|
MIDAZOLAM 2 MG/ML ORAL SYRUP
|
Facility
|
IP
|
$1,137.82
|
|
|
Service Code
|
NDC 00574015004
|
| 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: Cofinity Medicare Advantage |
$796.47
|
| 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 |
$853.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$967.15
|
| Rate for Payer: PHP Commercial |
$967.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.58
|
| 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 |
$853.37
|
|
|
MIDAZOLAM 2 MG/ML ORAL SYRUP
|
Facility
|
OP
|
$809.48
|
|
|
Service Code
|
NDC 00054356699
|
| Hospital Charge Code |
24176
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$299.51 |
| Max. Negotiated Rate |
$728.53 |
| Rate for Payer: Aetna American Axle |
$526.16
|
| Rate for Payer: Aetna Commercial |
$688.06
|
| Rate for Payer: Aetna Medicare |
$404.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.16
|
| Rate for Payer: BCBS Complete |
$323.79
|
| Rate for Payer: Cash Price |
$647.58
|
| Rate for Payer: Cofinity Commercial |
$566.64
|
| Rate for Payer: Cofinity Commercial |
$696.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$566.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$647.58
|
| Rate for Payer: Healthscope Commercial |
$728.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$566.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$607.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$688.06
|
| Rate for Payer: PHP Commercial |
$688.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$526.16
|
| Rate for Payer: Priority Health SBD |
$509.97
|
| Rate for Payer: UMR Bronson Commercial |
$299.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$607.11
|
|
|
MIDAZOLAM 2 MG/ML ORAL SYRUP
|
Facility
|
OP
|
$1,137.82
|
|
|
Service Code
|
NDC 00574015004
|
| Hospital Charge Code |
24176
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$420.99 |
| 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 Medicare |
$568.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$739.58
|
| Rate for Payer: BCBS Complete |
$455.13
|
| Rate for Payer: Cash Price |
$910.26
|
| Rate for Payer: Cofinity Commercial |
$796.47
|
| Rate for Payer: Cofinity Commercial |
$978.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$796.47
|
| 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 |
$853.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$967.15
|
| Rate for Payer: PHP Commercial |
$967.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$739.58
|
| Rate for Payer: Priority Health SBD |
$716.83
|
| Rate for Payer: UMR Bronson Commercial |
$420.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$853.37
|
|
|
MIDAZOLAM 2 MG/ML ORAL SYRUP
|
Facility
|
IP
|
$809.48
|
|
|
Service Code
|
NDC 00054356699
|
| Hospital Charge Code |
24176
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$356.17 |
| Max. Negotiated Rate |
$728.53 |
| Rate for Payer: Aetna American Axle |
$526.16
|
| Rate for Payer: Aetna Commercial |
$688.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$526.16
|
| Rate for Payer: Cash Price |
$647.58
|
| Rate for Payer: Cofinity Commercial |
$566.64
|
| Rate for Payer: Cofinity Commercial |
$696.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$566.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$647.58
|
| Rate for Payer: Healthscope Commercial |
$728.53
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$566.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$607.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$688.06
|
| Rate for Payer: PHP Commercial |
$688.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$526.16
|
| Rate for Payer: Priority Health SBD |
$509.97
|
| Rate for Payer: UMR Bronson Commercial |
$356.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$607.11
|
|
|
MIDAZOLAM 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$31.27
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$28.14 |
| Rate for Payer: Aetna American Axle |
$20.33
|
| Rate for Payer: Aetna American Axle |
$37.86
|
| Rate for Payer: Aetna American Axle |
$20.20
|
| Rate for Payer: Aetna American Axle |
$28.63
|
| Rate for Payer: Aetna American Axle |
$20.88
|
| Rate for Payer: Aetna American Axle |
$24.48
|
| Rate for Payer: Aetna American Axle |
$21.58
|
| Rate for Payer: Aetna American Axle |
$13.75
|
| Rate for Payer: Aetna American Axle |
$18.64
