|
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 Advantage |
$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 Commercial |
$13.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.62
|
| Rate for Payer: PHP Commercial |
$13.17
|
| 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 INJECTION SOLUTION
|
Facility
|
OP
|
$15.49
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
168785
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$13.94 |
| Rate for Payer: Aetna American Axle |
$10.07
|
| Rate for Payer: Aetna Commercial |
$13.17
|
| Rate for Payer: Aetna Medicare |
$7.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.07
|
| Rate for Payer: BCBS Complete |
$6.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$12.39
|
| Rate for Payer: Cash Price |
$12.39
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$12.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.62
|
| Rate for Payer: PHP Commercial |
$13.17
|
| Rate for Payer: Priority Health SBD |
$9.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UMR Bronson Commercial |
$5.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.62
|
|
|
MIDAZOLAM (PF) 5 MG/ML INTRANASAL SOLUTION
|
Facility
|
OP
|
$15.49
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
301170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$13.94 |
| Rate for Payer: Aetna American Axle |
$10.07
|
| Rate for Payer: Aetna Commercial |
$13.17
|
| Rate for Payer: Aetna Medicare |
$7.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.07
|
| Rate for Payer: BCBS Complete |
$6.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.45
|
| Rate for Payer: BCN Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$12.39
|
| Rate for Payer: Cash Price |
$12.39
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$12.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.62
|
| Rate for Payer: PHP Commercial |
$13.17
|
| Rate for Payer: Priority Health SBD |
$9.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UMR Bronson Commercial |
$5.73
|
| 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 Advantage |
$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 Commercial |
$13.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.62
|
| Rate for Payer: PHP Commercial |
$13.17
|
| 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
|
$10,683.35
|
|
|
Service Code
|
CPT 69440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,727.75 |
| Max. Negotiated Rate |
$10,683.35 |
| Rate for Payer: Aetna Medicare |
$3,435.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,129.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,129.43
|
| Rate for Payer: BCBS Complete |
$1,814.30
|
| Rate for Payer: BCBS MAPPO |
$3,303.54
|
| Rate for Payer: BCBS Trust/PPO |
$4,078.39
|
| Rate for Payer: BCN Commercial |
$4,078.39
|
| Rate for Payer: BCN Medicare Advantage |
$3,303.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,303.54
|
| Rate for Payer: Mclaren Medicaid |
$3,303.54
|
| Rate for Payer: Mclaren Medicare |
$3,303.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,468.72
|
| Rate for Payer: Meridian Medicaid |
$3,468.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,799.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,633.89
|
| Rate for Payer: Nomi Health Commercial |
$9,910.62
|
| Rate for Payer: PACE Medicare |
$3,138.36
|
| Rate for Payer: PACE SWMI |
$3,303.54
|
| Rate for Payer: PHP Medicare Advantage |
$3,303.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,727.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$10,683.35
|
| Rate for Payer: Priority Health Medicare |
$3,303.54
|
| Rate for Payer: Priority Health Tiered Network |
$8,546.68
|
| Rate for Payer: Railroad Medicare Medicare |
$3,303.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,303.54
|
| Rate for Payer: UHC Medicaid |
$1,727.75
|
| Rate for Payer: UHCCP Medicaid |
$1,727.75
|
| Rate for Payer: VA VA |
$3,303.54
|
|
|
MIDFACE FLAP (IE, ZYGOMATICOFACIAL FLAP) WITH PRESERVATION OF VASCULAR PEDICLE(S)
|
Facility
|
OP
|
$11,418.88
|
|
|
Service Code
|
CPT 15730
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,846.70 |
| Max. Negotiated Rate |
$11,418.88 |
| Rate for Payer: Aetna Medicare |
$3,672.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,413.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,413.73
|
| Rate for Payer: BCBS Complete |
$1,939.21
|
| Rate for Payer: BCBS MAPPO |
$3,530.98
|
| Rate for Payer: BCBS Trust/PPO |
$4,273.58
|
| Rate for Payer: BCN Commercial |
$4,273.58
|
| Rate for Payer: BCN Medicare Advantage |
$3,530.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,530.98
|
| Rate for Payer: Mclaren Medicaid |
$3,530.98
|
| Rate for Payer: Mclaren Medicare |
