|
MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$14.43
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
168786
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$12.99 |
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Commercial |
$11.72
|
| Rate for Payer: Aetna Commercial |
$12.43
|
| Rate for Payer: BCBS Trust/PPO |
$11.92
|
| Rate for Payer: BCBS Trust/PPO |
$12.07
|
| Rate for Payer: BCBS Trust/PPO |
$11.52
|
| Rate for Payer: BCBS Trust/PPO |
$11.39
|
| Rate for Payer: BCN Commercial |
$11.92
|
| Rate for Payer: BCN Commercial |
$11.39
|
| Rate for Payer: BCN Commercial |
$12.07
|
| Rate for Payer: BCN Commercial |
$11.52
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.03
|
| Rate for Payer: Cofinity Commercial |
$11.86
|
| Rate for Payer: Cofinity Commercial |
$12.57
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.70
|
| Rate for Payer: Healthscope Commercial |
$13.16
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$12.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.43
|
| Rate for Payer: Nomi Health Commercial |
$11.31
|
| Rate for Payer: Nomi Health Commercial |
$11.44
|
| Rate for Payer: Nomi Health Commercial |
$11.99
|
| Rate for Payer: Nomi Health Commercial |
$11.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.96
|
| Rate for Payer: PHP Commercial |
$12.43
|
| Rate for Payer: PHP Commercial |
$11.72
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.70
|
| Rate for Payer: UHC Core |
$12.05
|
| Rate for Payer: UHC Core |
$12.21
|
| Rate for Payer: UHC Core |
$11.65
|
| Rate for Payer: UHC Core |
$11.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.82
|
|
|
MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$15.49
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
168785
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.73 |
| Max. Negotiated Rate |
$13.94 |
| Rate for Payer: Aetna Commercial |
$13.17
|
| Rate for Payer: Aetna Medicare |
$4.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.84
|
| Rate for Payer: BCBS Complete |
$2.87
|
| Rate for Payer: BCBS MAPPO |
$3.87
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCN Commercial |
$12.73
|
| Rate for Payer: BCN Medicare Advantage |
$3.87
|
| Rate for Payer: Cash Price |
$12.39
|
| Rate for Payer: Cofinity Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.87
|
| Rate for Payer: Healthscope Commercial |
$13.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.62
|
| Rate for Payer: Mclaren Medicaid |
$2.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.07
|
| Rate for Payer: Meridian Medicaid |
$2.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.17
|
| Rate for Payer: Nomi Health Commercial |
$12.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.62
|
| Rate for Payer: PACE Senior Care Partners |
$3.68
|
| Rate for Payer: PACE SWMI |
$3.87
|
| Rate for Payer: PHP Commercial |
$13.17
|
| Rate for Payer: PHP Medicare Advantage |
$3.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.48
|
| Rate for Payer: Priority Health Medicare |
$3.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.78
|
| Rate for Payer: Railroad Medicare Medicare |
$3.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.63
|
| Rate for Payer: UHC Core |
$12.93
|
| Rate for Payer: UHC Exchange |
$3.87
|
| Rate for Payer: UHC Medicaid |
$2.73
|
| Rate for Payer: UHC Medicare Advantage |
$3.87
|
| Rate for Payer: UHCCP Medicaid |
$2.73
|
| Rate for Payer: VA VA |
$3.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.62
|
|
|
MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$15.49
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
168785
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$13.94 |
| Rate for Payer: Aetna Commercial |
$13.17
|
| Rate for Payer: BCBS Trust/PPO |
$12.79
|
| Rate for Payer: BCN Commercial |
$12.79
|
| Rate for Payer: Cash Price |
$12.39
|
| Rate for Payer: Cofinity Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.39
|
| Rate for Payer: Healthscope Commercial |
$13.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.17
|
| Rate for Payer: Nomi Health Commercial |
$12.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.62
|
| Rate for Payer: PHP Commercial |
$13.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$13.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.63
|
| Rate for Payer: UHC Core |
$12.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.62
