|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$9.41
|
|
|
Service Code
|
NDC 61269073514
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$8.47 |
| Rate for Payer: Aetna Commercial |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$7.68
|
| Rate for Payer: BCN Commercial |
$7.27
|
| Rate for Payer: Cash Price |
$7.53
|
| Rate for Payer: Cofinity Commercial |
$8.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.53
|
| Rate for Payer: Healthscope Commercial |
$8.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.00
|
| Rate for Payer: Nomi Health Commercial |
$7.72
|
| Rate for Payer: PHP Commercial |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.12
|
| Rate for Payer: Priority Health HMO/PPO |
$8.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.28
|
| Rate for Payer: UHC Core |
$7.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.06
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
NDC 53329077464
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna Commercial |
$32.30
|
| Rate for Payer: Aetna Medicare |
$9.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.88
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$9.50
|
| Rate for Payer: BCBS Trust/PPO |
$31.24
|
| Rate for Payer: BCN Commercial |
$29.54
|
| Rate for Payer: BCN Medicare Advantage |
$9.50
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$32.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.50
|
| Rate for Payer: Healthscope Commercial |
$34.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.30
|
| Rate for Payer: Nomi Health Commercial |
$31.16
|
| Rate for Payer: PACE Senior Care Partners |
$9.02
|
| Rate for Payer: PACE SWMI |
$9.50
|
| Rate for Payer: PHP Commercial |
$32.30
|
| Rate for Payer: PHP Medicare Advantage |
$9.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health HMO/PPO |
$33.06
|
| Rate for Payer: Priority Health Medicare |
$9.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.46
|
| Rate for Payer: Railroad Medicare Medicare |
$9.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.44
|
| Rate for Payer: UHC Core |
$31.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.50
|
| Rate for Payer: UHC Exchange |
$9.50
|
| Rate for Payer: UHC Medicare Advantage |
$9.50
|
| Rate for Payer: VA VA |
$9.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.50
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
NDC 53329077464
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna Commercial |
$32.30
|
| Rate for Payer: BCBS Trust/PPO |
$31.02
|
| Rate for Payer: BCN Commercial |
$29.37
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$32.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.40
|
| Rate for Payer: Healthscope Commercial |
$34.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.30
|
| Rate for Payer: Nomi Health Commercial |
$31.16
|
| Rate for Payer: PHP Commercial |
$32.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health HMO/PPO |
$33.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.44
|
| Rate for Payer: UHC Core |
$31.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.50
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$47.72
|
|
|
Service Code
|
NDC 11701006714
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$42.95 |
| Rate for Payer: Aetna Commercial |
$40.56
|
| Rate for Payer: Aetna Medicare |
$12.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.91
|
| Rate for Payer: BCBS Complete |
$19.09
|
| Rate for Payer: BCBS MAPPO |
$11.93
|
| Rate for Payer: BCBS Trust/PPO |
$39.23
|
| Rate for Payer: BCN Commercial |
$37.10
|
| Rate for Payer: BCN Medicare Advantage |
$11.93
|
| Rate for Payer: Cash Price |
$38.18
|
| Rate for Payer: Cofinity Commercial |
$41.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.93
|
| Rate for Payer: Healthscope Commercial |
$42.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.56
|
| Rate for Payer: Nomi Health Commercial |
$39.13
|
| Rate for Payer: PACE Senior Care Partners |
$11.33
|
| Rate for Payer: PACE SWMI |
$11.93
|
| Rate for Payer: PHP Commercial |
$40.56
|
| Rate for Payer: PHP Medicare Advantage |
$11.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.02
|
| Rate for Payer: Priority Health HMO/PPO |
$41.52
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.97
|
| Rate for Payer: Railroad Medicare Medicare |
$11.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.99
|
| Rate for Payer: UHC Core |
$39.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.93
|
| Rate for Payer: UHC Exchange |
$11.93
|
| Rate for Payer: UHC Medicare Advantage |
$11.93
|
| Rate for Payer: VA VA |
$11.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.79
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$47.72
|
|
|
Service Code
|
NDC 11701006714
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.02 |
| Max. Negotiated Rate |
$42.95 |
