|
MINERAL OIL ENEMA
|
Facility
|
OP
|
$46.88
|
|
|
Service Code
|
NDC 96295012753
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Aetna Commercial |
$42.19
|
| Rate for Payer: Aetna Medicare |
$23.44
|
| Rate for Payer: ASR ASR |
$45.47
|
| Rate for Payer: ASR Commercial |
$45.47
|
| Rate for Payer: BCBS Complete |
$18.75
|
| Rate for Payer: BCBS Trust/PPO |
$38.39
|
| Rate for Payer: BCN Commercial |
$36.35
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$44.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.50
|
| Rate for Payer: Healthscope Commercial |
$46.88
|
| Rate for Payer: Healthscope Whirlpool |
$45.47
|
| Rate for Payer: Mclaren Commercial |
$42.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.85
|
| Rate for Payer: Nomi Health Commercial |
$38.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.08
|
| Rate for Payer: Priority Health Narrow Network |
$32.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.25
|
|
|
MINERAL OIL ENEMA
|
Facility
|
IP
|
$46.88
|
|
|
Service Code
|
NDC 96295012753
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.47 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Aetna Commercial |
$42.19
|
| Rate for Payer: ASR ASR |
$45.47
|
| Rate for Payer: ASR Commercial |
$45.47
|
| Rate for Payer: BCBS Trust/PPO |
$38.20
|
| Rate for Payer: BCN Commercial |
$36.35
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$44.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.50
|
| Rate for Payer: Healthscope Commercial |
$46.88
|
| Rate for Payer: Healthscope Whirlpool |
$45.47
|
| Rate for Payer: Mclaren Commercial |
$42.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.85
|
| Rate for Payer: Nomi Health Commercial |
$38.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.25
|
|
|
MINERAL OIL ORAL
|
Facility
|
OP
|
$8.10
|
|
|
Service Code
|
NDC 48433020230
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna Commercial |
$7.29
|
| Rate for Payer: Aetna Medicare |
$4.05
|
| Rate for Payer: ASR ASR |
$7.86
|
| Rate for Payer: ASR Commercial |
$7.86
|
| Rate for Payer: BCBS Complete |
$3.24
|
| Rate for Payer: BCBS Trust/PPO |
$6.63
|
| Rate for Payer: BCN Commercial |
$6.28
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cofinity Commercial |
$7.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.48
|
| Rate for Payer: Healthscope Commercial |
$8.10
|
| Rate for Payer: Healthscope Whirlpool |
$7.86
|
| Rate for Payer: Mclaren Commercial |
$7.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.88
|
| Rate for Payer: Nomi Health Commercial |
$6.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.10
|
| Rate for Payer: Priority Health Narrow Network |
$5.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.13
|
|
|
MINERAL OIL ORAL
|
Facility
|
IP
|
$8.10
|
|
|
Service Code
|
NDC 48433020230
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna Commercial |
$7.29
|
| Rate for Payer: ASR ASR |
$7.86
|
| Rate for Payer: ASR Commercial |
$7.86
|
| Rate for Payer: BCBS Trust/PPO |
$6.60
|
| Rate for Payer: BCN Commercial |
$6.28
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cofinity Commercial |
$7.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.48
|
| Rate for Payer: Healthscope Commercial |
$8.10
|
| Rate for Payer: Healthscope Whirlpool |
$7.86
|
| Rate for Payer: Mclaren Commercial |
$7.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.88
|
| Rate for Payer: Nomi Health Commercial |
$6.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.13
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 68084020511
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: ASR ASR |
$2.60
|
| Rate for Payer: ASR Commercial |
$2.60
|
| Rate for Payer: BCBS Trust/PPO |
$2.18
|
| Rate for Payer: BCN Commercial |
$2.08
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.68
|
| Rate for Payer: Healthscope Whirlpool |
$2.60
|
| Rate for Payer: Mclaren Commercial |
$2.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.36
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$410.40
|
|
|
Service Code
|
NDC 00591564301
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.76 |
| Max. Negotiated Rate |
$410.40 |
| Rate for Payer: Aetna Commercial |
$369.36
|
| Rate for Payer: ASR ASR |
$398.09
|
| Rate for Payer: ASR Commercial |
$398.09
|
| Rate for Payer: BCBS Trust/PPO |
$334.43
|
| Rate for Payer: BCN Commercial |
$318.18
|
| Rate for Payer: Cash Price |