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$317.76
|
|
|
Service Code
|
NDC 51079045320
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.16 |
| Max. Negotiated Rate |
$285.98 |
| Rate for Payer: Aetna Commercial |
$270.10
|
| Rate for Payer: BCBS Trust/PPO |
$262.44
|
| Rate for Payer: BCN Commercial |
$262.44
|
| Rate for Payer: Cash Price |
$254.21
|
| 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: Lakeland Regional Health Systems Commercial |
$238.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.10
|
| Rate for Payer: Nomi Health Commercial |
$260.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.32
|
| Rate for Payer: PHP Commercial |
$270.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$276.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$221.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.63
|
| Rate for Payer: UHC Core |
$265.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.32
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$452.20
|
|
|
Service Code
|
NDC 00904681861
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.72 |
| Max. Negotiated Rate |
$406.98 |
| Rate for Payer: Aetna Commercial |
$384.37
|
| Rate for Payer: Aetna Medicare |
$117.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$141.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$141.31
|
| Rate for Payer: BCBS Complete |
$83.70
|
| Rate for Payer: BCBS MAPPO |
$113.05
|
| Rate for Payer: BCBS Trust/PPO |
$371.75
|
| Rate for Payer: BCN Commercial |
$371.75
|
| Rate for Payer: BCN Medicare Advantage |
$113.05
|
| Rate for Payer: Cash Price |
$361.76
|
| Rate for Payer: Cofinity Commercial |
$388.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.05
|
| Rate for Payer: Healthscope Commercial |
$406.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$339.15
|
| Rate for Payer: Mclaren Medicaid |
$79.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.70
|
| Rate for Payer: Meridian Medicaid |
$83.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$124.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.37
|
| Rate for Payer: Nomi Health Commercial |
$370.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.15
|
| Rate for Payer: PACE Senior Care Partners |
$107.40
|
| Rate for Payer: PACE SWMI |
$113.05
|
| Rate for Payer: PHP Commercial |
$384.37
|
| Rate for Payer: PHP Medicare Advantage |
$113.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$79.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$393.41
|
| Rate for Payer: Priority Health Medicare |
$114.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$314.73
|
| Rate for Payer: Railroad Medicare Medicare |
$113.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.94
|
| Rate for Payer: UHC Core |
$377.59
|
| Rate for Payer: UHC Exchange |
$113.05
|
| Rate for Payer: UHC Medicaid |
$79.72
|
| Rate for Payer: UHC Medicare Advantage |
$113.05
|
| Rate for Payer: UHCCP Medicaid |
$79.72
|
| Rate for Payer: VA VA |
$113.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.15
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$452.20
|
|
|
Service Code
|
NDC 00904681861
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$314.73 |
| Max. Negotiated Rate |
$406.98 |
| Rate for Payer: Aetna Commercial |
$384.37
|
| Rate for Payer: BCBS Trust/PPO |
$373.47
|
| Rate for Payer: BCN Commercial |
$373.47
|
| Rate for Payer: Cash Price |
$361.76
|
| 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: Lakeland Regional Health Systems Commercial |
$339.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.37
|
| Rate for Payer: Nomi Health Commercial |
$370.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.15
|
| Rate for Payer: PHP Commercial |
$384.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$393.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$314.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$397.94
|
| Rate for Payer: UHC Core |
$377.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$339.15
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$3.18
|
|
|
Service Code
|
NDC 51079045301
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Aetna Medicare |
$0.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.99
|
| Rate for Payer: BCBS Complete |
$0.59
|
| Rate for Payer: BCBS MAPPO |
$0.80
|
| Rate for Payer: BCBS Trust/PPO |
$2.61
|
