|
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 Commercial |
$229.15
|
| Rate for Payer: Cofinity Commercial |
$281.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$229.15
|
| 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: PHP Commercial |
$278.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.78
|
| 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
|
IP
|
$337.25
|
|
|
Service Code
|
NDC 00245021201
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.39 |
| Max. Negotiated Rate |
$303.52 |
| Rate for Payer: Aetna American Axle |
$219.21
|
| Rate for Payer: Aetna Commercial |
$286.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.21
|
| Rate for Payer: Cash Price |
$269.80
|
| Rate for Payer: Cofinity Commercial |
$236.08
|
| Rate for Payer: Cofinity Commercial |
$290.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$236.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.80
|
| Rate for Payer: Healthscope Commercial |
$303.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.66
|
| Rate for Payer: PHP Commercial |
$286.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.21
|
| Rate for Payer: Priority Health SBD |
$212.47
|
| Rate for Payer: UMR Bronson Commercial |
$148.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.94
|
|
|
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 |
$195.80 |
| 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 |
$195.80
|
| 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 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
|
|
|
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
|
$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
|
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
|
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 |
$161.02
|
| 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 |
$161.02
|
|
|
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 |
$195.80 |
| 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: Cofinity Medicare Advantage |
$152.28
|
| 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 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
|
$214.70
|
|
|
Service Code
|
NDC 00904681806
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.44 |
| Max. Negotiated Rate |
$193.23 |
| Rate for Payer: Aetna American Axle |
$139.56
|
| Rate for Payer: Aetna Commercial |
$182.50
|
| Rate for Payer: Aetna Medicare |
$107.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.56
|
| Rate for Payer: BCBS Complete |
$85.88
|
| 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 |
$161.02
|
| 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 |
$79.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.02
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$337.25
|
|
|
Service Code
|
NDC 00245021201
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.78 |
| Max. Negotiated Rate |
$303.52 |
| Rate for Payer: Aetna American Axle |
$219.21
|
| Rate for Payer: Aetna Commercial |
$286.66
|
| Rate for Payer: Aetna Medicare |
$168.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$219.21
|
| Rate for Payer: BCBS Complete |
$134.90
|
| Rate for Payer: Cash Price |
$269.80
|
| Rate for Payer: Cofinity Commercial |
$236.08
|
| Rate for Payer: Cofinity Commercial |
$290.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$236.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.80
|
| Rate for Payer: Healthscope Commercial |
$303.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$236.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$252.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.66
|
| Rate for Payer: PHP Commercial |
$286.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.21
|
| Rate for Payer: Priority Health SBD |
$212.47
|
| Rate for Payer: UMR Bronson Commercial |
$124.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$252.94
|
|
|
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 |
$286.42 |
| 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 Commercial |
$222.78
|
| Rate for Payer: Cofinity Commercial |
$273.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$222.78
|
| 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 Commercial |
$270.51
|
| Rate for Payer: PHP Commercial |
$270.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.86
|
| Rate for Payer: Priority Health SBD |
$200.50
|
| Rate for Payer: UMR Bronson Commercial |
$117.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$238.69
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$318.25
|
|
|
Service Code
|
NDC 59651024701
|
| 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: Cofinity Medicare Advantage |
