Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

MICONAZOLE NITRATE 2 % TOPICAL CREAM

Facility

$25.11

Service Code	NDC 00536113428
Hospital Charge Code	5039
Hospital Revenue Code	637
Min. Negotiated Rate	$15.82
Max. Negotiated Rate	$22.60
Rate for Payer: Aetna Commercial	$21.34
Rate for Payer: Aetna New Business (MI Preferred)	$16.32
Rate for Payer: Cash Price	$20.09
Rate for Payer: Cofinity Commercial	$17.58
Rate for Payer: Cofinity Commercial	$21.59
Rate for Payer: Cofinity Medicare Advantage	$17.58
Rate for Payer: Encore Health Key Benefits Commercial	$20.09
Rate for Payer: Healthscope Commercial	$22.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.34
Rate for Payer: PHP Commercial	$21.34
Rate for Payer: Priority Health Cigna Priority Health	$16.32
Rate for Payer: Priority Health SBD	$15.82

MICONAZOLE NITRATE 2 % TOPICAL OINTMENT

Facility

$28.33

Service Code	NDC 11701006723
Hospital Charge Code	13651
Hospital Revenue Code	637
Min. Negotiated Rate	$17.85
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$24.08
Rate for Payer: Aetna New Business (MI Preferred)	$18.41
Rate for Payer: Cash Price	$22.66
Rate for Payer: Cofinity Commercial	$19.83
Rate for Payer: Cofinity Commercial	$24.36
Rate for Payer: Cofinity Medicare Advantage	$19.83
Rate for Payer: Encore Health Key Benefits Commercial	$22.66
Rate for Payer: Healthscope Commercial	$25.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.08
Rate for Payer: PHP Commercial	$24.08
Rate for Payer: Priority Health Cigna Priority Health	$18.41
Rate for Payer: Priority Health SBD	$17.85

MICONAZOLE NITRATE 2 % TOPICAL OINTMENT

Facility

$23.92

Service Code	NDC 43553000302
Hospital Charge Code	13651
Hospital Revenue Code	637
Min. Negotiated Rate	$15.07
Max. Negotiated Rate	$21.53
Rate for Payer: Aetna Commercial	$20.33
Rate for Payer: Aetna New Business (MI Preferred)	$15.55
Rate for Payer: Cash Price	$19.14
Rate for Payer: Cofinity Commercial	$16.74
Rate for Payer: Cofinity Commercial	$20.57
Rate for Payer: Cofinity Medicare Advantage	$16.74
Rate for Payer: Encore Health Key Benefits Commercial	$19.14
Rate for Payer: Healthscope Commercial	$21.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.33
Rate for Payer: PHP Commercial	$20.33
Rate for Payer: Priority Health Cigna Priority Health	$15.55
Rate for Payer: Priority Health SBD	$15.07

MICONAZOLE NITRATE 2 % TOPICAL OINTMENT

Facility

$28.33

Service Code	NDC 11701006723
Hospital Charge Code	13651
Hospital Revenue Code	637
Min. Negotiated Rate	$11.33
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$24.08
Rate for Payer: Aetna Medicare	$14.16
Rate for Payer: Aetna New Business (MI Preferred)	$18.41
Rate for Payer: BCBS Complete	$11.33
Rate for Payer: Cash Price	$22.66
Rate for Payer: Cofinity Commercial	$19.83
Rate for Payer: Cofinity Commercial	$24.36
Rate for Payer: Cofinity Medicare Advantage	$19.83
Rate for Payer: Encore Health Key Benefits Commercial	$22.66
Rate for Payer: Healthscope Commercial	$25.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.08
Rate for Payer: PHP Commercial	$24.08
Rate for Payer: Priority Health Cigna Priority Health	$18.41
Rate for Payer: Priority Health SBD	$17.85

