010630
|
| Hospital Charge Code |
29531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.50 |
| 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 |
$176.00
|
| Rate for Payer: BCBS MAPPO |
$110.00
|
| Rate for Payer: BCBS Trust/PPO |
$361.73
|
| Rate for Payer: BCN Commercial |
$342.11
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$126.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.01
|
| Rate for Payer: Nomi Health Commercial |
$360.81
|
| 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 Cigna Priority Health |
$286.01
|
| Rate for Payer: Priority Health HMO/PPO |
$382.81
|
| Rate for Payer: Priority Health Medicare |
$111.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$294.81
|
| 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 Dual Complete DSNP |
$110.00
|
| Rate for Payer: UHC Exchange |
$110.00
|
| Rate for Payer: UHC Medicare Advantage |
$110.00
|
| Rate for Payer: VA VA |
$110.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.01
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$366.60
|
|
|
Service Code
|
NDC 51079008620
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.29 |
| Max. Negotiated Rate |
$329.94 |
| Rate for Payer: Aetna Commercial |
$311.61
|
| Rate for Payer: BCBS Trust/PPO |
$299.26
|
| Rate for Payer: BCN Commercial |
$283.31
|
| Rate for Payer: Cash Price |
$293.28
|
| Rate for Payer: Cofinity Commercial |
$315.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.28
|
| Rate for Payer: Healthscope Commercial |
$329.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.61
|
| Rate for Payer: Nomi Health Commercial |
$300.61
|
| Rate for Payer: PHP Commercial |
$311.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.29
|
| Rate for Payer: Priority Health HMO/PPO |
$318.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.61
|
| Rate for Payer: UHC Core |
$306.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.95
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$3.67
|
|
|
Service Code
|
NDC 51079008601
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna Commercial |
$3.12
|
| Rate for Payer: BCBS Trust/PPO |
$3.00
|
| Rate for Payer: BCN Commercial |
$2.84
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.12
|
| Rate for Payer: Nomi Health Commercial |
$3.01
|
| Rate for Payer: PHP Commercial |
$3.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: Priority Health HMO/PPO |
$3.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.23
|
| Rate for Payer: UHC Core |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$366.60
|
|
|
Service Code
|
NDC 51079008620
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.07 |
| Max. Negotiated Rate |
$329.94 |
| Rate for Payer: Aetna Commercial |
$311.61
|
| Rate for Payer: Aetna Medicare |
$95.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$114.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$114.56
|
| Rate for Payer: BCBS Complete |
$146.64
|
| Rate for Payer: BCBS MAPPO |
$91.65
|
| Rate for Payer: BCBS Trust/PPO |
$301.38
|
| Rate for Payer: BCN Commercial |
$285.03
|
| Rate for Payer: BCN Medicare Advantage |
$91.65
|
| Rate for Payer: Cash Price |
$293.28
|
| Rate for Payer: Cofinity Commercial |
$315.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$293.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$91.65
|
| Rate for Payer: Healthscope Commercial |
$329.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$274.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$105.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$311.61
|
| Rate for Payer: Nomi Health Commercial |
$300.61
|
| Rate for Payer: PACE Senior Care Partners |
$87.07
|
| Rate for Payer: PACE SWMI |
$91.65
|
| Rate for Payer: PHP Commercial |
$311.61
|
| Rate for Payer: PHP Medicare Advantage |
$91.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.29
|
| Rate for Payer: Priority Health HMO/PPO |
$318.94
|
| Rate for Payer: Priority Health Medicare |
$92.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.62
|
| Rate for Payer: Railroad Medicare Medicare |
$91.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$322.61
|
| Rate for Payer: UHC Core |
$306.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$91.65
|
| Rate for Payer: UHC Exchange |
$91.65
|
| Rate for Payer: UHC Medicare Advantage |
$91.65
|
| Rate for Payer: VA VA |
