|
MICROFIBRILLAR COLLAGEN HEMOSTAT POWDER
|
Facility
|
IP
|
$1,021.57
|
|
|
Service Code
|
NDC 53276-1010-02
|
| Hospital Charge Code |
10606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$449.49 |
| Max. Negotiated Rate |
$919.41 |
| Rate for Payer: Aetna American Axle |
$664.02
|
| Rate for Payer: Aetna Commercial |
$868.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$664.02
|
| Rate for Payer: Cash Price |
$817.26
|
| Rate for Payer: Cofinity Commercial |
$715.10
|
| Rate for Payer: Cofinity Commercial |
$878.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$817.26
|
| Rate for Payer: Healthscope Commercial |
$919.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$715.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$766.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$868.33
|
| Rate for Payer: PHP Commercial |
$868.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$715.10
|
| Rate for Payer: Priority Health SBD |
$643.59
|
| Rate for Payer: UMR Bronson Commercial |
$449.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$766.18
|
|
|
MICROFIBRILLAR COLLAGEN HEMOSTAT TOPICAL POWDER IN PACKET
|
Facility
|
IP
|
$509.49
|
|
|
Service Code
|
NDC 53276-1010-01
|
| Hospital Charge Code |
159416
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$224.18 |
| Max. Negotiated Rate |
$458.54 |
| Rate for Payer: Aetna American Axle |
$331.17
|
| Rate for Payer: Aetna Commercial |
$433.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$331.17
|
| Rate for Payer: Cash Price |
$407.59
|
| Rate for Payer: Cofinity Commercial |
$356.64
|
| Rate for Payer: Cofinity Commercial |
$438.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.59
|
| Rate for Payer: Healthscope Commercial |
$458.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$356.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$382.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$433.07
|
| Rate for Payer: PHP Commercial |
$433.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$356.64
|
| Rate for Payer: Priority Health SBD |
$320.98
|
| Rate for Payer: UMR Bronson Commercial |
$224.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$382.12
|
|
|
MICRO NEEDLING
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 00171
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
| Rate for Payer: UMR Bronson Commercial |
$92.00
|
|
|
MICROSURGICAL TECHNIQUES, REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$774.60
|
|
|
Service Code
|
CPT 69990
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$213.49 |
| Max. Negotiated Rate |
$774.60 |
| Rate for Payer: BCBS Trust/PPO |
$774.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$234.84
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$213.49
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
IP
|
$48.22
|
|
|
Service Code
|
NDC 9900-0000-15
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$43.40 |
| Rate for Payer: Aetna American Axle |
$31.34
|
| Rate for Payer: Aetna Commercial |
$40.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.34
|
| Rate for Payer: Cash Price |
$38.58
|
| Rate for Payer: Cofinity Commercial |
$33.75
|
| Rate for Payer: Cofinity Commercial |
$41.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.58
|
| Rate for Payer: Healthscope Commercial |
$43.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.99
|
| Rate for Payer: PHP Commercial |
$40.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.75
|
| Rate for Payer: Priority Health SBD |
$30.38
|
| Rate for Payer: UMR Bronson Commercial |
$21.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.16
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
IP
|
$39.38
|
|
|
Service Code
|
NDC 60687-576-40
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.33 |
| Max. Negotiated Rate |
$35.44 |
| Rate for Payer: Aetna American Axle |
$25.60
|
| Rate for Payer: Aetna Commercial |
$33.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.60
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cofinity Commercial |
$27.57
|
| Rate for Payer: Cofinity Commercial |
$33.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.50
|
| Rate for Payer: Healthscope Commercial |
$35.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.47
|
| Rate for Payer: PHP Commercial |
$33.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.57
|
| Rate for Payer: Priority Health SBD |
$24.81
|
| Rate for Payer: UMR Bronson Commercial |
$17.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.54
