|
MINOXIDIL 10 MG TABLET
|
Facility
|
OP
|
$234.65
|
|
|
Service Code
|
NDC 53489038701
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.82 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna American Axle |
$152.52
|
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: Aetna Medicare |
$117.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.52
|
| Rate for Payer: BCBS Complete |
$93.86
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Advantage |
$164.25
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$211.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.99
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health SBD |
$147.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$152.52
|
| Rate for Payer: UHC Core |
$122.25
|
| Rate for Payer: UHC Exchange |
$92.22
|
| Rate for Payer: UMR Bronson Commercial |
$86.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$284.64
|
|
|
Service Code
|
NDC 68084020501
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.24 |
| Max. Negotiated Rate |
$256.18 |
| Rate for Payer: Aetna American Axle |
$185.02
|
| Rate for Payer: Aetna Commercial |
$241.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.02
|
| Rate for Payer: Cash Price |
$227.71
|
| Rate for Payer: Cofinity Advantage |
$199.25
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$199.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$213.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.48
|
| Rate for Payer: PHP Commercial |
$241.94
|
| Rate for Payer: Priority Health SBD |
$179.32
|
| Rate for Payer: UMR Bronson Commercial |
$125.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$213.48
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
OP
|
$406.60
|
|
|
Service Code
|
NDC 49884025701
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.44 |
| Max. Negotiated Rate |
$365.94 |
| Rate for Payer: Aetna American Axle |
$264.29
|
| Rate for Payer: Aetna Commercial |
$345.61
|
| Rate for Payer: Aetna Medicare |
$203.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$264.29
|
| Rate for Payer: BCBS Complete |
$162.64
|
| Rate for Payer: Cash Price |
$325.28
|
| Rate for Payer: Cofinity Advantage |
$284.62
|
| Rate for Payer: Cofinity Commercial |
$349.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.28
|
| Rate for Payer: Healthscope Commercial |
$365.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$284.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$304.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$325.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$304.95
|
| Rate for Payer: PHP Commercial |
$345.61
|
| Rate for Payer: Priority Health SBD |
$256.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$264.29
|
| Rate for Payer: UHC Core |
$211.84
|
| Rate for Payer: UHC Exchange |
$159.79
|
| Rate for Payer: UMR Bronson Commercial |
$150.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$304.95
|
|
|
MINOXIDIL 2.5 MG TABLET
|
Facility
|
OP
|
$291.40
|
|
|
Service Code
|
NDC 53489038601
|
| Hospital Charge Code |
5115
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.82 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna American Axle |
$189.41
|
| Rate for Payer: Aetna Commercial |
$247.69
|
| Rate for Payer: Aetna Medicare |
$145.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.41
|
| Rate for Payer: BCBS Complete |
$116.56
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Advantage |
$203.98
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.12
|
| Rate for Payer: Healthscope Commercial |
$262.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$233.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.55
|
| Rate for Payer: PHP Commercial |
$247.69
|
| Rate for Payer: Priority Health SBD |
$183.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.41
|
| Rate for Payer: UHC Core |
$151.82
|
| Rate for Payer: UHC Exchange |
$114.52
|
| Rate for Payer: UMR Bronson Commercial |
$107.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.55
|
|
|
MINOXIDIL 2.5 MG TABLET
|
Facility
|
OP
|
$458.25
|
|
|
Service Code
|
NDC 49884025601
|
| Hospital Charge Code |
5115
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.55 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna American Axle |
$297.86
|
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna Medicare |
$229.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.86
|
| Rate for Payer: BCBS Complete |
$183.30
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Advantage |
$320.77
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$366.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.69
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health SBD |
$288.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$297.86
|
| Rate for Payer: UHC Core |
$238.75
|
| Rate for Payer: UHC Exchange |
$180.09
|
| Rate for Payer: UMR Bronson Commercial |
$169.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
MINOXIDIL 2.5 MG TABLET
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 49884025601
|
| Hospital Charge Code |
5115
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$201.63 |
| Max. Negotiated Rate |
$412.43 |
| Rate for Payer: Aetna American Axle |
$297.86
|
| Rate for Payer: Aetna Commercial |
$389.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.86