MICONAZOLE NITRATE 2 % TOPICAL OINTMENT

Facility

$23.92

Service Code	NDC 43553000302
Hospital Charge Code	13651
Hospital Revenue Code	637
Min. Negotiated Rate	$9.57
Max. Negotiated Rate	$21.53
Rate for Payer: Aetna Commercial	$20.33
Rate for Payer: Aetna Medicare	$11.96
Rate for Payer: Aetna New Business (MI Preferred)	$15.55
Rate for Payer: BCBS Complete	$9.57
Rate for Payer: Cash Price	$19.14
Rate for Payer: Cofinity Commercial	$16.74
Rate for Payer: Cofinity Commercial	$20.57
Rate for Payer: Cofinity Medicare Advantage	$16.74
Rate for Payer: Encore Health Key Benefits Commercial	$19.14
Rate for Payer: Healthscope Commercial	$21.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.33
Rate for Payer: PHP Commercial	$20.33
Rate for Payer: Priority Health Cigna Priority Health	$15.55
Rate for Payer: Priority Health SBD	$15.07

MICONAZOLE NITRATE 2 % TOPICAL POWDER

Facility

$27.97

Service Code	NDC 11701003816
Hospital Charge Code	10599
Hospital Revenue Code	637
Min. Negotiated Rate	$17.62
Max. Negotiated Rate	$25.17
Rate for Payer: Aetna Commercial	$23.77
Rate for Payer: Aetna New Business (MI Preferred)	$18.18
Rate for Payer: Cash Price	$22.38
Rate for Payer: Cofinity Commercial	$19.58
Rate for Payer: Cofinity Commercial	$24.05
Rate for Payer: Cofinity Medicare Advantage	$19.58
Rate for Payer: Encore Health Key Benefits Commercial	$22.38
Rate for Payer: Healthscope Commercial	$25.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.77
Rate for Payer: PHP Commercial	$23.77
Rate for Payer: Priority Health Cigna Priority Health	$18.18
Rate for Payer: Priority Health SBD	$17.62

MICONAZOLE NITRATE 2 % TOPICAL POWDER

Facility

$22.19

Service Code	NDC 80196052856
Hospital Charge Code	10599
Hospital Revenue Code	637
Min. Negotiated Rate	$8.88
Max. Negotiated Rate	$19.97
Rate for Payer: Aetna Commercial	$18.86
Rate for Payer: Aetna Medicare	$11.10
Rate for Payer: Aetna New Business (MI Preferred)	$14.42
Rate for Payer: BCBS Complete	$8.88
Rate for Payer: Cash Price	$17.75
Rate for Payer: Cofinity Commercial	$15.53
Rate for Payer: Cofinity Commercial	$19.08
Rate for Payer: Cofinity Medicare Advantage	$15.53
Rate for Payer: Encore Health Key Benefits Commercial	$17.75
Rate for Payer: Healthscope Commercial	$19.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.86
Rate for Payer: PHP Commercial	$18.86
Rate for Payer: Priority Health Cigna Priority Health	$14.42
Rate for Payer: Priority Health SBD	$13.98

MICONAZOLE NITRATE 2 % TOPICAL POWDER

Facility

$22.19

Service Code	NDC 80196052856
Hospital Charge Code	10599
Hospital Revenue Code	637
Min. Negotiated Rate	$13.98
Max. Negotiated Rate	$19.97
Rate for Payer: Aetna Commercial	$18.86
Rate for Payer: Aetna New Business (MI Preferred)	$14.42
Rate for Payer: Cash Price	$17.75
Rate for Payer: Cofinity Commercial	$15.53
Rate for Payer: Cofinity Commercial	$19.08
Rate for Payer: Cofinity Medicare Advantage	$15.53
Rate for Payer: Encore Health Key Benefits Commercial	$17.75
Rate for Payer: Healthscope Commercial	$19.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.86
Rate for Payer: PHP Commercial	$18.86
Rate for Payer: Priority Health Cigna Priority Health	$14.42
Rate for Payer: Priority Health SBD	$13.98