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
IP
|
$39.38
|
|
|
Service Code
|
NDC 60687-576-86
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.33 |
| Max. Negotiated Rate |
$35.44 |
| Rate for Payer: Aetna American Axle |
$25.60
|
| Rate for Payer: Aetna Commercial |
$33.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.60
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cofinity Commercial |
$27.57
|
| Rate for Payer: Cofinity Commercial |
$33.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.50
|
| Rate for Payer: Healthscope Commercial |
$35.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.47
|
| Rate for Payer: PHP Commercial |
$33.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.57
|
| Rate for Payer: Priority Health SBD |
$24.81
|
| Rate for Payer: UMR Bronson Commercial |
$17.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.54
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
IP
|
$9.65
|
|
|
Service Code
|
NDC 9900-0000-14
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$8.68 |
| Rate for Payer: Aetna American Axle |
$6.27
|
| Rate for Payer: Aetna Commercial |
$8.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.27
|
| Rate for Payer: Cash Price |
$7.72
|
| Rate for Payer: Cofinity Commercial |
$6.76
|
| Rate for Payer: Cofinity Commercial |
$8.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.72
|
| Rate for Payer: Healthscope Commercial |
$8.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.20
|
| Rate for Payer: PHP Commercial |
$8.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.76
|
| Rate for Payer: Priority Health SBD |
$6.08
|
| Rate for Payer: UMR Bronson Commercial |
$4.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.24
|
|
|
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 |
$10.50 |
| Max. Negotiated Rate |
$21.48 |
| Rate for Payer: Aetna American Axle |
$15.52
|
| Rate for Payer: Aetna American Axle |
$9.06
|
| Rate for Payer: Aetna American Axle |
$15.57
|
| Rate for Payer: Aetna Commercial |
$20.37
|
| Rate for Payer: Aetna Commercial |
$20.29
|
| Rate for Payer: Aetna Commercial |
$11.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.06
|
| Rate for Payer: Cash Price |
$19.10
|
| Rate for Payer: Cash Price |
$11.15
|
| Rate for Payer: Cash Price |
$19.17
|
| Rate for Payer: Cofinity Commercial |
$11.99
|
| Rate for Payer: Cofinity Commercial |
$16.71
|
| Rate for Payer: Cofinity Commercial |
$20.53
|
| Rate for Payer: Cofinity Commercial |
$20.61
|
| Rate for Payer: Cofinity Commercial |
$16.77
|
| Rate for Payer: Cofinity Commercial |
$9.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.10
|
| Rate for Payer: Healthscope Commercial |
$21.56
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$21.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.29
|
| Rate for Payer: PHP Commercial |
$11.85
|
| Rate for Payer: PHP Commercial |
$20.37
|
| Rate for Payer: PHP Commercial |
$20.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.76
|
| Rate for Payer: Priority Health SBD |
$15.04
|
| Rate for Payer: Priority Health SBD |
$8.78
|
| Rate for Payer: Priority Health SBD |
$15.09
|
| Rate for Payer: UMR Bronson Commercial |
$10.50
|
| Rate for Payer: UMR Bronson Commercial |
$10.54
|
| Rate for Payer: UMR Bronson Commercial |
$6.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.97
|
|
|
MIDAZOLAM 2 MG/ML ORAL SYRUP
|
Facility
|
IP
|
$1,137.82
|
|
|
Service Code
|
NDC 0574-0150-04
|
| Hospital Charge Code |
24176
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$500.64 |
| Max. Negotiated Rate |
$1,024.04 |
| Rate for Payer: Aetna American Axle |
$739.58
|
| Rate for Payer: Aetna Commercial |
$967.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$739.58
|
| Rate for Payer: Cash Price |
$910.26
|
| Rate for Payer: Cofinity Commercial |
$796.47
|
| Rate for Payer: Cofinity Commercial |
$978.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$910.26
|
| Rate for Payer: Healthscope Commercial |
$1,024.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$796.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$853.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$967.15
|
| Rate for Payer: PHP Commercial |
$967.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$796.47
|
| Rate for Payer: Priority Health SBD |
$716.83
|
| Rate for Payer: UMR Bronson Commercial |
$500.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$853.36
|
|
|
MIDAZOLAM 2 MG/ML ORAL SYRUP
|
Facility
|
IP
|
$787.18
|
