|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
OP
|
$40.15
|
|
|
Service Code
|
NDC 68094076462
|
| 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
|
$35.25
|
|
|
Service Code
|
NDC 00904711341
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.91 |
| Max. Negotiated Rate |
$31.72 |
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: BCBS Trust/PPO |
$28.77
|
| Rate for Payer: BCN Commercial |
$27.24
|
| 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: Healthscope Commercial |
$31.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.96
|
| Rate for Payer: Nomi Health Commercial |
$28.90
|
| Rate for Payer: PHP Commercial |
$29.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.91
|
| Rate for Payer: Priority Health HMO/PPO |
$30.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.02
|
| Rate for Payer: UHC Core |
$29.43
|
| 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 68094076462
|
| 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
|
$35.25
|
|
|
Service Code
|
NDC 00904711393
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.91 |
| Max. Negotiated Rate |
$31.72 |
| Rate for Payer: Aetna Commercial |
$29.96
|
| Rate for Payer: BCBS Trust/PPO |
$28.77
|
| Rate for Payer: BCN Commercial |
$27.24
|
| 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: Healthscope Commercial |
$31.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.96
|
| Rate for Payer: Nomi Health Commercial |
$28.90
|
| Rate for Payer: PHP Commercial |
$29.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.91
|
| Rate for Payer: Priority Health HMO/PPO |
$30.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.02
|
| Rate for Payer: UHC Core |
$29.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.44
|
|
|
MIDAZOLAM 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$14.28
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.39 |
| Max. Negotiated Rate |
$12.85 |
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna Commercial |
$12.95
|
| Rate for Payer: Aetna Commercial |
$13.16
|
| Rate for Payer: Aetna Commercial |
$9.23
|
| Rate for Payer: Aetna Commercial |
$20.29
|
| Rate for Payer: Aetna Medicare |
$3.96
|
| Rate for Payer: Aetna Medicare |
$2.82
|
| Rate for Payer: Aetna Medicare |
$3.71
|
| Rate for Payer: Aetna Medicare |
$4.02
|
| Rate for Payer: Aetna Medicare |
$6.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.39
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.84
|
| Rate for Payer: BCBS Complete |
$6.19
|
| Rate for Payer: BCBS Complete |
$4.34
|
| Rate for Payer: BCBS Complete |
$5.71
|
| Rate for Payer: BCBS Complete |
$6.09
|
| Rate for Payer: BCBS Complete |
$9.55
|
| Rate for Payer: BCBS MAPPO |
$3.81
|
| Rate for Payer: BCBS MAPPO |
$2.72
|
| Rate for Payer: BCBS MAPPO |
$3.57
|
| Rate for Payer: BCBS MAPPO |
$3.87
|
| Rate for Payer: BCBS MAPPO |
$5.97
|
| Rate for Payer: BCBS Trust/PPO |
$8.93
|
| Rate for Payer: BCBS Trust/PPO |
$11.74
|
| Rate for Payer: BCBS Trust/PPO |
$12.52
|
| Rate for Payer: BCBS Trust/PPO |
$19.62
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCN Commercial |
$18.56
|
| Rate for Payer: BCN Commercial |
$8.44
|
| Rate for Payer: BCN Commercial |
$11.10
|
| Rate for Payer: BCN Commercial |
$11.84
|
| Rate for Payer: BCN Commercial |
$12.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.97
|
| Rate for Payer: BCN Medicare Advantage |
$3.87
|
| Rate for Payer: BCN Medicare Advantage |
$2.72
|
| Rate for Payer: BCN Medicare Advantage |
$3.57
|
| Rate for Payer: BCN Medicare Advantage |
$3.81
|
| Rate for Payer: Cash Price |
$8.69
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Cash Price |
$19.10
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cofinity Commercial |
$20.53
|
| Rate for Payer: Cofinity Commercial |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Cofinity Commercial |
$13.31
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.81
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Healthscope Commercial |
$9.77
|
| Rate for Payer: Healthscope Commercial |
$13.93
|
| Rate for Payer: Healthscope Commercial |
$13.71
|
| Rate for Payer: Healthscope Commercial |
$21.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.29
|
| Rate for Payer: Nomi Health Commercial |
$11.71
|
| Rate for Payer: Nomi Health Commercial |
$12.69
|