| Rate for Payer: BCN Commercial |
$2.61
|
| Rate for Payer: BCN Medicare Advantage |
$0.80
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cofinity Commercial |
$2.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.80
|
| Rate for Payer: Healthscope Commercial |
$2.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.38
|
| Rate for Payer: Mclaren Medicaid |
$0.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.83
|
| Rate for Payer: Meridian Medicaid |
$0.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.70
|
| Rate for Payer: Nomi Health Commercial |
$2.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.38
|
| Rate for Payer: PACE Senior Care Partners |
$0.76
|
| Rate for Payer: PACE SWMI |
$0.80
|
| Rate for Payer: PHP Commercial |
$2.70
|
| Rate for Payer: PHP Medicare Advantage |
$0.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.77
|
| Rate for Payer: Priority Health Medicare |
$0.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.21
|
| Rate for Payer: Railroad Medicare Medicare |
$0.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.80
|
| Rate for Payer: UHC Core |
$2.66
|
| Rate for Payer: UHC Exchange |
$0.80
|
| Rate for Payer: UHC Medicaid |
$0.56
|
| Rate for Payer: UHC Medicare Advantage |
$0.80
|
| Rate for Payer: UHCCP Medicaid |
$0.56
|
| Rate for Payer: VA VA |
$0.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.38
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$317.76
|
|
|
Service Code
|
NDC 51079045320
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.02 |
| Max. Negotiated Rate |
$285.98 |
| Rate for Payer: Aetna Commercial |
$270.10
|
| Rate for Payer: Aetna Medicare |
$82.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.30
|
| Rate for Payer: BCBS Complete |
$58.82
|
| Rate for Payer: BCBS MAPPO |
$79.44
|
| Rate for Payer: BCBS Trust/PPO |
$261.23
|
| Rate for Payer: BCN Commercial |
$261.23
|
| Rate for Payer: BCN Medicare Advantage |
$79.44
|
| Rate for Payer: Cash Price |
$254.21
|
| Rate for Payer: Cofinity Commercial |
$273.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.44
|
| Rate for Payer: Healthscope Commercial |
$285.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.32
|
| Rate for Payer: Mclaren Medicaid |
$56.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.41
|
| Rate for Payer: Meridian Medicaid |
$58.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$87.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.10
|
| Rate for Payer: Nomi Health Commercial |
$260.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.32
|
| Rate for Payer: PACE Senior Care Partners |
$75.47
|
| Rate for Payer: PACE SWMI |
$79.44
|
| Rate for Payer: PHP Commercial |
$270.10
|
| Rate for Payer: PHP Medicare Advantage |
$79.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$276.45
|
| Rate for Payer: Priority Health Medicare |
$80.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$221.16
|
| Rate for Payer: Railroad Medicare Medicare |
$79.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.63
|
| Rate for Payer: UHC Core |
$265.33
|
| Rate for Payer: UHC Exchange |
$79.44
|
| Rate for Payer: UHC Medicaid |
$56.02
|
| Rate for Payer: UHC Medicare Advantage |
$79.44
|
| Rate for Payer: UHCCP Medicaid |
$56.02
|
| Rate for Payer: VA VA |
$79.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.32
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$318.25
|
|
|
Service Code
|
NDC 00245021211
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.11 |
| Max. Negotiated Rate |
$286.43 |
| Rate for Payer: Aetna Commercial |
$270.51
|
| Rate for Payer: Aetna Medicare |
$82.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.45
|
| Rate for Payer: BCBS Complete |
$58.91
|
| Rate for Payer: BCBS MAPPO |
$79.56
|
| Rate for Payer: BCBS Trust/PPO |
$261.63
|
| Rate for Payer: BCN Commercial |
$261.63
|
| Rate for Payer: BCN Medicare Advantage |
$79.56
|
| Rate for Payer: Cash Price |
$254.60
|
| Rate for Payer: Cofinity Commercial |
$273.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.56
|
| Rate for Payer: Healthscope Commercial |
$286.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.69
|
| Rate for Payer: Mclaren Medicaid |
$56.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.54
|
| Rate for Payer: Meridian Medicaid |
$58.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$87.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.51
