|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$198.55
|
|
|
Service Code
|
NDC 53489-387-01
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$178.70 |
| Rate for Payer: Aetna American Axle |
$129.06
|
| Rate for Payer: Aetna Commercial |
$168.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$129.06
|
| Rate for Payer: Cash Price |
$158.84
|
| Rate for Payer: Cofinity Commercial |
$138.98
|
| Rate for Payer: Cofinity Commercial |
$170.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$158.84
|
| Rate for Payer: Healthscope Commercial |
$178.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$138.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$148.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$168.77
|
| Rate for Payer: PHP Commercial |
$168.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.98
|
| Rate for Payer: Priority Health SBD |
$125.09
|
| Rate for Payer: UMR Bronson Commercial |
$87.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$148.91
|
|
|
MINOXIDIL 2.5 MG TABLET
|
Facility
|
IP
|
$305.50
|
|
|
Service Code
|
NDC 53489-386-01
|
| Hospital Charge Code |
5115
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.42 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna American Axle |
$198.58
|
| Rate for Payer: Aetna Commercial |
$259.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.58
|
| Rate for Payer: Cash Price |
$244.40
|
| Rate for Payer: Cofinity Commercial |
$262.73
|
| Rate for Payer: Cofinity Commercial |
$213.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$244.40
|
| Rate for Payer: Healthscope Commercial |
$274.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$213.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$229.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$259.68
|
| Rate for Payer: PHP Commercial |
$259.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.85
|
| Rate for Payer: Priority Health SBD |
$192.46
|
| Rate for Payer: UMR Bronson Commercial |
$134.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$229.12
|
|
|
MINOXIDIL 2.5 MG TABLET
|
Facility
|
IP
|
$453.55
|
|
|
Service Code
|
NDC 49884-256-01
|
| Hospital Charge Code |
5115
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.56 |
| Max. Negotiated Rate |
$408.20 |
| Rate for Payer: Aetna American Axle |
$294.81
|
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.81
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Commercial |
$317.48
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Healthscope Commercial |
$408.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$385.52
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.48
|
| Rate for Payer: Priority Health SBD |
$285.74
|
| Rate for Payer: UMR Bronson Commercial |
$199.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.16
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,537.80
|
|
|
Service Code
|
NDC 0469-2601-30
|
| Hospital Charge Code |
161790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$676.63 |
| Max. Negotiated Rate |
$1,384.02 |
| Rate for Payer: Aetna American Axle |
$999.57
|
| Rate for Payer: Aetna Commercial |
$1,307.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$999.57
|
| Rate for Payer: Cash Price |
$1,230.24
|
| Rate for Payer: Cofinity Commercial |
$1,076.46
|
| Rate for Payer: Cofinity Commercial |
$1,322.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,230.24
|
| Rate for Payer: Healthscope Commercial |
$1,384.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,076.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,153.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,307.13
|
| Rate for Payer: PHP Commercial |
$1,307.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,076.46
|
| Rate for Payer: Priority Health SBD |
$968.81
|
| Rate for Payer: UMR Bronson Commercial |
$676.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,153.35
|
|
|
MIRABEGRON ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,537.80
|
|
|
Service Code
|
NDC 0469-2602-30
|
| Hospital Charge Code |
161791
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$676.63 |
| Max. Negotiated Rate |
$1,384.02 |
| Rate for Payer: Aetna American Axle |
$999.57
|
| Rate for Payer: Aetna Commercial |
$1,307.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$999.57
|
| Rate for Payer: Cash Price |
$1,230.24
|
| Rate for Payer: Cofinity Commercial |
$1,076.46
|
| Rate for Payer: Cofinity Commercial |
$1,322.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,230.24
|
| Rate for Payer: Healthscope Commercial |
$1,384.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,076.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,153.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,307.13
|
| Rate for Payer: PHP Commercial |
$1,307.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,076.46
|
| Rate for Payer: Priority Health SBD |
$968.81
|
| Rate for Payer: UMR Bronson Commercial |
$676.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,153.35
|
|
|
MIRTAZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$440.01
|
|
|
Service Code
|
NDC 0052-0106-30
|
| Hospital Charge Code |
