Heights University Hospital

All Charges

Charge

Type

Setting

Price

Midazalam 2mg/ml syrup

Facility

$6.27

Hospital Charge Code	6062893
Hospital Revenue Code	250
Min. Negotiated Rate	$0.82
Max. Negotiated Rate	$3.13
Rate for Payer: Aetna Commercial	$1.88
Rate for Payer: Aetna Medicare Advantage	$1.88
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.60
Rate for Payer: Cigna Commercial	$3.13
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.82
Rate for Payer: Oxford Commercial	$3.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.94
Rate for Payer: UnitedHealthcare Commercial	$3.13

Midazalam 2mg/ml syrup

Facility

$6.27

Hospital Charge Code	6062893
Hospital Revenue Code	250
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$0.94
Rate for Payer: Qualcare PPO/HMO/WC	$0.94

MIDAZOLAM 100MG/100ML NACL

Facility

$225.12

Service Code	HCPCS J2250
Hospital Charge Code	60630239
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$67.54
Rate for Payer: Aetna Commercial	$67.54
Rate for Payer: Aetna Medicare Advantage	$67.54
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$57.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$57.41
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$57.41
Rate for Payer: Cigna Commercial	$0.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.48
Rate for Payer: Qualcare PPO/HMO/WC	$33.77

MIDAZOLAM 100MG/100ML NACL

Facility

$225.12

Service Code	HCPCS J2250
Hospital Charge Code	60630239
Hospital Revenue Code	636
Min. Negotiated Rate	$33.77
Max. Negotiated Rate	$54.48
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$54.48
Rate for Payer: Qualcare PPO/HMO/WC	$33.77

MIDAZOLAM 10MG/2ML INJ

Facility

$4.00

Service Code	HCPCS J2250
Hospital Charge Code	6063943137
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

MIDAZOLAM 10MG/2ML INJ

Facility

$4.00

Service Code	HCPCS J2250
Hospital Charge Code	6063943137
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$1.20
Rate for Payer: Aetna Commercial	$1.20
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$0.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

MIDAZOLAM 2 MG / 2 ML INJ

Facility

$23.72

Service Code	HCPCS J2250
Hospital Charge Code	6008734
Hospital Revenue Code	636
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$5.74
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.74
Rate for Payer: Qualcare PPO/HMO/WC	$3.56

MIDAZOLAM 2 MG / 2 ML INJ

Facility

$23.72

Service Code	HCPCS J2250
Hospital Charge Code	6008734
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$7.12
Rate for Payer: Aetna Commercial	$7.12
Rate for Payer: Aetna Medicare Advantage	$7.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$6.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$6.05
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$6.05
Rate for Payer: Cigna Commercial	$0.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.74
Rate for Payer: Qualcare PPO/HMO/WC	$3.56

MIDAZOLAM 2MG/ML 10ML LIQUID

Facility

$42.80

Hospital Charge Code	60629299
Hospital Revenue Code	250
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$21.40
Rate for Payer: Aetna Commercial	$12.84
Rate for Payer: Aetna Medicare Advantage	$12.84
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.91
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.91
Rate for Payer: Cigna Commercial	$21.40
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.56
Rate for Payer: Oxford Commercial	$21.40
Rate for Payer: Qualcare PPO/HMO/WC	$6.42
Rate for Payer: UnitedHealthcare Commercial	$21.40

MIDAZOLAM 2MG/ML 10ML LIQUID

Facility

$42.80

Hospital Charge Code	60629299
Hospital Revenue Code	250
Min. Negotiated Rate	$6.42
Max. Negotiated Rate	$6.42
Rate for Payer: Qualcare PPO/HMO/WC	$6.42

MIDAZOLAM 2MG/ML SYR ORAL

Facility

$750.25

Hospital Charge Code	6000468
Hospital Revenue Code	636
Min. Negotiated Rate	$112.54
Max. Negotiated Rate	$181.56
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.56
Rate for Payer: Qualcare PPO/HMO/WC	$112.54

MIDAZOLAM 2MG/ML SYR ORAL

Facility

$750.25

Hospital Charge Code	6000468
Hospital Revenue Code	636
Min. Negotiated Rate	$112.54
Max. Negotiated Rate	$375.12
Rate for Payer: Aetna Commercial	$225.07
Rate for Payer: Aetna Medicare Advantage	$225.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$191.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$191.31
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$191.31
Rate for Payer: Cigna Commercial	$375.12
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$181.56
Rate for Payer: Qualcare PPO/HMO/WC	$112.54

MIDAZOLAM 2 MG/ML SYRUP

Facility

$14.47

Service Code	NDC 52959091501
Hospital Charge Code	60628903
Hospital Revenue Code	250
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$7.24
Rate for Payer: Aetna Commercial	$4.34
Rate for Payer: Aetna Medicare Advantage	$4.34
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.69
Rate for Payer: Cigna Commercial	$7.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.88
Rate for Payer: Oxford Commercial	$7.24
Rate for Payer: Qualcare PPO/HMO/WC	$2.17
Rate for Payer: UnitedHealthcare Commercial	$7.24