|
| Rate for Payer: Nomi Health Commercial |
$260.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.69
|
| Rate for Payer: PACE Senior Care Partners |
$75.58
|
| Rate for Payer: PACE SWMI |
$79.56
|
| Rate for Payer: PHP Commercial |
$270.51
|
| Rate for Payer: PHP Medicare Advantage |
$79.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$276.88
|
| Rate for Payer: Priority Health Medicare |
$80.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$221.50
|
| Rate for Payer: Railroad Medicare Medicare |
$79.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.06
|
| Rate for Payer: UHC Core |
$265.74
|
| Rate for Payer: UHC Exchange |
$79.56
|
| Rate for Payer: UHC Medicaid |
$56.11
|
| Rate for Payer: UHC Medicare Advantage |
$79.56
|
| Rate for Payer: UHCCP Medicaid |
$56.11
|
| Rate for Payer: VA VA |
$79.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.69
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$318.25
|
|
|
Service Code
|
NDC 00245021211
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$221.50 |
| Max. Negotiated Rate |
$286.43 |
| Rate for Payer: Aetna Commercial |
$270.51
|
| Rate for Payer: BCBS Trust/PPO |
$262.84
|
| Rate for Payer: BCN Commercial |
$262.84
|
| Rate for Payer: Cash Price |
$254.60
|
| 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: Lakeland Regional Health Systems Commercial |
$238.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.51
|
| Rate for Payer: Nomi Health Commercial |
$260.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.69
|
| Rate for Payer: PHP Commercial |
$270.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$276.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$221.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.06
|
| Rate for Payer: UHC Core |
$265.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.69
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$3.18
|
|
|
Service Code
|
NDC 51079045301
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: BCBS Trust/PPO |
$2.63
|
| Rate for Payer: BCN Commercial |
$2.63
|
| Rate for Payer: Cash Price |
$2.54
|
| 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: Lakeland Regional Health Systems Commercial |
$2.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.70
|
| Rate for Payer: Nomi Health Commercial |
$2.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.38
|
| Rate for Payer: PHP Commercial |
$2.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.80
|
| Rate for Payer: UHC Core |
$2.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.38
|
|
|
MIGRAINE AND OTHER HEADACHES
|
Facility
|
IP
|
$9,392.55
|
|
|
Service Code
|
APR-DRG 0544
|
| Min. Negotiated Rate |
$8,945.29 |
| Max. Negotiated Rate |
$9,392.55 |
| Rate for Payer: BCBS Complete |
$9,392.55
|
| Rate for Payer: Mclaren Medicaid |
$8,945.29
|
| Rate for Payer: Meridian Medicaid |
$9,392.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,945.29
|
| Rate for Payer: UHC Medicaid |
$8,945.29
|
| Rate for Payer: UHCCP Medicaid |
$8,945.29
|
|
|
MIGRAINE AND OTHER HEADACHES
|
Facility
|
IP
|
$4,779.36
|
|
|
Service Code
|
APR-DRG 0542
|
| Min. Negotiated Rate |
$4,551.77 |
| Max. Negotiated Rate |
$4,779.36 |
| Rate for Payer: BCBS Complete |
$4,779.36
|
| Rate for Payer: Mclaren Medicaid |
$4,551.77
|
| Rate for Payer: Meridian Medicaid |
$4,779.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,551.77
|
| Rate for Payer: UHC Medicaid |
$4,551.77
|
| Rate for Payer: UHCCP Medicaid |
$4,551.77
|
|
|
MIGRAINE AND OTHER HEADACHES
|
Facility
|
IP
|
$3,879.65
|
|
|
Service Code
|
APR-DRG 0541
|
| Min. Negotiated Rate |
$3,694.90 |
| Max. Negotiated Rate |
$3,879.65 |
| Rate for Payer: BCBS Complete |
$3,879.65
|
| Rate for Payer: Mclaren Medicaid |
$3,694.90
|
| Rate for Payer: Meridian Medicaid |
$3,879.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,694.90
|
| Rate for Payer: UHC Medicaid |
$3,694.90
|
| Rate for Payer: UHCCP Medicaid |
$3,694.90
|
|
|
MIGRAINE AND OTHER HEADACHES
|
Facility
|
IP
|
$6,150.22
|
|
|
Service Code
|
APR-DRG 0543
|
| Min. Negotiated Rate |
$5,857.36 |
| Max. Negotiated Rate |
$6,150.22 |
| Rate for Payer: BCBS Complete |
$6,150.22
|
| Rate for Payer: Mclaren Medicaid |
$5,857.36
|
| Rate for Payer: Meridian Medicaid |
$6,150.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,857.36
|
| Rate for Payer: UHC Medicaid |
$5,857.36
|
