|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$4.21
|
|
|
Service Code
|
NDC 68084011911
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Aetna American Axle |
$2.74
|
| Rate for Payer: Aetna Commercial |
$3.58
|
| Rate for Payer: Aetna Medicare |
$2.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.74
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: Cash Price |
$3.37
|
| Rate for Payer: Cofinity Advantage |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$3.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.37
|
| Rate for Payer: Healthscope Commercial |
$3.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.16
|
| Rate for Payer: PHP Commercial |
$3.58
|
| Rate for Payer: Priority Health SBD |
$2.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.74
|
| Rate for Payer: UHC Core |
$2.19
|
| Rate for Payer: UHC Exchange |
$1.65
|
| Rate for Payer: UMR Bronson Commercial |
$1.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.16
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$78.66
|
|
|
Service Code
|
NDC 60505024701
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.61 |
| Max. Negotiated Rate |
$70.79 |
| Rate for Payer: Aetna American Axle |
$51.13
|
| Rate for Payer: Aetna Commercial |
$66.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.13
|
| Rate for Payer: Cash Price |
$62.93
|
| Rate for Payer: Cofinity Advantage |
$55.06
|
| Rate for Payer: Cofinity Commercial |
$67.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.93
|
| Rate for Payer: Healthscope Commercial |
$70.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.99
|
| Rate for Payer: PHP Commercial |
$66.86
|
| Rate for Payer: Priority Health SBD |
$49.56
|
| Rate for Payer: UMR Bronson Commercial |
$34.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.99
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$364.25
|
|
|
Service Code
|
NDC 00904651961
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.77 |
| Max. Negotiated Rate |
$327.82 |
| Rate for Payer: Aetna American Axle |
$236.76
|
| Rate for Payer: Aetna Commercial |
$309.61
|
| Rate for Payer: Aetna Medicare |
$182.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.76
|
| Rate for Payer: BCBS Complete |
$145.70
|
| 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: MI Amish Medical Board Commercial |
$291.40
|
| 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: UHC All Payor (Choice/PPO) |
$236.76
|
| Rate for Payer: UHC Core |
$189.77
|
| Rate for Payer: UHC Exchange |
$143.15
|
| Rate for Payer: UMR Bronson Commercial |
$134.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.19
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$587.50
|
|
|
Service Code
|
NDC 13107003105
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$217.38 |
| Max. Negotiated Rate |
$528.75 |
| Rate for Payer: Aetna American Axle |
$381.88
|
| Rate for Payer: Aetna Commercial |
$499.38
|
| Rate for Payer: Aetna Medicare |
$293.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$381.88
|
| Rate for Payer: BCBS Complete |
$235.00
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cofinity Advantage |
$411.25
|
| Rate for Payer: Cofinity Commercial |
$505.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.00
|
| Rate for Payer: Healthscope Commercial |
$528.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$411.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$440.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$470.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$440.62
|
| Rate for Payer: PHP Commercial |
$499.38
|
| Rate for Payer: Priority Health SBD |
$370.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$381.88
|
| Rate for Payer: UHC Core |
$306.09
|
| Rate for Payer: UHC Exchange |
$230.89
|
| Rate for Payer: UMR Bronson Commercial |
$217.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$440.62
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$312.55
|
|
|
Service Code
|
NDC 63739009810
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.64 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna American Axle |
$203.16
|
| Rate for Payer: Aetna Commercial |
$265.67
|
| Rate for Payer: Aetna Medicare |
$156.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.16
|
| Rate for Payer: BCBS Complete |
$125.02
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Advantage |
$218.78
|
| Rate for Payer: Cofinity Commercial |
$268.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$250.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.41
|
| Rate for Payer: PHP Commercial |
$265.67
|
| Rate for Payer: Priority Health SBD |
$196.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$203.16
|
| Rate for Payer: UHC Core |
$162.84
|
