|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
OP
|
$1,442.63
|
|
|
Service Code
|
NDC 00025145134
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$533.77 |
| Max. Negotiated Rate |
$1,298.37 |
| Rate for Payer: Aetna American Axle |
$937.71
|
| Rate for Payer: Aetna Commercial |
$1,226.24
|
| Rate for Payer: Aetna Medicare |
$721.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$937.71
|
| Rate for Payer: BCBS Complete |
$577.05
|
| Rate for Payer: Cash Price |
$1,154.10
|
| Rate for Payer: Cofinity Commercial |
$1,009.84
|
| Rate for Payer: Cofinity Commercial |
$1,240.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,009.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,154.10
|
| Rate for Payer: Healthscope Commercial |
$1,298.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,009.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,081.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,226.24
|
| Rate for Payer: PHP Commercial |
$1,226.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$937.71
|
| Rate for Payer: Priority Health SBD |
$908.86
|
| Rate for Payer: UMR Bronson Commercial |
$533.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,081.97
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$9.38
|
|
|
Service Code
|
NDC 60687073511
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$8.44 |
| Rate for Payer: Aetna American Axle |
$6.10
|
| Rate for Payer: Aetna Commercial |
$7.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.10
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cofinity Commercial |
$6.57
|
| Rate for Payer: Cofinity Commercial |
$8.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.50
|
| Rate for Payer: Healthscope Commercial |
$8.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.97
|
| Rate for Payer: PHP Commercial |
$7.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.10
|
| Rate for Payer: Priority Health SBD |
$5.91
|
| Rate for Payer: UMR Bronson Commercial |
$4.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.04
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$177.12
|
|
|
Service Code
|
NDC 43386016006
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.93 |
| Max. Negotiated Rate |
$159.41 |
| Rate for Payer: Aetna American Axle |
$115.13
|
| Rate for Payer: Aetna Commercial |
$150.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.13
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cofinity Commercial |
$123.98
|
| Rate for Payer: Cofinity Commercial |
$152.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.70
|
| Rate for Payer: Healthscope Commercial |
$159.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.55
|
| Rate for Payer: PHP Commercial |
$150.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.13
|
| Rate for Payer: Priority Health SBD |
$111.59
|
| Rate for Payer: UMR Bronson Commercial |
$77.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.84
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
OP
|
$699.84
|
|
|
Service Code
|
NDC 68084004001
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$258.94 |
| Max. Negotiated Rate |
$629.86 |
| Rate for Payer: Aetna American Axle |
$454.90
|
| Rate for Payer: Aetna Commercial |
$594.86
|
| Rate for Payer: Aetna Medicare |
$349.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.90
|
| Rate for Payer: BCBS Complete |
$279.94
|
| Rate for Payer: Cash Price |
$559.87
|
| Rate for Payer: Cofinity Commercial |
$489.89
|
| Rate for Payer: Cofinity Commercial |
$601.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$489.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.87
|
| Rate for Payer: Healthscope Commercial |
$629.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$489.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.86
|
| Rate for Payer: PHP Commercial |
$594.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.90
|
| Rate for Payer: Priority Health SBD |
$440.90
|
| Rate for Payer: UMR Bronson Commercial |
$258.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.88
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
OP
|
$177.12
|
|
|
Service Code
|
NDC 43386016006
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.53 |
| Max. Negotiated Rate |
$159.41 |
| Rate for Payer: Aetna American Axle |
$115.13
|
| Rate for Payer: Aetna Commercial |
$150.55
|
| Rate for Payer: Aetna Medicare |
$88.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.13
|
| Rate for Payer: BCBS Complete |
$70.85
|
| Rate for Payer: Cash Price |
$141.70
|
| Rate for Payer: Cofinity Commercial |
$123.98
|
| Rate for Payer: Cofinity Commercial |
$152.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$123.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.70
|
| Rate for Payer: Healthscope Commercial |
$159.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.55
|
| Rate for Payer: PHP Commercial |
$150.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.13
|