| Rate for Payer: Nomi Health Commercial |
$12.49
|
| Rate for Payer: Nomi Health Commercial |
$19.57
|
| Rate for Payer: Nomi Health Commercial |
$8.91
|
| Rate for Payer: PACE Senior Care Partners |
$2.58
|
| Rate for Payer: PACE Senior Care Partners |
$3.68
|
| Rate for Payer: PACE Senior Care Partners |
$3.39
|
| Rate for Payer: PACE Senior Care Partners |
$3.62
|
| Rate for Payer: PACE Senior Care Partners |
$5.67
|
| Rate for Payer: PACE SWMI |
$2.72
|
| Rate for Payer: PACE SWMI |
$3.87
|
| Rate for Payer: PACE SWMI |
$3.81
|
| Rate for Payer: PACE SWMI |
$3.57
|
| Rate for Payer: PACE SWMI |
$5.97
|
| Rate for Payer: PHP Commercial |
$20.29
|
| Rate for Payer: PHP Commercial |
$12.95
|
| Rate for Payer: PHP Commercial |
$13.16
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: PHP Commercial |
$9.23
|
| Rate for Payer: PHP Medicare Advantage |
$3.81
|
| Rate for Payer: PHP Medicare Advantage |
$3.87
|
| Rate for Payer: PHP Medicare Advantage |
$5.97
|
| Rate for Payer: PHP Medicare Advantage |
$2.72
|
| Rate for Payer: PHP Medicare Advantage |
$3.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.06
|
| Rate for Payer: Priority Health HMO/PPO |
$9.45
|
| Rate for Payer: Priority Health HMO/PPO |
$13.25
|
| Rate for Payer: Priority Health HMO/PPO |
$20.77
|
| Rate for Payer: Priority Health HMO/PPO |
$13.47
|
| Rate for Payer: Priority Health HMO/PPO |
$12.42
|
| Rate for Payer: Priority Health Medicare |
$6.03
|
| Rate for Payer: Priority Health Medicare |
$3.85
|
| Rate for Payer: Priority Health Medicare |
$3.61
|
| Rate for Payer: Priority Health Medicare |
$3.91
|
| Rate for Payer: Priority Health Medicare |
$2.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.99
|
| Rate for Payer: Railroad Medicare Medicare |
$3.87
|
| Rate for Payer: Railroad Medicare Medicare |
$3.81
|
| Rate for Payer: Railroad Medicare Medicare |
$2.72
|
| Rate for Payer: Railroad Medicare Medicare |
$3.57
|
| Rate for Payer: Railroad Medicare Medicare |
$5.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.40
|
| Rate for Payer: UHC Core |
$11.92
|
| Rate for Payer: UHC Core |
$19.93
|
| Rate for Payer: UHC Core |
$12.72
|
| Rate for Payer: UHC Core |
$12.93
|
| Rate for Payer: UHC Core |
$9.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.81
|
| Rate for Payer: UHC Exchange |
$3.81
|
| Rate for Payer: UHC Exchange |
$5.97
|
| Rate for Payer: UHC Exchange |
$2.72
|
| Rate for Payer: UHC Exchange |
$3.87
|
| Rate for Payer: UHC Exchange |
$3.57
|
| Rate for Payer: UHC Medicare Advantage |
$3.57
|
| Rate for Payer: UHC Medicare Advantage |
$5.97
|
| Rate for Payer: UHC Medicare Advantage |
$3.81
|
| Rate for Payer: UHC Medicare Advantage |
$2.72
|
| Rate for Payer: UHC Medicare Advantage |
$3.87
|
| Rate for Payer: VA VA |
$2.72
|
| Rate for Payer: VA VA |
$3.87
|
| Rate for Payer: VA VA |
$3.57
|
| Rate for Payer: VA VA |
$5.97
|
| Rate for Payer: VA VA |
$3.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.42
|
|
|
MIDAZOLAM 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$23.87
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.52 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna Commercial |
$20.29
|
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna Commercial |
$12.95
|
| Rate for Payer: Aetna Commercial |
$13.16
|
| Rate for Payer: Aetna Commercial |
$9.23
|
| Rate for Payer: BCBS Trust/PPO |
$12.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.49
|
| Rate for Payer: BCBS Trust/PPO |
$12.43
|
| Rate for Payer: BCBS Trust/PPO |
$11.66
|
| Rate for Payer: BCBS Trust/PPO |
$8.87
|
| Rate for Payer: BCN Commercial |
$11.96
|
| Rate for Payer: BCN Commercial |
$11.77
|
| Rate for Payer: BCN Commercial |
$8.39
|
| Rate for Payer: BCN Commercial |
$11.04
|
| Rate for Payer: BCN Commercial |
$18.45
|
| Rate for Payer: Cash Price |
$8.69
|
| Rate for Payer: Cash Price |
$19.10
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Cofinity Commercial |
$20.53
|
| Rate for Payer: Cofinity Commercial |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$13.31
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.10
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Healthscope Commercial |
$13.71
|
| Rate for Payer: Healthscope Commercial |
$9.77
|
| Rate for Payer: Healthscope Commercial |
$13.93
|
| Rate for Payer: Healthscope Commercial |