MICONAZOLE NITRATE 2 % TOPICAL POWDER

Facility

$22.19

Service Code	NDC 53329016979
Hospital Charge Code	10599
Hospital Revenue Code	637
Min. Negotiated Rate	$8.88
Max. Negotiated Rate	$19.97
Rate for Payer: Aetna Commercial	$18.86
Rate for Payer: Aetna Medicare	$11.10
Rate for Payer: Aetna New Business (MI Preferred)	$14.42
Rate for Payer: BCBS Complete	$8.88
Rate for Payer: Cash Price	$17.75
Rate for Payer: Cofinity Commercial	$15.53
Rate for Payer: Cofinity Commercial	$19.08
Rate for Payer: Cofinity Medicare Advantage	$15.53
Rate for Payer: Encore Health Key Benefits Commercial	$17.75
Rate for Payer: Healthscope Commercial	$19.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.86
Rate for Payer: PHP Commercial	$18.86
Rate for Payer: Priority Health Cigna Priority Health	$14.42
Rate for Payer: Priority Health SBD	$13.98

MICONAZOLE NITRATE 2 % TOPICAL POWDER

Facility

$22.19

Service Code	NDC 53329016979
Hospital Charge Code	10599
Hospital Revenue Code	637
Min. Negotiated Rate	$13.98
Max. Negotiated Rate	$19.97
Rate for Payer: Aetna Commercial	$18.86
Rate for Payer: Aetna New Business (MI Preferred)	$14.42
Rate for Payer: Cash Price	$17.75
Rate for Payer: Cofinity Commercial	$15.53
Rate for Payer: Cofinity Commercial	$19.08
Rate for Payer: Cofinity Medicare Advantage	$15.53
Rate for Payer: Encore Health Key Benefits Commercial	$17.75
Rate for Payer: Healthscope Commercial	$19.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.86
Rate for Payer: PHP Commercial	$18.86
Rate for Payer: Priority Health Cigna Priority Health	$14.42
Rate for Payer: Priority Health SBD	$13.98

MICONAZOLE NITRATE 2 % TOPICAL POWDER

Facility

$27.97

Service Code	NDC 11701003816
Hospital Charge Code	10599
Hospital Revenue Code	637
Min. Negotiated Rate	$11.19
Max. Negotiated Rate	$25.17
Rate for Payer: Aetna Commercial	$23.77
Rate for Payer: Aetna Medicare	$13.98
Rate for Payer: Aetna New Business (MI Preferred)	$18.18
Rate for Payer: BCBS Complete	$11.19
Rate for Payer: Cash Price	$22.38
Rate for Payer: Cofinity Commercial	$19.58
Rate for Payer: Cofinity Commercial	$24.05
Rate for Payer: Cofinity Medicare Advantage	$19.58
Rate for Payer: Encore Health Key Benefits Commercial	$22.38
Rate for Payer: Healthscope Commercial	$25.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.77
Rate for Payer: PHP Commercial	$23.77
Rate for Payer: Priority Health Cigna Priority Health	$18.18
Rate for Payer: Priority Health SBD	$17.62

MICONAZOLE NITRATE 2 % VAGINAL CREAM

Facility

$17.42

Service Code	NDC 51672203506
Hospital Charge Code	5040
Hospital Revenue Code	637
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$15.68
Rate for Payer: Aetna Commercial	$14.81
Rate for Payer: Aetna Medicare	$8.71
Rate for Payer: Aetna New Business (MI Preferred)	$11.32
Rate for Payer: BCBS Complete	$6.97
Rate for Payer: Cash Price	$13.94
Rate for Payer: Cofinity Commercial	$12.19
Rate for Payer: Cofinity Commercial	$14.98
Rate for Payer: Cofinity Medicare Advantage	$12.19
Rate for Payer: Encore Health Key Benefits Commercial	$13.94
Rate for Payer: Healthscope Commercial	$15.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.81
Rate for Payer: PHP Commercial	$14.81
Rate for Payer: Priority Health Cigna Priority Health	$11.32
Rate for Payer: Priority Health SBD	$10.97