| Rate for Payer: Priority Health SBD |
$111.59
|
| Rate for Payer: UMR Bronson Commercial |
$65.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.84
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$177.41
|
|
|
Service Code
|
NDC 59762500701
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.06 |
| Max. Negotiated Rate |
$159.67 |
| Rate for Payer: Aetna American Axle |
$115.32
|
| Rate for Payer: Aetna Commercial |
$150.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.32
|
| Rate for Payer: Cash Price |
$141.93
|
| Rate for Payer: Cofinity Commercial |
$124.19
|
| Rate for Payer: Cofinity Commercial |
$152.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.93
|
| Rate for Payer: Healthscope Commercial |
$159.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.80
|
| Rate for Payer: PHP Commercial |
$150.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.32
|
| Rate for Payer: Priority Health SBD |
$111.77
|
| Rate for Payer: UMR Bronson Commercial |
$78.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.06
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
OP
|
$354.82
|
|
|
Service Code
|
NDC 43386016012
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.28 |
| Max. Negotiated Rate |
$319.34 |
| Rate for Payer: Aetna American Axle |
$230.63
|
| Rate for Payer: Aetna Commercial |
$301.60
|
| Rate for Payer: Aetna Medicare |
$177.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.63
|
| Rate for Payer: BCBS Complete |
$141.93
|
| Rate for Payer: Cash Price |
$283.86
|
| Rate for Payer: Cofinity Commercial |
$248.37
|
| Rate for Payer: Cofinity Commercial |
$305.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$283.86
|
| Rate for Payer: Healthscope Commercial |
$319.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$301.60
|
| Rate for Payer: PHP Commercial |
$301.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$230.63
|
| Rate for Payer: Priority Health SBD |
$223.54
|
| Rate for Payer: UMR Bronson Commercial |
$131.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.12
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$355.40
|
|
|
Service Code
|
NDC 59762500702
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.38 |
| Max. Negotiated Rate |
$319.86 |
| Rate for Payer: Aetna American Axle |
$231.01
|
| Rate for Payer: Aetna Commercial |
$302.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.01
|
| Rate for Payer: Cash Price |
$284.32
|
| Rate for Payer: Cofinity Commercial |
$248.78
|
| Rate for Payer: Cofinity Commercial |
$305.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.32
|
| Rate for Payer: Healthscope Commercial |
$319.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.09
|
| Rate for Payer: PHP Commercial |
$302.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.01
|
| Rate for Payer: Priority Health SBD |
$223.90
|
| Rate for Payer: UMR Bronson Commercial |
$156.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.55
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
OP
|
$355.40
|
|
|
Service Code
|
NDC 59762500702
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.50 |
| Max. Negotiated Rate |
$319.86 |
| Rate for Payer: Aetna American Axle |
$231.01
|
| Rate for Payer: Aetna Commercial |
$302.09
|
| Rate for Payer: Aetna Medicare |
$177.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$231.01
|
| Rate for Payer: BCBS Complete |
$142.16
|
| Rate for Payer: Cash Price |
$284.32
|
| Rate for Payer: Cofinity Commercial |
$248.78
|
| Rate for Payer: Cofinity Commercial |
$305.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$248.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$284.32
|
| Rate for Payer: Healthscope Commercial |
$319.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$248.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$266.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$302.09
|
| Rate for Payer: PHP Commercial |
$302.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.01
|
| Rate for Payer: Priority Health SBD |
$223.90
|
| Rate for Payer: UMR Bronson Commercial |
$131.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$266.55
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
OP
|
$177.41
|
|
|
Service Code
|
NDC 59762500701
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.64 |
| Max. Negotiated Rate |
$159.67 |
| Rate for Payer: Aetna American Axle |
$115.32
|
| Rate for Payer: Aetna Commercial |
$150.80
|
| Rate for Payer: Aetna Medicare |
$88.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.32
|
| Rate for Payer: BCBS Complete |
$70.96
|
| Rate for Payer: Cash Price |
$141.93
|
| Rate for Payer: Cofinity Commercial |
$124.19
|
| Rate for Payer: Cofinity Commercial |
$152.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$124.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$141.93
|
| Rate for Payer: Healthscope Commercial |
$159.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$150.80
|
| Rate for Payer: PHP Commercial |