$21.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.16
|
| Rate for Payer: Nomi Health Commercial |
$8.91
|
| Rate for Payer: Nomi Health Commercial |
$11.71
|
| Rate for Payer: Nomi Health Commercial |
$12.49
|
| Rate for Payer: Nomi Health Commercial |
$12.69
|
| Rate for Payer: Nomi Health Commercial |
$19.57
|
| Rate for Payer: PHP Commercial |
$12.95
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: PHP Commercial |
$9.23
|
| Rate for Payer: PHP Commercial |
$13.16
|
| Rate for Payer: PHP Commercial |
$20.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.06
|
| Rate for Payer: Priority Health HMO/PPO |
$9.45
|
| Rate for Payer: Priority Health HMO/PPO |
$20.77
|
| Rate for Payer: Priority Health HMO/PPO |
$13.25
|
| Rate for Payer: Priority Health HMO/PPO |
$13.47
|
| Rate for Payer: Priority Health HMO/PPO |
$12.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.62
|
| Rate for Payer: UHC Core |
$9.07
|
| Rate for Payer: UHC Core |
$11.92
|
| Rate for Payer: UHC Core |
$12.93
|
| Rate for Payer: UHC Core |
$19.93
|
| Rate for Payer: UHC Core |
$12.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.61
|
|
|
MIDAZOLAM 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$18.62
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$16.76 |
| Rate for Payer: Aetna Commercial |
$15.83
|
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna Commercial |
$17.52
|
| Rate for Payer: Aetna Medicare |
$5.50
|
| Rate for Payer: Aetna Medicare |
$4.84
|
| Rate for Payer: Aetna Medicare |
$5.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.61
|
| Rate for Payer: BCBS Complete |
$8.24
|
| Rate for Payer: BCBS Complete |
$7.45
|
| Rate for Payer: BCBS Complete |
$8.46
|
| Rate for Payer: BCBS MAPPO |
$5.29
|
| Rate for Payer: BCBS MAPPO |
$4.66
|
| Rate for Payer: BCBS MAPPO |
$5.15
|
| Rate for Payer: BCBS Trust/PPO |
$16.94
|
| Rate for Payer: BCBS Trust/PPO |
$15.31
|
| Rate for Payer: BCBS Trust/PPO |
$17.40
|
| Rate for Payer: BCN Commercial |
$16.02
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: BCN Commercial |
$14.48
|
| Rate for Payer: BCN Medicare Advantage |
$4.66
|
| Rate for Payer: BCN Medicare Advantage |
$5.15
|
| Rate for Payer: BCN Medicare Advantage |
$5.29
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cofinity Commercial |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$16.01
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.66
|
| Rate for Payer: Healthscope Commercial |
$18.55
|
| Rate for Payer: Healthscope Commercial |
$16.76
|
| Rate for Payer: Healthscope Commercial |
$19.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.83
|
| Rate for Payer: Nomi Health Commercial |
$17.35
|
| Rate for Payer: Nomi Health Commercial |
$15.27
|
| Rate for Payer: Nomi Health Commercial |
$16.90
|
| Rate for Payer: PACE Senior Care Partners |
$5.03
|
| Rate for Payer: PACE Senior Care Partners |
$4.42
|
| Rate for Payer: PACE Senior Care Partners |
$4.89
|
| Rate for Payer: PACE SWMI |
$5.15
|
| Rate for Payer: PACE SWMI |
$4.66
|
| Rate for Payer: PACE SWMI |
$5.29
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: PHP Commercial |
$17.52
|
| Rate for Payer: PHP Commercial |
$15.83
|
| Rate for Payer: PHP Medicare Advantage |
$5.15
|
| Rate for Payer: PHP Medicare Advantage |
$5.29
|
| Rate for Payer: PHP Medicare Advantage |
$4.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.40
|
| Rate for Payer: Priority Health HMO/PPO |
$18.41
|
| Rate for Payer: Priority Health HMO/PPO |
$16.20
|
| Rate for Payer: Priority Health HMO/PPO |
$17.93
|
| Rate for Payer: Priority Health Medicare |
$4.70
|
| Rate for Payer: Priority Health Medicare |
$5.34
|
| Rate for Payer: Priority Health Medicare |
$5.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.48
|
| Rate for Payer: Railroad Medicare Medicare |
$5.15
|
| Rate for Payer: Railroad Medicare Medicare |
$5.29
|
| Rate for Payer: Railroad Medicare Medicare |
$4.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.39
|
| Rate for Payer: UHC Core |
$17.67
|
| Rate for Payer: UHC Core |
$17.21
|
| Rate for Payer: UHC Core |
$15.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.15
|
| Rate for Payer: UHC Exchange |
$5.15
|
| Rate for Payer: UHC Exchange |
$4.66
|
| Rate for Payer: UHC Exchange |
$5.29
|
| Rate for Payer: UHC Medicare Advantage |
$4.66
|
| Rate for Payer: UHC Medicare Advantage |