| Rate for Payer: UHC Exchange |
$122.83
|
| Rate for Payer: UMR Bronson Commercial |
$115.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.41
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$46.53
|
|
|
Service Code
|
NDC 13107003134
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.47 |
| Max. Negotiated Rate |
$41.88 |
| Rate for Payer: Aetna American Axle |
$30.24
|
| Rate for Payer: Aetna Commercial |
$39.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.24
|
| Rate for Payer: Cash Price |
$37.22
|
| Rate for Payer: Cofinity Advantage |
$32.57
|
| Rate for Payer: Cofinity Commercial |
$40.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$41.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.90
|
| Rate for Payer: PHP Commercial |
$39.55
|
| Rate for Payer: Priority Health SBD |
$29.31
|
| Rate for Payer: UMR Bronson Commercial |
$20.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.90
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$4.21
|
|
|
Service Code
|
NDC 68084011911
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Aetna American Axle |
$2.74
|
| Rate for Payer: Aetna Commercial |
$3.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.74
|
| Rate for Payer: Cash Price |
$3.37
|
| Rate for Payer: Cofinity Advantage |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$3.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.37
|
| Rate for Payer: Healthscope Commercial |
$3.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.16
|
| Rate for Payer: PHP Commercial |
$3.58
|
| Rate for Payer: Priority Health SBD |
$2.65
|
| Rate for Payer: UMR Bronson Commercial |
$1.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.16
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$312.55
|
|
|
Service Code
|
NDC 63739009810
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.52 |
| Max. Negotiated Rate |
$281.30 |
| Rate for Payer: Aetna American Axle |
$203.16
|
| Rate for Payer: Aetna Commercial |
$265.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.16
|
| Rate for Payer: Cash Price |
$250.04
|
| Rate for Payer: Cofinity Advantage |
$218.78
|
| Rate for Payer: Cofinity Commercial |
$268.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.04
|
| Rate for Payer: Healthscope Commercial |
$281.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$234.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$234.41
|
| Rate for Payer: PHP Commercial |
$265.67
|
| Rate for Payer: Priority Health SBD |
$196.91
|
| Rate for Payer: UMR Bronson Commercial |
$137.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$234.41
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$46.53
|
|
|
Service Code
|
NDC 13107003134
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.22 |
| Max. Negotiated Rate |
$41.88 |
| Rate for Payer: Aetna American Axle |
$30.24
|
| Rate for Payer: Aetna Commercial |
$39.55
|
| Rate for Payer: Aetna Medicare |
$23.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.24
|
| Rate for Payer: BCBS Complete |
$18.61
|
| Rate for Payer: Cash Price |
$37.22
|
| Rate for Payer: Cofinity Advantage |
$32.57
|
| Rate for Payer: Cofinity Commercial |
$40.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.22
|
| Rate for Payer: Healthscope Commercial |
$41.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$34.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.90
|
| Rate for Payer: PHP Commercial |
$39.55
|
| Rate for Payer: Priority Health SBD |
$29.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.24
|
| Rate for Payer: UHC Core |
$24.24
|
| Rate for Payer: UHC Exchange |
$18.29
|
| Rate for Payer: UMR Bronson Commercial |
$17.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$34.90
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$420.65
|
|
|
Service Code
|
NDC 68084011901
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.64 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna American Axle |
$273.42
|
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: Aetna Medicare |
$210.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.42
|
| Rate for Payer: BCBS Complete |
$168.26
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Advantage |
$294.45
|
| Rate for Payer: Cofinity Commercial |
$361.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Healthscope Commercial |
$378.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$336.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.49
|
| Rate for Payer: PHP Commercial |
$357.55
|
| Rate for Payer: Priority Health SBD |
$265.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.42
|
| Rate for Payer: UHC Core |
$219.16
|
| Rate for Payer: UHC Exchange |
$165.32
|
| Rate for Payer: UMR Bronson Commercial |