|
| Rate for Payer: Aetna Commercial |
$49.51
|
| Rate for Payer: Aetna Commercial |
$24.38
|
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna Commercial |
$26.42
|
| Rate for Payer: Aetna Commercial |
$37.44
|
| Rate for Payer: Aetna Commercial |
$28.22
|
| Rate for Payer: Aetna Commercial |
$27.31
|
| Rate for Payer: Aetna Commercial |
$26.58
|
| Rate for Payer: Aetna Commercial |
$32.01
|
| 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) |
$18.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.88
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Cash Price |
$35.24
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Cash Price |
$24.86
|
| Rate for Payer: Cash Price |
$22.94
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Cash Price |
$46.60
|
| Rate for Payer: Cofinity Commercial |
$26.73
|
| Rate for Payer: Cofinity Commercial |
$14.81
|
| Rate for Payer: Cofinity Commercial |
$26.89
|
| Rate for Payer: Cofinity Commercial |
$21.89
|
| Rate for Payer: Cofinity Commercial |
$21.76
|
| Rate for Payer: Cofinity Commercial |
$20.08
|
| Rate for Payer: Cofinity Commercial |
$24.66
|
| Rate for Payer: Cofinity Commercial |
$28.55
|
| Rate for Payer: Cofinity Commercial |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$50.09
|
| Rate for Payer: Cofinity Commercial |
$40.77
|
| Rate for Payer: Cofinity Commercial |
$37.88
|
| Rate for Payer: Cofinity Commercial |
$30.84
|
| Rate for Payer: Cofinity Commercial |
$22.49
|
| Rate for Payer: Cofinity Commercial |
$27.63
|
| Rate for Payer: Cofinity Commercial |
$32.39
|
| Rate for Payer: Cofinity Commercial |
$26.36
|
| Rate for Payer: Cofinity Commercial |
$23.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.02
|
| Rate for Payer: Healthscope Commercial |
$27.97
|
| Rate for Payer: Healthscope Commercial |
$33.89
|
| Rate for Payer: Healthscope Commercial |
$52.42
|
| Rate for Payer: Healthscope Commercial |
$19.04
|
| Rate for Payer: Healthscope Commercial |
$29.88
|
| Rate for Payer: Healthscope Commercial |
$28.92
|
| Rate for Payer: Healthscope Commercial |
$39.65
|
| Rate for Payer: Healthscope Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$25.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.84
|
| 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 |
$15.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.22
|
| Rate for Payer: PHP Commercial |
$27.31
|
| Rate for Payer: PHP Commercial |
$37.44
|
| Rate for Payer: PHP Commercial |
$49.51
|
| Rate for Payer: PHP Commercial |
$28.22
|
| Rate for Payer: PHP Commercial |
$32.01
|
| Rate for Payer: PHP Commercial |
$26.42
|
| Rate for Payer: PHP Commercial |
$26.58
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: PHP Commercial |
$24.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.86
|
| Rate for Payer: Priority Health SBD |
$13.33
|
| Rate for Payer: Priority Health SBD |
$20.24
|
| Rate for Payer: Priority Health SBD |
$19.70
|
| Rate for Payer: Priority Health SBD |
$36.70
|
| Rate for Payer: Priority Health SBD |
$23.73
|
| Rate for Payer: Priority Health SBD |
$19.58
|
| Rate for Payer: Priority Health SBD |
$18.07
|
| Rate for Payer: Priority Health SBD |
$20.92
|
| Rate for Payer: Priority Health SBD |
$27.75
|
| Rate for Payer: UMR Bronson Commercial |
$14.61
|
| Rate for Payer: UMR Bronson Commercial |
$19.38
|
| Rate for Payer: UMR Bronson Commercial |
$25.63
|
| Rate for Payer: UMR Bronson Commercial |
$12.62
|
| Rate for Payer: UMR Bronson Commercial |
$13.68
|
| Rate for Payer: UMR Bronson Commercial |
$9.31
|
| Rate for Payer: UMR Bronson Commercial |
$16.57
|
| Rate for Payer: UMR Bronson Commercial |
$13.76
|
| Rate for Payer: UMR Bronson Commercial |
$14.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.25
|
|
|
MIDAZOLAM 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$31.27
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$28.14 |
| Rate for Payer: Aetna American Axle |
$20.33
|
| Rate for Payer: Aetna American Axle |
$18.64
|
| Rate for Payer: Aetna American Axle |
$20.20
|
| Rate for Payer: Aetna American Axle |
$37.86
|
| Rate for Payer: Aetna American Axle |
$13.75
|
| Rate for Payer: Aetna American Axle |
$24.48
|
| Rate for Payer: Aetna American Axle |
$28.63
|
| Rate for Payer: Aetna American Axle |
$20.88
|
| Rate for Payer: Aetna American Axle |
$21.58
|
| Rate for Payer: Aetna Commercial |