$150.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.32
|
| Rate for Payer: Priority Health SBD |
$111.77
|
| Rate for Payer: UMR Bronson Commercial |
$65.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.06
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$699.84
|
|
|
Service Code
|
NDC 68084004001
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$307.93 |
| Max. Negotiated Rate |
$629.86 |
| Rate for Payer: Aetna American Axle |
$454.90
|
| Rate for Payer: Aetna Commercial |
$594.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.90
|
| Rate for Payer: Cash Price |
$559.87
|
| Rate for Payer: Cofinity Commercial |
$489.89
|
| Rate for Payer: Cofinity Commercial |
$601.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$489.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.87
|
| Rate for Payer: Healthscope Commercial |
$629.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$489.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.86
|
| Rate for Payer: PHP Commercial |
$594.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.90
|
| Rate for Payer: Priority Health SBD |
$440.90
|
| Rate for Payer: UMR Bronson Commercial |
$307.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.88
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$937.44
|
|
|
Service Code
|
NDC 60687073501
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$412.47 |
| Max. Negotiated Rate |
$843.70 |
| Rate for Payer: Aetna American Axle |
$609.34
|
| Rate for Payer: Aetna Commercial |
$796.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.34
|
| Rate for Payer: Cash Price |
$749.95
|
| Rate for Payer: Cofinity Commercial |
$656.21
|
| Rate for Payer: Cofinity Commercial |
$806.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$656.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$749.95
|
| Rate for Payer: Healthscope Commercial |
$843.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$656.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$703.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$796.82
|
| Rate for Payer: PHP Commercial |
$796.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.34
|
| Rate for Payer: Priority Health SBD |
$590.59
|
| Rate for Payer: UMR Bronson Commercial |
$412.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$703.08
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
IP
|
$200.07
|
|
|
Service Code
|
NDC 70954044310
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.03 |
| Max. Negotiated Rate |
$180.06 |
| Rate for Payer: Aetna American Axle |
$130.05
|
| Rate for Payer: Aetna Commercial |
$170.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.05
|
| Rate for Payer: Cash Price |
$160.06
|
| Rate for Payer: Cofinity Commercial |
$140.05
|
| Rate for Payer: Cofinity Commercial |
$172.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.06
|
| Rate for Payer: Healthscope Commercial |
$180.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.06
|
| Rate for Payer: PHP Commercial |
$170.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.05
|
| Rate for Payer: Priority Health SBD |
$126.04
|
| Rate for Payer: UMR Bronson Commercial |
$88.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.05
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
OP
|
$937.44
|
|
|
Service Code
|
NDC 60687073501
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$346.85 |
| Max. Negotiated Rate |
$843.70 |
| Rate for Payer: Aetna American Axle |
$609.34
|
| Rate for Payer: Aetna Commercial |
$796.82
|
| Rate for Payer: Aetna Medicare |
$468.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$609.34
|
| Rate for Payer: BCBS Complete |
$374.98
|
| Rate for Payer: Cash Price |
$749.95
|
| Rate for Payer: Cofinity Commercial |
$656.21
|
| Rate for Payer: Cofinity Commercial |
$806.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$656.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$749.95
|
| Rate for Payer: Healthscope Commercial |
$843.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$656.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$703.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$796.82
|
| Rate for Payer: PHP Commercial |
$796.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$609.34
|
| Rate for Payer: Priority Health SBD |
$590.59
|
| Rate for Payer: UMR Bronson Commercial |
$346.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$703.08
|
|
|
MISOPROSTOL 100 MCG TABLET
|
Facility
|
OP
|
$200.07
|
|
|
Service Code
|
NDC 70954044310
|
| Hospital Charge Code |
10628
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.03 |
| Max. Negotiated Rate |
$180.06 |
| Rate for Payer: Aetna American Axle |
$130.05
|
| Rate for Payer: Aetna Commercial |
$170.06
|
| Rate for Payer: Aetna Medicare |
$100.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.05
|
| Rate for Payer: BCBS Complete |
$80.03
|
| Rate for Payer: Cash Price |
$160.06
|
| Rate for Payer: Cofinity Commercial |