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Advantage |
$320.77
|
| Rate for Payer: Cofinity Commercial |
$394.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$412.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.69
|
| Rate for Payer: PHP Commercial |
$389.51
|
| Rate for Payer: Priority Health SBD |
$288.70
|
| Rate for Payer: UMR Bronson Commercial |
$201.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.69
|
|
|
MINOXIDIL 2.5 MG TABLET
|
Facility
|
IP
|
$291.40
|
|
|
Service Code
|
NDC 53489038601
|
| Hospital Charge Code |
5115
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.22 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna American Axle |
$189.41
|
| Rate for Payer: Aetna Commercial |
$247.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.41
|
| Rate for Payer: Cash Price |
$233.12
|
| Rate for Payer: Cofinity Advantage |
$203.98
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.12
|
| Rate for Payer: Healthscope Commercial |
$262.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.55
|
| Rate for Payer: PHP Commercial |
$247.69
|
| Rate for Payer: Priority Health SBD |
$183.58
|
| Rate for Payer: UMR Bronson Commercial |
$128.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.55
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,259.19
|
|
|
Service Code
|
NDC 70710115903
|
| Hospital Charge Code |
161790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$465.90 |
| Max. Negotiated Rate |
$1,133.27 |
| Rate for Payer: Aetna American Axle |
$818.47
|
| Rate for Payer: Aetna Commercial |
$1,070.31
|
| Rate for Payer: Aetna Medicare |
$629.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$818.47
|
| Rate for Payer: BCBS Complete |
$503.68
|
| Rate for Payer: Cash Price |
$1,007.35
|
| Rate for Payer: Cofinity Advantage |
$881.43
|
| Rate for Payer: Cofinity Commercial |
$1,082.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,007.35
|
| Rate for Payer: Healthscope Commercial |
$1,133.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$881.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$944.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,007.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,070.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$944.39
|
| Rate for Payer: PHP Commercial |
$1,070.31
|
| Rate for Payer: Priority Health SBD |
$793.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$818.47
|
| Rate for Payer: UHC Core |
$656.04
|
| Rate for Payer: UHC Exchange |
$494.86
|
| Rate for Payer: UMR Bronson Commercial |
$465.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$944.39
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,259.19
|
|
|
Service Code
|
NDC 70710115903
|
| Hospital Charge Code |
161790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$554.04 |
| Max. Negotiated Rate |
$1,133.27 |
| Rate for Payer: Aetna American Axle |
$818.47
|
| Rate for Payer: Aetna Commercial |
$1,070.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$818.47
|
| Rate for Payer: Cash Price |
$1,007.35
|
| Rate for Payer: Cofinity Advantage |
$881.43
|
| Rate for Payer: Cofinity Commercial |
$1,082.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,007.35
|
| Rate for Payer: Healthscope Commercial |
$1,133.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$881.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$944.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,070.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$944.39
|
| Rate for Payer: PHP Commercial |
$1,070.31
|
| Rate for Payer: Priority Health SBD |
$793.29
|
| Rate for Payer: UMR Bronson Commercial |
$554.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$944.39
|
|
|
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 |
$696.90 |
| Max. Negotiated Rate |
$1,425.47 |
| Rate for Payer: Aetna American Axle |
$1,029.51
|
| Rate for Payer: Aetna Commercial |
$1,346.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,029.51
|
| Rate for Payer: Cash Price |
$1,267.09
|
| Rate for Payer: Cofinity Advantage |
$1,108.70
|
| Rate for Payer: Cofinity Commercial |
$1,362.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,267.09
|
| Rate for Payer: Healthscope Commercial |
$1,425.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,108.70
|
| 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: Opus (Opus Packaging Group) HMA |
$1,187.89
|
| Rate for Payer: PHP Commercial |
$1,346.28
|
| Rate for Payer: Priority Health SBD |
$997.83
|
| Rate for Payer: UMR Bronson Commercial |
$696.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,187.89
|
|
|
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 |
$586.03 |
| Max. Negotiated Rate |
$1,425.47 |
| Rate for Payer: Aetna American Axle |
$1,029.51
|
| Rate for Payer: Aetna Commercial |
$1,346.28
|
| Rate for Payer: Aetna Medicare |
$791.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,029.51
|
| Rate for Payer: BCBS Complete |
$633.54
|
| Rate for Payer: Cash Price |
$1,267.09
|
| Rate for Payer: Cofinity Advantage |
$1,108.70
|
| Rate for Payer: Cofinity Commercial |
$1,362.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,267.09
|
| Rate for Payer: Healthscope Commercial |