$222.78
|
| 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 Commercial |
$270.51
|
| Rate for Payer: PHP Commercial |
$270.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.86
|
| 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
|
$3.38
|
|
|
Service Code
|
NDC 00245021289
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$3.04 |
| Rate for Payer: Aetna American Axle |
$2.20
|
| Rate for Payer: Aetna Commercial |
$2.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.20
|
| 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 |
$1.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.54
|
|
|
MIDOSTAURIN 25 MG CAPSULE
|
Facility
|
OP
|
$20,028.89
|
|
|
Service Code
|
NDC 00078069851
|
| Hospital Charge Code |
183299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7,410.69 |
| Max. Negotiated Rate |
$18,026.00 |
| Rate for Payer: Aetna American Axle |
$13,018.78
|
| Rate for Payer: Aetna Commercial |
$17,024.56
|
| Rate for Payer: Aetna Medicare |
$10,014.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,018.78
|
| Rate for Payer: BCBS Complete |
$8,011.56
|
| Rate for Payer: Cash Price |
$16,023.11
|
| Rate for Payer: Cofinity Commercial |
$14,020.22
|
| Rate for Payer: Cofinity Commercial |
$17,224.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,020.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,023.11
|
| Rate for Payer: Healthscope Commercial |
$18,026.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,020.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,021.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,024.56
|
| Rate for Payer: PHP Commercial |
$17,024.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,018.78
|
| Rate for Payer: Priority Health SBD |
$12,618.20
|
| Rate for Payer: UMR Bronson Commercial |
$7,410.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,021.67
|
|
|
MIDOSTAURIN 25 MG CAPSULE
|
Facility
|
IP
|
$20,028.89
|
|
|
Service Code
|
NDC 00078069851
|
| Hospital Charge Code |
183299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8,812.71 |
| Max. Negotiated Rate |
$18,026.00 |
| Rate for Payer: Aetna American Axle |
$13,018.78
|
| Rate for Payer: Aetna Commercial |
$17,024.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13,018.78
|
| Rate for Payer: Cash Price |
$16,023.11
|
| Rate for Payer: Cofinity Commercial |
$14,020.22
|
| Rate for Payer: Cofinity Commercial |
$17,224.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$14,020.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16,023.11
|
| Rate for Payer: Healthscope Commercial |
$18,026.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14,020.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15,021.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17,024.56
|
| Rate for Payer: PHP Commercial |
$17,024.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13,018.78
|
| Rate for Payer: Priority Health SBD |
$12,618.20
|
| Rate for Payer: UMR Bronson Commercial |
$8,812.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15,021.67
|
|
|
MIDOSTAURIN 25 MG CAPSULE
|
Facility
|
IP
|
$40,057.77
|
|
|
Service Code
|
NDC 00078069899
|
| Hospital Charge Code |
183299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17,625.42 |
| Max. Negotiated Rate |
$36,051.99 |
| Rate for Payer: Aetna American Axle |
$26,037.55
|
| Rate for Payer: Aetna Commercial |
$34,049.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26,037.55
|
| Rate for Payer: Cash Price |
$32,046.22
|
| Rate for Payer: Cofinity Commercial |
$28,040.44
|
| Rate for Payer: Cofinity Commercial |
$34,449.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$28,040.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32,046.22
|
| Rate for Payer: Healthscope Commercial |
$36,051.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28,040.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30,043.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34,049.10
|
| Rate for Payer: PHP Commercial |
$34,049.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26,037.55
|
| Rate for Payer: Priority Health SBD |
$25,236.40
|
| Rate for Payer: UMR Bronson Commercial |
$17,625.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30,043.33
|
|
|
MIDOSTAURIN 25 MG CAPSULE
|
Facility
|
OP
|
$40,057.77
|
|
|
Service Code
|
NDC 00078069899
|
| Hospital Charge Code |
183299
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14,821.37 |
| Max. Negotiated Rate |
$36,051.99 |
| Rate for Payer: Aetna American Axle |
$26,037.55
|
| Rate for Payer: Aetna Commercial |
$34,049.10
|
| Rate for Payer: Aetna Medicare |