29531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.60 |
| Max. Negotiated Rate |
$396.01 |
| Rate for Payer: Aetna American Axle |
$286.01
|
| Rate for Payer: Aetna Commercial |
$374.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.01
|
| Rate for Payer: Cash Price |
$352.01
|
| Rate for Payer: Cofinity Commercial |
$378.41
|
| Rate for Payer: Cofinity Commercial |
$308.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$352.01
|
| Rate for Payer: Healthscope Commercial |
$396.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$308.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$374.01
|
| Rate for Payer: PHP Commercial |
$374.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.01
|
| Rate for Payer: Priority Health SBD |
$277.21
|
| Rate for Payer: UMR Bronson Commercial |
$193.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$330.01
|
|
|
MIRTAZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$101.46
|
|
|
Service Code
|
NDC 65862-021-06
|
| Hospital Charge Code |
29531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.64 |
| Max. Negotiated Rate |
$91.31 |
| Rate for Payer: Aetna American Axle |
$65.95
|
| Rate for Payer: Aetna Commercial |
$86.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.95
|
| Rate for Payer: Cash Price |
$81.17
|
| Rate for Payer: Cofinity Commercial |
$71.02
|
| Rate for Payer: Cofinity Commercial |
$87.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.17
|
| Rate for Payer: Healthscope Commercial |
$91.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$71.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$86.24
|
| Rate for Payer: PHP Commercial |
$86.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.02
|
| Rate for Payer: Priority Health SBD |
$63.92
|
| Rate for Payer: UMR Bronson Commercial |
$44.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.10
|
|
|
MIRTAZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$88.01
|
|
|
Service Code
|
NDC 0052-0106-06
|
| Hospital Charge Code |
29531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.72 |
| Max. Negotiated Rate |
$79.21 |
| Rate for Payer: Aetna American Axle |
$57.21
|
| Rate for Payer: Aetna Commercial |
$74.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.21
|
| Rate for Payer: Cash Price |
$70.41
|
| Rate for Payer: Cofinity Commercial |
$61.61
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$61.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$74.81
|
| Rate for Payer: PHP Commercial |
$74.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.61
|
| Rate for Payer: Priority Health SBD |
$55.45
|
| Rate for Payer: UMR Bronson Commercial |
$38.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.01
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$37.37
|
|
|
Service Code
|
NDC 13107-031-34
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.44 |
| Max. Negotiated Rate |
$33.63 |
| Rate for Payer: Aetna American Axle |
$24.29
|
| Rate for Payer: Aetna Commercial |
$31.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.29
|
| Rate for Payer: Cash Price |
$29.90
|
| Rate for Payer: Cofinity Commercial |
$26.16
|
| Rate for Payer: Cofinity Commercial |
$32.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.90
|
| Rate for Payer: Healthscope Commercial |
$33.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.76
|
| Rate for Payer: PHP Commercial |
$31.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.16
|
| Rate for Payer: Priority Health SBD |
$23.54
|
| Rate for Payer: UMR Bronson Commercial |
$16.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.03
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$286.70
|
|
|
Service Code
|
NDC 63739-098-10
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.15 |
| Max. Negotiated Rate |
$258.03 |
| Rate for Payer: Aetna American Axle |
$186.36
|
| Rate for Payer: Aetna Commercial |
$243.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.36
|
| Rate for Payer: Cash Price |
$229.36
|
| Rate for Payer: Cofinity Commercial |
$200.69
|
| Rate for Payer: Cofinity Commercial |
$246.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$229.36
|
| Rate for Payer: Healthscope Commercial |
$258.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$200.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$215.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$243.70
|
| Rate for Payer: PHP Commercial |
$243.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.69
|
| Rate for Payer: Priority Health SBD |
$180.62
|
| Rate for Payer: UMR Bronson Commercial |
$126.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$215.02
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$195.70
|
|
|
Service Code
|
NDC 68084-119-01
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.11 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna American Axle |
$127.20
|
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.20
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$136.99
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.34
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.99
|
| Rate for Payer: Priority Health SBD |
$123.29
|
