|
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 |
$12.55
|
| 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
|
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 |
$195.79 |
| 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 |
$195.79
|
| 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
|
|
|
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 |
$195.79 |
| 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 |
$195.79
|
| 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
|
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
|
IP
|
$306.85
|
|
|
Service Code
|
NDC 00904681861
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.45 |
| Max. Negotiated Rate |
$276.17 |
| 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 |
$276.17
|
| 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
|
$306.85
|
|
|
Service Code
|
NDC 00904681861
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.88 |
| Max. Negotiated Rate |
$276.17 |
| 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 |
$276.17
|
| 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
|
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
|
|
|
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
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 68084020501
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.10 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: BCBS Trust/PPO |
$218.64
|
| Rate for Payer: BCN Commercial |
$206.99
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Nomi Health Commercial |
$219.63
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.10
|
| Rate for Payer: Priority Health HMO/PPO |
$233.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.70
|
| Rate for Payer: UHC Core |
$223.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
NDC 68084020511
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: Aetna Medicare |
$0.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.84
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.84
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: BCBS MAPPO |
$0.67
|
| Rate for Payer: BCBS Trust/PPO |
$2.20
|
| Rate for Payer: BCN Commercial |
$2.08
|
| Rate for Payer: BCN Medicare Advantage |
$0.67
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.67
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: PACE Senior Care Partners |
$0.64
|
| Rate for Payer: PACE SWMI |
$0.67
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: PHP Medicare Advantage |
$0.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health HMO/PPO |
$2.33
|
| Rate for Payer: Priority Health Medicare |
$0.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: Railroad Medicare Medicare |
$0.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.36
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.67
|
| Rate for Payer: UHC Exchange |
$0.67
|
| Rate for Payer: UHC Medicare Advantage |
$0.67
|
| Rate for Payer: VA VA |
$0.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 68084020511
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$2.41 |
| Rate for Payer: Aetna Commercial |
$2.28
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: BCN Commercial |
$2.07
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: PHP Commercial |
$2.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health HMO/PPO |
$2.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.36
|
| Rate for Payer: UHC Core |
$2.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.01
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$234.65
|
|
|
Service Code
|
NDC 53489038701
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.52 |
| Max. Negotiated Rate |
$211.19 |
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: BCBS Trust/PPO |
$191.54
|
| Rate for Payer: BCN Commercial |
$181.34
|
| Rate for Payer: Cash Price |
$187.72
|
| Rate for Payer: Cofinity Commercial |
$201.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$187.72
|
| Rate for Payer: Healthscope Commercial |
$211.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$175.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.45
|
| Rate for Payer: Nomi Health Commercial |
$192.41
|
| Rate for Payer: PHP Commercial |
$199.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.52
|
| Rate for Payer: Priority Health HMO/PPO |
$204.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.49
|
| Rate for Payer: UHC Core |
$195.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$175.99
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
OP
|
$267.84
|
|
|
Service Code
|
NDC 68084020501
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.61 |
| Max. Negotiated Rate |
$241.06 |
| Rate for Payer: Aetna Commercial |
$227.66
|
| Rate for Payer: Aetna Medicare |
$69.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$83.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$83.70
|
| Rate for Payer: BCBS Complete |
$107.14
|
| Rate for Payer: BCBS MAPPO |
$66.96
|
| Rate for Payer: BCBS Trust/PPO |
$220.19
|
| Rate for Payer: BCN Commercial |
$208.25
|
| Rate for Payer: BCN Medicare Advantage |
$66.96
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$230.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.96
|
| Rate for Payer: Healthscope Commercial |
$241.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$200.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Nomi Health Commercial |
$219.63
|
| Rate for Payer: PACE Senior Care Partners |
$63.61
|
| Rate for Payer: PACE SWMI |
$66.96
|
| Rate for Payer: PHP Commercial |
$227.66
|
| Rate for Payer: PHP Medicare Advantage |
$66.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.10
|
| Rate for Payer: Priority Health HMO/PPO |
$233.02
|
| Rate for Payer: Priority Health Medicare |
$67.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.45
|
| Rate for Payer: Railroad Medicare Medicare |
$66.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.70
|
| Rate for Payer: UHC Core |
$223.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.96
|
| Rate for Payer: UHC Exchange |
$66.96
|
| Rate for Payer: UHC Medicare Advantage |
$66.96
|
| Rate for Payer: VA VA |
$66.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$200.88
|
|
|
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 |
$211.19 |
| Rate for Payer: Aetna Commercial |
$199.45
|
| Rate for Payer: Aetna Medicare |
$61.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.33
|
| Rate for Payer: BCBS Complete |
$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 |