$328.32
|
| Rate for Payer: Cofinity Commercial |
$385.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.32
|
| Rate for Payer: Healthscope Commercial |
$410.40
|
| Rate for Payer: Healthscope Whirlpool |
$398.09
|
| Rate for Payer: Mclaren Commercial |
$369.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.84
|
| Rate for Payer: Nomi Health Commercial |
$336.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.15
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
OP
|
$401.85
|
|
|
Service Code
|
NDC 49884025701
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.74 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna Commercial |
$361.67
|
| Rate for Payer: Aetna Medicare |
$200.93
|
| Rate for Payer: ASR ASR |
$389.79
|
| Rate for Payer: ASR Commercial |
$389.79
|
| Rate for Payer: BCBS Complete |
$160.74
|
| Rate for Payer: BCBS Trust/PPO |
$329.07
|
| Rate for Payer: BCN Commercial |
$311.55
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Commercial |
$377.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Healthscope Whirlpool |
$389.79
|
| Rate for Payer: Mclaren Commercial |
$361.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.57
|
| Rate for Payer: Nomi Health Commercial |
$329.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$352.10
|
| Rate for Payer: Priority Health Narrow Network |
$281.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$353.63
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
OP
|
$267.84
|
|
|
Service Code
|
NDC 68084020501
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.14 |
| Max. Negotiated Rate |
$267.84 |
| Rate for Payer: Aetna Commercial |
$241.06
|
| Rate for Payer: Aetna Medicare |
$133.92
|
| Rate for Payer: ASR ASR |
$259.80
|
| Rate for Payer: ASR Commercial |
$259.80
|
| Rate for Payer: BCBS Complete |
$107.14
|
| Rate for Payer: BCBS Trust/PPO |
$219.33
|
| Rate for Payer: BCN Commercial |
$207.66
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$251.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$267.84
|
| Rate for Payer: Healthscope Whirlpool |
$259.80
|
| Rate for Payer: Mclaren Commercial |
$241.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Nomi Health Commercial |
$219.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.68
|
| Rate for Payer: Priority Health Narrow Network |
$187.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.70
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
OP
|
$410.40
|
|
|
Service Code
|
NDC 00591564301
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.16 |
| Max. Negotiated Rate |
$410.40 |
| Rate for Payer: Aetna Commercial |
$369.36
|
| Rate for Payer: Aetna Medicare |
$205.20
|
| Rate for Payer: ASR ASR |
$398.09
|
| Rate for Payer: ASR Commercial |
$398.09
|
| Rate for Payer: BCBS Complete |
$164.16
|
| Rate for Payer: BCBS Trust/PPO |
$336.08
|
| Rate for Payer: BCN Commercial |
$318.18
|
| Rate for Payer: Cash Price |
$328.32
|
| Rate for Payer: Cofinity Commercial |
$385.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.32
|
| Rate for Payer: Healthscope Commercial |
$410.40
|
| Rate for Payer: Healthscope Whirlpool |
$398.09
|
| Rate for Payer: Mclaren Commercial |
$369.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.84
|
| Rate for Payer: Nomi Health Commercial |
$336.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$359.59
|
| Rate for Payer: Priority Health Narrow Network |
$287.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.15
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 68084020501
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.10 |
| Max. Negotiated Rate |
$267.84 |
| Rate for Payer: Aetna Commercial |
$241.06
|
| Rate for Payer: ASR ASR |
$259.80
|
| Rate for Payer: ASR Commercial |
$259.80
|
| Rate for Payer: BCBS Trust/PPO |
$218.26
|
| Rate for Payer: BCN Commercial |
$207.66
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$251.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$267.84
|
| Rate for Payer: Healthscope Whirlpool |
$259.80
|
| Rate for Payer: Mclaren Commercial |
$241.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Nomi Health Commercial |
$219.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.70
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$401.85
|
|
|
Service Code
|
NDC 49884025701
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$261.20 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna Commercial |