$155.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.49
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$420.65
|
|
|
Service Code
|
NDC 68084011901
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.09 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna American Axle |
$273.42
|
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.42
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Advantage |
$294.45
|
| Rate for Payer: Cofinity Commercial |
$361.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Healthscope Commercial |
$378.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.49
|
| Rate for Payer: PHP Commercial |
$357.55
|
| Rate for Payer: Priority Health SBD |
$265.01
|
| Rate for Payer: UMR Bronson Commercial |
$185.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.49
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$587.50
|
|
|
Service Code
|
NDC 13107003105
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$258.50 |
| Max. Negotiated Rate |
$528.75 |
| Rate for Payer: Aetna American Axle |
$381.88
|
| Rate for Payer: Aetna Commercial |
$499.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$381.88
|
| Rate for Payer: Cash Price |
$470.00
|
| Rate for Payer: Cofinity Advantage |
$411.25
|
| Rate for Payer: Cofinity Commercial |
$505.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$470.00
|
| Rate for Payer: Healthscope Commercial |
$528.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$411.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$440.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$499.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$440.62
|
| Rate for Payer: PHP Commercial |
$499.38
|
| Rate for Payer: Priority Health SBD |
$370.12
|
| Rate for Payer: UMR Bronson Commercial |
$258.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$440.62
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$78.66
|
|
|
Service Code
|
NDC 60505024701
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.10 |
| Max. Negotiated Rate |
$70.79 |
| Rate for Payer: Aetna American Axle |
$51.13
|
| Rate for Payer: Aetna Commercial |
$66.86
|
| Rate for Payer: Aetna Medicare |
$39.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.13
|
| Rate for Payer: BCBS Complete |
$31.46
|
| Rate for Payer: Cash Price |
$62.93
|
| Rate for Payer: Cofinity Advantage |
$55.06
|
| Rate for Payer: Cofinity Commercial |
$67.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.93
|
| Rate for Payer: Healthscope Commercial |
$70.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.99
|
| Rate for Payer: PHP Commercial |
$66.86
|
| Rate for Payer: Priority Health SBD |
$49.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.13
|
| Rate for Payer: UHC Core |
$40.98
|
| Rate for Payer: UHC Exchange |
$30.91
|
| Rate for Payer: UMR Bronson Commercial |
$29.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.99
|
|
|
MIRTAZAPINE 30 MG TABLET
|
Facility
|
IP
|
$467.65
|
|
|
Service Code
|
NDC 68084012001
|
| Hospital Charge Code |
17465
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.77 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna American Axle |
$303.97
|
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.97
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Advantage |
$327.36
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.12
|
| Rate for Payer: Healthscope Commercial |
$420.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health SBD |
$294.62
|
| Rate for Payer: UMR Bronson Commercial |
$205.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
MIRTAZAPINE 30 MG TABLET
|
Facility
|
IP
|
$57.81
|
|
|
Service Code
|
NDC 13107000334
|
| Hospital Charge Code |
17465
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$52.03 |
| Rate for Payer: Aetna American Axle |
$37.58
|
| Rate for Payer: Aetna Commercial |
$49.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.58
|
| Rate for Payer: Cash Price |
$46.25
|
| Rate for Payer: Cofinity Advantage |
$40.47
|
| Rate for Payer: Cofinity Commercial |
$49.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.25
|
| Rate for Payer: Healthscope Commercial |
$52.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.36
|
| Rate for Payer: PHP Commercial |
$49.14
|
| Rate for Payer: Priority Health SBD |
$36.42
|
| Rate for Payer: UMR Bronson Commercial |
$25.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.36
|
|
|
MIRTAZAPINE 30 MG TABLET
|
Facility
|
IP
|
$467.65
|
|
|
Service Code
|
NDC 68084012011
|
| Hospital Charge Code |
17465
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.77 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna American Axle |
$303.97
|
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.97