| Rate for Payer: UMR Bronson Commercial |
$86.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.78
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$195.70
|
|
|
Service Code
|
NDC 68084-119-11
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.11 |
| Max. Negotiated Rate |
$176.13 |
| Rate for Payer: Aetna American Axle |
$127.20
|
| Rate for Payer: Aetna Commercial |
$166.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.20
|
| Rate for Payer: Cash Price |
$156.56
|
| Rate for Payer: Cofinity Commercial |
$136.99
|
| Rate for Payer: Cofinity Commercial |
$168.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.56
|
| Rate for Payer: Healthscope Commercial |
$176.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$136.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$146.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$166.34
|
| Rate for Payer: PHP Commercial |
$166.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.99
|
| Rate for Payer: Priority Health SBD |
$123.29
|
| Rate for Payer: UMR Bronson Commercial |
$86.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$146.78
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$599.25
|
|
|
Service Code
|
NDC 13107-031-05
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$263.67 |
| Max. Negotiated Rate |
$539.32 |
| Rate for Payer: Aetna American Axle |
$389.51
|
| Rate for Payer: Aetna Commercial |
$509.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$389.51
|
| Rate for Payer: Cash Price |
$479.40
|
| Rate for Payer: Cofinity Commercial |
$419.48
|
| Rate for Payer: Cofinity Commercial |
$515.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$479.40
|
| Rate for Payer: Healthscope Commercial |
$539.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$419.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$449.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$509.36
|
| Rate for Payer: PHP Commercial |
$509.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$419.48
|
| Rate for Payer: Priority Health SBD |
$377.53
|
| Rate for Payer: UMR Bronson Commercial |
$263.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$449.44
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$279.65
|
|
|
Service Code
|
NDC 0904-6519-61
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.05 |
| Max. Negotiated Rate |
$251.68 |
| Rate for Payer: Aetna American Axle |
$181.77
|
| Rate for Payer: Aetna Commercial |
$237.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.77
|
| Rate for Payer: Cash Price |
$223.72
|
| Rate for Payer: Cofinity Commercial |
$195.76
|
| Rate for Payer: Cofinity Commercial |
$240.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$223.72
|
| Rate for Payer: Healthscope Commercial |
$251.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$195.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$209.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$237.70
|
| Rate for Payer: PHP Commercial |
$237.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.76
|
| Rate for Payer: Priority Health SBD |
$176.18
|
| Rate for Payer: UMR Bronson Commercial |
$123.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$209.74
|
|
|
MIRTAZAPINE 30 MG TABLET
|
Facility
|
IP
|
$43.01
|
|
|
Service Code
|
NDC 13107-003-34
|
| Hospital Charge Code |
17465
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.92 |
| Max. Negotiated Rate |
$38.71 |
| Rate for Payer: Aetna American Axle |
$27.96
|
| Rate for Payer: Aetna Commercial |
$36.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.96
|
| Rate for Payer: Cash Price |
$34.41
|
| Rate for Payer: Cofinity Commercial |
$30.11
|
| Rate for Payer: Cofinity Commercial |
$36.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$34.41
|
| Rate for Payer: Healthscope Commercial |
$38.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$32.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$36.56
|
| Rate for Payer: PHP Commercial |
$36.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.11
|
| Rate for Payer: Priority Health SBD |
$27.10
|
| Rate for Payer: UMR Bronson Commercial |
$18.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$32.26
|
|
|
MIRTAZAPINE 30 MG TABLET
|
Facility
|
IP
|
$444.15
|
|
|
Service Code
|
NDC 68084-120-01
|
| Hospital Charge Code |
17465
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.43 |
| Max. Negotiated Rate |
$399.74 |
| Rate for Payer: Aetna American Axle |
$288.70
|
| Rate for Payer: Aetna Commercial |
$377.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.70
|
| Rate for Payer: Cash Price |
$355.32
|
| Rate for Payer: Cofinity Commercial |
$310.90
|
| Rate for Payer: Cofinity Commercial |
$381.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.32
|
| Rate for Payer: Healthscope Commercial |
$399.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$377.53
|
| Rate for Payer: PHP Commercial |
$377.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.90
|
| Rate for Payer: Priority Health SBD |
$279.81
|
| Rate for Payer: UMR Bronson Commercial |
$195.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.11
|
|
|
MIRTAZAPINE 30 MG TABLET
|