$3,530.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,707.53
|
| Rate for Payer: Meridian Medicaid |
$3,707.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,060.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,884.08
|
| Rate for Payer: Nomi Health Commercial |
$10,592.94
|
| Rate for Payer: PACE Medicare |
$3,354.43
|
| Rate for Payer: PACE SWMI |
$3,530.98
|
| Rate for Payer: PHP Medicare Advantage |
$3,530.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,846.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$11,418.88
|
| Rate for Payer: Priority Health Medicare |
$3,530.98
|
| Rate for Payer: Priority Health Tiered Network |
$9,135.10
|
| Rate for Payer: Railroad Medicare Medicare |
$3,530.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$3,530.98
|
| Rate for Payer: UHC Medicaid |
$1,846.70
|
| Rate for Payer: UHCCP Medicaid |
$1,846.70
|
| Rate for Payer: VA VA |
$3,530.98
|
|
|
MIDODRINE 2.5 MG TABLET
|
Facility
|
OP
|
$277.30
|
|
|
Service Code
|
NDC 70756001011
|
| Hospital Charge Code |
10609
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.60 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna American Axle |
$180.25
|
| Rate for Payer: Aetna Commercial |
$235.71
|
| Rate for Payer: Aetna Medicare |
$138.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.25
|
| Rate for Payer: BCBS Complete |
$110.92
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Advantage |
$194.11
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$221.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: PHP Commercial |
$235.71
|
| Rate for Payer: Priority Health SBD |
$174.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.25
|
| Rate for Payer: UHC Core |
$144.47
|
| Rate for Payer: UHC Exchange |
$108.98
|
| Rate for Payer: UMR Bronson Commercial |
$102.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.97
|
|
|
MIDODRINE 2.5 MG TABLET
|
Facility
|
IP
|
$277.30
|
|
|
Service Code
|
NDC 70756001011
|
| Hospital Charge Code |
10609
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.01 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna American Axle |
$180.25
|
| Rate for Payer: Aetna Commercial |
$235.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.25
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Advantage |
$194.11
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$235.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$207.97
|
| Rate for Payer: PHP Commercial |
$235.71
|
| Rate for Payer: Priority Health SBD |
$174.70
|
| Rate for Payer: UMR Bronson Commercial |
$122.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.97
|
|
|
MIDODRINE 2.5 MG TABLET
|
Facility
|
OP
|
$211.85
|
|
|
Service Code
|
NDC 00245021111
|
| Hospital Charge Code |
10609
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$190.66 |
| Rate for Payer: Aetna American Axle |
$137.70
|
| Rate for Payer: Aetna Commercial |
$180.07
|
| Rate for Payer: Aetna Medicare |
$105.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.70
|
| Rate for Payer: BCBS Complete |
$84.74
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cofinity Advantage |
$148.29
|
| Rate for Payer: Cofinity Commercial |
$182.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.48
|
| Rate for Payer: Healthscope Commercial |
$190.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health SBD |
$133.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.70
|
| Rate for Payer: UHC Core |
$110.37
|
| Rate for Payer: UHC Exchange |
$83.26
|
| Rate for Payer: UMR Bronson Commercial |
$78.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.89
|
|
|
MIDODRINE 2.5 MG TABLET
|
Facility
|
IP
|
$211.85
|
|
|
Service Code
|
NDC 00245021111
|
| Hospital Charge Code |
10609
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.21 |
| Max. Negotiated Rate |
$190.66 |
| Rate for Payer: Aetna American Axle |
$137.70
|
| Rate for Payer: Aetna Commercial |
$180.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.70
|
| Rate for Payer: Cash Price |
$169.48
|
| Rate for Payer: Cofinity Advantage |
$148.29
|
| Rate for Payer: Cofinity Commercial |
$182.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.48
|
| Rate for Payer: Healthscope Commercial |
$190.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.89
|
| Rate for Payer: PHP Commercial |
$180.07
|
| Rate for Payer: Priority Health SBD |
$133.47
|
| Rate for Payer: UMR Bronson Commercial |
$93.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.89
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$342.00
|
|
|
Service Code
|
NDC 63739014510
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.48 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna American Axle |
$222.30
|
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.30