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Advantage |
$327.36
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.12
|
| Rate for Payer: Healthscope Commercial |
$420.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health SBD |
$294.62
|
| Rate for Payer: UMR Bronson Commercial |
$205.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
MIRTAZAPINE 30 MG TABLET
|
Facility
|
OP
|
$467.65
|
|
|
Service Code
|
NDC 68084012011
|
| Hospital Charge Code |
17465
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.03 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna American Axle |
$303.97
|
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna Medicare |
$233.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.97
|
| Rate for Payer: BCBS Complete |
$187.06
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Advantage |
$327.36
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.12
|
| Rate for Payer: Healthscope Commercial |
$420.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health SBD |
$294.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.97
|
| Rate for Payer: UHC Core |
$243.65
|
| Rate for Payer: UHC Exchange |
$183.79
|
| Rate for Payer: UMR Bronson Commercial |
$173.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
MIRTAZAPINE 30 MG TABLET
|
Facility
|
OP
|
$57.81
|
|
|
Service Code
|
NDC 13107000334
|
| Hospital Charge Code |
17465
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.39 |
| Max. Negotiated Rate |
$52.03 |
| Rate for Payer: Aetna American Axle |
$37.58
|
| Rate for Payer: Aetna Commercial |
$49.14
|
| Rate for Payer: Aetna Medicare |
$28.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.58
|
| Rate for Payer: BCBS Complete |
$23.12
|
| Rate for Payer: Cash Price |
$46.25
|
| Rate for Payer: Cofinity Advantage |
$40.47
|
| Rate for Payer: Cofinity Commercial |
$49.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.25
|
| Rate for Payer: Healthscope Commercial |
$52.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.36
|
| Rate for Payer: PHP Commercial |
$49.14
|
| Rate for Payer: Priority Health SBD |
$36.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.58
|
| Rate for Payer: UHC Core |
$30.12
|
| Rate for Payer: UHC Exchange |
$22.72
|
| Rate for Payer: UMR Bronson Commercial |
$21.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.36
|
|
|
MIRTAZAPINE 30 MG TABLET
|
Facility
|
OP
|
$467.65
|
|
|
Service Code
|
NDC 68084012001
|
| Hospital Charge Code |
17465
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.03 |
| Max. Negotiated Rate |
$420.88 |
| Rate for Payer: Aetna American Axle |
$303.97
|
| Rate for Payer: Aetna Commercial |
$397.50
|
| Rate for Payer: Aetna Medicare |
$233.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.97
|
| Rate for Payer: BCBS Complete |
$187.06
|
| Rate for Payer: Cash Price |
$374.12
|
| Rate for Payer: Cofinity Advantage |
$327.36
|
| Rate for Payer: Cofinity Commercial |
$402.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.12
|
| Rate for Payer: Healthscope Commercial |
$420.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$374.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$350.74
|
| Rate for Payer: PHP Commercial |
$397.50
|
| Rate for Payer: Priority Health SBD |
$294.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.97
|
| Rate for Payer: UHC Core |
$243.65
|
| Rate for Payer: UHC Exchange |
$183.79
|
| Rate for Payer: UMR Bronson Commercial |
$173.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.74
|
|
|
MIRTAZAPINE 7.5 MG TABLET
|
Facility
|
IP
|
$10.85
|
|
|
Service Code
|
NDC 60687058411
|
| Hospital Charge Code |
38421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$9.77 |
| Rate for Payer: Aetna American Axle |
$7.05
|
| Rate for Payer: Aetna Commercial |
$9.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.05
|
| Rate for Payer: Cash Price |
$8.68
|
| Rate for Payer: Cofinity Advantage |
$7.59
|
| Rate for Payer: Cofinity Commercial |
$9.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.68
|
| Rate for Payer: Healthscope Commercial |
$9.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.14
|
| Rate for Payer: PHP Commercial |
$9.22
|
| Rate for Payer: Priority Health SBD |
$6.84
|
| Rate for Payer: UMR Bronson Commercial |
$4.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.14
|
|
|
MIRTAZAPINE 7.5 MG TABLET
|
Facility
|
IP
|
$88.71
|
|
|
Service Code
|
NDC 13107000130
|
| Hospital Charge Code |
38421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.03 |
| Max. Negotiated Rate |
$79.84 |
| Rate for Payer: Aetna American Axle |
$57.66
|
| Rate for Payer: Aetna Commercial |
$75.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.66
|
| Rate for Payer: Cash Price |
$70.97
|
| Rate for Payer: Cofinity Advantage |