$5.15
|
| Rate for Payer: UHC Medicare Advantage |
$5.29
|
| Rate for Payer: VA VA |
$5.15
|
| Rate for Payer: VA VA |
$5.29
|
| Rate for Payer: VA VA |
$4.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.46
|
|
|
MIDAZOLAM 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$18.62
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.10 |
| Max. Negotiated Rate |
$16.76 |
| Rate for Payer: Aetna Commercial |
$15.83
|
| Rate for Payer: Aetna Commercial |
$17.52
|
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: BCBS Trust/PPO |
$16.82
|
| Rate for Payer: BCBS Trust/PPO |
$15.20
|
| Rate for Payer: BCBS Trust/PPO |
$17.27
|
| Rate for Payer: BCN Commercial |
$15.93
|
| Rate for Payer: BCN Commercial |
$14.39
|
| Rate for Payer: BCN Commercial |
$16.35
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Cofinity Commercial |
$16.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.93
|
| Rate for Payer: Healthscope Commercial |
$18.55
|
| Rate for Payer: Healthscope Commercial |
$16.76
|
| Rate for Payer: Healthscope Commercial |
$19.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| Rate for Payer: Nomi Health Commercial |
$15.27
|
| Rate for Payer: Nomi Health Commercial |
$16.90
|
| Rate for Payer: Nomi Health Commercial |
$17.35
|
| Rate for Payer: PHP Commercial |
$17.52
|
| Rate for Payer: PHP Commercial |
$15.83
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.40
|
| Rate for Payer: Priority Health HMO/PPO |
$18.41
|
| Rate for Payer: Priority Health HMO/PPO |
$17.93
|
| Rate for Payer: Priority Health HMO/PPO |
$16.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.39
|
| Rate for Payer: UHC Core |
$15.55
|
| Rate for Payer: UHC Core |
$17.67
|
| Rate for Payer: UHC Core |
$17.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.46
|
|
|
MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$13.95
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
168786
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.07 |
| Max. Negotiated Rate |
$12.56 |
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: BCBS Trust/PPO |
$11.39
|
| Rate for Payer: BCBS Trust/PPO |
$11.78
|
| Rate for Payer: BCN Commercial |
$10.78
|
| Rate for Payer: BCN Commercial |
$11.15
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$12.56
|
| Rate for Payer: Healthscope Commercial |
$12.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Nomi Health Commercial |
$11.44
|
| Rate for Payer: Nomi Health Commercial |
$11.83
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.07
|
| Rate for Payer: Priority Health HMO/PPO |
$12.55
|
| Rate for Payer: Priority Health HMO/PPO |
$12.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.67
|
| 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 |
$11.65
|
| Rate for Payer: UHC Core |
$12.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.82
|
|
|
MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$14.43
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
168786
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$12.99 |
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Medicare |
$3.75
|
| Rate for Payer: Aetna Medicare |
$3.63
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.36
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS Complete |
$5.77
|
| Rate for Payer: BCBS MAPPO |
$3.49
|
| Rate for Payer: BCBS MAPPO |
$3.61
|
| Rate for Payer: BCBS Trust/PPO |
$11.86
|
| Rate for Payer: BCBS Trust/PPO |
$11.47
|
| Rate for Payer: BCN Commercial |
$11.22
|
| Rate for Payer: BCN Commercial |
$10.85
|
| Rate for Payer: BCN Medicare Advantage |
$3.61
|
| Rate for Payer: BCN Medicare Advantage |
$3.49
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.61
|
| Rate for Payer: Healthscope Commercial |
$12.56
|
| Rate for Payer: Healthscope Commercial |
$12.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Nomi Health Commercial |
$11.83
|
| Rate for Payer: Nomi Health Commercial |
$11.44
|
| Rate for Payer: PACE Senior Care Partners |
$3.43
|
| Rate for Payer: PACE Senior Care Partners |
$3.31
|
| Rate for Payer: PACE SWMI |
$3.61
|
| Rate for Payer: PACE SWMI |
$3.49
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: PHP Medicare Advantage |
$3.49
|
| Rate for Payer: PHP Medicare Advantage |
$3.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.07
|