| Rate for Payer: Aetna Commercial |
$40.56
|
| Rate for Payer: BCBS Trust/PPO |
$38.95
|
| Rate for Payer: BCN Commercial |
$36.88
|
| Rate for Payer: Cash Price |
$38.18
|
| Rate for Payer: Cofinity Commercial |
$41.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.18
|
| Rate for Payer: Healthscope Commercial |
$42.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.56
|
| Rate for Payer: Nomi Health Commercial |
$39.13
|
| Rate for Payer: PHP Commercial |
$40.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.02
|
| Rate for Payer: Priority Health HMO/PPO |
$41.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.99
|
| Rate for Payer: UHC Core |
$39.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.79
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$19.51
|
|
|
Service Code
|
NDC 00316022530
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: BCBS Trust/PPO |
$15.93
|
| Rate for Payer: BCN Commercial |
$15.08
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cofinity Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.61
|
| Rate for Payer: Healthscope Commercial |
$17.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.58
|
| Rate for Payer: Nomi Health Commercial |
$16.00
|
| Rate for Payer: PHP Commercial |
$16.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.68
|
| Rate for Payer: Priority Health HMO/PPO |
$16.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.17
|
| Rate for Payer: UHC Core |
$16.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.63
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
NDC 11017025030
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.46 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna Commercial |
$19.55
|
| Rate for Payer: Aetna Medicare |
$5.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.19
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$5.75
|
| Rate for Payer: BCBS Trust/PPO |
$18.91
|
| Rate for Payer: BCN Commercial |
$17.88
|
| Rate for Payer: BCN Medicare Advantage |
$5.75
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$19.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.75
|
| Rate for Payer: Healthscope Commercial |
$20.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.55
|
| Rate for Payer: Nomi Health Commercial |
$18.86
|
| Rate for Payer: PACE Senior Care Partners |
$5.46
|
| Rate for Payer: PACE SWMI |
$5.75
|
| Rate for Payer: PHP Commercial |
$19.55
|
| Rate for Payer: PHP Medicare Advantage |
$5.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO |
$20.01
|
| Rate for Payer: Priority Health Medicare |
$5.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.41
|
| Rate for Payer: Railroad Medicare Medicare |
$5.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.24
|
| Rate for Payer: UHC Core |
$19.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.75
|
| Rate for Payer: UHC Exchange |
$5.75
|
| Rate for Payer: UHC Medicare Advantage |
$5.75
|
| Rate for Payer: VA VA |
$5.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.25
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
OP
|
$19.51
|
|
|
Service Code
|
NDC 00316022530
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: Aetna Medicare |
$5.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.10
|
| Rate for Payer: BCBS Complete |
$7.80
|
| Rate for Payer: BCBS MAPPO |
$4.88
|
| Rate for Payer: BCBS Trust/PPO |
$16.04
|
| Rate for Payer: BCN Commercial |
$15.17
|
| Rate for Payer: BCN Medicare Advantage |
$4.88
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cofinity Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.88
|
| Rate for Payer: Healthscope Commercial |
$17.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.58
|
| Rate for Payer: Nomi Health Commercial |
$16.00
|
| Rate for Payer: PACE Senior Care Partners |
$4.63
|
| Rate for Payer: PACE SWMI |
$4.88
|
| Rate for Payer: PHP Commercial |
$16.58
|
| Rate for Payer: PHP Medicare Advantage |
$4.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.68
|
| Rate for Payer: Priority Health HMO/PPO |
$16.97
|
| Rate for Payer: Priority Health Medicare |
$4.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.07
|
| Rate for Payer: Railroad Medicare Medicare |
$4.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.17
|
| Rate for Payer: UHC Core |
$16.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.88
|
| Rate for Payer: UHC Exchange |
$4.88
|
| Rate for Payer: UHC Medicare Advantage |
$4.88
|
| Rate for Payer: VA VA |
$4.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.63
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$22.19
|
|
|
Service Code
|
NDC 80196052856
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$19.97 |
| Rate for Payer: Aetna Commercial |
$18.86
|
| Rate for Payer: BCBS Trust/PPO |
$18.11
|
| Rate for Payer: BCN Commercial |
$17.15
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$19.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.75