$20,028.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26,037.55
|
| Rate for Payer: BCBS Complete |
$16,023.11
|
| Rate for Payer: Cash Price |
$32,046.22
|
| Rate for Payer: Cofinity Commercial |
$28,040.44
|
| Rate for Payer: Cofinity Commercial |
$34,449.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$28,040.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32,046.22
|
| Rate for Payer: Healthscope Commercial |
$36,051.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$28,040.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30,043.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34,049.10
|
| Rate for Payer: PHP Commercial |
$34,049.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26,037.55
|
| Rate for Payer: Priority Health SBD |
$25,236.40
|
| Rate for Payer: UMR Bronson Commercial |
$14,821.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30,043.33
|
|
|
MILNACIPRAN 50 MG TABLET
|
Facility
|
OP
|
$1,761.13
|
|
|
Service Code
|
NDC 00456155060
|
| Hospital Charge Code |
97089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$651.62 |
| Max. Negotiated Rate |
$1,585.02 |
| Rate for Payer: Aetna American Axle |
$1,144.73
|
| Rate for Payer: Aetna Commercial |
$1,496.96
|
| Rate for Payer: Aetna Medicare |
$880.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,144.73
|
| Rate for Payer: BCBS Complete |
$704.45
|
| Rate for Payer: Cash Price |
$1,408.90
|
| Rate for Payer: Cofinity Commercial |
$1,232.79
|
| Rate for Payer: Cofinity Commercial |
$1,514.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,232.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,408.90
|
| Rate for Payer: Healthscope Commercial |
$1,585.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,232.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,496.96
|
| Rate for Payer: PHP Commercial |
$1,496.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,144.73
|
| Rate for Payer: Priority Health SBD |
$1,109.51
|
| Rate for Payer: UMR Bronson Commercial |
$651.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,320.85
|
|
|
MILNACIPRAN 50 MG TABLET
|
Facility
|
IP
|
$1,761.13
|
|
|
Service Code
|
NDC 00456155060
|
| Hospital Charge Code |
97089
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$774.90 |
| Max. Negotiated Rate |
$1,585.02 |
| Rate for Payer: Aetna American Axle |
$1,144.73
|
| Rate for Payer: Aetna Commercial |
$1,496.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,144.73
|
| Rate for Payer: Cash Price |
$1,408.90
|
| Rate for Payer: Cofinity Commercial |
$1,232.79
|
| Rate for Payer: Cofinity Commercial |
$1,514.57
|
| Rate for Payer: Cofinity Medicare Advantage |
$1,232.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,408.90
|
| Rate for Payer: Healthscope Commercial |
$1,585.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,232.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,320.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,496.96
|
| Rate for Payer: PHP Commercial |
$1,496.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,144.73
|
| Rate for Payer: Priority Health SBD |
$1,109.51
|
| Rate for Payer: UMR Bronson Commercial |
$774.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,320.85
|
|
|
MILRINONE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$139.50
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
27327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.38 |
| Max. Negotiated Rate |
$125.55 |
| Rate for Payer: Aetna American Axle |
$90.68
|
| Rate for Payer: Aetna American Axle |
$73.12
|
| Rate for Payer: Aetna Commercial |
$95.62
|
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.68
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cofinity Commercial |
$97.65
|
| Rate for Payer: Cofinity Commercial |
$119.97
|
| Rate for Payer: Cofinity Commercial |
$96.75
|
| Rate for Payer: Cofinity Commercial |
$78.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.60
|
| Rate for Payer: Healthscope Commercial |
$101.25
|
| Rate for Payer: Healthscope Commercial |
$125.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.58
|
| Rate for Payer: PHP Commercial |
$118.58
|
| Rate for Payer: PHP Commercial |
$95.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.68
|
| Rate for Payer: Priority Health SBD |
$87.88
|
| Rate for Payer: Priority Health SBD |
$70.88
|
| Rate for Payer: UMR Bronson Commercial |
$49.50
|
| Rate for Payer: UMR Bronson Commercial |
$61.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.62
|
|
|
MILRINONE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$112.50
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