$1,425.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,108.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,187.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,267.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,346.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,187.89
|
| Rate for Payer: PHP Commercial |
$1,346.28
|
| Rate for Payer: Priority Health SBD |
$997.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,029.51
|
| Rate for Payer: UHC Core |
$825.19
|
| Rate for Payer: UHC Exchange |
$622.46
|
| Rate for Payer: UMR Bronson Commercial |
$586.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,187.89
|
|
|
MIRABEGRON ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,583.86
|
|
|
Service Code
|
NDC 00469260230
|
| Hospital Charge Code |
161791
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$586.03 |
| Max. Negotiated Rate |
$1,425.47 |
| Rate for Payer: Aetna American Axle |
$1,029.51
|
| Rate for Payer: Aetna Commercial |
$1,346.28
|
| Rate for Payer: Aetna Medicare |
$791.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,029.51
|
| Rate for Payer: BCBS Complete |
$633.54
|
| Rate for Payer: Cash Price |
$1,267.09
|
| Rate for Payer: Cofinity Advantage |
$1,108.70
|
| Rate for Payer: Cofinity Commercial |
$1,362.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,267.09
|
| Rate for Payer: Healthscope Commercial |
$1,425.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,108.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,187.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,267.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,346.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,187.89
|
| Rate for Payer: PHP Commercial |
$1,346.28
|
| Rate for Payer: Priority Health SBD |
$997.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,029.51
|
| Rate for Payer: UHC Core |
$825.19
|
| Rate for Payer: UHC Exchange |
$622.46
|
| Rate for Payer: UMR Bronson Commercial |
$586.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,187.89
|
|
|
MIRABEGRON ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,370.08
|
|
|
Service Code
|
NDC 70710116003
|
| Hospital Charge Code |
161791
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$506.93 |
| Max. Negotiated Rate |
$1,233.07 |
| Rate for Payer: Aetna American Axle |
$890.55
|
| Rate for Payer: Aetna Commercial |
$1,164.57
|
| Rate for Payer: Aetna Medicare |
$685.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$890.55
|
| Rate for Payer: BCBS Complete |
$548.03
|
| Rate for Payer: Cash Price |
$1,096.06
|
| Rate for Payer: Cofinity Advantage |
$959.06
|
| Rate for Payer: Cofinity Commercial |
$1,178.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,096.06
|
| Rate for Payer: Healthscope Commercial |
$1,233.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$959.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,027.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,096.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,164.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,027.56
|
| Rate for Payer: PHP Commercial |
$1,164.57
|
| Rate for Payer: Priority Health SBD |
$863.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$890.55
|
| Rate for Payer: UHC Core |
$713.81
|
| Rate for Payer: UHC Exchange |
$538.44
|
| Rate for Payer: UMR Bronson Commercial |
$506.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,027.56
|
|
|
MIRABEGRON ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,583.86
|
|
|
Service Code
|
NDC 00469260230
|
| Hospital Charge Code |
161791
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$696.90 |
| Max. Negotiated Rate |
$1,425.47 |
| Rate for Payer: Aetna American Axle |
$1,029.51
|
| Rate for Payer: Aetna Commercial |
$1,346.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,029.51
|
| Rate for Payer: Cash Price |
$1,267.09
|
| Rate for Payer: Cofinity Advantage |
$1,108.70
|
| Rate for Payer: Cofinity Commercial |
$1,362.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,267.09
|
| Rate for Payer: Healthscope Commercial |
$1,425.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,108.70
|
| 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: Opus (Opus Packaging Group) HMA |
$1,187.89
|
| Rate for Payer: PHP Commercial |
$1,346.28
|
| Rate for Payer: Priority Health SBD |
$997.83
|
| Rate for Payer: UMR Bronson Commercial |
$696.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,187.89
|
|
|
MIRABEGRON ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$3,475.86
|
|
|
Service Code
|
NDC 70710116009
|
| Hospital Charge Code |
161791
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,286.07 |
| Max. Negotiated Rate |
$3,128.27 |
| Rate for Payer: Aetna American Axle |
$2,259.31
|
| Rate for Payer: Aetna Commercial |
$2,954.48
|
| Rate for Payer: Aetna Medicare |
$1,737.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,259.31
|
| Rate for Payer: BCBS Complete |
$1,390.34
|
| Rate for Payer: Cash Price |
$2,780.69
|
| Rate for Payer: Cofinity Advantage |
$2,433.10
|
| Rate for Payer: Cofinity Commercial |
$2,989.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,780.69
|
| Rate for Payer: Healthscope Commercial |
$3,128.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,433.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,606.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,780.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,954.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,606.89