$62.10
|
| Rate for Payer: Cofinity Commercial |
$76.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.97
|
| Rate for Payer: Healthscope Commercial |
$79.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.53
|
| Rate for Payer: PHP Commercial |
$75.40
|
| Rate for Payer: Priority Health SBD |
$55.89
|
| Rate for Payer: UMR Bronson Commercial |
$39.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.53
|
|
|
MIRTAZAPINE 7.5 MG TABLET
|
Facility
|
OP
|
$325.46
|
|
|
Service Code
|
NDC 60687058421
|
| Hospital Charge Code |
38421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.42 |
| Max. Negotiated Rate |
$292.91 |
| Rate for Payer: Aetna American Axle |
$211.55
|
| Rate for Payer: Aetna Commercial |
$276.64
|
| Rate for Payer: Aetna Medicare |
$162.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.55
|
| Rate for Payer: BCBS Complete |
$130.18
|
| Rate for Payer: Cash Price |
$260.37
|
| Rate for Payer: Cofinity Advantage |
$227.82
|
| Rate for Payer: Cofinity Commercial |
$279.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.37
|
| Rate for Payer: Healthscope Commercial |
$292.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$260.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.09
|
| Rate for Payer: PHP Commercial |
$276.64
|
| Rate for Payer: Priority Health SBD |
$205.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.55
|
| Rate for Payer: UHC Core |
$169.56
|
| Rate for Payer: UHC Exchange |
$127.91
|
| Rate for Payer: UMR Bronson Commercial |
$120.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.09
|
|
|
MIRTAZAPINE 7.5 MG TABLET
|
Facility
|
IP
|
$325.46
|
|
|
Service Code
|
NDC 60687058421
|
| Hospital Charge Code |
38421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.20 |
| Max. Negotiated Rate |
$292.91 |
| Rate for Payer: Aetna American Axle |
$211.55
|
| Rate for Payer: Aetna Commercial |
$276.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.55
|
| Rate for Payer: Cash Price |
$260.37
|
| Rate for Payer: Cofinity Advantage |
$227.82
|
| Rate for Payer: Cofinity Commercial |
$279.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$260.37
|
| Rate for Payer: Healthscope Commercial |
$292.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$244.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.09
|
| Rate for Payer: PHP Commercial |
$276.64
|
| Rate for Payer: Priority Health SBD |
$205.04
|
| Rate for Payer: UMR Bronson Commercial |
$143.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$244.09
|
|
|
MIRTAZAPINE 7.5 MG TABLET
|
Facility
|
OP
|
$10.85
|
|
|
Service Code
|
NDC 60687058411
|
| Hospital Charge Code |
38421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.01 |
| Max. Negotiated Rate |
$9.77 |
| Rate for Payer: Aetna American Axle |
$7.05
|
| Rate for Payer: Aetna Commercial |
$9.22
|
| Rate for Payer: Aetna Medicare |
$5.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.05
|
| Rate for Payer: BCBS Complete |
$4.34
|
| Rate for Payer: Cash Price |
$8.68
|
| Rate for Payer: Cofinity Advantage |
$7.59
|
| Rate for Payer: Cofinity Commercial |
$9.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.68
|
| Rate for Payer: Healthscope Commercial |
$9.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.14
|
| Rate for Payer: PHP Commercial |
$9.22
|
| Rate for Payer: Priority Health SBD |
$6.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.05
|
| Rate for Payer: UHC Core |
$5.65
|
| Rate for Payer: UHC Exchange |
$4.26
|
| Rate for Payer: UMR Bronson Commercial |
$4.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.14
|
|
|
MIRTAZAPINE 7.5 MG TABLET
|
Facility
|
OP
|
$88.71
|
|
|
Service Code
|
NDC 13107000130
|
| Hospital Charge Code |
38421
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.82 |
| Max. Negotiated Rate |
$79.84 |
| Rate for Payer: Aetna American Axle |
$57.66
|
| Rate for Payer: Aetna Commercial |
$75.40
|
| Rate for Payer: Aetna Medicare |
$44.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.66
|
| Rate for Payer: BCBS Complete |
$35.48
|
| Rate for Payer: Cash Price |
$70.97
|
| Rate for Payer: Cofinity Advantage |
$62.10
|
| Rate for Payer: Cofinity Commercial |
$76.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$70.97
|
| Rate for Payer: Healthscope Commercial |
$79.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$70.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.53
|
| Rate for Payer: PHP Commercial |
$75.40
|
| Rate for Payer: Priority Health SBD |
$55.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.66
|
| Rate for Payer: UHC Core |
$46.22
|
| Rate for Payer: UHC Exchange |
$34.86
|
| Rate for Payer: UMR Bronson Commercial |
$32.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.53
|
|