|
|
Service Code
|
NDC 0054-3566-99
|
| Hospital Charge Code |
24176
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$346.36 |
| Max. Negotiated Rate |
$708.46 |
| Rate for Payer: Aetna American Axle |
$511.67
|
| Rate for Payer: Aetna Commercial |
$669.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$511.67
|
| Rate for Payer: Cash Price |
$629.74
|
| Rate for Payer: Cofinity Commercial |
$551.03
|
| Rate for Payer: Cofinity Commercial |
$676.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$629.74
|
| Rate for Payer: Healthscope Commercial |
$708.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$551.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$590.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$669.10
|
| Rate for Payer: PHP Commercial |
$669.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$551.03
|
| Rate for Payer: Priority Health SBD |
$495.92
|
| Rate for Payer: UMR Bronson Commercial |
$346.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$590.38
|
|
|
MIDAZOLAM 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$18.55
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$16.70 |
| Rate for Payer: Aetna American Axle |
$12.06
|
| Rate for Payer: Aetna American Axle |
$21.58
|
| Rate for Payer: Aetna American Axle |
$18.97
|
| Rate for Payer: Aetna American Axle |
$19.96
|
| Rate for Payer: Aetna American Axle |
$28.63
|
| Rate for Payer: Aetna American Axle |
$23.21
|
| Rate for Payer: Aetna American Axle |
$37.86
|
| Rate for Payer: Aetna American Axle |
$18.64
|
| Rate for Payer: Aetna American Axle |
$24.48
|
| Rate for Payer: Aetna Commercial |
$28.22
|
| Rate for Payer: Aetna Commercial |
$15.77
|
| Rate for Payer: Aetna Commercial |
$30.35
|
| Rate for Payer: Aetna Commercial |
$37.44
|
| Rate for Payer: Aetna Commercial |
$32.01
|
| Rate for Payer: Aetna Commercial |
$24.38
|
| Rate for Payer: Aetna Commercial |
$49.51
|
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Commercial |
$24.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.97
|
| Rate for Payer: Cash Price |
$22.94
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cash Price |
$14.84
|
| Rate for Payer: Cash Price |
$46.60
|
| Rate for Payer: Cash Price |
$23.35
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Cash Price |
$35.24
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Cash Price |
$28.57
|
| Rate for Payer: Cofinity Commercial |
$32.39
|
| Rate for Payer: Cofinity Commercial |
$20.43
|
| Rate for Payer: Cofinity Commercial |
$50.10
|
| Rate for Payer: Cofinity Commercial |
$21.50
|
| Rate for Payer: Cofinity Commercial |
$26.41
|
| Rate for Payer: Cofinity Commercial |
$25.10
|
| Rate for Payer: Cofinity Commercial |
$12.98
|
| Rate for Payer: Cofinity Commercial |
$15.95
|
| Rate for Payer: Cofinity Commercial |
$30.84
|
| Rate for Payer: Cofinity Commercial |
$30.71
|
| Rate for Payer: Cofinity Commercial |
$40.78
|
| Rate for Payer: Cofinity Commercial |
$23.24
|
| Rate for Payer: Cofinity Commercial |
$28.55
|
| Rate for Payer: Cofinity Commercial |
$25.00
|
| Rate for Payer: Cofinity Commercial |
$26.36
|
| Rate for Payer: Cofinity Commercial |
$37.88
|
| Rate for Payer: Cofinity Commercial |
$24.66
|
| Rate for Payer: Cofinity Commercial |
$20.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.24
|
| Rate for Payer: Healthscope Commercial |
$33.89
|
| Rate for Payer: Healthscope Commercial |
$26.27
|
| Rate for Payer: Healthscope Commercial |
$39.64
|
| Rate for Payer: Healthscope Commercial |
$27.64
|
| Rate for Payer: Healthscope Commercial |
$32.14
|
| Rate for Payer: Healthscope Commercial |
$52.42
|
| Rate for Payer: Healthscope Commercial |
$16.70
|
| Rate for Payer: Healthscope Commercial |
$29.88
|
| Rate for Payer: Healthscope Commercial |
$25.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$26.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$28.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$30.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$37.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$49.51
|
| Rate for Payer: PHP Commercial |
$24.81
|
| Rate for Payer: PHP Commercial |
$15.77
|
| Rate for Payer: PHP Commercial |
$24.38
|
| Rate for Payer: PHP Commercial |
$30.35
|
| Rate for Payer: PHP Commercial |
$37.44
|
| Rate for Payer: PHP Commercial |
$28.22
|
| Rate for Payer: PHP Commercial |
$49.51
|
| Rate for Payer: PHP Commercial |
$32.01
|
| Rate for Payer: PHP Commercial |
$26.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.50