MIDAZOLAM 2 MG/ML SYRUP

Facility

$14.47

Service Code	NDC 52959091501
Hospital Charge Code	60628903
Hospital Revenue Code	250
Min. Negotiated Rate	$2.17
Max. Negotiated Rate	$2.17
Rate for Payer: Qualcare PPO/HMO/WC	$2.17

MIDAZOLAM 50 MG / 10 ML INJ

Facility

$102.91

Service Code	HCPCS J2250
Hospital Charge Code	60629282
Hospital Revenue Code	636
Min. Negotiated Rate	$15.44
Max. Negotiated Rate	$24.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.44

MIDAZOLAM 50 MG / 10 ML INJ

Facility

$102.91

Service Code	HCPCS J2250
Hospital Charge Code	60629282
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$30.87
Rate for Payer: Aetna Commercial	$30.87
Rate for Payer: Aetna Medicare Advantage	$30.87
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$26.24
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$26.24
Rate for Payer: Cigna Commercial	$0.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$24.90
Rate for Payer: Qualcare PPO/HMO/WC	$15.44

MIDAZOLAM 50MG/50ML

Facility

$176.81

Service Code	NDC 44567061010
Hospital Charge Code	6063943396
Hospital Revenue Code	250
Min. Negotiated Rate	$22.99
Max. Negotiated Rate	$88.41
Rate for Payer: Aetna Commercial	$53.04
Rate for Payer: Aetna Medicare Advantage	$53.04
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.09
Rate for Payer: Cigna Commercial	$88.41
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$22.99
Rate for Payer: Oxford Commercial	$88.41
Rate for Payer: Qualcare PPO/HMO/WC	$26.52
Rate for Payer: UnitedHealthcare Commercial	$88.41

MIDAZOLAM 50MG/50ML

Facility

$176.81

Service Code	NDC 44567061010
Hospital Charge Code	6063943396
Hospital Revenue Code	250
Min. Negotiated Rate	$26.52
Max. Negotiated Rate	$26.52
Rate for Payer: Qualcare PPO/HMO/WC	$26.52

MIDAZOLAM 50MG/50ML NS

Facility

$131.90

Hospital Charge Code	606390576
Hospital Revenue Code	250
Min. Negotiated Rate	$17.15
Max. Negotiated Rate	$65.95
Rate for Payer: Aetna Commercial	$39.57
Rate for Payer: Aetna Medicare Advantage	$39.57
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$33.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$33.63
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$33.63
Rate for Payer: Cigna Commercial	$65.95
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$17.15
Rate for Payer: Oxford Commercial	$65.95
Rate for Payer: Qualcare PPO/HMO/WC	$19.79
Rate for Payer: UnitedHealthcare Commercial	$65.95

MIDAZOLAM 50MG/50ML NS

Facility

$131.90

Hospital Charge Code	606390576
Hospital Revenue Code	250
Min. Negotiated Rate	$19.79
Max. Negotiated Rate	$19.79
Rate for Payer: Qualcare PPO/HMO/WC	$19.79

MIDAZOLAM 5MG/2.5ML DOSE CUPS

Facility

$42.41

Service Code	NDC 68094076259
Hospital Charge Code	6063943399
Hospital Revenue Code	250
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$21.20
Rate for Payer: Aetna Commercial	$12.72
Rate for Payer: Aetna Medicare Advantage	$12.72
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$10.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$10.81
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$10.81
Rate for Payer: Cigna Commercial	$21.20
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5.51
Rate for Payer: Oxford Commercial	$21.20
Rate for Payer: Qualcare PPO/HMO/WC	$6.36
Rate for Payer: UnitedHealthcare Commercial	$21.20

MIDAZOLAM 5MG/2.5ML DOSE CUPS

Facility

$42.41

Service Code	NDC 68094076259
Hospital Charge Code	6063943399
Hospital Revenue Code	250
Min. Negotiated Rate	$6.36
Max. Negotiated Rate	$6.36
Rate for Payer: Qualcare PPO/HMO/WC	$6.36

MIDAZOLAM 5MG/5ML

Facility

$13.65

Hospital Charge Code	60635792
Hospital Revenue Code	636
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$6.83
Rate for Payer: Aetna Commercial	$4.09
Rate for Payer: Aetna Medicare Advantage	$4.09
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.48
Rate for Payer: Cigna Commercial	$6.83
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

MIDAZOLAM 5MG/5ML

Facility

$13.65

Hospital Charge Code	60635792
Hospital Revenue Code	636
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$3.30
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.30
Rate for Payer: Qualcare PPO/HMO/WC	$2.05

MIDAZOLAM 5 MG/5 ML VIAL

Facility

$12.06

Service Code	HCPCS J2250
Hospital Charge Code	6008726
Hospital Revenue Code	636
Min. Negotiated Rate	$1.81
Max. Negotiated Rate	$2.92
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.92
Rate for Payer: Qualcare PPO/HMO/WC	$1.81

Know your out-of-pocket cost for care.

All Charges