Facility
|
IP
|
$444.15
|
|
|
Service Code
|
NDC 68084-120-11
|
| Hospital Charge Code |
17465
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$195.43 |
| Max. Negotiated Rate |
$399.74 |
| Rate for Payer: Aetna American Axle |
$288.70
|
| Rate for Payer: Aetna Commercial |
$377.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.70
|
| Rate for Payer: Cash Price |
$355.32
|
| Rate for Payer: Cofinity Commercial |
$310.90
|
| Rate for Payer: Cofinity Commercial |
$381.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$355.32
|
| Rate for Payer: Healthscope Commercial |
$399.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$310.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$333.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$377.53
|
| Rate for Payer: PHP Commercial |
$377.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$310.90
|
| Rate for Payer: Priority Health SBD |
$279.81
|
| Rate for Payer: UMR Bronson Commercial |
$195.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$333.11
|
|
|
MIRTAZAPINE 7.5 MG TABLET
|
Facility
|
IP
|
$249.42
|
|
|
Service Code
|
NDC 60687-584-21
|
| Hospital Charge Code |
38421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.74 |
| Max. Negotiated Rate |
$224.48 |
| Rate for Payer: Aetna American Axle |
$162.12
|
| Rate for Payer: Aetna Commercial |
$212.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$162.12
|
| Rate for Payer: Cash Price |
$199.54
|
| Rate for Payer: Cofinity Commercial |
$174.59
|
| Rate for Payer: Cofinity Commercial |
$214.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.54
|
| Rate for Payer: Healthscope Commercial |
$224.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.01
|
| Rate for Payer: PHP Commercial |
$212.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.59
|
| Rate for Payer: Priority Health SBD |
$157.13
|
| Rate for Payer: UMR Bronson Commercial |
$109.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.06
|
|
|
MIRTAZAPINE 7.5 MG TABLET
|
Facility
|
IP
|
$8.32
|
|
|
Service Code
|
NDC 60687-584-11
|
| Hospital Charge Code |
38421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$7.49 |
| Rate for Payer: Aetna American Axle |
$5.41
|
| Rate for Payer: Aetna Commercial |
$7.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.41
|
| Rate for Payer: Cash Price |
$6.66
|
| Rate for Payer: Cofinity Commercial |
$5.82
|
| Rate for Payer: Cofinity Commercial |
$7.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.66
|
| Rate for Payer: Healthscope Commercial |
$7.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.07
|
| Rate for Payer: PHP Commercial |
$7.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.82
|
| Rate for Payer: Priority Health SBD |
$5.24
|
| Rate for Payer: UMR Bronson Commercial |
$3.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.24
|
|
|
MIRVETUXIMAB SORAVTANSINE-GYNX 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$28,486.36
|
|
|
Service Code
|
HCPCS J9063
|
| Hospital Charge Code |
202156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.94 |
| Max. Negotiated Rate |
$25,637.72 |
| Rate for Payer: Aetna American Axle |
$18,516.13
|
| Rate for Payer: Aetna Commercial |
$24,213.41
|
| Rate for Payer: Aetna Medicare |
$68.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18,516.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$82.14
|
| Rate for Payer: Amish Plain Church Group Commercial |
$82.14
|
| Rate for Payer: BCBS Complete |
$37.74
|
| Rate for Payer: BCBS MAPPO |
$65.71
|
| Rate for Payer: BCBS Trust/PPO |
$212.31
|
| Rate for Payer: BCN Medicare Advantage |
$65.71
|
| Rate for Payer: Cash Price |
$22,789.09
|
| Rate for Payer: Cash Price |
$22,789.09
|
| Rate for Payer: Cofinity Commercial |
$19,940.45
|
| Rate for Payer: Cofinity Commercial |
$24,498.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22,789.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.71
|
| Rate for Payer: Healthscope Commercial |
$25,637.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19,940.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21,364.77
|
| Rate for Payer: Mclaren Medicaid |
$35.94
|
| Rate for Payer: Mclaren Medicare |
$65.71
|
| Rate for Payer: Meridian Medicaid |
$37.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$69.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$75.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24,213.41
|
| Rate for Payer: PACE Medicare |
$62.42
|
| Rate for Payer: PACE SWMI |
$65.71
|
| Rate for Payer: PHP Commercial |
$24,213.41
|
| Rate for Payer: PHP Medicare Advantage |
$65.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19,940.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.11
|
| Rate for Payer: Priority Health Medicare |
$65.71
|
| Rate for Payer: Priority Health Narrow Network |
$154.49
|
| Rate for Payer: Priority Health SBD |
$17,946.41
|
| Rate for Payer: Railroad Medicare Medicare |
$65.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.71
|
| Rate for Payer: UHC Medicare Advantage |
$67.68
|
| Rate for Payer: UMR Bronson Commercial |
$10,539.95
|
| Rate for Payer: VA VA |