$91.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$274.95
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$448.85
|
|
|
Service Code
|
NDC 68084011901
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$291.75 |
| Max. Negotiated Rate |
$403.96 |
| Rate for Payer: Aetna Commercial |
$381.52
|
| Rate for Payer: BCBS Trust/PPO |
$366.40
|
| Rate for Payer: BCN Commercial |
$346.87
|
| Rate for Payer: Cash Price |
$359.08
|
| Rate for Payer: Cofinity Commercial |
$386.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.08
|
| Rate for Payer: Healthscope Commercial |
$403.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.52
|
| Rate for Payer: Nomi Health Commercial |
$368.06
|
| Rate for Payer: PHP Commercial |
$381.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.75
|
| Rate for Payer: Priority Health HMO/PPO |
$390.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.99
|
| Rate for Payer: UHC Core |
$374.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.64
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$448.85
|
|
|
Service Code
|
NDC 68084011911
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$291.75 |
| Max. Negotiated Rate |
$403.96 |
| Rate for Payer: Aetna Commercial |
$381.52
|
| Rate for Payer: BCBS Trust/PPO |
$366.40
|
| Rate for Payer: BCN Commercial |
$346.87
|
| Rate for Payer: Cash Price |
$359.08
|
| Rate for Payer: Cofinity Commercial |
$386.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.08
|
| Rate for Payer: Healthscope Commercial |
$403.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.52
|
| Rate for Payer: Nomi Health Commercial |
$368.06
|
| Rate for Payer: PHP Commercial |
$381.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.75
|
| Rate for Payer: Priority Health HMO/PPO |
$390.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.99
|
| Rate for Payer: UHC Core |
$374.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.64
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$448.85
|
|
|
Service Code
|
NDC 68084011901
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.60 |
| Max. Negotiated Rate |
$403.96 |
| Rate for Payer: Aetna Commercial |
$381.52
|
| Rate for Payer: Aetna Medicare |
$116.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.27
|
| Rate for Payer: BCBS Complete |
$179.54
|
| Rate for Payer: BCBS MAPPO |
$112.21
|
| Rate for Payer: BCBS Trust/PPO |
$369.00
|
| Rate for Payer: BCN Commercial |
$348.98
|
| Rate for Payer: BCN Medicare Advantage |
$112.21
|
| Rate for Payer: Cash Price |
$359.08
|
| Rate for Payer: Cofinity Commercial |
$386.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.21
|
| Rate for Payer: Healthscope Commercial |
$403.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.52
|
| Rate for Payer: Nomi Health Commercial |
$368.06
|
| Rate for Payer: PACE Senior Care Partners |
$106.60
|
| Rate for Payer: PACE SWMI |
$112.21
|
| Rate for Payer: PHP Commercial |
$381.52
|
| Rate for Payer: PHP Medicare Advantage |
$112.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.75
|
| Rate for Payer: Priority Health HMO/PPO |
$390.50
|
| Rate for Payer: Priority Health Medicare |
$113.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.73
|
| Rate for Payer: Railroad Medicare Medicare |
$112.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.99
|
| Rate for Payer: UHC Core |
$374.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.21
|
| Rate for Payer: UHC Exchange |
$112.21
|
| Rate for Payer: UHC Medicare Advantage |
$112.21
|
| Rate for Payer: VA VA |
$112.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.64
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$3.67
|
|
|
Service Code
|
NDC 51079008601
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Aetna Commercial |
$3.12
|
| Rate for Payer: Aetna Medicare |
$0.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.15
|
| Rate for Payer: BCBS Complete |
$1.47
|
| Rate for Payer: BCBS MAPPO |
$0.92
|
| Rate for Payer: BCBS Trust/PPO |
$3.02
|
| Rate for Payer: BCN Commercial |
$2.85
|
| Rate for Payer: BCN Medicare Advantage |
$0.92
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cofinity Commercial |
$3.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.92
|
| Rate for Payer: Healthscope Commercial |
$3.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.12
|
| Rate for Payer: Nomi Health Commercial |
