|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$452.20
|
|
|
Service Code
|
NDC 00904681861
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.89 |
| Max. Negotiated Rate |
$406.98 |
| Rate for Payer: Aetna Commercial |
$384.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.93
|
| Rate for Payer: Cash Price |
$361.76
|
| Rate for Payer: Cofinity Advantage |
$316.54
|
| Rate for Payer: Cofinity Commercial |
$388.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.76
|
| Rate for Payer: Healthscope Commercial |
$406.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.15
|
| Rate for Payer: PHP Commercial |
$384.37
|
| Rate for Payer: Priority Health SBD |
$284.89
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$317.76
|
|
|
Service Code
|
NDC 51079045320
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.88 |
| Max. Negotiated Rate |
$285.98 |
| Rate for Payer: Aetna Commercial |
$270.10
|
| Rate for Payer: Aetna Medicare |
$158.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.54
|
| Rate for Payer: BCBS Complete |
$127.10
|
| Rate for Payer: Cash Price |
$254.21
|
| Rate for Payer: Cofinity Advantage |
$222.43
|
| Rate for Payer: Cofinity Commercial |
$273.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.21
|
| Rate for Payer: Healthscope Commercial |
$285.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.32
|
| Rate for Payer: PHP Commercial |
$270.10
|
| Rate for Payer: Priority Health SBD |
$200.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.54
|
| Rate for Payer: UHC Core |
$165.55
|
| Rate for Payer: UHC Exchange |
$124.88
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$3.18
|
|
|
Service Code
|
NDC 51079045301
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Aetna Medicare |
$1.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.07
|
| Rate for Payer: BCBS Complete |
$1.27
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cofinity Advantage |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$2.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.54
|
| Rate for Payer: Healthscope Commercial |
$2.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.38
|
| Rate for Payer: PHP Commercial |
$2.70
|
| Rate for Payer: Priority Health SBD |
$2.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.07
|
| Rate for Payer: UHC Core |
$1.66
|
| Rate for Payer: UHC Exchange |
$1.25
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$2.92
|
|
|
Service Code
|
NDC 60687039811
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Aetna Commercial |
$2.48
|
| Rate for Payer: Aetna Medicare |
$1.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.90
|
| Rate for Payer: BCBS Complete |
$1.17
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cofinity Advantage |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.34
|
| Rate for Payer: Healthscope Commercial |
$2.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.19
|
| Rate for Payer: PHP Commercial |
$2.48
|
| Rate for Payer: Priority Health SBD |
$1.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.90
|
| Rate for Payer: UHC Core |
$1.52
|
| Rate for Payer: UHC Exchange |
$1.15
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$327.36
|
|
|
Service Code
|
NDC 60505132101
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.65 |
| Max. Negotiated Rate |
$294.62 |
| Rate for Payer: Aetna Commercial |
$278.26
|
| Rate for Payer: Aetna Medicare |
$163.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.78
|
| Rate for Payer: BCBS Complete |
$130.94
|
| Rate for Payer: Cash Price |
$261.89
|
| Rate for Payer: Cofinity Advantage |
$229.15
|
| Rate for Payer: Cofinity Commercial |
$281.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.89
|
| Rate for Payer: Healthscope Commercial |
$294.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.52
|
| Rate for Payer: PHP Commercial |
$278.26
|
| Rate for Payer: Priority Health SBD |
$206.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.78
|
| Rate for Payer: UHC Core |
$170.55
|
| Rate for Payer: UHC Exchange |
$128.65
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$318.25
|
|
|
Service Code
|
NDC 00245021211
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.50 |
| Max. Negotiated Rate |
$286.43 |
| Rate for Payer: Aetna Commercial |
$270.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.86
|
| Rate for Payer: Cash Price |
$254.60
|
| Rate for Payer: Cofinity Advantage |
$222.78
|
| Rate for Payer: Cofinity Commercial |
$273.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.60
|
| Rate for Payer: Healthscope Commercial |
$286.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.69
|
