|
MINERAL OIL ENEMA
|
Facility
|
OP
|
$46.89
|
|
|
Service Code
|
NDC 96295012753
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$42.20 |
| Rate for Payer: Aetna American Axle |
$30.48
|
| Rate for Payer: Aetna Commercial |
$39.86
|
| Rate for Payer: Aetna Medicare |
$23.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.48
|
| Rate for Payer: BCBS Complete |
$18.76
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$32.82
|
| Rate for Payer: Cofinity Commercial |
$40.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.51
|
| Rate for Payer: Healthscope Commercial |
$42.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.86
|
| Rate for Payer: PHP Commercial |
$39.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.48
|
| Rate for Payer: Priority Health SBD |
$29.54
|
| Rate for Payer: UMR Bronson Commercial |
$17.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.17
|
|
|
MINERAL OIL ENEMA
|
Facility
|
IP
|
$46.89
|
|
|
Service Code
|
NDC 96295012753
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.63 |
| Max. Negotiated Rate |
$42.20 |
| Rate for Payer: Aetna American Axle |
$30.48
|
| Rate for Payer: Aetna Commercial |
$39.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.48
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$32.82
|
| Rate for Payer: Cofinity Commercial |
$40.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$32.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.51
|
| Rate for Payer: Healthscope Commercial |
$42.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$32.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.86
|
| Rate for Payer: PHP Commercial |
$39.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.48
|
| Rate for Payer: Priority Health SBD |
$29.54
|
| Rate for Payer: UMR Bronson Commercial |
$20.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.17
|
|
|
MINERAL OIL ORAL
|
Facility
|
OP
|
$8.11
|
|
|
Service Code
|
NDC 48433020230
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$7.30 |
| Rate for Payer: Aetna American Axle |
$5.27
|
| Rate for Payer: Aetna Commercial |
$6.89
|
| Rate for Payer: Aetna Medicare |
$4.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.27
|
| Rate for Payer: BCBS Complete |
$3.24
|
| Rate for Payer: Cash Price |
$6.49
|
| Rate for Payer: Cofinity Commercial |
$5.68
|
| Rate for Payer: Cofinity Commercial |
$6.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.49
|
| Rate for Payer: Healthscope Commercial |
$7.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.89
|
| Rate for Payer: PHP Commercial |
$6.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.27
|
| Rate for Payer: Priority Health SBD |
$5.11
|
| Rate for Payer: UMR Bronson Commercial |
$3.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.08
|
|
|
MINERAL OIL ORAL
|
Facility
|
IP
|
$8.88
|
|
|
Service Code
|
NDC 96295013630
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$7.99 |
| Rate for Payer: Aetna American Axle |
$5.77
|
| Rate for Payer: Aetna Commercial |
$7.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.77
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Commercial |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$7.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$7.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.55
|
| Rate for Payer: PHP Commercial |
$7.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.77
|
| Rate for Payer: Priority Health SBD |
$5.59
|
| Rate for Payer: UMR Bronson Commercial |
$3.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.66
|
|
|
MINERAL OIL ORAL
|
Facility
|
IP
|
$8.11
|
|
|
Service Code
|
NDC 48433020230
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$7.30 |
| Rate for Payer: Aetna American Axle |
$5.27
|
| Rate for Payer: Aetna Commercial |
$6.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.27
|
| Rate for Payer: Cash Price |
$6.49
|
| Rate for Payer: Cofinity Commercial |
$5.68
|
| Rate for Payer: Cofinity Commercial |
$6.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.49
|
| Rate for Payer: Healthscope Commercial |
$7.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.89
|
| Rate for Payer: PHP Commercial |
$6.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.27
|
| Rate for Payer: Priority Health SBD |
$5.11
|
| Rate for Payer: UMR Bronson Commercial |
$3.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.08
|
|
|
MINERAL OIL ORAL
|
Facility
|
OP
|
$3.53
|
|
|
Service Code
|
NDC 09900000569
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Aetna American Axle |
$2.29
|
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna Medicare |
$1.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.29
|
| Rate for Payer: BCBS Complete |
$1.41
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cofinity Commercial |
$2.47
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$3.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| Rate for Payer: PHP Commercial |
$3.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.29
|
| Rate for Payer: Priority Health SBD |
$2.22
|
| Rate for Payer: UMR Bronson Commercial |
$1.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.65
|
|
|
MINERAL OIL ORAL
|
Facility
|
IP
|
$3.53
|
|
|
Service Code
|
NDC 09900000569
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Aetna American Axle |
$2.29
|
| Rate for Payer: Aetna Commercial |
$3.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.29
|
| Rate for Payer: Cash Price |
$2.82
|
| Rate for Payer: Cofinity Commercial |
$2.47
|
| Rate for Payer: Cofinity Commercial |
$3.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$3.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.00
|
| Rate for Payer: PHP Commercial |
$3.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.29
|
| Rate for Payer: Priority Health SBD |
$2.22
|
| Rate for Payer: UMR Bronson Commercial |
$1.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.65
|
|
|