|
| Rate for Payer: Healthscope Commercial |
$19.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.86
|
| Rate for Payer: Nomi Health Commercial |
$18.20
|
| Rate for Payer: PHP Commercial |
$18.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.42
|
| Rate for Payer: Priority Health HMO/PPO |
$19.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.53
|
| Rate for Payer: UHC Core |
$18.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.64
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
OP
|
$22.19
|
|
|
Service Code
|
NDC 80196052856
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$19.97 |
| Rate for Payer: Aetna Commercial |
$18.86
|
| Rate for Payer: Aetna Medicare |
$5.77
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.93
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: BCBS MAPPO |
$5.55
|
| Rate for Payer: BCBS Trust/PPO |
$18.24
|
| Rate for Payer: BCN Commercial |
$17.25
|
| Rate for Payer: BCN Medicare Advantage |
$5.55
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$19.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.55
|
| Rate for Payer: Healthscope Commercial |
$19.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.86
|
| Rate for Payer: Nomi Health Commercial |
$18.20
|
| Rate for Payer: PACE Senior Care Partners |
$5.27
|
| Rate for Payer: PACE SWMI |
$5.55
|
| Rate for Payer: PHP Commercial |
$18.86
|
| Rate for Payer: PHP Medicare Advantage |
$5.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.42
|
| Rate for Payer: Priority Health HMO/PPO |
$19.31
|
| Rate for Payer: Priority Health Medicare |
$5.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.87
|
| Rate for Payer: Railroad Medicare Medicare |
$5.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.53
|
| Rate for Payer: UHC Core |
$18.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.55
|
| Rate for Payer: UHC Exchange |
$5.55
|
| Rate for Payer: UHC Medicare Advantage |
$5.55
|
| Rate for Payer: VA VA |
$5.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.64
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
OP
|
$27.97
|
|
|
Service Code
|
NDC 11701003816
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$25.17 |
| Rate for Payer: Aetna Commercial |
$23.77
|
| Rate for Payer: Aetna Medicare |
$7.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.74
|
| Rate for Payer: BCBS Complete |
$11.19
|
| Rate for Payer: BCBS MAPPO |
$6.99
|
| Rate for Payer: BCBS Trust/PPO |
$22.99
|
| Rate for Payer: BCN Commercial |
$21.75
|
| Rate for Payer: BCN Medicare Advantage |
$6.99
|
| Rate for Payer: Cash Price |
$22.38
|
| Rate for Payer: Cofinity Commercial |
$24.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.99
|
| Rate for Payer: Healthscope Commercial |
$25.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.77
|
| Rate for Payer: Nomi Health Commercial |
$22.94
|
| Rate for Payer: PACE Senior Care Partners |
$6.64
|
| Rate for Payer: PACE SWMI |
$6.99
|
| Rate for Payer: PHP Commercial |
$23.77
|
| Rate for Payer: PHP Medicare Advantage |
$6.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.18
|
| Rate for Payer: Priority Health HMO/PPO |
$24.33
|
| Rate for Payer: Priority Health Medicare |
$7.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.74
|
| Rate for Payer: Railroad Medicare Medicare |
$6.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.61
|
| Rate for Payer: UHC Core |
$23.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.99
|
| Rate for Payer: UHC Exchange |
$6.99
|
| Rate for Payer: UHC Medicare Advantage |
$6.99
|
| Rate for Payer: VA VA |
$6.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.98
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$27.97
|
|
|
Service Code
|
NDC 11701003816
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.18 |
| Max. Negotiated Rate |
$25.17 |
| Rate for Payer: Aetna Commercial |
$23.77
|
| Rate for Payer: BCBS Trust/PPO |
$22.83
|
| Rate for Payer: BCN Commercial |
$21.62
|
| Rate for Payer: Cash Price |
$22.38
|
| Rate for Payer: Cofinity Commercial |
$24.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.38
|
| Rate for Payer: Healthscope Commercial |
$25.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.77
|
| Rate for Payer: Nomi Health Commercial |
$22.94
|
| Rate for Payer: PHP Commercial |
$23.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.18
|
| Rate for Payer: Priority Health HMO/PPO |
$24.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.61
|
| Rate for Payer: UHC Core |
$23.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.98
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
NDC 11017025030
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.95 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna Commercial |
$19.55
|
| Rate for Payer: BCBS Trust/PPO |
$18.77
|