|
| Rate for Payer: Priority Health SBD |
$11.69
|
| Rate for Payer: Priority Health SBD |
$22.50
|
| Rate for Payer: Priority Health SBD |
$36.70
|
| Rate for Payer: Priority Health SBD |
$23.73
|
| Rate for Payer: Priority Health SBD |
$19.35
|
| Rate for Payer: Priority Health SBD |
$20.92
|
| Rate for Payer: Priority Health SBD |
$18.39
|
| Rate for Payer: Priority Health SBD |
$27.75
|
| Rate for Payer: Priority Health SBD |
$18.07
|
| Rate for Payer: UMR Bronson Commercial |
$19.38
|
| Rate for Payer: UMR Bronson Commercial |
$12.84
|
| Rate for Payer: UMR Bronson Commercial |
$13.51
|
| Rate for Payer: UMR Bronson Commercial |
$12.62
|
| Rate for Payer: UMR Bronson Commercial |
$8.16
|
| Rate for Payer: UMR Bronson Commercial |
$14.61
|
| Rate for Payer: UMR Bronson Commercial |
$16.57
|
| Rate for Payer: UMR Bronson Commercial |
$15.71
|
| Rate for Payer: UMR Bronson Commercial |
$25.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$26.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.69
|
|
|
MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$14.43
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
168786
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$12.99 |
| Rate for Payer: Aetna American Axle |
$9.38
|
| Rate for Payer: Aetna American Axle |
$8.27
|
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna Commercial |
$10.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.38
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Cofinity Commercial |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$10.95
|
| Rate for Payer: Cofinity Commercial |
$8.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$11.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.27
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: PHP Commercial |
$10.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.10
|
| Rate for Payer: Priority Health SBD |
$8.02
|
| Rate for Payer: Priority Health SBD |
$9.09
|
| Rate for Payer: UMR Bronson Commercial |
$6.35
|
| Rate for Payer: UMR Bronson Commercial |
$5.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.82
|
|
|
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 |
$6.82 |
| Max. Negotiated Rate |
$13.94 |
| Rate for Payer: Aetna American Axle |
$10.07
|
| Rate for Payer: Aetna Commercial |
$13.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.07
|
| Rate for Payer: Cash Price |
$12.39
|
| Rate for Payer: Cofinity Commercial |
$13.32
|
| Rate for Payer: Cofinity Commercial |
$10.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.39
|
| Rate for Payer: Healthscope Commercial |
$13.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.17
|
| Rate for Payer: PHP Commercial |
$13.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.84
|
| Rate for Payer: Priority Health SBD |
$9.76
|
| Rate for Payer: UMR Bronson Commercial |
$6.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.62
|
|
|
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLUTION
|
Facility
|
IP
|
$15.49
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
301170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$13.94 |
| Rate for Payer: Aetna American Axle |
$10.07
|
| Rate for Payer: Aetna Commercial |
$13.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.07
|
| Rate for Payer: Cash Price |
$12.39
|
| Rate for Payer: Cofinity Commercial |
$10.84
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$10.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.17
|
| Rate for Payer: PHP Commercial |
$13.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.84
|
| Rate for Payer: Priority Health SBD |
$9.76
|
| Rate for Payer: UMR Bronson Commercial |
$6.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.62
|
|
|
MIDDLE EAR EXPLORATION THROUGH POSTAURICULAR OR EAR CANAL INCISION
|
Facility
|
OP
|
$9,009.23
|
|
|
Service Code
|
CPT 69440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$685.66 |
| Max. Negotiated Rate |
$9,009.23 |
| Rate for Payer: Aetna Medicare |
$2,976.31
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,577.30
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,577.30
|
| Rate for Payer: BCBS Complete |
$1,643.84
|
| Rate for Payer: BCBS MAPPO |
$2,861.84
|
| Rate for Payer: BCBS Trust/PPO |
$3,218.77
|
| Rate for Payer: BCN Medicare Advantage |
$2,861.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,861.84
|
| Rate for Payer: Mclaren Medicaid |
$1,565.43
|
| Rate for Payer: Mclaren Medicare |
$2,861.84
|