| Rate for Payer: PHP Commercial |
$270.51
|
| Rate for Payer: Priority Health SBD |
$200.50
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$291.36
|
|
|
Service Code
|
NDC 60687039801
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.56 |
| Max. Negotiated Rate |
$262.22 |
| Rate for Payer: Aetna Commercial |
$247.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.38
|
| Rate for Payer: Cash Price |
$233.09
|
| Rate for Payer: Cofinity Advantage |
$203.95
|
| Rate for Payer: Cofinity Commercial |
$250.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.09
|
| Rate for Payer: Healthscope Commercial |
$262.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.52
|
| Rate for Payer: PHP Commercial |
$247.66
|
| Rate for Payer: Priority Health SBD |
$183.56
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$3.87
|
|
|
Service Code
|
NDC 00245021289
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Advantage |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.90
|
| Rate for Payer: PHP Commercial |
$3.29
|
| Rate for Payer: Priority Health SBD |
$2.44
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$291.36
|
|
|
Service Code
|
NDC 60687039801
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.50 |
| Max. Negotiated Rate |
$262.22 |
| Rate for Payer: Aetna Commercial |
$247.66
|
| Rate for Payer: Aetna Medicare |
$145.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.38
|
| Rate for Payer: BCBS Complete |
$116.54
|
| Rate for Payer: Cash Price |
$233.09
|
| Rate for Payer: Cofinity Advantage |
$203.95
|
| Rate for Payer: Cofinity Commercial |
$250.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.09
|
| Rate for Payer: Healthscope Commercial |
$262.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$233.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.52
|
| Rate for Payer: PHP Commercial |
$247.66
|
| Rate for Payer: Priority Health SBD |
$183.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.38
|
| Rate for Payer: UHC Core |
$151.80
|
| Rate for Payer: UHC Exchange |
$114.50
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$326.65
|
|
|
Service Code
|
NDC 70756004911
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.37 |
| Max. Negotiated Rate |
$293.99 |
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: Aetna Medicare |
$163.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.32
|
| Rate for Payer: BCBS Complete |
$130.66
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Advantage |
$228.66
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$293.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.99
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health SBD |
$205.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.32
|
| Rate for Payer: UHC Core |
$170.18
|
| Rate for Payer: UHC Exchange |
$128.37
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$327.36
|
|
|
Service Code
|
NDC 60505132101
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$206.24 |
| Max. Negotiated Rate |
$294.62 |
| Rate for Payer: Aetna Commercial |
$278.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.78
|
| Rate for Payer: Cash Price |
$261.89
|
| Rate for Payer: Cofinity Advantage |
$229.15
|
| Rate for Payer: Cofinity Commercial |
$281.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.89
|
| Rate for Payer: Healthscope Commercial |
$294.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.52
|
| Rate for Payer: PHP Commercial |
$278.26
|
| Rate for Payer: Priority Health SBD |
$206.24
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$452.20
|
|
|
Service Code
|
NDC 00904681861
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.71 |
| Max. Negotiated Rate |
$406.98 |
| Rate for Payer: Aetna Commercial |
$384.37
|
| Rate for Payer: Aetna Medicare |
$226.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.93
|
| Rate for Payer: BCBS Complete |
$180.88
|
| Rate for Payer: Cash Price |
$361.76
|
| Rate for Payer: Cofinity Advantage |
$316.54
|
| Rate for Payer: Cofinity Commercial |
$388.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.76
|
| Rate for Payer: Healthscope Commercial |
$406.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$361.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.15
|
| Rate for Payer: PHP Commercial |
$384.37
|
| Rate for Payer: Priority Health SBD |
$284.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$293.93
|
| Rate for Payer: UHC Core |
$235.60
|
| Rate for Payer: UHC Exchange |
$177.71
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$3.18
|
|
|
Service Code
|
NDC 51079045301
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.07
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cofinity Advantage |