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Advantage |
$239.40
|
| Rate for Payer: Cofinity Commercial |
$294.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.60
|
| Rate for Payer: Healthscope Commercial |
$307.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$256.50
|
| Rate for Payer: PHP Commercial |
$290.70
|
| Rate for Payer: Priority Health SBD |
$215.46
|
| Rate for Payer: UMR Bronson Commercial |
$150.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.50
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$291.36
|
|
|
Service Code
|
NDC 60687039801
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$262.22 |
| Rate for Payer: Aetna American Axle |
$189.38
|
| Rate for Payer: Aetna Commercial |
$247.66
|
| Rate for Payer: Aetna Medicare |
$145.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.38
|
| Rate for Payer: BCBS Complete |
$116.54
|
| Rate for Payer: Cash Price |
$233.09
|
| Rate for Payer: Cofinity Advantage |
$203.95
|
| Rate for Payer: Cofinity Commercial |
$250.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.09
|
| Rate for Payer: Healthscope Commercial |
$262.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$233.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.52
|
| Rate for Payer: PHP Commercial |
$247.66
|
| Rate for Payer: Priority Health SBD |
$183.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.38
|
| Rate for Payer: UHC Core |
$151.80
|
| Rate for Payer: UHC Exchange |
$114.50
|
| Rate for Payer: UMR Bronson Commercial |
$107.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.52
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$342.00
|
|
|
Service Code
|
NDC 63739014510
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.54 |
| Max. Negotiated Rate |
$307.80 |
| Rate for Payer: Aetna American Axle |
$222.30
|
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna Medicare |
$171.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$222.30
|
| Rate for Payer: BCBS Complete |
$136.80
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Advantage |
$239.40
|
| Rate for Payer: Cofinity Commercial |
$294.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.60
|
| Rate for Payer: Healthscope Commercial |
$307.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$239.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$256.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$273.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$290.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$256.50
|
| Rate for Payer: PHP Commercial |
$290.70
|
| Rate for Payer: Priority Health SBD |
$215.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$222.30
|
| Rate for Payer: UHC Core |
$178.18
|
| Rate for Payer: UHC Exchange |
$134.41
|
| Rate for Payer: UMR Bronson Commercial |
$126.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$256.50
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$291.36
|
|
|
Service Code
|
NDC 60687039801
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.20 |
| Max. Negotiated Rate |
$262.22 |
| Rate for Payer: Aetna American Axle |
$189.38
|
| Rate for Payer: Aetna Commercial |
$247.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.38
|
| Rate for Payer: Cash Price |
$233.09
|
| Rate for Payer: Cofinity Advantage |
$203.95
|
| Rate for Payer: Cofinity Commercial |
$250.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.09
|
| Rate for Payer: Healthscope Commercial |
$262.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$203.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$218.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.52
|
| Rate for Payer: PHP Commercial |
$247.66
|
| Rate for Payer: Priority Health SBD |
$183.56
|
| Rate for Payer: UMR Bronson Commercial |
$128.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$218.52
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$220.88
|
|
|
Service Code
|
NDC 00904681806
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.19 |
| Max. Negotiated Rate |
$198.79 |
| Rate for Payer: Aetna American Axle |
$143.57
|
| Rate for Payer: Aetna Commercial |
$187.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.57
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cofinity Advantage |
$154.62
|
| Rate for Payer: Cofinity Commercial |
$189.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.70
|
| Rate for Payer: Healthscope Commercial |
$198.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.66
|
| Rate for Payer: PHP Commercial |
$187.75
|
| Rate for Payer: Priority Health SBD |
$139.15
|
| Rate for Payer: UMR Bronson Commercial |
$97.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.66
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$318.25
|
|
|
Service Code
|