$27.31
|
| Rate for Payer: Aetna Commercial |
$32.01
|
| Rate for Payer: Aetna Commercial |
$24.38
|
| Rate for Payer: Aetna Commercial |
$28.22
|
| Rate for Payer: Aetna Commercial |
$17.99
|
| Rate for Payer: Aetna Commercial |
$49.51
|
| Rate for Payer: Aetna Commercial |
$37.44
|
| Rate for Payer: Aetna Commercial |
$26.42
|
| Rate for Payer: Aetna Commercial |
$26.58
|
| Rate for Payer: Aetna Medicare |
$22.02
|
| Rate for Payer: Aetna Medicare |
$29.12
|
| Rate for Payer: Aetna Medicare |
$15.54
|
| Rate for Payer: Aetna Medicare |
$10.58
|
| Rate for Payer: Aetna Medicare |
$15.63
|
| Rate for Payer: Aetna Medicare |
$14.34
|
| Rate for Payer: Aetna Medicare |
$16.60
|
| Rate for Payer: Aetna Medicare |
$18.83
|
| Rate for Payer: Aetna Medicare |
$16.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.58
|
| Rate for Payer: BCBS Complete |
$13.28
|
| Rate for Payer: BCBS Complete |
$11.47
|
| Rate for Payer: BCBS Complete |
$15.06
|
| Rate for Payer: BCBS Complete |
$12.43
|
| Rate for Payer: BCBS Complete |
$12.85
|
| Rate for Payer: BCBS Complete |
$23.30
|
| Rate for Payer: BCBS Complete |
$17.62
|
| Rate for Payer: BCBS Complete |
$12.51
|
| Rate for Payer: BCBS Complete |
$8.46
|
| Rate for Payer: Cash Price |
$46.60
|
| Rate for Payer: Cash Price |
$26.56
|
| Rate for Payer: Cash Price |
$24.86
|
| Rate for Payer: Cash Price |
$16.93
|
| Rate for Payer: Cash Price |
$22.94
|
| Rate for Payer: Cash Price |
$25.02
|
| Rate for Payer: Cash Price |
$35.24
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cash Price |
$25.70
|
| Rate for Payer: Cofinity Commercial |
$20.08
|
| Rate for Payer: Cofinity Commercial |
$22.49
|
| Rate for Payer: Cofinity Commercial |
$27.63
|
| Rate for Payer: Cofinity Commercial |
$26.89
|
| Rate for Payer: Cofinity Commercial |
$14.81
|
| Rate for Payer: Cofinity Commercial |
$37.88
|
| Rate for Payer: Cofinity Commercial |
$26.73
|
| Rate for Payer: Cofinity Commercial |
$30.84
|
| Rate for Payer: Cofinity Commercial |
$32.39
|
| Rate for Payer: Cofinity Commercial |
$26.36
|
| Rate for Payer: Cofinity Commercial |
$28.55
|
| Rate for Payer: Cofinity Commercial |
$23.24
|
| Rate for Payer: Cofinity Commercial |
$50.09
|
| Rate for Payer: Cofinity Commercial |
$21.76
|
| Rate for Payer: Cofinity Commercial |
$18.20
|
| Rate for Payer: Cofinity Commercial |
$21.89
|
| Rate for Payer: Cofinity Commercial |
$40.77
|
| Rate for Payer: Cofinity Commercial |
$24.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$30.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$23.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$21.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$24.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.93
|
| 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 |
$25.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$26.56
|
| Rate for Payer: Healthscope Commercial |
$33.89
|
| Rate for Payer: Healthscope Commercial |
$28.14
|
| Rate for Payer: Healthscope Commercial |
$27.97
|
| Rate for Payer: Healthscope Commercial |
$19.04
|
| Rate for Payer: Healthscope Commercial |
$29.88
|
| Rate for Payer: Healthscope Commercial |
$39.65
|
| Rate for Payer: Healthscope Commercial |
$25.81
|
| Rate for Payer: Healthscope Commercial |
$52.42
|
| Rate for Payer: Healthscope Commercial |
$28.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$23.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$21.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$30.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$24.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$33.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.58
|
| Rate for Payer: PHP Commercial |
$17.99
|
| Rate for Payer: PHP Commercial |
$37.44
|
| Rate for Payer: PHP Commercial |
$49.51
|
| Rate for Payer: PHP Commercial |
$28.22
|
| Rate for Payer: PHP Commercial |
$27.31
|
| Rate for Payer: PHP Commercial |
$26.58
|
| Rate for Payer: PHP Commercial |
$32.01
|
| Rate for Payer: PHP Commercial |
$24.38
|
| Rate for Payer: PHP Commercial |
$26.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.86
|
| Rate for Payer: Priority Health SBD |
$20.92
|
| Rate for Payer: Priority Health SBD |
$20.24
|
| Rate for Payer: Priority Health SBD |
$19.70
|
| Rate for Payer: Priority Health SBD |
$36.70
|
| Rate for Payer: Priority Health SBD |
$27.75
|