MICONAZOLE NITRATE 2 % VAGINAL CREAM

Facility

$17.42

Service Code	NDC 51672203506
Hospital Charge Code	5040
Hospital Revenue Code	637
Min. Negotiated Rate	$10.97
Max. Negotiated Rate	$15.68
Rate for Payer: Aetna Commercial	$14.81
Rate for Payer: Aetna New Business (MI Preferred)	$11.32
Rate for Payer: Cash Price	$13.94
Rate for Payer: Cofinity Commercial	$12.19
Rate for Payer: Cofinity Commercial	$14.98
Rate for Payer: Cofinity Medicare Advantage	$12.19
Rate for Payer: Encore Health Key Benefits Commercial	$13.94
Rate for Payer: Healthscope Commercial	$15.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.81
Rate for Payer: PHP Commercial	$14.81
Rate for Payer: Priority Health Cigna Priority Health	$11.32
Rate for Payer: Priority Health SBD	$10.97

MICRODERMABRASION

Professional

Both

$102.00

Service Code	HCPCS 00173
Hospital Revenue Code	960
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$66.30
Rate for Payer: Aetna Medicare	$51.00
Rate for Payer: BCBS Complete	$40.80
Rate for Payer: Cash Price	$81.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$66.30
Rate for Payer: Priority Health Cigna Priority Health	$66.30

MICRO NEEDLING

Professional

Both

$204.00

Service Code	HCPCS 00171
Hospital Revenue Code	960
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$132.60
Rate for Payer: Aetna Medicare	$102.00
Rate for Payer: BCBS Complete	$81.60
Rate for Payer: Cash Price	$163.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$132.60
Rate for Payer: Priority Health Cigna Priority Health	$132.60

MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP

Facility

$38.71

Service Code	NDC 60687057640
Hospital Charge Code	120031
Hospital Revenue Code	637
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$34.84
Rate for Payer: Aetna Commercial	$32.90
Rate for Payer: Aetna Medicare	$19.36
Rate for Payer: Aetna New Business (MI Preferred)	$25.16
Rate for Payer: BCBS Complete	$15.48
Rate for Payer: Cash Price	$30.97
Rate for Payer: Cofinity Commercial	$27.10
Rate for Payer: Cofinity Commercial	$33.29
Rate for Payer: Cofinity Medicare Advantage	$27.10
Rate for Payer: Encore Health Key Benefits Commercial	$30.97
Rate for Payer: Healthscope Commercial	$34.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$32.90
Rate for Payer: PHP Commercial	$32.90
Rate for Payer: Priority Health Cigna Priority Health	$25.16
Rate for Payer: Priority Health SBD	$24.39

MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP

Facility

$38.71

Service Code	NDC 60687057686
Hospital Charge Code	120031
Hospital Revenue Code	637
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$34.84
Rate for Payer: Aetna Commercial	$32.90
Rate for Payer: Aetna Medicare	$19.36
Rate for Payer: Aetna New Business (MI Preferred)	$25.16
Rate for Payer: BCBS Complete	$15.48
Rate for Payer: Cash Price	$30.97
Rate for Payer: Cofinity Commercial	$27.10
Rate for Payer: Cofinity Commercial	$33.29
Rate for Payer: Cofinity Medicare Advantage	$27.10
Rate for Payer: Encore Health Key Benefits Commercial	$30.97
Rate for Payer: Healthscope Commercial	$34.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$32.90
Rate for Payer: PHP Commercial	$32.90
Rate for Payer: Priority Health Cigna Priority Health	$25.16
Rate for Payer: Priority Health SBD	$24.39

MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP

Facility

$38.71

Service Code	NDC 60687057686
Hospital Charge Code	120031
Hospital Revenue Code	637
Min. Negotiated Rate	$24.39
Max. Negotiated Rate	$34.84
Rate for Payer: Aetna Commercial	$32.90
Rate for Payer: Aetna New Business (MI Preferred)	$25.16
Rate for Payer: Cash Price	$30.97
Rate for Payer: Cofinity Commercial	$27.10
Rate for Payer: Cofinity Commercial	$33.29
Rate for Payer: Cofinity Medicare Advantage	$27.10
Rate for Payer: Encore Health Key Benefits Commercial	$30.97
Rate for Payer: Healthscope Commercial	$34.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$32.90
Rate for Payer: PHP Commercial	$32.90
Rate for Payer: Priority Health Cigna Priority Health	$25.16
Rate for Payer: Priority Health SBD	$24.39

MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP

Facility

$38.71

Service Code	NDC 60687057640
Hospital Charge Code	120031
Hospital Revenue Code	637
Min. Negotiated Rate	$24.39
Max. Negotiated Rate	$34.84
Rate for Payer: Aetna Commercial	$32.90
Rate for Payer: Aetna New Business (MI Preferred)	$25.16
Rate for Payer: Cash Price	$30.97
Rate for Payer: Cofinity Commercial	$27.10
Rate for Payer: Cofinity Commercial	$33.29
Rate for Payer: Cofinity Medicare Advantage	$27.10
Rate for Payer: Encore Health Key Benefits Commercial	$30.97
Rate for Payer: Healthscope Commercial	$34.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$32.90
Rate for Payer: PHP Commercial	$32.90
Rate for Payer: Priority Health Cigna Priority Health	$25.16
Rate for Payer: Priority Health SBD	$24.39

MIDAZOLAM 1 MG/ML INJECTION SOLUTION

Facility

$15.23

Service Code	HCPCS J2250
Hospital Charge Code	10607
Hospital Revenue Code	636
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$13.71
Rate for Payer: Aetna Commercial	$12.95
Rate for Payer: Aetna Commercial	$9.92
Rate for Payer: Aetna Commercial	$13.16
Rate for Payer: Aetna Commercial	$9.23
Rate for Payer: Aetna Medicare	$7.74
Rate for Payer: Aetna Medicare	$7.62
Rate for Payer: Aetna Medicare	$5.83
Rate for Payer: Aetna Medicare	$5.43
Rate for Payer: Aetna New Business (MI Preferred)	$9.90
Rate for Payer: Aetna New Business (MI Preferred)	$7.06
Rate for Payer: Aetna New Business (MI Preferred)	$7.59
Rate for Payer: Aetna New Business (MI Preferred)	$10.06
Rate for Payer: BCBS Complete	$4.34
Rate for Payer: BCBS Complete	$6.19
Rate for Payer: BCBS Complete	$4.67
Rate for Payer: BCBS Complete	$6.09
Rate for Payer: Cash Price	$12.38
Rate for Payer: Cash Price	$9.34
Rate for Payer: Cash Price	$12.18
Rate for Payer: Cash Price	$8.69
Rate for Payer: Cofinity Commercial	$8.17
Rate for Payer: Cofinity Commercial	$13.31
Rate for Payer: Cofinity Commercial	$10.66
Rate for Payer: Cofinity Commercial	$10.84
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$7.60
Rate for Payer: Cofinity Commercial	$9.34
Rate for Payer: Cofinity Commercial	$10.04
Rate for Payer: Cofinity Medicare Advantage	$10.66
Rate for Payer: Cofinity Medicare Advantage	$7.60
Rate for Payer: Cofinity Medicare Advantage	$8.17
Rate for Payer: Cofinity Medicare Advantage	$10.84
Rate for Payer: Encore Health Key Benefits Commercial	$12.18
Rate for Payer: Encore Health Key Benefits Commercial	$12.38
Rate for Payer: Encore Health Key Benefits Commercial	$8.69
Rate for Payer: Encore Health Key Benefits Commercial	$9.34
Rate for Payer: Healthscope Commercial	$9.77
Rate for Payer: Healthscope Commercial	$13.93
Rate for Payer: Healthscope Commercial	$10.50
Rate for Payer: Healthscope Commercial	$13.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.23
Rate for Payer: PHP Commercial	$9.92
Rate for Payer: PHP Commercial	$13.16
Rate for Payer: PHP Commercial	$12.95
Rate for Payer: PHP Commercial	$9.23
Rate for Payer: Priority Health Cigna Priority Health	$7.59
Rate for Payer: Priority Health Cigna Priority Health	$9.90
Rate for Payer: Priority Health Cigna Priority Health	$7.06
Rate for Payer: Priority Health Cigna Priority Health	$10.06
Rate for Payer: Priority Health SBD	$6.84
Rate for Payer: Priority Health SBD	$9.59
Rate for Payer: Priority Health SBD	$7.35
Rate for Payer: Priority Health SBD	$9.75