$140.05
|
| Rate for Payer: Cofinity Commercial |
$172.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.06
|
| Rate for Payer: Healthscope Commercial |
$180.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.06
|
| Rate for Payer: PHP Commercial |
$170.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.05
|
| Rate for Payer: Priority Health SBD |
$126.04
|
| Rate for Payer: UMR Bronson Commercial |
$74.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.05
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
OP
|
$431.04
|
|
|
Service Code
|
NDC 59762500802
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.48 |
| Max. Negotiated Rate |
$387.94 |
| Rate for Payer: Aetna American Axle |
$280.18
|
| Rate for Payer: Aetna Commercial |
$366.38
|
| Rate for Payer: Aetna Medicare |
$215.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.18
|
| Rate for Payer: BCBS Complete |
$172.42
|
| Rate for Payer: Cash Price |
$344.83
|
| Rate for Payer: Cofinity Commercial |
$301.73
|
| Rate for Payer: Cofinity Commercial |
$370.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.83
|
| Rate for Payer: Healthscope Commercial |
$387.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.38
|
| Rate for Payer: PHP Commercial |
$366.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.18
|
| Rate for Payer: Priority Health SBD |
$271.56
|
| Rate for Payer: UMR Bronson Commercial |
$159.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.28
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
OP
|
$334.08
|
|
|
Service Code
|
NDC 70954044420
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$123.61 |
| Max. Negotiated Rate |
$300.67 |
| Rate for Payer: Aetna American Axle |
$217.15
|
| Rate for Payer: Aetna Commercial |
$283.97
|
| Rate for Payer: Aetna Medicare |
$167.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.15
|
| Rate for Payer: BCBS Complete |
$133.63
|
| Rate for Payer: Cash Price |
$267.26
|
| Rate for Payer: Cofinity Commercial |
$233.86
|
| Rate for Payer: Cofinity Commercial |
$287.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.26
|
| Rate for Payer: Healthscope Commercial |
$300.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.97
|
| Rate for Payer: PHP Commercial |
$283.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.15
|
| Rate for Payer: Priority Health SBD |
$210.47
|
| Rate for Payer: UMR Bronson Commercial |
$123.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.56
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
OP
|
$7.95
|
|
|
Service Code
|
NDC 68084004111
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Aetna American Axle |
$5.17
|
| Rate for Payer: Aetna Commercial |
$6.76
|
| Rate for Payer: Aetna Medicare |
$3.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.17
|
| Rate for Payer: BCBS Complete |
$3.18
|
| Rate for Payer: Cash Price |
$6.36
|
| Rate for Payer: Cofinity Commercial |
$5.56
|
| Rate for Payer: Cofinity Commercial |
$6.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.36
|
| Rate for Payer: Healthscope Commercial |
$7.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.76
|
| Rate for Payer: PHP Commercial |
$6.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.17
|
| Rate for Payer: Priority Health SBD |
$5.01
|
| Rate for Payer: UMR Bronson Commercial |
$2.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.96
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
OP
|
$258.63
|
|
|
Service Code
|
NDC 59762500801
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.69 |
| Max. Negotiated Rate |
$232.77 |
| Rate for Payer: Aetna American Axle |
$168.11
|
| Rate for Payer: Aetna Commercial |
$219.84
|
| Rate for Payer: Aetna Medicare |
$129.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.11
|
| Rate for Payer: BCBS Complete |
$103.45
|
| Rate for Payer: Cash Price |
$206.90
|
| Rate for Payer: Cofinity Commercial |
$181.04
|
| Rate for Payer: Cofinity Commercial |
$222.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.90
|
| Rate for Payer: Healthscope Commercial |
$232.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.84
|
| Rate for Payer: PHP Commercial |
$219.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.11
|
| Rate for Payer: Priority Health SBD |
$162.94
|
| Rate for Payer: UMR Bronson Commercial |
$95.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.97
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$431.04
|
|
|
Service Code
|
NDC 59762500802
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.66 |
| Max. Negotiated Rate |
$387.94 |
| Rate for Payer: Aetna American Axle |
$280.18
|
| Rate for Payer: Aetna Commercial |
$366.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.18
|
| Rate for Payer: Cash Price |
$344.83
|
| Rate for Payer: Cofinity Commercial |
$301.73
|
| Rate for Payer: Cofinity Commercial |
$370.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.83
|
| Rate for Payer: Healthscope Commercial |