| Rate for Payer: UHCCP Medicaid |
$5,857.36
|
|
|
MINERAL OIL
|
Facility
|
OP
|
$78.37
|
|
|
Service Code
|
NDC 63323025410
|
| Hospital Charge Code |
109056
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$70.53 |
| Rate for Payer: Aetna Commercial |
$66.61
|
| Rate for Payer: Aetna Medicare |
$20.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$24.49
|
| Rate for Payer: Amish Plain Church Group Commercial |
$24.49
|
| Rate for Payer: BCBS Complete |
$14.51
|
| Rate for Payer: BCBS MAPPO |
$19.59
|
| Rate for Payer: BCBS Trust/PPO |
$64.43
|
| Rate for Payer: BCN Commercial |
$64.43
|
| Rate for Payer: BCN Medicare Advantage |
$19.59
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cofinity Commercial |
$67.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.59
|
| Rate for Payer: Healthscope Commercial |
$70.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.78
|
| Rate for Payer: Mclaren Medicaid |
$13.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.57
|
| Rate for Payer: Meridian Medicaid |
$14.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$21.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.61
|
| Rate for Payer: Nomi Health Commercial |
$64.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.78
|
| Rate for Payer: PACE Senior Care Partners |
$18.61
|
| Rate for Payer: PACE SWMI |
$19.59
|
| Rate for Payer: PHP Commercial |
$66.61
|
| Rate for Payer: PHP Medicare Advantage |
$19.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$68.18
|
| Rate for Payer: Priority Health Medicare |
$19.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.55
|
| Rate for Payer: Railroad Medicare Medicare |
$19.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.97
|
| Rate for Payer: UHC Core |
$65.44
|
| Rate for Payer: UHC Exchange |
$19.59
|
| Rate for Payer: UHC Medicaid |
$13.82
|
| Rate for Payer: UHC Medicare Advantage |
$19.59
|
| Rate for Payer: UHCCP Medicaid |
$13.82
|
| Rate for Payer: VA VA |
$19.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.78
|
|
|
MINERAL OIL
|
Facility
|
IP
|
$78.37
|
|
|
Service Code
|
NDC 63323025410
|
| Hospital Charge Code |
109056
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.55 |
| Max. Negotiated Rate |
$70.53 |
| Rate for Payer: Aetna Commercial |
$66.61
|
| Rate for Payer: BCBS Trust/PPO |
$64.73
|
| Rate for Payer: BCN Commercial |
$64.73
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cofinity Commercial |
$67.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.70
|
| Rate for Payer: Healthscope Commercial |
$70.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.61
|
| Rate for Payer: Nomi Health Commercial |
$64.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.78
|
| Rate for Payer: PHP Commercial |
$66.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$68.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$54.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.97
|
| Rate for Payer: UHC Core |
$65.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.78
|
|
|
MINERAL OIL ENEMA
|
Facility
|
IP
|
$59.39
|
|
|
Service Code
|
NDC 00132030140
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.34 |
| Max. Negotiated Rate |
$53.45 |
| Rate for Payer: Aetna Commercial |
$50.48
|
| Rate for Payer: BCBS Trust/PPO |
$49.05
|
| Rate for Payer: BCN Commercial |
$49.05
|
| Rate for Payer: Cash Price |
$47.51
|
| Rate for Payer: Cofinity Commercial |
$51.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.51
|
| Rate for Payer: Healthscope Commercial |
$53.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.48
|
| Rate for Payer: Nomi Health Commercial |
$48.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.54
|
| Rate for Payer: PHP Commercial |
$50.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$51.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.26
|
| Rate for Payer: UHC Core |
$49.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.54
|
|
|
MINERAL OIL ENEMA
|
Facility
|
IP
|
$46.89
|
|
|
Service Code
|
NDC 96295012753
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.64 |
| Max. Negotiated Rate |
$42.20 |
| Rate for Payer: Aetna Commercial |
$39.86
|
| Rate for Payer: BCBS Trust/PPO |
$38.73
|
| Rate for Payer: BCN Commercial |
$38.73
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$40.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.51
|
| Rate for Payer: Healthscope Commercial |