NDC 59651024701
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.75 |
| Max. Negotiated Rate |
$286.43 |
| Rate for Payer: Aetna American Axle |
$206.86
|
| Rate for Payer: Aetna Commercial |
$270.51
|
| Rate for Payer: Aetna Medicare |
$159.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.86
|
| Rate for Payer: BCBS Complete |
$127.30
|
| Rate for Payer: Cash Price |
$254.60
|
| Rate for Payer: Cofinity Advantage |
$222.78
|
| Rate for Payer: Cofinity Commercial |
$273.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.60
|
| Rate for Payer: Healthscope Commercial |
$286.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.69
|
| Rate for Payer: PHP Commercial |
$270.51
|
| Rate for Payer: Priority Health SBD |
$200.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.86
|
| Rate for Payer: UHC Core |
$165.81
|
| Rate for Payer: UHC Exchange |
$125.07
|
| Rate for Payer: UMR Bronson Commercial |
$117.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.69
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$220.88
|
|
|
Service Code
|
NDC 00904681806
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.73 |
| Max. Negotiated Rate |
$198.79 |
| Rate for Payer: Aetna American Axle |
$143.57
|
| Rate for Payer: Aetna Commercial |
$187.75
|
| Rate for Payer: Aetna Medicare |
$110.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.57
|
| Rate for Payer: BCBS Complete |
$88.35
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cofinity Advantage |
$154.62
|
| Rate for Payer: Cofinity Commercial |
$189.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.70
|
| Rate for Payer: Healthscope Commercial |
$198.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.66
|
| Rate for Payer: PHP Commercial |
$187.75
|
| Rate for Payer: Priority Health SBD |
$139.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.57
|
| Rate for Payer: UHC Core |
$115.08
|
| Rate for Payer: UHC Exchange |
$86.81
|
| Rate for Payer: UMR Bronson Commercial |
$81.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.66
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$318.25
|
|
|
Service Code
|
NDC 00245021211
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.75 |
| Max. Negotiated Rate |
$286.43 |
| Rate for Payer: Aetna American Axle |
$206.86
|
| Rate for Payer: Aetna Commercial |
$270.51
|
| Rate for Payer: Aetna Medicare |
$159.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.86
|
| Rate for Payer: BCBS Complete |
$127.30
|
| Rate for Payer: Cash Price |
$254.60
|
| Rate for Payer: Cofinity Advantage |
$222.78
|
| Rate for Payer: Cofinity Commercial |
$273.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.60
|
| Rate for Payer: Healthscope Commercial |
$286.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$222.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$238.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.69
|
| Rate for Payer: PHP Commercial |
$270.51
|
| Rate for Payer: Priority Health SBD |
$200.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$206.86
|
| Rate for Payer: UHC Core |
$165.81
|
| Rate for Payer: UHC Exchange |
$125.07
|
| Rate for Payer: UMR Bronson Commercial |
$117.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.69
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$386.88
|
|
|
Service Code
|
NDC 00245021201
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.15 |
| Max. Negotiated Rate |
$348.19 |
| Rate for Payer: Aetna American Axle |
$251.47
|
| Rate for Payer: Aetna Commercial |
$328.85
|
| Rate for Payer: Aetna Medicare |
$193.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.47
|
| Rate for Payer: BCBS Complete |
$154.75
|
| Rate for Payer: Cash Price |
$309.50
|
| Rate for Payer: Cofinity Advantage |
$270.82
|
| Rate for Payer: Cofinity Commercial |
$332.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.50
|
| Rate for Payer: Healthscope Commercial |
$348.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$270.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$309.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.16
|
| Rate for Payer: PHP Commercial |
$328.85
|
| Rate for Payer: Priority Health SBD |
$243.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.47
|
| Rate for Payer: UHC Core |
$201.56
|
| Rate for Payer: UHC Exchange |
$152.04
|
| Rate for Payer: UMR Bronson Commercial |
$143.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.16
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$3.87
|
|
|
Service Code
|
NDC 00245021289
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Aetna American Axle |
$2.52
|
| Rate for Payer: Aetna Commercial |
$3.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.52