$387.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.38
|
| Rate for Payer: PHP Commercial |
$366.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.18
|
| Rate for Payer: Priority Health SBD |
$271.56
|
| Rate for Payer: UMR Bronson Commercial |
$189.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.28
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$431.04
|
|
|
Service Code
|
NDC 43386016101
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.66 |
| Max. Negotiated Rate |
$387.94 |
| Rate for Payer: Aetna American Axle |
$280.18
|
| Rate for Payer: Aetna Commercial |
$366.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.18
|
| Rate for Payer: Cash Price |
$344.83
|
| Rate for Payer: Cofinity Commercial |
$301.73
|
| Rate for Payer: Cofinity Commercial |
$370.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.83
|
| Rate for Payer: Healthscope Commercial |
$387.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.38
|
| Rate for Payer: PHP Commercial |
$366.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.18
|
| Rate for Payer: Priority Health SBD |
$271.56
|
| Rate for Payer: UMR Bronson Commercial |
$189.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.28
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$258.63
|
|
|
Service Code
|
NDC 59762500801
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.80 |
| Max. Negotiated Rate |
$232.77 |
| Rate for Payer: Aetna American Axle |
$168.11
|
| Rate for Payer: Aetna Commercial |
$219.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.11
|
| Rate for Payer: Cash Price |
$206.90
|
| Rate for Payer: Cofinity Commercial |
$181.04
|
| Rate for Payer: Cofinity Commercial |
$222.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.90
|
| Rate for Payer: Healthscope Commercial |
$232.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$181.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.84
|
| Rate for Payer: PHP Commercial |
$219.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.11
|
| Rate for Payer: Priority Health SBD |
$162.94
|
| Rate for Payer: UMR Bronson Commercial |
$113.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.97
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$7.95
|
|
|
Service Code
|
NDC 68084004111
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Aetna American Axle |
$5.17
|
| Rate for Payer: Aetna Commercial |
$6.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.17
|
| Rate for Payer: Cash Price |
$6.36
|
| Rate for Payer: Cofinity Commercial |
$5.56
|
| Rate for Payer: Cofinity Commercial |
$6.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.36
|
| Rate for Payer: Healthscope Commercial |
$7.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.76
|
| Rate for Payer: PHP Commercial |
$6.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.17
|
| Rate for Payer: Priority Health SBD |
$5.01
|
| Rate for Payer: UMR Bronson Commercial |
$3.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.96
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$334.08
|
|
|
Service Code
|
NDC 70954044420
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$300.67 |
| Rate for Payer: Aetna American Axle |
$217.15
|
| Rate for Payer: Aetna Commercial |
$283.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.15
|
| Rate for Payer: Cash Price |
$267.26
|
| Rate for Payer: Cofinity Commercial |
$233.86
|
| Rate for Payer: Cofinity Commercial |
$287.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.26
|
| Rate for Payer: Healthscope Commercial |
$300.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.97
|
| Rate for Payer: PHP Commercial |
$283.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.15
|
| Rate for Payer: Priority Health SBD |
$210.47
|
| Rate for Payer: UMR Bronson Commercial |
$147.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.56
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$794.88
|
|
|
Service Code
|
NDC 68084004101
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$349.75 |
| Max. Negotiated Rate |
$715.39 |
| Rate for Payer: Aetna American Axle |
$516.67
|
| Rate for Payer: Aetna Commercial |
$675.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$516.67
|
| Rate for Payer: Cash Price |
$635.90
|
| Rate for Payer: Cofinity Commercial |
$556.42
|
| Rate for Payer: Cofinity Commercial |
$683.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$556.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$635.90
|
| Rate for Payer: Healthscope Commercial |
$715.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$556.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$596.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$675.65
|
| Rate for Payer: PHP Commercial |
$675.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$516.67
|
| Rate for Payer: Priority Health SBD |
$500.77
|
| Rate for Payer: UMR Bronson Commercial |
$349.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$596.16
|
|