| Rate for Payer: Meridian Medicaid |
$1,643.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,004.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,291.12
|
| Rate for Payer: PACE Medicare |
$2,718.75
|
| Rate for Payer: PACE SWMI |
$2,861.84
|
| Rate for Payer: PHP Medicare Advantage |
$2,861.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,565.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9,009.23
|
| Rate for Payer: Priority Health Medicare |
$2,861.84
|
| Rate for Payer: Priority Health Narrow Network |
$7,207.38
|
| Rate for Payer: Railroad Medicare Medicare |
$2,861.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$754.23
|
| Rate for Payer: UHC Core |
$3,604.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,861.84
|
| Rate for Payer: UHC Exchange |
$685.66
|
| Rate for Payer: UHC Medicare Advantage |
$2,947.70
|
| Rate for Payer: VA VA |
$2,861.84
|
|
|
MIDODRINE 2.5 MG TABLET
|
Facility
|
IP
|
$303.15
|
|
|
Service Code
|
NDC 0245-0211-11
|
| Hospital Charge Code |
10609
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.39 |
| Max. Negotiated Rate |
$272.84 |
| Rate for Payer: Aetna American Axle |
$197.05
|
| Rate for Payer: Aetna Commercial |
$257.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.05
|
| Rate for Payer: Cash Price |
$242.52
|
| Rate for Payer: Cofinity Commercial |
$212.20
|
| Rate for Payer: Cofinity Commercial |
$260.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.52
|
| Rate for Payer: Healthscope Commercial |
$272.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$257.68
|
| Rate for Payer: PHP Commercial |
$257.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.20
|
| Rate for Payer: Priority Health SBD |
$190.98
|
| Rate for Payer: UMR Bronson Commercial |
$133.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.36
|
|
|
MIDODRINE 2.5 MG TABLET
|
Facility
|
IP
|
$417.60
|
|
|
Service Code
|
NDC 0115-4211-01
|
| Hospital Charge Code |
10609
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.74 |
| Max. Negotiated Rate |
$375.84 |
| Rate for Payer: Aetna American Axle |
$271.44
|
| Rate for Payer: Aetna Commercial |
$354.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.44
|
| Rate for Payer: Cash Price |
$334.08
|
| Rate for Payer: Cofinity Commercial |
$292.32
|
| Rate for Payer: Cofinity Commercial |
$359.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.08
|
| Rate for Payer: Healthscope Commercial |
$375.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$292.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$354.96
|
| Rate for Payer: PHP Commercial |
$354.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.32
|
| Rate for Payer: Priority Health SBD |
$263.09
|
| Rate for Payer: UMR Bronson Commercial |
$183.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.20
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$334.56
|
|
|
Service Code
|
NDC 60687-398-01
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.21 |
| Max. Negotiated Rate |
$301.10 |
| Rate for Payer: Aetna American Axle |
$217.46
|
| Rate for Payer: Aetna Commercial |
$284.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.46
|
| Rate for Payer: Cash Price |
$267.65
|
| Rate for Payer: Cofinity Commercial |
$234.19
|
| Rate for Payer: Cofinity Commercial |
$287.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.65
|
| Rate for Payer: Healthscope Commercial |
$301.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$284.38
|
| Rate for Payer: PHP Commercial |
$284.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.19
|
| Rate for Payer: Priority Health SBD |
$210.77
|
| Rate for Payer: UMR Bronson Commercial |
$147.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.92
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$318.25
|
|
|
Service Code
|
NDC 59651-247-01
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.03 |
| Max. Negotiated Rate |
$286.42 |
| Rate for Payer: Aetna American Axle |
$206.86
|
| Rate for Payer: Aetna Commercial |
$270.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.86
|
| Rate for Payer: Cash Price |
$254.60
|
| Rate for Payer: Cofinity Commercial |
$222.78
|
| Rate for Payer: Cofinity Commercial |
$273.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.60
|
| Rate for Payer: Healthscope Commercial |
$286.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$270.51
|
| Rate for Payer: PHP Commercial |
$270.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.78
|
| Rate for Payer: Priority Health SBD |