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Advantage |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$3.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.90
|
| Rate for Payer: PHP Commercial |
$3.29
|
| Rate for Payer: Priority Health SBD |
$2.44
|
| Rate for Payer: UMR Bronson Commercial |
$1.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.90
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$327.36
|
|
|
Service Code
|
NDC 60505132101
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.12 |
| Max. Negotiated Rate |
$294.62 |
| Rate for Payer: Aetna American Axle |
$212.78
|
| Rate for Payer: Aetna Commercial |
$278.26
|
| Rate for Payer: Aetna Medicare |
$163.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.78
|
| Rate for Payer: BCBS Complete |
$130.94
|
| Rate for Payer: Cash Price |
$261.89
|
| Rate for Payer: Cofinity Advantage |
$229.15
|
| Rate for Payer: Cofinity Commercial |
$281.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.89
|
| Rate for Payer: Healthscope Commercial |
$294.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$261.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.52
|
| Rate for Payer: PHP Commercial |
$278.26
|
| Rate for Payer: Priority Health SBD |
$206.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.78
|
| Rate for Payer: UHC Core |
$170.55
|
| Rate for Payer: UHC Exchange |
$128.65
|
| Rate for Payer: UMR Bronson Commercial |
$121.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.52
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$318.25
|
|
|
Service Code
|
NDC 00245021211
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.03 |
| Max. Negotiated Rate |
$286.43 |
| 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 Advantage |
$222.78
|
| Rate for Payer: Cofinity Commercial |
$273.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.60
|
| Rate for Payer: Healthscope Commercial |
$286.43
|
| Rate for Payer: 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 Commercial |
$270.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.69
|
| Rate for Payer: PHP Commercial |
$270.51
|
| 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
|
$2.92
|
|
|
Service Code
|
NDC 60687039811
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Aetna American Axle |
$1.90
|
| Rate for Payer: Aetna Commercial |
$2.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.90
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cofinity Advantage |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.34
|
| Rate for Payer: Healthscope Commercial |
$2.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.19
|
| Rate for Payer: PHP Commercial |
$2.48
|
| Rate for Payer: Priority Health SBD |
$1.84
|
| Rate for Payer: UMR Bronson Commercial |
$1.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.19
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$327.36
|
|
|
Service Code
|
NDC 60505132101
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.04 |
| Max. Negotiated Rate |
$294.62 |
| Rate for Payer: Aetna American Axle |
$212.78
|
| Rate for Payer: Aetna Commercial |
$278.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.78
|
| Rate for Payer: Cash Price |
$261.89
|
| Rate for Payer: Cofinity Advantage |
$229.15
|
| Rate for Payer: Cofinity Commercial |
$281.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$261.89
|
| Rate for Payer: Healthscope Commercial |
$294.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$229.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$245.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$278.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$245.52
|
| Rate for Payer: PHP Commercial |
$278.26
|
| Rate for Payer: Priority Health SBD |
$206.24
|
| Rate for Payer: UMR Bronson Commercial |
$144.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$245.52
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$2.92
|
|
|
Service Code
|
NDC 60687039811
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$2.63 |
| Rate for Payer: Aetna American Axle |
$1.90
|
| Rate for Payer: Aetna Commercial |
$2.48
|
| Rate for Payer: Aetna Medicare |
$1.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.90
|
| Rate for Payer: BCBS Complete |
$1.17
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cofinity Advantage |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.34
|
| Rate for Payer: Healthscope Commercial |
$2.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.19
|
| Rate for Payer: PHP Commercial |
$2.48
|
| Rate for Payer: Priority Health SBD |
$1.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.90
|
| Rate for Payer: UHC Core |
$1.52
|
| Rate for Payer: UHC Exchange |
$1.15
|
| Rate for Payer: UMR Bronson Commercial |
$1.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.19
|
|