$42.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.86
|
| Rate for Payer: Nomi Health Commercial |
$38.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.17
|
| Rate for Payer: PHP Commercial |
$39.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.26
|
| Rate for Payer: UHC Core |
$39.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.17
|
|
|
MINERAL OIL ENEMA
|
Facility
|
OP
|
$46.89
|
|
|
Service Code
|
NDC 96295012753
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.27 |
| Max. Negotiated Rate |
$42.20 |
| Rate for Payer: Aetna Commercial |
$39.86
|
| Rate for Payer: Aetna Medicare |
$12.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.65
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.65
|
| Rate for Payer: BCBS Complete |
$8.68
|
| Rate for Payer: BCBS MAPPO |
$11.72
|
| Rate for Payer: BCBS Trust/PPO |
$38.55
|
| Rate for Payer: BCN Commercial |
$38.55
|
| Rate for Payer: BCN Medicare Advantage |
$11.72
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$40.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.72
|
| Rate for Payer: Healthscope Commercial |
$42.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.17
|
| Rate for Payer: Mclaren Medicaid |
$8.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.31
|
| Rate for Payer: Meridian Medicaid |
$8.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$12.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.86
|
| Rate for Payer: Nomi Health Commercial |
$38.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.17
|
| Rate for Payer: PACE Senior Care Partners |
$11.14
|
| Rate for Payer: PACE SWMI |
$11.72
|
| Rate for Payer: PHP Commercial |
$39.86
|
| Rate for Payer: PHP Medicare Advantage |
$11.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$40.79
|
| Rate for Payer: Priority Health Medicare |
$11.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$32.64
|
| Rate for Payer: Railroad Medicare Medicare |
$11.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.26
|
| Rate for Payer: UHC Core |
$39.15
|
| Rate for Payer: UHC Exchange |
$11.72
|
| Rate for Payer: UHC Medicaid |
$8.27
|
| Rate for Payer: UHC Medicare Advantage |
$11.72
|
| Rate for Payer: UHCCP Medicaid |
$8.27
|
| Rate for Payer: VA VA |
$11.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.17
|
|
|
MINERAL OIL ENEMA
|
Facility
|
OP
|
$59.39
|
|
|
Service Code
|
NDC 00132030140
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.47 |
| Max. Negotiated Rate |
$53.45 |
| Rate for Payer: Aetna Commercial |
$50.48
|
| Rate for Payer: Aetna Medicare |
$15.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.56
|
| Rate for Payer: BCBS Complete |
$10.99
|
| Rate for Payer: BCBS MAPPO |
$14.85
|
| Rate for Payer: BCBS Trust/PPO |
$48.82
|
| Rate for Payer: BCN Commercial |
$48.82
|
| Rate for Payer: BCN Medicare Advantage |
$14.85
|
| Rate for Payer: Cash Price |
$47.51
|
| Rate for Payer: Cofinity Commercial |
$51.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.85
|
| Rate for Payer: Healthscope Commercial |
$53.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.54
|
| Rate for Payer: Mclaren Medicaid |
$10.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.59
|
| Rate for Payer: Meridian Medicaid |
$10.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.48
|
| Rate for Payer: Nomi Health Commercial |
$48.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.54
|
| Rate for Payer: PACE Senior Care Partners |
$14.11
|
| Rate for Payer: PACE SWMI |
$14.85
|
| Rate for Payer: PHP Commercial |
$50.48
|
| Rate for Payer: PHP Medicare Advantage |
$14.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$51.67
|
| Rate for Payer: Priority Health Medicare |
$15.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$41.34
|
| Rate for Payer: Railroad Medicare Medicare |
$14.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.26
|
| Rate for Payer: UHC Core |
$49.59
|
| Rate for Payer: UHC Exchange |
$14.85
|
| Rate for Payer: UHC Medicaid |
$10.47
|
| Rate for Payer: UHC Medicare Advantage |
$14.85
|
| Rate for Payer: UHCCP Medicaid |
$10.47
|
| Rate for Payer: VA VA |
$14.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.54
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
OP
|
$234.65
|
|
|
Service Code
|
NDC 53489038701
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.37 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: Aetna Medicare |