| Rate for Payer: Priority Health SBD |
$23.73
|
| Rate for Payer: Priority Health SBD |
$19.58
|
| Rate for Payer: Priority Health SBD |
$13.33
|
| Rate for Payer: Priority Health SBD |
$18.07
|
| Rate for Payer: UMR Bronson Commercial |
$12.28
|
| Rate for Payer: UMR Bronson Commercial |
$7.83
|
| Rate for Payer: UMR Bronson Commercial |
$10.61
|
| Rate for Payer: UMR Bronson Commercial |
$16.30
|
| Rate for Payer: UMR Bronson Commercial |
$11.89
|
| Rate for Payer: UMR Bronson Commercial |
$13.93
|
| Rate for Payer: UMR Bronson Commercial |
$11.57
|
| Rate for Payer: UMR Bronson Commercial |
$11.50
|
| Rate for Payer: UMR Bronson Commercial |
$21.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$24.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$33.04
|
|
|
MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$20.50
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
168786
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$18.45 |
| Rate for Payer: Aetna American Axle |
$13.32
|
| Rate for Payer: Aetna American Axle |
$9.07
|
| Rate for Payer: Aetna American Axle |
$9.38
|
| Rate for Payer: Aetna Commercial |
$17.43
|
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Medicare |
$10.25
|
| Rate for Payer: Aetna Medicare |
$7.21
|
| Rate for Payer: Aetna Medicare |
$6.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS Complete |
$5.77
|
| Rate for Payer: BCBS Complete |
$8.20
|
| Rate for Payer: Cash Price |
$16.40
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$9.77
|
| Rate for Payer: Cofinity Commercial |
$17.63
|
| Rate for Payer: Cofinity Commercial |
$14.35
|
| Rate for Payer: Cofinity Commercial |
$10.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.40
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$18.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.43
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: PHP Commercial |
$17.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.32
|
| 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 SBD |
$9.09
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: Priority Health SBD |
$12.91
|
| Rate for Payer: UMR Bronson Commercial |
$7.58
|
| Rate for Payer: UMR Bronson Commercial |
$5.16
|
| Rate for Payer: UMR Bronson Commercial |
$5.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.38
|
|
|
MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$13.95
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
168786
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Aetna American Axle |
$9.07
|
| Rate for Payer: Aetna American Axle |
$9.38
|
| Rate for Payer: Aetna American Axle |
$13.32
|
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Commercial |
$17.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.38
|
| Rate for Payer: Cash Price |
$16.40
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Commercial |
$9.77
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Cofinity Commercial |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$17.63
|
| Rate for Payer: Cofinity Commercial |
$14.35
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$10.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Healthscope Commercial |
$18.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.27
|
| Rate for Payer: PHP Commercial |
$17.43
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.07
|
| Rate for Payer: Priority Health SBD |
$12.91
|
| Rate for Payer: Priority Health SBD |
$9.09
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: UMR Bronson Commercial |
$6.14
|
| Rate for Payer: UMR Bronson Commercial |
$9.02
|
| Rate for Payer: UMR Bronson Commercial |
$6.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.82
|
|
|
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 |
$5.73 |
| 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: Cash Price |
$12.39
|
| Rate for Payer: Cofinity Commercial |
$10.84
|
| Rate for Payer: Cofinity Commercial |
$13.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 Commercial |
$13.17
|
| Rate for Payer: PHP Commercial |
$13.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.07
|
| Rate for Payer: Priority Health SBD |
$9.76
|
| Rate for Payer: UMR Bronson Commercial |
$5.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.62
|
|
|
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 |
$10.84
|
| Rate for Payer: Cofinity Commercial |