MINERAL OIL ORAL
|
Facility
|
OP
|
$8.88
|
|
|
Service Code
|
NDC 96295013630
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.29 |
| Max. Negotiated Rate |
$7.99 |
| Rate for Payer: Aetna American Axle |
$5.77
|
| Rate for Payer: Aetna Commercial |
$7.55
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.77
|
| Rate for Payer: BCBS Complete |
$3.55
|
| Rate for Payer: Cash Price |
$7.10
|
| Rate for Payer: Cofinity Commercial |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$7.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.10
|
| Rate for Payer: Healthscope Commercial |
$7.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.55
|
| Rate for Payer: PHP Commercial |
$7.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.77
|
| Rate for Payer: Priority Health SBD |
$5.59
|
| Rate for Payer: UMR Bronson Commercial |
$3.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.66
|
|
|
MINOCYCLINE 50 MG CAPSULE
|
Facility
|
OP
|
$234.65
|
|
|
Service Code
|
NDC 00591569401
|
| Hospital Charge Code |
5111
|
|
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 Commercial |
$164.25
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.25
|
| 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: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.52
|
| Rate for Payer: Priority Health SBD |
$147.83
|
| Rate for Payer: UMR Bronson Commercial |
$86.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
|
MINOCYCLINE 50 MG CAPSULE
|
Facility
|
IP
|
$234.65
|
|
|
Service Code
|
NDC 00591569401
|
| Hospital Charge Code |
5111
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.25 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna American Axle |
$152.52
|
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.52
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Commercial |
$164.25
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.25
|
| 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: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.52
|
| Rate for Payer: Priority Health SBD |
$147.83
|
| Rate for Payer: UMR Bronson Commercial |
$103.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$234.65
|
|
|
Service Code
|
NDC 53489038701
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.25 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna American Axle |
$152.52
|
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.52
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Commercial |
$164.25
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.25
|
| 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: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.52
|
| Rate for Payer: Priority Health SBD |
$147.83
|
| Rate for Payer: UMR Bronson Commercial |
$103.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 68084020511
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna American Axle |
$1.74
|
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: UMR Bronson Commercial |
$1.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
OP
|
$267.84
|
|
|
Service Code
|
NDC 68084020501
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.10 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna Medicare |
$133.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: BCBS Complete |
$107.14
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.10
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UMR Bronson Commercial |
$99.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 68084020501
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.85 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna American Axle |
$174.10
|
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$174.10
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$187.49
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$187.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$187.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.10
|
| Rate for Payer: Priority Health SBD |
$168.74
|
| Rate for Payer: UMR Bronson Commercial |
$117.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
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 Commercial |
$164.25
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.25
|
| 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: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.52
|
| Rate for Payer: Priority Health SBD |
$147.83
|
| Rate for Payer: UMR Bronson Commercial |
$86.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
NDC 68084020511
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna American Axle |
$1.74
|
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Medicare |
$1.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.74
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$1.88
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health SBD |
$1.69
|
| Rate for Payer: UMR Bronson Commercial |
$0.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
OP
|
$401.85
|
|
|
Service Code
|
NDC 49884025701
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.68 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna American Axle |
$261.20
|
| Rate for Payer: Aetna Commercial |
$341.57
|
| Rate for Payer: Aetna Medicare |
$200.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.20
|
| Rate for Payer: BCBS Complete |
$160.74
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Commercial |
$281.30
|
| Rate for Payer: Cofinity Commercial |
$345.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$361.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.57
|
| Rate for Payer: PHP Commercial |
$341.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.20
|
| Rate for Payer: Priority Health SBD |
$253.17
|
| Rate for Payer: UMR Bronson Commercial |
$148.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.39
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$401.85
|
|
|
Service Code
|
NDC 49884025701