$65.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21,364.77
|
|
|
MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC
|
Facility
|
IP
|
$24,518.37
|
|
|
Service Code
|
MS-DRG 640
|
| Min. Negotiated Rate |
$10,114.95 |
| Max. Negotiated Rate |
$24,518.37 |
| Rate for Payer: Aetna Medicare |
$11,073.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,309.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,309.15
|
| Rate for Payer: BCBS MAPPO |
$10,647.32
|
| Rate for Payer: BCBS Trust/PPO |
$24,518.37
|
| Rate for Payer: BCN Medicare Advantage |
$10,647.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,647.32
|
| Rate for Payer: Mclaren Medicare |
$10,647.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,179.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,244.42
|
| Rate for Payer: PACE Medicare |
$10,114.95
|
| Rate for Payer: PACE SWMI |
$10,647.32
|
| Rate for Payer: PHP Medicare Advantage |
$10,647.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,873.01
|
| Rate for Payer: Priority Health Medicare |
$10,647.32
|
| Rate for Payer: Priority Health Narrow Network |
$15,098.41
|
| Rate for Payer: Railroad Medicare Medicare |
$10,647.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20,062.06
|
| Rate for Payer: UHC Core |
$16,450.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,647.32
|
| Rate for Payer: UHC Exchange |
$13,078.35
|
| Rate for Payer: UHC Medicare Advantage |
$10,966.74
|
| Rate for Payer: VA VA |
$10,647.32
|
|
|
MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC
|
Facility
|
IP
|
$13,705.36
|
|
|
Service Code
|
MS-DRG 641
|
| Min. Negotiated Rate |
$6,207.15 |
| Max. Negotiated Rate |
$13,705.36 |
| Rate for Payer: Aetna Medicare |
$6,795.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8,167.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8,167.30
|
| Rate for Payer: BCBS MAPPO |
$6,533.84
|
| Rate for Payer: BCBS Trust/PPO |
$13,705.36
|
| Rate for Payer: BCN Medicare Advantage |
$6,533.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6,533.84
|
| Rate for Payer: Mclaren Medicare |
$6,533.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6,860.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,513.92
|
| Rate for Payer: PACE Medicare |
$6,207.15
|
| Rate for Payer: PACE SWMI |
$6,533.84
|
| Rate for Payer: PHP Medicare Advantage |
$6,533.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,213.03
|
| Rate for Payer: Priority Health Medicare |
$6,533.84
|
| Rate for Payer: Priority Health Narrow Network |
$8,970.42
|
| Rate for Payer: Railroad Medicare Medicare |
$6,533.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11,919.48
|
| Rate for Payer: UHC Core |
$9,773.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$6,533.84
|
| Rate for Payer: UHC Exchange |
$7,770.24
|
| Rate for Payer: UHC Medicare Advantage |
$6,729.86
|
| Rate for Payer: VA VA |
$6,533.84
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$355.40
|
|
|
Service Code
|
NDC 59762-5007-2
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.38 |
| Max. Negotiated Rate |
$319.86 |
| Rate for Payer: Aetna American Axle |
$231.01
|
| 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 Commercial |
$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: Kalamazoo County Sherrif's Dept Commercial |
$248.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$302.09
|
| Rate for Payer: PHP Commercial |
$302.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.78
|
| Rate for Payer: Priority Health SBD |
$223.90
|
| Rate for Payer: UMR Bronson Commercial |
$156.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.55
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$354.82
|
|
|
Service Code
|
NDC 43386-160-12
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.12 |
| Max. Negotiated Rate |
$319.34 |
| Rate for Payer: Aetna American Axle |
$230.63
|
| Rate for Payer: Aetna Commercial |
$301.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.63
|
| Rate for Payer: Cash Price |
$283.86
|
| Rate for Payer: Cofinity Commercial |
$248.37
|
| Rate for Payer: Cofinity Commercial |
$305.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.86
|
| Rate for Payer: Healthscope Commercial |
$319.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$301.60
|
| Rate for Payer: PHP Commercial |
$301.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.37
|
| Rate for Payer: Priority Health SBD |
$223.54
|
| Rate for Payer: UMR Bronson Commercial |
$156.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.12
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 68084-040-11
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Aetna American Axle |
$4.55
|
| 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 Commercial |
$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: Kalamazoo County Sherrif's Dept Commercial |
$4.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.95
|
| Rate for Payer: PHP Commercial |
$5.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.90
|
| Rate for Payer: Priority Health SBD |
$4.41
|
| Rate for Payer: UMR Bronson Commercial |
$3.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.25
|
|