MIDAZOLAM 1 MG/ML INJECTION SOLUTION

Facility

$15.23

Service Code	HCPCS J2250
Hospital Charge Code	10607
Hospital Revenue Code	636
Min. Negotiated Rate	$9.59
Max. Negotiated Rate	$13.71
Rate for Payer: Aetna Commercial	$12.95
Rate for Payer: Aetna Commercial	$13.16
Rate for Payer: Aetna Commercial	$9.23
Rate for Payer: Aetna Commercial	$9.92
Rate for Payer: Aetna New Business (MI Preferred)	$7.06
Rate for Payer: Aetna New Business (MI Preferred)	$9.90
Rate for Payer: Aetna New Business (MI Preferred)	$7.59
Rate for Payer: Aetna New Business (MI Preferred)	$10.06
Rate for Payer: Cash Price	$9.34
Rate for Payer: Cash Price	$8.69
Rate for Payer: Cash Price	$12.18
Rate for Payer: Cash Price	$12.38
Rate for Payer: Cofinity Commercial	$7.60
Rate for Payer: Cofinity Commercial	$9.34
Rate for Payer: Cofinity Commercial	$13.10
Rate for Payer: Cofinity Commercial	$10.04
Rate for Payer: Cofinity Commercial	$8.17
Rate for Payer: Cofinity Commercial	$10.66
Rate for Payer: Cofinity Commercial	$13.31
Rate for Payer: Cofinity Commercial	$10.84
Rate for Payer: Cofinity Medicare Advantage	$10.84
Rate for Payer: Cofinity Medicare Advantage	$10.66
Rate for Payer: Cofinity Medicare Advantage	$7.60
Rate for Payer: Cofinity Medicare Advantage	$8.17
Rate for Payer: Encore Health Key Benefits Commercial	$8.69
Rate for Payer: Encore Health Key Benefits Commercial	$9.34
Rate for Payer: Encore Health Key Benefits Commercial	$12.18
Rate for Payer: Encore Health Key Benefits Commercial	$12.38
Rate for Payer: Healthscope Commercial	$13.71
Rate for Payer: Healthscope Commercial	$10.50
Rate for Payer: Healthscope Commercial	$9.77
Rate for Payer: Healthscope Commercial	$13.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.92
Rate for Payer: PHP Commercial	$9.92
Rate for Payer: PHP Commercial	$9.23
Rate for Payer: PHP Commercial	$13.16
Rate for Payer: PHP Commercial	$12.95
Rate for Payer: Priority Health Cigna Priority Health	$10.06
Rate for Payer: Priority Health Cigna Priority Health	$7.06
Rate for Payer: Priority Health Cigna Priority Health	$7.59
Rate for Payer: Priority Health Cigna Priority Health	$9.90
Rate for Payer: Priority Health SBD	$6.84
Rate for Payer: Priority Health SBD	$9.59
Rate for Payer: Priority Health SBD	$7.35
Rate for Payer: Priority Health SBD	$9.75