| Rate for Payer: BCN Commercial |
$17.77
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$19.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$20.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.55
|
| Rate for Payer: Nomi Health Commercial |
$18.86
|
| Rate for Payer: PHP Commercial |
$19.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO |
$20.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.24
|
| Rate for Payer: UHC Core |
$19.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.25
|
|
|
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: Priority Health Cigna Priority Health |
$66.30
|
|
|
MICROFIBRILLAR COLLAGEN HEMOSTAT POWDER
|
Facility
|
IP
|
$1,025.98
|
|
|
Service Code
|
NDC 53276101002
|
| Hospital Charge Code |
10606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$666.89 |
| Max. Negotiated Rate |
$923.38 |
| Rate for Payer: Aetna Commercial |
$872.08
|
| Rate for Payer: BCBS Trust/PPO |
$837.51
|
| Rate for Payer: BCN Commercial |
$792.88
|
| Rate for Payer: Cash Price |
$820.78
|
| Rate for Payer: Cofinity Commercial |
$882.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$820.78
|
| Rate for Payer: Healthscope Commercial |
$923.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$769.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$872.08
|
| Rate for Payer: Nomi Health Commercial |
$841.30
|
| Rate for Payer: PHP Commercial |
$872.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.89
|
| Rate for Payer: Priority Health HMO/PPO |
$892.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$687.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$902.86
|
| Rate for Payer: UHC Core |
$856.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$769.48
|
|
|
MICROFIBRILLAR COLLAGEN HEMOSTAT POWDER
|
Facility
|
OP
|
$1,025.98
|
|
|
Service Code
|
NDC 53276101002
|
| Hospital Charge Code |
10606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$243.67 |
| Max. Negotiated Rate |
$923.38 |
| Rate for Payer: Aetna Commercial |
$872.08
|
| Rate for Payer: Aetna Medicare |
$266.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$320.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$320.62
|
| Rate for Payer: BCBS Complete |
$410.39
|
| Rate for Payer: BCBS MAPPO |
$256.50
|
| Rate for Payer: BCBS Trust/PPO |
$843.46
|
| Rate for Payer: BCN Commercial |
$797.70
|
| Rate for Payer: BCN Medicare Advantage |
$256.50
|
| Rate for Payer: Cash Price |
$820.78
|
| Rate for Payer: Cofinity Commercial |
$882.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$820.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$256.50
|
| Rate for Payer: Healthscope Commercial |
$923.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$769.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$269.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$294.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$872.08
|
| Rate for Payer: Nomi Health Commercial |
$841.30
|
| Rate for Payer: PACE Senior Care Partners |
$243.67
|
| Rate for Payer: PACE SWMI |
$256.50
|
| Rate for Payer: PHP Commercial |
$872.08
|
| Rate for Payer: PHP Medicare Advantage |
$256.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.89
|
| Rate for Payer: Priority Health HMO/PPO |
$892.60
|
| Rate for Payer: Priority Health Medicare |
$259.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$687.41
|
| Rate for Payer: Railroad Medicare Medicare |
$256.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$902.86
|
| Rate for Payer: UHC Core |
$856.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$256.50
|
| Rate for Payer: UHC Exchange |
$256.50
|
| Rate for Payer: UHC Medicare Advantage |
$256.50
|
| Rate for Payer: VA VA |
$256.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$769.48
|
|
|
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: Priority Health Cigna Priority Health |
$132.60
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
OP
|
$38.71
|
|
|
Service Code
|
NDC 60687057646
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$34.84 |
| Rate for Payer: Aetna Commercial |
$32.90
|
| Rate for Payer: Aetna Medicare |
$10.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.10
|
| Rate for Payer: BCBS Complete |
$15.48
|
| Rate for Payer: BCBS MAPPO |
$9.68
|
| Rate for Payer: BCBS Trust/PPO |
$31.82
|
| Rate for Payer: BCN Commercial |
$30.10
|
| Rate for Payer: BCN Medicare Advantage |
$9.68
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cofinity Commercial |
$33.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.68
|
| Rate for Payer: Healthscope Commercial |
$34.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.90
|
| Rate for Payer: Nomi Health Commercial |
$31.74
|
| Rate for Payer: PACE Senior Care Partners |
$9.19
|
| Rate for Payer: PACE SWMI |
$9.68
|
| Rate for Payer: PHP Commercial |
$32.90
|
| Rate for Payer: PHP Medicare Advantage |