$361.67
|
| Rate for Payer: ASR ASR |
$389.79
|
| Rate for Payer: ASR Commercial |
$389.79
|
| Rate for Payer: BCBS Trust/PPO |
$327.47
|
| Rate for Payer: BCN Commercial |
$311.55
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Commercial |
$377.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Healthscope Whirlpool |
$389.79
|
| Rate for Payer: Mclaren Commercial |
$361.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.57
|
| Rate for Payer: Nomi Health Commercial |
$329.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$353.63
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
NDC 68084020511
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: Aetna Medicare |
$1.34
|
| Rate for Payer: ASR ASR |
$2.60
|
| Rate for Payer: ASR Commercial |
$2.60
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: BCN Commercial |
$2.08
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.68
|
| Rate for Payer: Healthscope Whirlpool |
$2.60
|
| Rate for Payer: Mclaren Commercial |
$2.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.35
|
| Rate for Payer: Priority Health Narrow Network |
$1.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.36
|
|
|
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 |
$823.60 |
| Max. Negotiated Rate |
$1,267.07 |
| Rate for Payer: Aetna Commercial |
$1,140.36
|
| Rate for Payer: ASR ASR |
$1,229.06
|
| Rate for Payer: ASR Commercial |
$1,229.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,032.54
|
| Rate for Payer: BCN Commercial |
$982.36
|
| Rate for Payer: Cash Price |
$1,013.65
|
| Rate for Payer: Cofinity Commercial |
$1,191.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.66
|
| Rate for Payer: Healthscope Commercial |
$1,267.07
|
| Rate for Payer: Healthscope Whirlpool |
$1,229.06
|
| Rate for Payer: Mclaren Commercial |
$1,140.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.01
|
| Rate for Payer: Nomi Health Commercial |
$1,039.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,115.02
|
|
|
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 |
$1,029.51 |
| Max. Negotiated Rate |
$1,583.86 |
| Rate for Payer: Aetna Commercial |
$1,425.47
|
| Rate for Payer: ASR ASR |
$1,536.34
|
| Rate for Payer: ASR Commercial |
$1,536.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,290.69
|
| Rate for Payer: BCN Commercial |
$1,227.97
|
| Rate for Payer: Cash Price |
$1,267.09
|
| Rate for Payer: Cofinity Commercial |
$1,488.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,267.09
|
| Rate for Payer: Healthscope Commercial |
$1,583.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,536.34
|
| Rate for Payer: Mclaren Commercial |
$1,425.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,346.28
|
| Rate for Payer: Nomi Health Commercial |
$1,298.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,029.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,393.80
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,583.86
|
|
|
Service Code
|
NDC 00469260130
|
| Hospital Charge Code |
161790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$633.54 |
| Max. Negotiated Rate |
$1,583.86 |
| Rate for Payer: Aetna Commercial |
$1,425.47
|
| Rate for Payer: Aetna Medicare |
$791.93
|
| Rate for Payer: ASR ASR |
$1,536.34
|
| Rate for Payer: ASR Commercial |
$1,536.34
|
| Rate for Payer: BCBS Complete |
$633.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,297.02
|
| Rate for Payer: BCN Commercial |
$1,227.97
|
| Rate for Payer: Cash Price |
$1,267.09
|
| Rate for Payer: Cofinity Commercial |
$1,488.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,267.09
|
| Rate for Payer: Healthscope Commercial |
$1,583.86
|
| Rate for Payer: Healthscope Whirlpool |
$1,536.34
|
| Rate for Payer: Mclaren Commercial |
$1,425.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,346.28
|
| Rate for Payer: Nomi Health Commercial |
$1,298.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,029.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,387.78
|
| Rate for Payer: Priority Health Narrow Network |
$1,110.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,393.80
|
|
|
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 |
$506.83 |
| Max. Negotiated Rate |
$1,267.07 |
| Rate for Payer: Aetna Commercial |
$1,140.36
|
| Rate for Payer: Aetna Medicare |
$633.53
|
| Rate for Payer: ASR ASR |
$1,229.06
|
| Rate for Payer: ASR Commercial |
$1,229.06
|