| Rate for Payer: Priority Health HMO/PPO |
$12.14
|
| Rate for Payer: Priority Health HMO/PPO |
$12.55
|
| Rate for Payer: Priority Health Medicare |
$3.64
|
| Rate for Payer: Priority Health Medicare |
$3.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.35
|
| Rate for Payer: Railroad Medicare Medicare |
$3.49
|
| Rate for Payer: Railroad Medicare Medicare |
$3.61
|
| 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 |
$11.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.49
|
| Rate for Payer: UHC Exchange |
$3.49
|
| Rate for Payer: UHC Exchange |
$3.61
|
| Rate for Payer: UHC Medicare Advantage |
$3.49
|
| Rate for Payer: UHC Medicare Advantage |
$3.61
|
| Rate for Payer: VA VA |
$3.49
|
| Rate for Payer: VA VA |
$3.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
|
|
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 |
$10.07 |
| Max. Negotiated Rate |
$13.94 |
| Rate for Payer: Aetna Commercial |
$13.17
|
| Rate for Payer: BCBS Trust/PPO |
$12.64
|
| Rate for Payer: BCN Commercial |
$11.97
|
| 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: PHP Commercial |
$13.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.07
|
| Rate for Payer: Priority Health HMO/PPO |
$13.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.38
|
| 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
|
|
|
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 |
$3.68 |
| 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 |
$6.20
|
| Rate for Payer: BCBS MAPPO |
$3.87
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCN Commercial |
$12.04
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.17
|
| Rate for Payer: Nomi Health Commercial |
$12.70
|
| 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 Cigna Priority Health |
$10.07
|
| Rate for Payer: Priority Health HMO/PPO |
$13.48
|
| Rate for Payer: Priority Health Medicare |
$3.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.38
|
| 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 Dual Complete DSNP |
$3.87
|
| Rate for Payer: UHC Exchange |
$3.87
|
| Rate for Payer: UHC Medicare Advantage |
$3.87
|
| Rate for Payer: VA VA |
$3.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.62
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$3.39
|
|
|
Service Code
|
NDC 51079045301
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.81 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: Aetna Medicare |
$0.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.06
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: BCBS MAPPO |
$0.85
|
| Rate for Payer: BCBS Trust/PPO |
$2.79
|
| Rate for Payer: BCN Commercial |
$2.64
|
| Rate for Payer: BCN Medicare Advantage |
$0.85
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.85
|
| Rate for Payer: Healthscope Commercial |
$3.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.88
|
| Rate for Payer: Nomi Health Commercial |
$2.78
|
| Rate for Payer: PACE Senior Care Partners |
$0.81
|
| Rate for Payer: PACE SWMI |
$0.85
|
| Rate for Payer: PHP Commercial |
$2.88
|
| Rate for Payer: PHP Medicare Advantage |
$0.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health HMO/PPO |
$2.95
|
| Rate for Payer: Priority Health Medicare |
$0.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.27
|
| Rate for Payer: Railroad Medicare Medicare |
$0.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.98
|
| Rate for Payer: UHC Core |
$2.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.85
|
| Rate for Payer: UHC Exchange |
$0.85
|
| Rate for Payer: UHC Medicare Advantage |
$0.85
|
| Rate for Payer: VA VA |
$0.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$3.39
|
|
|
Service Code
|
NDC 51079045301
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$3.05 |
| Rate for Payer: Aetna Commercial |
$2.88
|
| Rate for Payer: BCBS Trust/PPO |
$2.77
|
| Rate for Payer: BCN Commercial |
$2.62
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$2.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.71
|
| Rate for Payer: Healthscope Commercial |
$3.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.88
|
| Rate for Payer: Nomi Health Commercial |
$2.78
|
| Rate for Payer: PHP Commercial |
$2.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health HMO/PPO |
$2.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.98
|
| Rate for Payer: UHC Core |