27327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$101.25 |
| Rate for Payer: Aetna American Axle |
$73.12
|
| Rate for Payer: Aetna American Axle |
$90.68
|
| Rate for Payer: Aetna Commercial |
$118.58
|
| Rate for Payer: Aetna Commercial |
$95.62
|
| Rate for Payer: Aetna Medicare |
$56.25
|
| Rate for Payer: Aetna Medicare |
$69.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.68
|
| Rate for Payer: BCBS Complete |
$55.80
|
| Rate for Payer: BCBS Complete |
$45.00
|
| Rate for Payer: BCBS Trust/PPO |
$3.78
|
| Rate for Payer: BCBS Trust/PPO |
$3.78
|
| Rate for Payer: BCN Commercial |
$3.78
|
| Rate for Payer: BCN Commercial |
$3.78
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cofinity Commercial |
$97.65
|
| Rate for Payer: Cofinity Commercial |
$78.75
|
| Rate for Payer: Cofinity Commercial |
$119.97
|
| Rate for Payer: Cofinity Commercial |
$96.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$78.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$111.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.00
|
| Rate for Payer: Healthscope Commercial |
$125.55
|
| Rate for Payer: Healthscope Commercial |
$101.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$78.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$95.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$118.58
|
| Rate for Payer: PHP Commercial |
$95.62
|
| Rate for Payer: PHP Commercial |
$118.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.68
|
| Rate for Payer: Priority Health SBD |
$87.88
|
| Rate for Payer: Priority Health SBD |
$70.88
|
| Rate for Payer: UMR Bronson Commercial |
$41.62
|
| Rate for Payer: UMR Bronson Commercial |
$51.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.38
|
|
|
MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK
|
Facility
|
OP
|
$99.67
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
14961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$89.70 |
| Rate for Payer: Aetna American Axle |
$64.79
|
| Rate for Payer: Aetna American Axle |
$59.67
|
| Rate for Payer: Aetna American Axle |
$44.58
|
| Rate for Payer: Aetna Commercial |
$84.72
|
| Rate for Payer: Aetna Commercial |
$58.30
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Medicare |
$45.90
|
| Rate for Payer: Aetna Medicare |
$34.30
|
| Rate for Payer: Aetna Medicare |
$49.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: BCBS Complete |
$36.72
|
| Rate for Payer: BCBS Complete |
$39.87
|
| Rate for Payer: BCBS Complete |
$27.44
|
| Rate for Payer: BCBS Trust/PPO |
$3.78
|
| Rate for Payer: BCBS Trust/PPO |
$3.78
|
| Rate for Payer: BCBS Trust/PPO |
$3.78
|
| Rate for Payer: BCN Commercial |
$3.78
|
| Rate for Payer: BCN Commercial |
$3.78
|
| Rate for Payer: BCN Commercial |
$3.78
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$79.74
|
| Rate for Payer: Cash Price |
$54.87
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$54.87
|
| Rate for Payer: Cash Price |
$79.74
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Commercial |
$48.01
|
| Rate for Payer: Cofinity Commercial |
$58.99
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$69.77
|
| Rate for Payer: Cofinity Commercial |
$85.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.74
|
| Rate for Payer: Healthscope Commercial |
$89.70
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Healthscope Commercial |
$61.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.72
|
| Rate for Payer: PHP Commercial |
$84.72
|
| Rate for Payer: PHP Commercial |
$58.30
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.79
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: Priority Health SBD |
$62.79
|
| Rate for Payer: Priority Health SBD |
$43.21
|
| Rate for Payer: UMR Bronson Commercial |
$36.88
|
| Rate for Payer: UMR Bronson Commercial |
$25.38
|
| Rate for Payer: UMR Bronson Commercial |
$33.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.75
|
|
|
MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK
|
Facility
|
IP
|
$68.59
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
14961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.18 |
| Max. Negotiated Rate |
$61.73 |
| Rate for Payer: Aetna American Axle |
$44.58
|
| Rate for Payer: Aetna American Axle |
$59.67
|
| Rate for Payer: Aetna American Axle |
$64.79
|
| Rate for Payer: Aetna Commercial |
$78.03
|
| Rate for Payer: Aetna Commercial |
$58.30
|
| Rate for Payer: Aetna Commercial |
$84.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.67
|
| Rate for Payer: Cash Price |
$79.74
|
| Rate for Payer: Cash Price |
$73.44
|
| Rate for Payer: Cash Price |
$54.87
|