$61.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.33
|
| Rate for Payer: BCBS Complete |
$43.43
|
| Rate for Payer: BCBS MAPPO |
$58.66
|
| Rate for Payer: BCBS Trust/PPO |
$192.91
|
| Rate for Payer: BCN Commercial |
$192.91
|
| Rate for Payer: BCN Medicare Advantage |
$58.66
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.66
|
| Rate for Payer: Healthscope Commercial |
$211.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.99
|
| Rate for Payer: Mclaren Medicaid |
$41.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.60
|
| Rate for Payer: Meridian Medicaid |
$43.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Nomi Health Commercial |
$192.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.99
|
| Rate for Payer: PACE Senior Care Partners |
$55.73
|
| Rate for Payer: PACE SWMI |
$58.66
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: PHP Medicare Advantage |
$58.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$204.15
|
| Rate for Payer: Priority Health Medicare |
$59.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.32
|
| Rate for Payer: Railroad Medicare Medicare |
$58.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.49
|
| Rate for Payer: UHC Core |
$195.93
|
| Rate for Payer: UHC Exchange |
$58.66
|
| Rate for Payer: UHC Medicaid |
$41.37
|
| Rate for Payer: UHC Medicare Advantage |
$58.66
|
| Rate for Payer: UHCCP Medicaid |
$41.37
|
| Rate for Payer: VA VA |
$58.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$234.65
|
|
|
Service Code
|
NDC 53489038701
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.32 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: BCBS Trust/PPO |
$193.80
|
| Rate for Payer: BCN Commercial |
$193.80
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$211.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Nomi Health Commercial |
$192.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.99
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$204.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.49
|
| Rate for Payer: UHC Core |
$195.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$2.85
|
|
|
Service Code
|
NDC 68084020511
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$2.35
|
| Rate for Payer: BCN Commercial |
$2.35
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.28
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.42
|
| Rate for Payer: Nomi Health Commercial |
$2.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.14
|
| Rate for Payer: PHP Commercial |
$2.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.51
|
| Rate for Payer: UHC Core |
$2.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.14
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
OP
|
$2.85
|
|
|
Service Code
|
NDC 68084020511
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.42
|
| Rate for Payer: Aetna Medicare |
$0.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.89
|
| Rate for Payer: BCBS Complete |
$0.53
|
| Rate for Payer: BCBS MAPPO |
$0.71
|
| Rate for Payer: BCBS Trust/PPO |
$2.34
|
| Rate for Payer: BCN Commercial |
$2.34
|
| Rate for Payer: BCN Medicare Advantage |
$0.71
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.71
|
| Rate for Payer: Healthscope Commercial |
$2.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.14
|
| Rate for Payer: Mclaren Medicaid |
$0.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.75
|
| Rate for Payer: Meridian Medicaid |
$0.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.42
|
| Rate for Payer: Nomi Health Commercial |
$2.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.14
|
| Rate for Payer: PACE Senior Care Partners |
$0.68
|
| Rate for Payer: PACE SWMI |
$0.71
|
| Rate for Payer: PHP Commercial |
$2.42
|
| Rate for Payer: PHP Medicare Advantage |
$0.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.48
|
| Rate for Payer: Priority Health Medicare |
$0.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.98
|
| Rate for Payer: Railroad Medicare Medicare |
$0.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.51
|
| Rate for Payer: UHC Core |
$2.38
|
| Rate for Payer: UHC Exchange |
$0.71
|
| Rate for Payer: UHC Medicaid |
$0.50
|
| Rate for Payer: UHC Medicare Advantage |
$0.71
|
| Rate for Payer: UHCCP Medicaid |
$0.50
|
| Rate for Payer: VA VA |
$0.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.14
|
|