$3.01
|
| Rate for Payer: PACE Senior Care Partners |
$0.87
|
| Rate for Payer: PACE SWMI |
$0.92
|
| Rate for Payer: PHP Commercial |
$3.12
|
| Rate for Payer: PHP Medicare Advantage |
$0.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: Priority Health HMO/PPO |
$3.19
|
| Rate for Payer: Priority Health Medicare |
$0.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.46
|
| Rate for Payer: Railroad Medicare Medicare |
$0.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.23
|
| Rate for Payer: UHC Core |
$3.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.92
|
| Rate for Payer: UHC Exchange |
$0.92
|
| Rate for Payer: UHC Medicare Advantage |
$0.92
|
| Rate for Payer: VA VA |
$0.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.75
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$38.07
|
|
|
Service Code
|
NDC 13107003134
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$34.26 |
| Rate for Payer: Aetna Commercial |
$32.36
|
| Rate for Payer: BCBS Trust/PPO |
$31.08
|
| Rate for Payer: BCN Commercial |
$29.42
|
| Rate for Payer: Cash Price |
$30.46
|
| Rate for Payer: Cofinity Commercial |
$32.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.46
|
| Rate for Payer: Healthscope Commercial |
$34.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.36
|
| Rate for Payer: Nomi Health Commercial |
$31.22
|
| Rate for Payer: PHP Commercial |
$32.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.75
|
| Rate for Payer: Priority Health HMO/PPO |
$33.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.50
|
| Rate for Payer: UHC Core |
$31.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.55
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$448.85
|
|
|
Service Code
|
NDC 68084011911
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$106.60 |
| Max. Negotiated Rate |
$403.96 |
| Rate for Payer: Aetna Commercial |
$381.52
|
| Rate for Payer: Aetna Medicare |
$116.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$140.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$140.27
|
| Rate for Payer: BCBS Complete |
$179.54
|
| Rate for Payer: BCBS MAPPO |
$112.21
|
| Rate for Payer: BCBS Trust/PPO |
$369.00
|
| Rate for Payer: BCN Commercial |
$348.98
|
| Rate for Payer: BCN Medicare Advantage |
$112.21
|
| Rate for Payer: Cash Price |
$359.08
|
| Rate for Payer: Cofinity Commercial |
$386.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$359.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.21
|
| Rate for Payer: Healthscope Commercial |
$403.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$336.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$381.52
|
| Rate for Payer: Nomi Health Commercial |
$368.06
|
| Rate for Payer: PACE Senior Care Partners |
$106.60
|
| Rate for Payer: PACE SWMI |
$112.21
|
| Rate for Payer: PHP Commercial |
$381.52
|
| Rate for Payer: PHP Medicare Advantage |
$112.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.75
|
| Rate for Payer: Priority Health HMO/PPO |
$390.50
|
| Rate for Payer: Priority Health Medicare |
$113.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.73
|
| Rate for Payer: Railroad Medicare Medicare |
$112.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.99
|
| Rate for Payer: UHC Core |
$374.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$112.21
|
| Rate for Payer: UHC Exchange |
$112.21
|
| Rate for Payer: UHC Medicare Advantage |
$112.21
|
| Rate for Payer: VA VA |
$112.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$336.64
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$284.35
|
|
|
Service Code
|
NDC 00904651961
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.83 |
| Max. Negotiated Rate |
$255.92 |
| Rate for Payer: Aetna Commercial |
$241.70
|
| Rate for Payer: BCBS Trust/PPO |
$232.11
|
| Rate for Payer: BCN Commercial |
$219.75
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$244.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$255.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: PHP Commercial |
$241.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.83
|
| Rate for Payer: Priority Health HMO/PPO |
$247.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$190.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$250.23
|
| Rate for Payer: UHC Core |
$237.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.26
|
|