$2.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$338.88
|
|
|
Service Code
|
NDC 51079045320
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.48 |
| Max. Negotiated Rate |
$304.99 |
| Rate for Payer: Aetna Commercial |
$288.05
|
| Rate for Payer: Aetna Medicare |
$88.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$105.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$105.90
|
| Rate for Payer: BCBS Complete |
$135.55
|
| Rate for Payer: BCBS MAPPO |
$84.72
|
| Rate for Payer: BCBS Trust/PPO |
$278.59
|
| Rate for Payer: BCN Commercial |
$263.48
|
| Rate for Payer: BCN Medicare Advantage |
$84.72
|
| Rate for Payer: Cash Price |
$271.10
|
| Rate for Payer: Cofinity Commercial |
$291.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.72
|
| Rate for Payer: Healthscope Commercial |
$304.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.05
|
| Rate for Payer: Nomi Health Commercial |
$277.88
|
| Rate for Payer: PACE Senior Care Partners |
$80.48
|
| Rate for Payer: PACE SWMI |
$84.72
|
| Rate for Payer: PHP Commercial |
$288.05
|
| Rate for Payer: PHP Medicare Advantage |
$84.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.27
|
| Rate for Payer: Priority Health HMO/PPO |
$294.83
|
| Rate for Payer: Priority Health Medicare |
$85.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.05
|
| Rate for Payer: Railroad Medicare Medicare |
$84.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.21
|
| Rate for Payer: UHC Core |
$282.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$84.72
|
| Rate for Payer: UHC Exchange |
$84.72
|
| Rate for Payer: UHC Medicare Advantage |
$84.72
|
| Rate for Payer: VA VA |
$84.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.16
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$306.85
|
|
|
Service Code
|
NDC 00904681861
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.88 |
| Max. Negotiated Rate |
$276.16 |
| Rate for Payer: Aetna Commercial |
$260.82
|
| Rate for Payer: Aetna Medicare |
$79.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$95.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$95.89
|
| Rate for Payer: BCBS Complete |
$122.74
|
| Rate for Payer: BCBS MAPPO |
$76.71
|
| Rate for Payer: BCBS Trust/PPO |
$252.26
|
| Rate for Payer: BCN Commercial |
$238.58
|
| Rate for Payer: BCN Medicare Advantage |
$76.71
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Commercial |
$263.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.71
|
| Rate for Payer: Healthscope Commercial |
$276.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: Nomi Health Commercial |
$251.62
|
| Rate for Payer: PACE Senior Care Partners |
$72.88
|
| Rate for Payer: PACE SWMI |
$76.71
|
| Rate for Payer: PHP Commercial |
$260.82
|
| Rate for Payer: PHP Medicare Advantage |
$76.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.45
|
| Rate for Payer: Priority Health HMO/PPO |
$266.96
|
| Rate for Payer: Priority Health Medicare |
$77.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$205.59
|
| Rate for Payer: Railroad Medicare Medicare |
$76.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.03
|
| Rate for Payer: UHC Core |
$256.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.71
|
| Rate for Payer: UHC Exchange |
$76.71
|
| Rate for Payer: UHC Medicare Advantage |
$76.71
|
| Rate for Payer: VA VA |
$76.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.14
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$306.85
|
|
|
Service Code
|
NDC 00904681861
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.45 |
| Max. Negotiated Rate |
$276.16 |
| Rate for Payer: Aetna Commercial |
$260.82
|
| Rate for Payer: BCBS Trust/PPO |
$250.48
|
| Rate for Payer: BCN Commercial |
$237.13
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Commercial |
$263.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$276.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: Nomi Health Commercial |
$251.62
|
| Rate for Payer: PHP Commercial |
$260.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.45
|
| Rate for Payer: Priority Health HMO/PPO |
$266.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$205.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.03
|
| Rate for Payer: UHC Core |
$256.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.14
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$217.55