$13.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 Commercial |
$13.17
|
| Rate for Payer: PHP Commercial |
$13.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.07
|
| 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: Cofinity Medicare Advantage |
$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 Commercial |
$13.17
|
| Rate for Payer: PHP Commercial |
$13.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.07
|
| 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
|
OP
|
$15.49
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
301170
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.73 |
| 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: Cash Price |
$12.39
|
| Rate for Payer: Cofinity Commercial |
$10.84
|
| Rate for Payer: Cofinity Commercial |
$13.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 Commercial |
$13.17
|
| Rate for Payer: PHP Commercial |
$13.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.07
|
| Rate for Payer: Priority Health SBD |
$9.76
|
| Rate for Payer: UMR Bronson Commercial |
$5.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.62
|
|
|
MIDDLE EAR EXPLORATION THROUGH POSTAURICULAR OR EAR CANAL INCISION
|
Facility
|
OP
|
$8,903.25
|
|
|
Service Code
|
CPT 69440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,695.31 |
| Max. Negotiated Rate |
$8,903.25 |
| Rate for Payer: Aetna Medicare |
$3,289.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,953.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,953.62
|
| Rate for Payer: BCBS Complete |
$1,780.08
|
| Rate for Payer: BCBS MAPPO |
$3,162.90
|
| Rate for Payer: BCN Medicare Advantage |
$3,162.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,162.90
|
| Rate for Payer: Mclaren Medicaid |
$1,695.31
|
| Rate for Payer: Mclaren Medicare |
$3,162.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,321.05
|
| Rate for Payer: Meridian Medicaid |
$1,780.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,637.34
|
| Rate for Payer: PACE Medicare |
$3,004.76
|
| Rate for Payer: PACE SWMI |
$3,162.90
|
| Rate for Payer: PHP Medicare Advantage |
$3,162.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,695.31
|
| Rate for Payer: Priority Health Medicare |
$3,162.90
|
| Rate for Payer: Railroad Medicare Medicare |
$3,162.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,903.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,162.90
|
| Rate for Payer: UHC Exchange |
$6,044.62
|
| Rate for Payer: UHC Medicare Advantage |
$3,162.90
|
| Rate for Payer: UHCCP Medicaid |
$1,695.31
|
| Rate for Payer: VA VA |
$3,162.90
|
|
|
MIDFACE FLAP (IE, ZYGOMATICOFACIAL FLAP) WITH PRESERVATION OF VASCULAR PEDICLE(S)
|
Facility
|
OP
|
$10,050.52
|
|
|
Service Code
|
CPT 15730
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,913.77 |
| Max. Negotiated Rate |
$10,050.52 |
| Rate for Payer: Aetna Medicare |
$3,713.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4,463.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4,463.09
|
| Rate for Payer: BCBS Complete |
$2,009.46
|
| Rate for Payer: BCBS MAPPO |
$3,570.47
|
| Rate for Payer: BCN Medicare Advantage |
$3,570.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,570.47
|
| Rate for Payer: Mclaren Medicaid |
$1,913.77
|
| Rate for Payer: Mclaren Medicare |
$3,570.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,748.99
|
| Rate for Payer: Meridian Medicaid |
$2,009.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4,106.04
|
| Rate for Payer: PACE Medicare |
$3,391.95
|
| Rate for Payer: PACE SWMI |
$3,570.47
|
| Rate for Payer: PHP Medicare Advantage |
$3,570.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,913.77
|
| Rate for Payer: Priority Health Medicare |
$3,570.47
|
| Rate for Payer: Railroad Medicare Medicare |
$3,570.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10,050.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,570.47
|
| Rate for Payer: UHC Exchange |
$6,823.53
|
| Rate for Payer: UHC Medicare Advantage |
$3,570.47
|
| Rate for Payer: UHCCP Medicaid |
$1,913.77
|
| Rate for Payer: VA VA |
$3,570.47
|
|
|
MIDODRINE 2.5 MG TABLET
|
Facility
|
IP
|
$310.20
|
|
|
Service Code
|
NDC 00245021111
|
| Hospital Charge Code |
10609
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.49 |
| Max. Negotiated Rate |
$279.18 |
| Rate for Payer: Aetna American Axle |
$201.63
|