MIDAZOLAM 2 MG/ML ORAL SYRUP

Facility

$809.48

Service Code	NDC 00054356699
Hospital Charge Code	24176
Hospital Revenue Code	250
Min. Negotiated Rate	$509.97
Max. Negotiated Rate	$728.53
Rate for Payer: Aetna Commercial	$688.06
Rate for Payer: Aetna New Business (MI Preferred)	$526.16
Rate for Payer: Cash Price	$647.58
Rate for Payer: Cofinity Commercial	$566.64
Rate for Payer: Cofinity Commercial	$696.15
Rate for Payer: Cofinity Medicare Advantage	$566.64
Rate for Payer: Encore Health Key Benefits Commercial	$647.58
Rate for Payer: Healthscope Commercial	$728.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$688.06
Rate for Payer: PHP Commercial	$688.06
Rate for Payer: Priority Health Cigna Priority Health	$526.16
Rate for Payer: Priority Health SBD	$509.97

MIDAZOLAM 2 MG/ML ORAL SYRUP

Facility

$44.37

Service Code	NDC 09999001903
Hospital Charge Code	24176
Hospital Revenue Code	250
Min. Negotiated Rate	$27.95
Max. Negotiated Rate	$39.93
Rate for Payer: Aetna Commercial	$37.71
Rate for Payer: Aetna New Business (MI Preferred)	$28.84
Rate for Payer: Cash Price	$35.50
Rate for Payer: Cofinity Commercial	$31.06
Rate for Payer: Cofinity Commercial	$38.16
Rate for Payer: Cofinity Medicare Advantage	$31.06
Rate for Payer: Encore Health Key Benefits Commercial	$35.50
Rate for Payer: Healthscope Commercial	$39.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.71
Rate for Payer: PHP Commercial	$37.71
Rate for Payer: Priority Health Cigna Priority Health	$28.84
Rate for Payer: Priority Health SBD	$27.95

MIDAZOLAM 2 MG/ML ORAL SYRUP

Facility

$809.48

Service Code	NDC 00054356699
Hospital Charge Code	24176
Hospital Revenue Code	250
Min. Negotiated Rate	$323.79
Max. Negotiated Rate	$728.53
Rate for Payer: Aetna Commercial	$688.06
Rate for Payer: Aetna Medicare	$404.74
Rate for Payer: Aetna New Business (MI Preferred)	$526.16
Rate for Payer: BCBS Complete	$323.79
Rate for Payer: Cash Price	$647.58
Rate for Payer: Cofinity Commercial	$566.64
Rate for Payer: Cofinity Commercial	$696.15
Rate for Payer: Cofinity Medicare Advantage	$566.64
Rate for Payer: Encore Health Key Benefits Commercial	$647.58
Rate for Payer: Healthscope Commercial	$728.53
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$688.06
Rate for Payer: PHP Commercial	$688.06
Rate for Payer: Priority Health Cigna Priority Health	$526.16
Rate for Payer: Priority Health SBD	$509.97

MIDAZOLAM 2 MG/ML ORAL SYRUP

Facility

$44.37

Service Code	NDC 09999001903
Hospital Charge Code	24176
Hospital Revenue Code	250
Min. Negotiated Rate	$17.75
Max. Negotiated Rate	$39.93
Rate for Payer: Aetna Commercial	$37.71
Rate for Payer: Aetna Medicare	$22.18
Rate for Payer: Aetna New Business (MI Preferred)	$28.84
Rate for Payer: BCBS Complete	$17.75
Rate for Payer: Cash Price	$35.50
Rate for Payer: Cofinity Commercial	$31.06
Rate for Payer: Cofinity Commercial	$38.16
Rate for Payer: Cofinity Medicare Advantage	$31.06
Rate for Payer: Encore Health Key Benefits Commercial	$35.50
Rate for Payer: Healthscope Commercial	$39.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$37.71
Rate for Payer: PHP Commercial	$37.71
Rate for Payer: Priority Health Cigna Priority Health	$28.84
Rate for Payer: Priority Health SBD	$27.95

Know your out-of-pocket cost for care.

All Charges