|
|
|
Service Code
|
NDC 00245021211
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.67 |
| Max. Negotiated Rate |
$195.80 |
| Rate for Payer: Aetna Commercial |
$184.92
|
| Rate for Payer: Aetna Medicare |
$56.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$67.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$67.98
|
| Rate for Payer: BCBS Complete |
$87.02
|
| Rate for Payer: BCBS MAPPO |
$54.39
|
| Rate for Payer: BCBS Trust/PPO |
$178.85
|
| Rate for Payer: BCN Commercial |
$169.15
|
| Rate for Payer: BCN Medicare Advantage |
$54.39
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Commercial |
$187.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.39
|
| Rate for Payer: Healthscope Commercial |
$195.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.92
|
| Rate for Payer: Nomi Health Commercial |
$178.39
|
| Rate for Payer: PACE Senior Care Partners |
$51.67
|
| Rate for Payer: PACE SWMI |
$54.39
|
| Rate for Payer: PHP Commercial |
$184.92
|
| Rate for Payer: PHP Medicare Advantage |
$54.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.41
|
| Rate for Payer: Priority Health HMO/PPO |
$189.27
|
| Rate for Payer: Priority Health Medicare |
$54.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.76
|
| Rate for Payer: Railroad Medicare Medicare |
$54.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.44
|
| Rate for Payer: UHC Core |
$181.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.39
|
| Rate for Payer: UHC Exchange |
$54.39
|
| Rate for Payer: UHC Medicare Advantage |
$54.39
|
| Rate for Payer: VA VA |
$54.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.16
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$338.88
|
|
|
Service Code
|
NDC 51079045320
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.27 |
| Max. Negotiated Rate |
$304.99 |
| Rate for Payer: Aetna Commercial |
$288.05
|
| Rate for Payer: BCBS Trust/PPO |
$276.63
|
| Rate for Payer: BCN Commercial |
$261.89
|
| Rate for Payer: Cash Price |
$271.10
|
| Rate for Payer: Cofinity Commercial |
$291.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.10
|
| Rate for Payer: Healthscope Commercial |
$304.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.05
|
| Rate for Payer: Nomi Health Commercial |
$277.88
|
| Rate for Payer: PHP Commercial |
$288.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.27
|
| Rate for Payer: Priority Health HMO/PPO |
$294.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$227.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$298.21
|
| Rate for Payer: UHC Core |
$282.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.16
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$217.55
|
|
|
Service Code
|
NDC 00245021211
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.41 |
| Max. Negotiated Rate |
$195.80 |
| Rate for Payer: Aetna Commercial |
$184.92
|
| Rate for Payer: BCBS Trust/PPO |
$177.59
|
| Rate for Payer: BCN Commercial |
$168.12
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Commercial |
$187.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.04
|
| Rate for Payer: Healthscope Commercial |
$195.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.92
|
| Rate for Payer: Nomi Health Commercial |
$178.39
|
| Rate for Payer: PHP Commercial |
$184.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.41
|
| Rate for Payer: Priority Health HMO/PPO |
$189.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$145.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.44
|
| Rate for Payer: UHC Core |
$181.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.16
|
|
|
MINERAL OIL
|
Facility
|
OP
|
$68.71
|
|
|
Service Code
|
NDC 63323025410
|
| Hospital Charge Code |
109056
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$61.84 |
| Rate for Payer: Aetna Commercial |
$58.40
|
| Rate for Payer: Aetna Medicare |
$17.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.47
|
| Rate for Payer: BCBS Complete |
$27.48
|
| Rate for Payer: BCBS MAPPO |
$17.18
|
| Rate for Payer: BCBS Trust/PPO |
$56.49
|
| Rate for Payer: BCN Commercial |
$53.42
|
| Rate for Payer: BCN Medicare Advantage |
$17.18
|
| Rate for Payer: Cash Price |
$54.97
|
| Rate for Payer: Cofinity Commercial |
$59.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$61.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.40