| Rate for Payer: Aetna Commercial |
$263.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.63
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cofinity Commercial |
$217.14
|
| Rate for Payer: Cofinity Commercial |
$266.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$217.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.16
|
| Rate for Payer: Healthscope Commercial |
$279.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.67
|
| Rate for Payer: PHP Commercial |
$263.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.63
|
| Rate for Payer: Priority Health SBD |
$195.43
|
| Rate for Payer: UMR Bronson Commercial |
$136.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.65
|
|
|
MIDODRINE 2.5 MG TABLET
|
Facility
|
OP
|
$310.20
|
|
|
Service Code
|
NDC 00245021111
|
| Hospital Charge Code |
10609
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.77 |
| Max. Negotiated Rate |
$279.18 |
| Rate for Payer: Aetna American Axle |
$201.63
|
| Rate for Payer: Aetna Commercial |
$263.67
|
| Rate for Payer: Aetna Medicare |
$155.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.63
|
| Rate for Payer: BCBS Complete |
$124.08
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cofinity Commercial |
$217.14
|
| Rate for Payer: Cofinity Commercial |
$266.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$217.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.16
|
| Rate for Payer: Healthscope Commercial |
$279.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.67
|
| Rate for Payer: PHP Commercial |
$263.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.63
|
| Rate for Payer: Priority Health SBD |
$195.43
|
| Rate for Payer: UMR Bronson Commercial |
$114.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.65
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
NDC 60687039811
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Aetna American Axle |
$2.03
|
| Rate for Payer: Aetna Commercial |
$2.65
|
| Rate for Payer: Aetna Medicare |
$1.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.03
|
| Rate for Payer: BCBS Complete |
$1.25
|
| Rate for Payer: Cash Price |
$2.50
|
| Rate for Payer: Cofinity Commercial |
$2.18
|
| Rate for Payer: Cofinity Commercial |
$2.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.50
|
| Rate for Payer: Healthscope Commercial |
$2.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.65
|
| Rate for Payer: PHP Commercial |
$2.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.03
|
| Rate for Payer: Priority Health SBD |
$1.97
|
| Rate for Payer: UMR Bronson Commercial |
$1.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.34
|
|
|
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 Commercial |
$239.40
|
| Rate for Payer: Cofinity Commercial |
$294.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$239.40
|
| 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: PHP Commercial |
$290.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.30
|
| Rate for Payer: Priority Health SBD |
$215.46
|
| 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
|
$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 Commercial |
$239.40
|
| Rate for Payer: Cofinity Commercial |
$294.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$239.40
|
| 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: PHP Commercial |
$290.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$222.30
|
| 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
|
IP
|
$311.52
|
|
|
Service Code
|
NDC 60687039801
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.07 |
| Max. Negotiated Rate |
$280.37 |
| Rate for Payer: Aetna American Axle |
$202.49
|
| Rate for Payer: Aetna Commercial |
$264.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.49
|
| Rate for Payer: Cash Price |
$249.22
|
| Rate for Payer: Cofinity Commercial |
$218.06
|
| Rate for Payer: Cofinity Commercial |
$267.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.22
|
| Rate for Payer: Healthscope Commercial |
$280.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.79
|
| Rate for Payer: PHP Commercial |
$264.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.49
|
| Rate for Payer: Priority Health SBD |
$196.26
|
| Rate for Payer: UMR Bronson Commercial |
$137.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.64
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$214.70