$2.23
|
| Rate for Payer: Cofinity Commercial |
$2.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.54
|
| Rate for Payer: Healthscope Commercial |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.38
|
| Rate for Payer: PHP Commercial |
$2.70
|
| Rate for Payer: Priority Health SBD |
$2.00
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$318.25
|
|
|
Service Code
|
NDC 00245021211
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.07 |
| Max. Negotiated Rate |
$286.43 |
| Rate for Payer: Aetna Commercial |
$270.51
|
| Rate for Payer: Aetna Medicare |
$159.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.86
|
| Rate for Payer: BCBS Complete |
$127.30
|
| Rate for Payer: Cash Price |
$254.60
|
| Rate for Payer: Cofinity Advantage |
$222.78
|
| Rate for Payer: Cofinity Commercial |
$273.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.60
|
| Rate for Payer: Healthscope Commercial |
$286.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.69
|
| Rate for Payer: PHP Commercial |
$270.51
|
| Rate for Payer: Priority Health SBD |
$200.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.86
|
| Rate for Payer: UHC Core |
$165.81
|
| Rate for Payer: UHC Exchange |
$125.07
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$386.88
|
|
|
Service Code
|
NDC 00245021201
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.04 |
| Max. Negotiated Rate |
$348.19 |
| Rate for Payer: Aetna Commercial |
$328.85
|
| Rate for Payer: Aetna Medicare |
$193.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.47
|
| Rate for Payer: BCBS Complete |
$154.75
|
| Rate for Payer: Cash Price |
$309.50
|
| Rate for Payer: Cofinity Advantage |
$270.82
|
| Rate for Payer: Cofinity Commercial |
$332.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.50
|
| Rate for Payer: Healthscope Commercial |
$348.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$309.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.16
|
| Rate for Payer: PHP Commercial |
$328.85
|
| Rate for Payer: Priority Health SBD |
$243.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.47
|
| Rate for Payer: UHC Core |
$201.56
|
| Rate for Payer: UHC Exchange |
$152.04
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$2.92
|
|
|
Service Code
|
NDC 60687039811
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Aetna Commercial |
$2.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.90
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cofinity Advantage |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.34
|
| Rate for Payer: Healthscope Commercial |
$2.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.19
|
| Rate for Payer: PHP Commercial |
$2.48
|
| Rate for Payer: Priority Health SBD |
$1.84
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$317.76
|
|
|
Service Code
|
NDC 51079045320
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.19 |
| Max. Negotiated Rate |
$285.98 |
| Rate for Payer: Aetna Commercial |
$270.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.54
|
| Rate for Payer: Cash Price |
$254.21
|
| Rate for Payer: Cofinity Advantage |
$222.43
|
| Rate for Payer: Cofinity Commercial |
$273.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.21
|
| Rate for Payer: Healthscope Commercial |
$285.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.32
|
| Rate for Payer: PHP Commercial |
$270.10
|
| Rate for Payer: Priority Health SBD |
$200.19
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$3.87
|
|
|
Service Code
|
NDC 00245021289
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Aetna Medicare |
$1.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Advantage |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.90
|
| Rate for Payer: PHP Commercial |
$3.29
|
| Rate for Payer: Priority Health SBD |
$2.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.52
|
| Rate for Payer: UHC Core |
$2.02
|
| Rate for Payer: UHC Exchange |
$1.52
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$386.88
|
|
|
Service Code
|
NDC 00245021201
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$243.73 |
| Max. Negotiated Rate |
$348.19 |
| Rate for Payer: Aetna Commercial |
$328.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.47
|
| Rate for Payer: Cash Price |
$309.50
|
| Rate for Payer: Cofinity Advantage |
$270.82
|
| Rate for Payer: Cofinity Commercial |
$332.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.50
|
| Rate for Payer: Healthscope Commercial |
$348.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.16
|
| Rate for Payer: PHP Commercial |
$328.85
|
| Rate for Payer: Priority Health SBD |
$243.73