|
| Rate for Payer: PHP Commercial |
$2,954.48
|
| Rate for Payer: Priority Health SBD |
$2,189.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,259.31
|
| Rate for Payer: UHC Core |
$1,810.92
|
| Rate for Payer: UHC Exchange |
$1,366.01
|
| Rate for Payer: UMR Bronson Commercial |
$1,286.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,606.89
|
|
|
MIRABEGRON ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,370.08
|
|
|
Service Code
|
NDC 70710116003
|
| Hospital Charge Code |
161791
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$602.84 |
| Max. Negotiated Rate |
$1,233.07 |
| Rate for Payer: Aetna American Axle |
$890.55
|
| Rate for Payer: Aetna Commercial |
$1,164.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$890.55
|
| Rate for Payer: Cash Price |
$1,096.06
|
| Rate for Payer: Cofinity Advantage |
$959.06
|
| Rate for Payer: Cofinity Commercial |
$1,178.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,096.06
|
| Rate for Payer: Healthscope Commercial |
$1,233.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$959.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,027.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,164.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,027.56
|
| Rate for Payer: PHP Commercial |
$1,164.57
|
| Rate for Payer: Priority Health SBD |
$863.15
|
| Rate for Payer: UMR Bronson Commercial |
$602.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,027.56
|
|
|
MIRABEGRON ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$3,475.86
|
|
|
Service Code
|
NDC 70710116009
|
| Hospital Charge Code |
161791
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,529.38 |
| Max. Negotiated Rate |
$3,128.27 |
| Rate for Payer: Aetna American Axle |
$2,259.31
|
| Rate for Payer: Aetna Commercial |
$2,954.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,259.31
|
| Rate for Payer: Cash Price |
$2,780.69
|
| Rate for Payer: Cofinity Advantage |
$2,433.10
|
| Rate for Payer: Cofinity Commercial |
$2,989.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,780.69
|
| Rate for Payer: Healthscope Commercial |
$3,128.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,433.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,606.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,954.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,606.89
|
| Rate for Payer: PHP Commercial |
$2,954.48
|
| Rate for Payer: Priority Health SBD |
$2,189.79
|
| Rate for Payer: UMR Bronson Commercial |
$1,529.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,606.89
|
|
|
MIRIKIZUMAB-MRKZ 300 MG/15 ML (20 MG/ML) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24,942.38
|
|
|
Service Code
|
HCPCS J2267
|
| Hospital Charge Code |
205881
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.01 |
| Max. Negotiated Rate |
$22,448.14 |
| Rate for Payer: Aetna American Axle |
$16,212.55
|
| Rate for Payer: Aetna Commercial |
$21,201.02
|
| Rate for Payer: Aetna Medicare |
$43.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,212.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.61
|
| Rate for Payer: BCBS Complete |
$23.12
|
| Rate for Payer: BCBS MAPPO |
$42.09
|
| Rate for Payer: BCBS Trust/PPO |
$135.90
|
| Rate for Payer: BCN Commercial |
$135.90
|
| Rate for Payer: BCN Medicare Advantage |
$42.09
|
| Rate for Payer: Cash Price |
$19,953.90
|
| Rate for Payer: Cash Price |
$19,953.90
|
| Rate for Payer: Cofinity Advantage |
$17,459.67
|
| Rate for Payer: Cofinity Commercial |
$21,450.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,953.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.09
|
| Rate for Payer: Healthscope Commercial |
$22,448.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,459.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,706.78
|
| Rate for Payer: Mclaren Medicaid |
$42.09
|
| Rate for Payer: Mclaren Medicare |
$42.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.19
|
| Rate for Payer: Meridian Medicaid |
$44.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$46.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,201.02
|
| Rate for Payer: Nomi Health Commercial |
$126.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18,706.78
|
| Rate for Payer: PACE Medicare |
$39.99
|
| Rate for Payer: PACE SWMI |
$42.09
|
| Rate for Payer: PHP Commercial |
$21,201.02
|
| Rate for Payer: PHP Medicare Advantage |
$42.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$135.77
|
| Rate for Payer: Priority Health Medicare |
$42.09
|
| Rate for Payer: Priority Health SBD |
$15,713.70
|
| Rate for Payer: Priority Health Tiered Network |
$108.62
|
| Rate for Payer: Railroad Medicare Medicare |
$42.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,212.55
|
| Rate for Payer: UHC Core |
$12,994.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42.09
|
| Rate for Payer: UHC Exchange |
$9,802.36
|
| Rate for Payer: UHC Medicaid |
$22.01
|
| Rate for Payer: UHCCP Medicaid |
$22.01
|
| Rate for Payer: UMR Bronson Commercial |
$9,228.68
|
| Rate for Payer: VA VA |
$42.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,706.78
|
|
|
MIRTAZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
IP
|
$106.02
|
|
|
Service Code
|
NDC 65862002106
|
| Hospital Charge Code |
29531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$95.42 |
| Rate for Payer: Aetna American Axle |
$68.91
|
| Rate for Payer: Aetna Commercial |
$90.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.91
|
| Rate for Payer: Cash Price |
$84.82
|
| Rate for Payer: Cofinity Advantage |
$74.21
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$74.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.52
|
| Rate for Payer: PHP Commercial |
$90.12
|
| Rate for Payer: Priority Health SBD |
$66.79
|
| Rate for Payer: UMR Bronson Commercial |
$46.65
|
| 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 |
$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 Advantage |
$308.01
|
| 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: 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 Commercial |
$374.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$330.01
|
| Rate for Payer: PHP Commercial |
$374.01
|
| 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
|
OP
|
$106.02
|
|
|
Service Code
|
NDC 65862002106
|
| Hospital Charge Code |
29531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.23 |
| Max. Negotiated Rate |
$95.42 |
| Rate for Payer: Aetna American Axle |
$68.91
|
| Rate for Payer: Aetna Commercial |
$90.12
|
| Rate for Payer: Aetna Medicare |
$53.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.91
|
| Rate for Payer: BCBS Complete |
$42.41
|
| Rate for Payer: Cash Price |
$84.82
|
| Rate for Payer: Cofinity Advantage |
$74.21
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$74.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.52
|
| Rate for Payer: PHP Commercial |
$90.12
|
| Rate for Payer: Priority Health SBD |
$66.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.91
|
| Rate for Payer: UHC Core |
$55.24
|
| Rate for Payer: UHC Exchange |
$41.67
|
| Rate for Payer: UMR Bronson Commercial |
$39.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.52
|
|
|
MIRTAZAPINE 15 MG DISINTEGRATING TABLET
|
Facility
|
OP
|
$440.01
|
|
|
Service Code
|
NDC 00052010630
|
| Hospital Charge Code |
29531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.80 |
| Max. Negotiated Rate |
$396.01 |
| Rate for Payer: Aetna American Axle |
$286.01
|
| Rate for Payer: Aetna Commercial |
$374.01
|
| Rate for Payer: Aetna Medicare |
$220.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$286.01
|
| Rate for Payer: BCBS Complete |
$176.00
|
| Rate for Payer: Cash Price |
$352.01
|
| Rate for Payer: Cofinity Advantage |
$308.01
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$308.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$330.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$352.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$374.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$330.01
|
| Rate for Payer: PHP Commercial |
$374.01
|
| Rate for Payer: Priority Health SBD |
$277.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$286.01
|
| Rate for Payer: UHC Core |
$229.25
|
| Rate for Payer: UHC Exchange |
$172.92
|
| Rate for Payer: UMR Bronson Commercial |
$162.80
|
| 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 |
$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 Advantage |
$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 Commercial |
$74.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.01
|
| Rate for Payer: PHP Commercial |
$74.81
|
| 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 DISINTEGRATING TABLET
|
Facility
|
OP
|
$88.01
|
|
|
Service Code
|
NDC 00052010606
|
| Hospital Charge Code |
29531
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.56 |
| Max. Negotiated Rate |
$79.21 |
| Rate for Payer: Aetna American Axle |
$57.21
|
| Rate for Payer: Aetna Commercial |
$74.81
|
| Rate for Payer: Aetna Medicare |
$44.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.21
|
| Rate for Payer: BCBS Complete |
$35.20
|
| Rate for Payer: Cash Price |
$70.41
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$70.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.01
|
| Rate for Payer: PHP Commercial |
$74.81
|
| Rate for Payer: Priority Health SBD |
$55.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.21
|
| Rate for Payer: UHC Core |
$45.85
|
| Rate for Payer: UHC Exchange |
$34.59
|
| Rate for Payer: UMR Bronson Commercial |
$32.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.01
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$364.25
|
|
|
Service Code
|
NDC 00904651961
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.27 |
| Max. Negotiated Rate |
$327.82 |
| Rate for Payer: Aetna American Axle |
$236.76
|
| Rate for Payer: Aetna Commercial |
$309.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.76
|
| Rate for Payer: Cash Price |
$291.40
|
| Rate for Payer: Cofinity Advantage |
$254.97
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$254.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$309.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.19
|
| Rate for Payer: PHP Commercial |
$309.61
|
| Rate for Payer: Priority Health SBD |
$229.48
|
| Rate for Payer: UMR Bronson Commercial |
$160.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.19
|
|