|
|
|
Service Code
|
NDC 00904681806
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.47 |
| Max. Negotiated Rate |
$193.23 |
| Rate for Payer: Aetna American Axle |
$139.56
|
| Rate for Payer: Aetna Commercial |
$182.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.56
|
| Rate for Payer: Cash Price |
$171.76
|
| Rate for Payer: Cofinity Commercial |
$150.29
|
| Rate for Payer: Cofinity Commercial |
$184.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$150.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$171.76
|
| Rate for Payer: Healthscope Commercial |
$193.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$182.50
|
| Rate for Payer: PHP Commercial |
$182.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.56
|
| Rate for Payer: Priority Health SBD |
$135.26
|
| Rate for Payer: UMR Bronson Commercial |
$94.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.03
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$311.52
|
|
|
Service Code
|
NDC 60687039801
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.26 |
| Max. Negotiated Rate |
$280.37 |
| Rate for Payer: Aetna American Axle |
$202.49
|
| Rate for Payer: Aetna Commercial |
$264.79
|
| Rate for Payer: Aetna Medicare |
$155.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.49
|
| Rate for Payer: BCBS Complete |
$124.61
|
| Rate for Payer: Cash Price |
$249.22
|
| Rate for Payer: Cofinity Commercial |
$218.06
|
| Rate for Payer: Cofinity Commercial |
$267.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$218.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$249.22
|
| Rate for Payer: Healthscope Commercial |
$280.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$218.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$233.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$264.79
|
| Rate for Payer: PHP Commercial |
$264.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$202.49
|
| Rate for Payer: Priority Health SBD |
$196.26
|
| Rate for Payer: UMR Bronson Commercial |
$115.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$233.64
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$217.55
|
|
|
Service Code
|
NDC 00245021211
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.72 |
| Max. Negotiated Rate |
$195.79 |
| 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: Cofinity Medicare Advantage |
$152.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.04
|
| Rate for Payer: Healthscope Commercial |
$195.79
|
| 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 Commercial |
$184.92
|
| Rate for Payer: PHP Commercial |
$184.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.41
|
| 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
|
OP
|
$3.38
|
|
|
Service Code
|
NDC 00245021289
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna American Axle |
$2.20
|
| Rate for Payer: Aetna Commercial |
$2.87
|
| Rate for Payer: Aetna Medicare |
$1.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.20
|
| Rate for Payer: BCBS Complete |
$1.35
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$2.37
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.87
|
| Rate for Payer: PHP Commercial |
$2.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health SBD |
$2.13
|
| Rate for Payer: UMR Bronson Commercial |
$1.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$217.55
|
|
|
Service Code
|
NDC 00245021211
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.49 |
| Max. Negotiated Rate |
$195.79 |
| Rate for Payer: Aetna American Axle |
$141.41
|
| Rate for Payer: Aetna Commercial |
$184.92
|
| Rate for Payer: Aetna Medicare |
$108.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.41
|
| Rate for Payer: BCBS Complete |
$87.02
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Commercial |
$152.28
|
| Rate for Payer: Cofinity Commercial |
$187.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$152.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.04
|
| Rate for Payer: Healthscope Commercial |
$195.79
|
| 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 Commercial |
$184.92
|
| Rate for Payer: PHP Commercial |
$184.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.41
|
| Rate for Payer: Priority Health SBD |
$137.06
|
| Rate for Payer: UMR Bronson Commercial |
$80.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.16
|
|