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.81 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna American Axle |
$261.20
|
| Rate for Payer: Aetna Commercial |
$341.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.20
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Commercial |
$281.30
|
| Rate for Payer: Cofinity Commercial |
$345.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$281.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$361.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$281.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$301.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.57
|
| Rate for Payer: PHP Commercial |
$341.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.20
|
| Rate for Payer: Priority Health SBD |
$253.17
|
| Rate for Payer: UMR Bronson Commercial |
$176.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$301.39
|
|
|
MINOXIDIL 2.5 MG TABLET
|
Facility
|
IP
|
$453.55
|
|
|
Service Code
|
NDC 49884025601
|
| Hospital Charge Code |
5115
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.56 |
| Max. Negotiated Rate |
$408.19 |
| 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 |
$317.49
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$317.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Healthscope Commercial |
$408.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.52
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.81
|
| 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
|
|
|
MINOXIDIL 2.5 MG TABLET
|
Facility
|
OP
|
$453.55
|
|
|
Service Code
|
NDC 49884025601
|
| Hospital Charge Code |
5115
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.81 |
| Max. Negotiated Rate |
$408.19 |
| Rate for Payer: Aetna American Axle |
$294.81
|
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna Medicare |
$226.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.81
|
| Rate for Payer: BCBS Complete |
$181.42
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Commercial |
$317.49
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$317.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Healthscope Commercial |
$408.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.52
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.81
|
| Rate for Payer: Priority Health SBD |
$285.74
|
| Rate for Payer: UMR Bronson Commercial |
$167.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.16
|
|
|
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 Commercial |
$203.98
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.98
|
| 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: PHP Commercial |
$247.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.41
|
| 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
|
|
|
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 Commercial |
$203.98
|
| Rate for Payer: Cofinity Commercial |
$250.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$203.98
|
| 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: PHP Commercial |
$247.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.41
|
| Rate for Payer: Priority Health SBD |
$183.58
|
| Rate for Payer: UMR Bronson Commercial |
$107.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.55
|
|
|
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 Commercial |
$1,108.70
|
| Rate for Payer: Cofinity Commercial |
$1,362.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,108.70
|
| 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: PHP Commercial |
$1,346.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,029.51
|
| 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
|
IP
|
$1,267.07
|
|
|
Service Code
|
NDC 70710115903
|
| Hospital Charge Code |
161790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$557.51 |
| Max. Negotiated Rate |
$1,140.36 |
| Rate for Payer: Aetna American Axle |
$823.60
|
| Rate for Payer: Aetna Commercial |
$1,077.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$823.60
|
| Rate for Payer: Cash Price |
$1,013.66
|
| Rate for Payer: Cofinity Commercial |
$1,089.68
|
| Rate for Payer: Cofinity Commercial |
$886.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$886.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.66
|
| Rate for Payer: Healthscope Commercial |
$1,140.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$886.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$950.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.01
|
| Rate for Payer: PHP Commercial |
$1,077.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.60
|
| Rate for Payer: Priority Health SBD |
$798.25
|
| Rate for Payer: UMR Bronson Commercial |
$557.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$950.30
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,267.07
|
|
|
Service Code
|
NDC 70710115903
|
| Hospital Charge Code |
161790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$468.82 |
| Max. Negotiated Rate |
$1,140.36 |
| Rate for Payer: Aetna American Axle |
$823.60
|
| Rate for Payer: Aetna Commercial |
$1,077.01
|
| Rate for Payer: Aetna Medicare |
$633.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$823.60
|
| Rate for Payer: BCBS Complete |
$506.83
|
| Rate for Payer: Cash Price |
$1,013.66
|
| Rate for Payer: Cofinity Commercial |
$1,089.68
|
| Rate for Payer: Cofinity Commercial |
$886.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$886.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.66
|
| Rate for Payer: Healthscope Commercial |
$1,140.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$886.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$950.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.01
|
| Rate for Payer: PHP Commercial |
$1,077.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.60
|
| Rate for Payer: Priority Health SBD |
$798.25
|
| Rate for Payer: UMR Bronson Commercial |
$468.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$950.30
|
|