| Rate for Payer: Cofinity Commercial |
$58.99
|
| Rate for Payer: Cofinity Commercial |
$78.95
|
| Rate for Payer: Cofinity Commercial |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$85.72
|
| Rate for Payer: Cofinity Commercial |
$69.77
|
| Rate for Payer: Cofinity Commercial |
$48.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$64.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.44
|
| Rate for Payer: Healthscope Commercial |
$82.62
|
| Rate for Payer: Healthscope Commercial |
$61.73
|
| Rate for Payer: Healthscope Commercial |
$89.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.03
|
| Rate for Payer: PHP Commercial |
$84.72
|
| Rate for Payer: PHP Commercial |
$78.03
|
| Rate for Payer: PHP Commercial |
$58.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.58
|
| Rate for Payer: Priority Health SBD |
$62.79
|
| Rate for Payer: Priority Health SBD |
$57.83
|
| Rate for Payer: Priority Health SBD |
$43.21
|
| Rate for Payer: UMR Bronson Commercial |
$30.18
|
| Rate for Payer: UMR Bronson Commercial |
$43.85
|
| Rate for Payer: UMR Bronson Commercial |
$40.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.85
|
|
|
MILRINONE 40 MG/200 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK
|
Facility
|
OP
|
$100.98
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
118311
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$90.88 |
| Rate for Payer: Aetna American Axle |
$65.64
|
| Rate for Payer: Aetna American Axle |
$88.67
|
| Rate for Payer: Aetna Commercial |
$115.96
|
| Rate for Payer: Aetna Commercial |
$85.83
|
| Rate for Payer: Aetna Medicare |
$50.49
|
| Rate for Payer: Aetna Medicare |
$68.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.67
|
| Rate for Payer: BCBS Complete |
$54.57
|
| Rate for Payer: BCBS Complete |
$40.39
|
| Rate for Payer: BCBS Trust/PPO |
$3.78
|
| Rate for Payer: BCBS Trust/PPO |
$3.78
|
| Rate for Payer: BCN Commercial |
$3.78
|
| Rate for Payer: BCN Commercial |
$3.78
|
| Rate for Payer: Cash Price |
$109.14
|
| Rate for Payer: Cash Price |
$109.14
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cofinity Commercial |
$95.49
|
| Rate for Payer: Cofinity Commercial |
$70.69
|
| Rate for Payer: Cofinity Commercial |
$117.32
|
| Rate for Payer: Cofinity Commercial |
$86.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.78
|
| Rate for Payer: Healthscope Commercial |
$122.78
|
| Rate for Payer: Healthscope Commercial |
$90.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.96
|
| Rate for Payer: PHP Commercial |
$85.83
|
| Rate for Payer: PHP Commercial |
$115.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.67
|
| Rate for Payer: Priority Health SBD |
$85.94
|
| Rate for Payer: Priority Health SBD |
$63.62
|
| Rate for Payer: UMR Bronson Commercial |
$37.36
|
| Rate for Payer: UMR Bronson Commercial |
$50.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.74
|
|
|
MILRINONE 40 MG/200 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK
|
Facility
|
IP
|
$100.98
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
118311
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.43 |
| Max. Negotiated Rate |
$90.88 |
| Rate for Payer: Aetna American Axle |
$65.64
|
| Rate for Payer: Aetna American Axle |
$88.67
|
| Rate for Payer: Aetna Commercial |
$85.83
|
| Rate for Payer: Aetna Commercial |
$115.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.67
|
| Rate for Payer: Cash Price |
$80.78
|
| Rate for Payer: Cash Price |
$109.14
|
| Rate for Payer: Cofinity Commercial |
$95.49
|
| Rate for Payer: Cofinity Commercial |
$117.32
|
| Rate for Payer: Cofinity Commercial |
$70.69
|
| Rate for Payer: Cofinity Commercial |
$86.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$70.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$95.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$80.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.14
|
| Rate for Payer: Healthscope Commercial |
$90.88
|
| Rate for Payer: Healthscope Commercial |
$122.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$70.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$75.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.83
|
| Rate for Payer: PHP Commercial |
$115.96
|
| Rate for Payer: PHP Commercial |
$85.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.67
|
| Rate for Payer: Priority Health SBD |
$63.62
|
| Rate for Payer: Priority Health SBD |
$85.94
|
| Rate for Payer: UMR Bronson Commercial |
$44.43
|
| Rate for Payer: UMR Bronson Commercial |
$60.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$75.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.32
|
|