| Rate for Payer: BCBS Complete |
$506.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,037.60
|
| Rate for Payer: BCN Commercial |
$982.36
|
| Rate for Payer: Cash Price |
$1,013.65
|
| Rate for Payer: Cofinity Commercial |
$1,191.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,013.66
|
| Rate for Payer: Healthscope Commercial |
$1,267.07
|
| Rate for Payer: Healthscope Whirlpool |
$1,229.06
|
| Rate for Payer: Mclaren Commercial |
$1,140.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,077.01
|
| Rate for Payer: Nomi Health Commercial |
$1,039.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$823.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,110.21
|
| Rate for Payer: Priority Health Narrow Network |
$888.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,115.02
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$284.35
|
|
|
Service Code
|
NDC 00904651961
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$184.83 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$255.91
|
| Rate for Payer: ASR ASR |
$275.82
|
| Rate for Payer: ASR Commercial |
$275.82
|
| Rate for Payer: BCBS Trust/PPO |
$231.72
|
| Rate for Payer: BCN Commercial |
$220.46
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$267.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$284.35
|
| Rate for Payer: Healthscope Whirlpool |
$275.82
|
| Rate for Payer: Mclaren Commercial |
$255.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.23
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$3.67
|
|
|
Service Code
|
NDC 51079008601
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Aetna Medicare |
$1.83
|
| Rate for Payer: ASR ASR |
$3.56
|
| Rate for Payer: ASR Commercial |
$3.56
|
| Rate for Payer: BCBS Complete |
$1.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.01
|
| Rate for Payer: BCN Commercial |
$2.85
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.67
|
| Rate for Payer: Healthscope Whirlpool |
$3.56
|
| Rate for Payer: Mclaren Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.12
|
| Rate for Payer: Nomi Health Commercial |
$3.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.22
|
| Rate for Payer: Priority Health Narrow Network |
$2.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.23
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
OP
|
$284.35
|
|
|
Service Code
|
NDC 00904651961
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.74 |
| Max. Negotiated Rate |
$284.35 |
| Rate for Payer: Aetna Commercial |
$255.91
|
| Rate for Payer: Aetna Medicare |
$142.18
|
| Rate for Payer: ASR ASR |
$275.82
|
| Rate for Payer: ASR Commercial |
$275.82
|
| Rate for Payer: BCBS Complete |
$113.74
|
| Rate for Payer: BCBS Trust/PPO |
$232.85
|
| Rate for Payer: BCN Commercial |
$220.46
|
| Rate for Payer: Cash Price |
$227.48
|
| Rate for Payer: Cofinity Commercial |
$267.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$227.48
|
| Rate for Payer: Healthscope Commercial |
$284.35
|
| Rate for Payer: Healthscope Whirlpool |
$275.82
|
| Rate for Payer: Mclaren Commercial |
$255.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$241.70
|
| Rate for Payer: Nomi Health Commercial |
$233.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$249.15
|
| Rate for Payer: Priority Health Narrow Network |
$199.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.23
|
|
|
MIRTAZAPINE 15 MG TABLET
|
Facility
|
IP
|
$3.67
|
|
|
Service Code
|
NDC 51079008601
|
| Hospital Charge Code |
17466
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: ASR ASR |
$3.56
|
| Rate for Payer: ASR Commercial |
$3.56
|
| Rate for Payer: BCBS Trust/PPO |
$2.99
|
| Rate for Payer: BCN Commercial |
$2.85
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.94
|
| Rate for Payer: Healthscope Commercial |
$3.67
|
| Rate for Payer: Healthscope Whirlpool |
$3.56
|
| Rate for Payer: Mclaren Commercial |
$3.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.12
|
| Rate for Payer: Nomi Health Commercial |
$3.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.23
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$213.41
|
|
|
Service Code
|
NDC 70954044410
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.72 |
| Max. Negotiated Rate |
$213.41 |
| Rate for Payer: Aetna Commercial |
$192.07
|
| Rate for Payer: ASR ASR |
$207.01
|
| Rate for Payer: ASR Commercial |
$207.01
|
| Rate for Payer: BCBS Trust/PPO |
$173.91
|