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$326.65
|
|
|
Service Code
|
NDC 70756004911
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.79 |
| Max. Negotiated Rate |
$293.99 |
| Rate for Payer: Aetna Commercial |
$277.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.32
|
| Rate for Payer: Cash Price |
$261.32
|
| Rate for Payer: Cofinity Advantage |
$228.66
|
| Rate for Payer: Cofinity Commercial |
$280.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.32
|
| Rate for Payer: Healthscope Commercial |
$293.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$277.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$244.99
|
| Rate for Payer: PHP Commercial |
$277.65
|
| Rate for Payer: Priority Health SBD |
$205.79
|
|
|
MIGRAINE AND OTHER HEADACHES
|
Facility
|
IP
|
$6,705.32
|
|
|
Service Code
|
APR-DRG 0543
|
| Min. Negotiated Rate |
$6,386.02 |
| Max. Negotiated Rate |
$6,705.32 |
| Rate for Payer: BCBS Complete |
$6,705.32
|
| Rate for Payer: Mclaren Medicaid |
$6,386.02
|
| Rate for Payer: Meridian Medicaid |
$6,705.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,386.02
|
| Rate for Payer: UHC Medicaid |
$6,386.02
|
| Rate for Payer: UHCCP Medicaid |
$6,386.02
|
|
|
MIGRAINE AND OTHER HEADACHES
|
Facility
|
IP
|
$4,229.81
|
|
|
Service Code
|
APR-DRG 0541
|
| Min. Negotiated Rate |
$4,028.39 |
| Max. Negotiated Rate |
$4,229.81 |
| Rate for Payer: BCBS Complete |
$4,229.81
|
| Rate for Payer: Mclaren Medicaid |
$4,028.39
|
| Rate for Payer: Meridian Medicaid |
$4,229.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,028.39
|
| Rate for Payer: UHC Medicaid |
$4,028.39
|
| Rate for Payer: UHCCP Medicaid |
$4,028.39
|
|
|
MIGRAINE AND OTHER HEADACHES
|
Facility
|
IP
|
$10,240.28
|
|
|
Service Code
|
APR-DRG 0544
|
| Min. Negotiated Rate |
$9,752.65 |
| Max. Negotiated Rate |
$10,240.28 |
| Rate for Payer: BCBS Complete |
$10,240.28
|
| Rate for Payer: Mclaren Medicaid |
$9,752.65
|
| Rate for Payer: Meridian Medicaid |
$10,240.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,752.65
|
| Rate for Payer: UHC Medicaid |
$9,752.65
|
| Rate for Payer: UHCCP Medicaid |
$9,752.65
|
|
|
MIGRAINE AND OTHER HEADACHES
|
Facility
|
IP
|
$5,210.72
|
|
|
Service Code
|
APR-DRG 0542
|
| Min. Negotiated Rate |
$4,962.59 |
| Max. Negotiated Rate |
$5,210.72 |
| Rate for Payer: BCBS Complete |
$5,210.72
|
| Rate for Payer: Mclaren Medicaid |
$4,962.59
|
| Rate for Payer: Meridian Medicaid |
$5,210.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,962.59
|
| Rate for Payer: UHC Medicaid |
$4,962.59
|
| Rate for Payer: UHCCP Medicaid |
$4,962.59
|
|
|
MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK
|
Facility
|
OP
|
$52.64
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
14961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$47.38 |
| Rate for Payer: Aetna Commercial |
$44.74
|
| Rate for Payer: Aetna Commercial |
$56.19
|
| Rate for Payer: Aetna Commercial |
$79.59
|
| Rate for Payer: Aetna Medicare |
$26.32
|
| Rate for Payer: Aetna Medicare |
$33.05
|
| Rate for Payer: Aetna Medicare |
$46.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.87
|
| Rate for Payer: BCBS Complete |
$37.46
|
| Rate for Payer: BCBS Complete |
$21.06
|
| Rate for Payer: BCBS Complete |
$26.44
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cash Price |
$42.11
|
| Rate for Payer: Cash Price |
$42.11
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cash Price |
$74.91
|
| Rate for Payer: Cash Price |
$52.88
|
| Rate for Payer: Cofinity Advantage |
$46.27
|
| Rate for Payer: Cofinity Advantage |
$36.85
|
| Rate for Payer: Cofinity Advantage |
$65.55
|
| Rate for Payer: Cofinity Commercial |
$45.27
|
| Rate for Payer: Cofinity Commercial |
$56.85
|
| Rate for Payer: Cofinity Commercial |
$80.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.11
|
| Rate for Payer: Healthscope Commercial |
$84.28
|
| Rate for Payer: Healthscope Commercial |
$59.49
|
| Rate for Payer: Healthscope Commercial |
$47.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$42.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.23
|
| Rate for Payer: PHP Commercial |
$44.74
|
| Rate for Payer: PHP Commercial |
$56.19
|
| Rate for Payer: PHP Commercial |
$79.59
|
| Rate for Payer: Priority Health SBD |
$33.16
|
| Rate for Payer: Priority Health SBD |
$58.99
|
| Rate for Payer: Priority Health SBD |
$41.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.23
|
| Rate for Payer: UHC Core |
$2.23
|
| Rate for Payer: UHC Core |
$2.23
|
| Rate for Payer: UHC Core |
$2.23
|
| Rate for Payer: UHC Exchange |
$2.23
|
| Rate for Payer: UHC Exchange |
$2.23
|
| Rate for Payer: UHC Exchange |
$2.23
|
|