$200.50
|
| Rate for Payer: UMR Bronson Commercial |
$140.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.69
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$3.35
|
|
|
Service Code
|
NDC 60687-398-11
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: Aetna American Axle |
$2.18
|
| Rate for Payer: Aetna Commercial |
$2.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.18
|
| Rate for Payer: Cash Price |
$2.68
|
| Rate for Payer: Cofinity Commercial |
$2.34
|
| Rate for Payer: Cofinity Commercial |
$2.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.68
|
| Rate for Payer: Healthscope Commercial |
$3.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.85
|
| Rate for Payer: PHP Commercial |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.34
|
| Rate for Payer: Priority Health SBD |
$2.11
|
| Rate for Payer: UMR Bronson Commercial |
$1.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.51
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$372.40
|
|
|
Service Code
|
NDC 63739-145-10
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.86 |
| Max. Negotiated Rate |
$335.16 |
| Rate for Payer: Aetna American Axle |
$242.06
|
| Rate for Payer: Aetna Commercial |
$316.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.06
|
| Rate for Payer: Cash Price |
$297.92
|
| Rate for Payer: Cofinity Commercial |
$320.26
|
| Rate for Payer: Cofinity Commercial |
$260.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$297.92
|
| Rate for Payer: Healthscope Commercial |
$335.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$260.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$279.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$316.54
|
| Rate for Payer: PHP Commercial |
$316.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.68
|
| Rate for Payer: Priority Health SBD |
$234.61
|
| Rate for Payer: UMR Bronson Commercial |
$163.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$279.30
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$217.55
|
|
|
Service Code
|
NDC 0245-0212-11
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.72 |
| Max. Negotiated Rate |
$195.80 |
| Rate for Payer: Aetna American Axle |
$141.41
|
| Rate for Payer: Aetna Commercial |
$184.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.41
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Commercial |
$152.28
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$152.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$184.92
|
| Rate for Payer: PHP Commercial |
$184.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.28
|
| Rate for Payer: Priority Health SBD |
$137.06
|
| Rate for Payer: UMR Bronson Commercial |
$95.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.16
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$3.15
|
|
|
Service Code
|
NDC 0245-0212-89
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna American Axle |
$2.05
|
| Rate for Payer: Aetna Commercial |
$2.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.05
|
| Rate for Payer: Cash Price |
$2.52
|
| Rate for Payer: Cofinity Commercial |
$2.20
|
| Rate for Payer: Cofinity Commercial |
$2.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.52
|
| Rate for Payer: Healthscope Commercial |
$2.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.68
|
| Rate for Payer: PHP Commercial |
$2.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health SBD |
$1.98
|
| Rate for Payer: UMR Bronson Commercial |
$1.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.36
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$314.45
|
|
|
Service Code
|
NDC 0245-0212-01
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.36 |
| Max. Negotiated Rate |
$283.00 |
| Rate for Payer: Aetna American Axle |
$204.39
|
| Rate for Payer: Aetna Commercial |
$267.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.39
|
| Rate for Payer: Cash Price |
$251.56
|
| Rate for Payer: Cofinity Commercial |
$220.12
|
| Rate for Payer: Cofinity Commercial |
$270.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.56
|
| Rate for Payer: Healthscope Commercial |
$283.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$220.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$267.28
|
| Rate for Payer: PHP Commercial |
$267.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.12
|
| Rate for Payer: Priority Health SBD |
$198.10
|
| Rate for Payer: UMR Bronson Commercial |
$138.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.84
|
|