$9.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.16
|
| Rate for Payer: Priority Health HMO/PPO |
$33.68
|
| Rate for Payer: Priority Health Medicare |
$9.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.94
|
| Rate for Payer: Railroad Medicare Medicare |
$9.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.06
|
| Rate for Payer: UHC Core |
$32.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.68
|
| Rate for Payer: UHC Exchange |
$9.68
|
| Rate for Payer: UHC Medicare Advantage |
$9.68
|
| Rate for Payer: VA VA |
$9.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.03
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
OP
|
$35.25
|
|
|
Service Code
|
NDC 00904711393
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$31.72 |
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: Aetna Medicare |
$9.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.02
|
| Rate for Payer: BCBS Complete |
$14.10
|
| Rate for Payer: BCBS MAPPO |
$8.81
|
| Rate for Payer: BCBS Trust/PPO |
$28.98
|
| Rate for Payer: BCN Commercial |
$27.41
|
| Rate for Payer: BCN Medicare Advantage |
$8.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.81
|
| Rate for Payer: Healthscope Commercial |
$31.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.96
|
| Rate for Payer: Nomi Health Commercial |
$28.90
|
| Rate for Payer: PACE Senior Care Partners |
$8.37
|
| Rate for Payer: PACE SWMI |
$8.81
|
| Rate for Payer: PHP Commercial |
$29.96
|
| Rate for Payer: PHP Medicare Advantage |
$8.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.91
|
| Rate for Payer: Priority Health HMO/PPO |
$30.67
|
| Rate for Payer: Priority Health Medicare |
$8.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.62
|
| Rate for Payer: Railroad Medicare Medicare |
$8.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.02
|
| Rate for Payer: UHC Core |
$29.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.81
|
| Rate for Payer: UHC Exchange |
$8.81
|
| Rate for Payer: UHC Medicare Advantage |
$8.81
|
| Rate for Payer: VA VA |
$8.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.44
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
IP
|
$40.15
|
|
|
Service Code
|
NDC 68094076459
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$36.14 |
| Rate for Payer: Aetna Commercial |
$34.13
|
| Rate for Payer: BCBS Trust/PPO |
$32.77
|
| Rate for Payer: BCN Commercial |
$31.03
|
| Rate for Payer: Cash Price |
$32.12
|
| Rate for Payer: Cofinity Commercial |
$34.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.12
|
| Rate for Payer: Healthscope Commercial |
$36.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.13
|
| Rate for Payer: Nomi Health Commercial |
$32.92
|
| Rate for Payer: PHP Commercial |
$34.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.10
|
| Rate for Payer: Priority Health HMO/PPO |
$34.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.33
|
| Rate for Payer: UHC Core |
$33.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.11
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
IP
|
$38.71
|
|
|
Service Code
|
NDC 60687057640
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$34.84 |
| Rate for Payer: Aetna Commercial |
$32.90
|
| Rate for Payer: BCBS Trust/PPO |
$31.60
|
| Rate for Payer: BCN Commercial |
$29.92
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cofinity Commercial |
$33.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.97
|
| Rate for Payer: Healthscope Commercial |
$34.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.90
|
| Rate for Payer: Nomi Health Commercial |
$31.74
|
| Rate for Payer: PHP Commercial |
$32.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.16
|
| Rate for Payer: Priority Health HMO/PPO |
$33.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.06
|
| Rate for Payer: UHC Core |
$32.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.03
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
OP
|
$38.71
|
|
|
Service Code
|
NDC 60687057640
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.19 |
| Max. Negotiated Rate |
$34.84 |
| Rate for Payer: Aetna Commercial |
$32.90
|
| Rate for Payer: Aetna Medicare |
$10.06
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.10
|
| Rate for Payer: BCBS Complete |
$15.48
|
| Rate for Payer: BCBS MAPPO |
$9.68
|
| Rate for Payer: BCBS Trust/PPO |
$31.82
|
| Rate for Payer: BCN Commercial |
$30.10
|
| Rate for Payer: BCN Medicare Advantage |
$9.68
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cofinity Commercial |
$33.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.68
|
| Rate for Payer: Healthscope Commercial |
$34.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.90
|
| Rate for Payer: Nomi Health Commercial |
$31.74
|
| Rate for Payer: PACE Senior Care Partners |
$9.19
|
| Rate for Payer: PACE SWMI |
$9.68
|
| Rate for Payer: PHP Commercial |
$32.90
|