| Rate for Payer: BCN Commercial |
$165.46
|
| Rate for Payer: Cash Price |
$170.73
|
| Rate for Payer: Cofinity Commercial |
$200.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$170.73
|
| Rate for Payer: Healthscope Commercial |
$213.41
|
| Rate for Payer: Healthscope Whirlpool |
$207.01
|
| Rate for Payer: Mclaren Commercial |
$192.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$181.40
|
| Rate for Payer: Nomi Health Commercial |
$175.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.80
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$258.62
|
|
|
Service Code
|
NDC 59762500801
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.10 |
| Max. Negotiated Rate |
$258.62 |
| Rate for Payer: Aetna Commercial |
$232.76
|
| Rate for Payer: ASR ASR |
$250.86
|
| Rate for Payer: ASR Commercial |
$250.86
|
| Rate for Payer: BCBS Trust/PPO |
$210.75
|
| Rate for Payer: BCN Commercial |
$200.51
|
| Rate for Payer: Cash Price |
$206.90
|
| Rate for Payer: Cofinity Commercial |
$243.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.90
|
| Rate for Payer: Healthscope Commercial |
$258.62
|
| Rate for Payer: Healthscope Whirlpool |
$250.86
|
| Rate for Payer: Mclaren Commercial |
$232.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.83
|
| Rate for Payer: Nomi Health Commercial |
$212.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.59
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
OP
|
$258.62
|
|
|
Service Code
|
NDC 59762500801
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.45 |
| Max. Negotiated Rate |
$258.62 |
| Rate for Payer: Aetna Commercial |
$232.76
|
| Rate for Payer: Aetna Medicare |
$129.31
|
| Rate for Payer: ASR ASR |
$250.86
|
| Rate for Payer: ASR Commercial |
$250.86
|
| Rate for Payer: BCBS Complete |
$103.45
|
| Rate for Payer: BCBS Trust/PPO |
$211.78
|
| Rate for Payer: BCN Commercial |
$200.51
|
| Rate for Payer: Cash Price |
$206.90
|
| Rate for Payer: Cofinity Commercial |
$243.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.90
|
| Rate for Payer: Healthscope Commercial |
$258.62
|
| Rate for Payer: Healthscope Whirlpool |
$250.86
|
| Rate for Payer: Mclaren Commercial |
$232.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.83
|
| Rate for Payer: Nomi Health Commercial |
$212.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.60
|
| Rate for Payer: Priority Health Narrow Network |
$181.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.59
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
IP
|
$431.04
|
|
|
Service Code
|
NDC 59762500802
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$280.18 |
| Max. Negotiated Rate |
$431.04 |
| Rate for Payer: Aetna Commercial |
$387.94
|
| Rate for Payer: ASR ASR |
$418.11
|
| Rate for Payer: ASR Commercial |
$418.11
|
| Rate for Payer: BCBS Trust/PPO |
$351.25
|
| Rate for Payer: BCN Commercial |
$334.19
|
| Rate for Payer: Cash Price |
$344.83
|
| Rate for Payer: Cofinity Commercial |
$405.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.83
|
| Rate for Payer: Healthscope Commercial |
$431.04
|
| Rate for Payer: Healthscope Whirlpool |
$418.11
|
| Rate for Payer: Mclaren Commercial |
$387.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.38
|
| Rate for Payer: Nomi Health Commercial |
$353.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$379.32
|
|
|
MISOPROSTOL 200 MCG TABLET
|
Facility
|
OP
|
$258.62
|
|
|
Service Code
|
NDC 43386016106
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.45 |
| Max. Negotiated Rate |
$258.62 |
| Rate for Payer: Aetna Commercial |
$232.76
|
| Rate for Payer: Aetna Medicare |
$129.31
|
| Rate for Payer: ASR ASR |
$250.86
|
| Rate for Payer: ASR Commercial |
$250.86
|
| Rate for Payer: BCBS Complete |
$103.45
|
| Rate for Payer: BCBS Trust/PPO |
$211.78
|
| Rate for Payer: BCN Commercial |
$200.51
|
| Rate for Payer: Cash Price |
$206.90
|
| Rate for Payer: Cofinity Commercial |
$243.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.90
|
| Rate for Payer: Healthscope Commercial |
$258.62
|
| Rate for Payer: Healthscope Whirlpool |
$250.86
|
| Rate for Payer: Mclaren Commercial |
$232.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.83
|
| Rate for Payer: Nomi Health Commercial |
$212.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$226.60
|
| Rate for Payer: Priority Health Narrow Network |
$181.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.59
|
|