|
| Rate for Payer: Nomi Health Commercial |
$56.34
|
| Rate for Payer: PACE Senior Care Partners |
$16.32
|
| Rate for Payer: PACE SWMI |
$17.18
|
| Rate for Payer: PHP Commercial |
$58.40
|
| Rate for Payer: PHP Medicare Advantage |
$17.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.66
|
| Rate for Payer: Priority Health HMO/PPO |
$59.78
|
| Rate for Payer: Priority Health Medicare |
$17.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.04
|
| Rate for Payer: Railroad Medicare Medicare |
$17.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.46
|
| Rate for Payer: UHC Core |
$57.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.18
|
| Rate for Payer: UHC Exchange |
$17.18
|
| Rate for Payer: UHC Medicare Advantage |
$17.18
|
| Rate for Payer: VA VA |
$17.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.53
|
|
|
MINERAL OIL
|
Facility
|
IP
|
$68.71
|
|
|
Service Code
|
NDC 63323025410
|
| Hospital Charge Code |
109056
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.66 |
| Max. Negotiated Rate |
$61.84 |
| Rate for Payer: Aetna Commercial |
$58.40
|
| Rate for Payer: BCBS Trust/PPO |
$56.09
|
| Rate for Payer: BCN Commercial |
$53.10
|
| Rate for Payer: Cash Price |
$54.97
|
| Rate for Payer: Cofinity Commercial |
$59.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.97
|
| Rate for Payer: Healthscope Commercial |
$61.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.40
|
| Rate for Payer: Nomi Health Commercial |
$56.34
|
| Rate for Payer: PHP Commercial |
$58.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.66
|
| Rate for Payer: Priority Health HMO/PPO |
$59.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$46.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.46
|
| Rate for Payer: UHC Core |
$57.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.53
|
|
|
MINERAL OIL ENEMA
|
Facility
|
IP
|
$46.89
|
|
|
Service Code
|
NDC 96295012753
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$42.20 |
| Rate for Payer: Aetna Commercial |
$39.86
|
| Rate for Payer: BCBS Trust/PPO |
$38.28
|
| Rate for Payer: BCN Commercial |
$36.24
|
| 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: PHP Commercial |
$39.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.48
|
| Rate for Payer: Priority Health HMO/PPO |
$40.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.42
|
| 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 |
$11.14 |
| 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 |
$18.76
|
| Rate for Payer: BCBS MAPPO |
$11.72
|
| Rate for Payer: BCBS Trust/PPO |
$38.55
|
| Rate for Payer: BCN Commercial |
$36.46
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.86
|
| Rate for Payer: Nomi Health Commercial |
$38.45
|
| 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 Cigna Priority Health |
$30.48
|
| Rate for Payer: Priority Health HMO/PPO |
$40.79
|
| Rate for Payer: Priority Health Medicare |
$11.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$31.42
|
| 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 Dual Complete DSNP |
$11.72
|
| Rate for Payer: UHC Exchange |
$11.72
|
| Rate for Payer: UHC Medicare Advantage |
$11.72
|
| Rate for Payer: VA VA |
$11.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.17
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
OP
|
$234.65
|
|
|
Service Code
|
NDC 53489038701
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.73 |
| Max. Negotiated Rate |
$211.18 |
| 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 |
$93.86
|
| Rate for Payer: BCBS MAPPO |
$58.66
|
| Rate for Payer: BCBS Trust/PPO |
$192.91
|
| Rate for Payer: BCN Commercial |
$182.44
|
| 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 |
$211.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Nomi Health Commercial |
$192.41
|
| 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 Cigna Priority Health |
$152.52
|
| Rate for Payer: Priority Health HMO/PPO |
$204.15
|
| Rate for Payer: Priority Health Medicare |
$59.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.22
|
| 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 Dual Complete DSNP |
$58.66
|
| Rate for Payer: UHC Exchange |
$58.66
|
| Rate for Payer: UHC Medicare Advantage |
$58.66
|
| Rate for Payer: VA VA |
$58.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