| Rate for Payer: PHP Medicare Advantage |
$9.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.16
|
| Rate for Payer: Priority Health HMO/PPO |
$33.68
|
| Rate for Payer: Priority Health Medicare |
$9.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.94
|
| Rate for Payer: Railroad Medicare Medicare |
$9.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.06
|
| Rate for Payer: UHC Core |
$32.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.68
|
| Rate for Payer: UHC Exchange |
$9.68
|
| Rate for Payer: UHC Medicare Advantage |
$9.68
|
| Rate for Payer: VA VA |
$9.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.03
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
OP
|
$35.25
|
|
|
Service Code
|
NDC 00904711341
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$31.72 |
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: Aetna Medicare |
$9.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11.02
|
| Rate for Payer: BCBS Complete |
$14.10
|
| Rate for Payer: BCBS MAPPO |
$8.81
|
| Rate for Payer: BCBS Trust/PPO |
$28.98
|
| Rate for Payer: BCN Commercial |
$27.41
|
| Rate for Payer: BCN Medicare Advantage |
$8.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cofinity Commercial |
$30.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.81
|
| Rate for Payer: Healthscope Commercial |
$31.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.96
|
| Rate for Payer: Nomi Health Commercial |
$28.90
|
| Rate for Payer: PACE Senior Care Partners |
$8.37
|
| Rate for Payer: PACE SWMI |
$8.81
|
| Rate for Payer: PHP Commercial |
$29.96
|
| Rate for Payer: PHP Medicare Advantage |
$8.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.91
|
| Rate for Payer: Priority Health HMO/PPO |
$30.67
|
| Rate for Payer: Priority Health Medicare |
$8.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.62
|
| Rate for Payer: Railroad Medicare Medicare |
$8.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.02
|
| Rate for Payer: UHC Core |
$29.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.81
|
| Rate for Payer: UHC Exchange |
$8.81
|
| Rate for Payer: UHC Medicare Advantage |
$8.81
|
| Rate for Payer: VA VA |
$8.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.44
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
OP
|
$40.15
|
|
|
Service Code
|
NDC 68094076459
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.54 |
| Max. Negotiated Rate |
$36.14 |
| Rate for Payer: Aetna Commercial |
$34.13
|
| Rate for Payer: Aetna Medicare |
$10.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12.55
|
| Rate for Payer: BCBS Complete |
$16.06
|
| Rate for Payer: BCBS MAPPO |
$10.04
|
| Rate for Payer: BCBS Trust/PPO |
$33.01
|
| Rate for Payer: BCN Commercial |
$31.22
|
| Rate for Payer: BCN Medicare Advantage |
$10.04
|
| Rate for Payer: Cash Price |
$32.12
|
| Rate for Payer: Cofinity Commercial |
$34.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.04
|
| Rate for Payer: Healthscope Commercial |
$36.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.13
|
| Rate for Payer: Nomi Health Commercial |
$32.92
|
| Rate for Payer: PACE Senior Care Partners |
$9.54
|
| Rate for Payer: PACE SWMI |
$10.04
|
| Rate for Payer: PHP Commercial |
$34.13
|
| Rate for Payer: PHP Medicare Advantage |
$10.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.10
|
| Rate for Payer: Priority Health HMO/PPO |
$34.93
|
| Rate for Payer: Priority Health Medicare |
$10.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$26.90
|
| Rate for Payer: Railroad Medicare Medicare |
$10.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.33
|
| Rate for Payer: UHC Core |
$33.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.04
|
| Rate for Payer: UHC Exchange |
$10.04
|
| Rate for Payer: UHC Medicare Advantage |
$10.04
|
| Rate for Payer: VA VA |
$10.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.11
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
IP
|
$38.71
|
|
|
Service Code
|
NDC 60687057646
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.16 |
| Max. Negotiated Rate |
$34.84 |
| Rate for Payer: Aetna Commercial |
$32.90
|
| Rate for Payer: BCBS Trust/PPO |
$31.60
|
| Rate for Payer: BCN Commercial |
$29.92
|
| Rate for Payer: Cash Price |
$30.97
|
| Rate for Payer: Cofinity Commercial |
$33.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.97
|
| Rate for Payer: Healthscope Commercial |
$34.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.90
|
| Rate for Payer: Nomi Health Commercial |
$31.74
|
| Rate for Payer: PHP Commercial |
$32.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.16
|
| Rate for Payer: Priority Health HMO/PPO |
$33.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$25.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.06
|
| Rate for Payer: UHC Core |
$32.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.03
|
|