$211.19
|
| 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
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$1,583.86
|
|
|
Service Code
|
NDC 00469260130
|
| Hospital Charge Code |
161790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$376.17 |
| Max. Negotiated Rate |
$1,425.47 |
| Rate for Payer: Aetna Commercial |
$1,346.28
|
| Rate for Payer: Aetna Medicare |
$411.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$494.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$494.96
|
| Rate for Payer: BCBS Complete |
$633.54
|
| Rate for Payer: BCBS MAPPO |
$395.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,302.09
|
| Rate for Payer: BCN Commercial |
$1,231.45
|
| Rate for Payer: BCN Medicare Advantage |
$395.96
|
| Rate for Payer: Cash Price |
$1,267.09
|
| Rate for Payer: Cofinity Commercial |
$1,362.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,267.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$395.96
|
| Rate for Payer: Healthscope Commercial |
$1,425.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,187.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$415.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$455.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,346.28
|
| Rate for Payer: Nomi Health Commercial |
$1,298.77
|
| Rate for Payer: PACE Senior Care Partners |
$376.17
|
| Rate for Payer: PACE SWMI |
$395.96
|
| Rate for Payer: PHP Commercial |
$1,346.28
|
| Rate for Payer: PHP Medicare Advantage |
$395.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,029.51
|
| Rate for Payer: Priority Health HMO/PPO |
$1,377.96
|
| Rate for Payer: Priority Health Medicare |
$399.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,061.19
|
| Rate for Payer: Railroad Medicare Medicare |
$395.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,393.80
|
| Rate for Payer: UHC Core |
$1,322.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$395.96
|
| Rate for Payer: UHC Exchange |
$395.96
|
| Rate for Payer: UHC Medicare Advantage |
$395.96
|
| Rate for Payer: VA VA |
$395.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,187.89
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$4,751.58
|
|
|
Service Code
|
NDC 00469260190
|
| Hospital Charge Code |
161790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,128.50 |
| Max. Negotiated Rate |
$4,276.42 |
| Rate for Payer: Aetna Commercial |
$4,038.84
|
| Rate for Payer: Aetna Medicare |
$1,235.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,484.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,484.87
|
| Rate for Payer: BCBS Complete |
$1,900.63
|
| Rate for Payer: BCBS MAPPO |
$1,187.89
|
| Rate for Payer: BCBS Trust/PPO |
$3,906.27
|
| Rate for Payer: BCN Commercial |
$3,694.35
|
| Rate for Payer: BCN Medicare Advantage |
$1,187.89
|
| Rate for Payer: Cash Price |
$3,801.26
|
| Rate for Payer: Cofinity Commercial |
$4,086.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,801.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,187.89
|
| Rate for Payer: Healthscope Commercial |
$4,276.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,563.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,247.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,366.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,038.84
|
| Rate for Payer: Nomi Health Commercial |
$3,896.30
|
| Rate for Payer: PACE Senior Care Partners |
$1,128.50
|
| Rate for Payer: PACE SWMI |
$1,187.89
|
| Rate for Payer: PHP Commercial |
$4,038.84
|
| Rate for Payer: PHP Medicare Advantage |
$1,187.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,088.53
|
| Rate for Payer: Priority Health HMO/PPO |
$4,133.87
|
| Rate for Payer: Priority Health Medicare |
$1,199.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,183.56
|
| Rate for Payer: Railroad Medicare Medicare |
$1,187.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,181.39
|
| Rate for Payer: UHC Core |
$3,967.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,187.89
|
| Rate for Payer: UHC Exchange |
$1,187.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,187.89
|
| Rate for Payer: VA VA |
$1,187.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,563.68
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$1,583.86
|
|
|
Service Code
|
NDC 00469260130
|
| Hospital Charge Code |
161790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,029.51 |
| Max. Negotiated Rate |
$1,425.47 |
| Rate for Payer: Aetna Commercial |
$1,346.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,292.90
|
| Rate for Payer: BCN Commercial |
$1,224.01
|
| Rate for Payer: Cash Price |
$1,267.09
|
| Rate for Payer: Cofinity Commercial |
$1,362.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,267.09
|
| Rate for Payer: Healthscope Commercial |
$1,425.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,187.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,346.28
|
| Rate for Payer: Nomi Health Commercial |
$1,298.77
|
| Rate for Payer: PHP Commercial |
$1,346.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,029.51
|
| Rate for Payer: Priority Health HMO/PPO |
$1,377.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,061.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,393.80
|
| Rate for Payer: UHC Core |
$1,322.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,187.89
|
|
|
MIRABEGRON ER 25 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$4,751.58
|
|
|
Service Code
|
NDC 00469260190
|
| Hospital Charge Code |
161790
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,088.53 |
| Max. Negotiated Rate |
$4,276.42 |
| Rate for Payer: Aetna Commercial |
$4,038.84
|
| Rate for Payer: BCBS Trust/PPO |
$3,878.71
|
| Rate for Payer: BCN Commercial |
$3,672.02
|
| Rate for Payer: Cash Price |
$3,801.26
|
| Rate for Payer: Cofinity Commercial |
$4,086.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,801.26
|
| Rate for Payer: Healthscope Commercial |
$4,276.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,563.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,038.84
|
| Rate for Payer: Nomi Health Commercial |
$3,896.30
|
| Rate for Payer: PHP Commercial |
$4,038.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,088.53
|
| Rate for Payer: Priority Health HMO/PPO |
$4,133.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3,183.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,181.39
|
| Rate for Payer: UHC Core |
$3,967.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,563.68
|
|
