Heights University Hospital

All Charges

Charge

Type

Setting

Price

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

MIDAZOLAM 5MG/ML 10ML

Facility

$75.00

Hospital Charge Code	60635759
Hospital Revenue Code	636
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$22.50
Rate for Payer: Aetna Medicare Advantage	$22.50
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$19.12
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$19.12
Rate for Payer: Cigna Commercial	$37.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

MIDAZOLAM 5MG/ML 10ML

Facility

$75.00

Hospital Charge Code	60635759
Hospital Revenue Code	636
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$18.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$18.15
Rate for Payer: Qualcare PPO/HMO/WC	$11.25

MIDAZOLAM 5 MG/ML VIAL

Facility

$44.62

Service Code	HCPCS J2250
Hospital Charge Code	60627849
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$13.39
Rate for Payer: Aetna Commercial	$13.39
Rate for Payer: Aetna Medicare Advantage	$13.39
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$11.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$11.38
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$11.38
Rate for Payer: Cigna Commercial	$0.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.69

MIDAZOLAM 5 MG/ML VIAL

Facility

$44.62

Service Code	HCPCS J2250
Hospital Charge Code	60627849
Hospital Revenue Code	636
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$10.80
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$10.80
Rate for Payer: Qualcare PPO/HMO/WC	$6.69

MIDAZOLAM HCL 25MG/5ML VIAL

Facility

$7.27

Hospital Charge Code	6063943265
Hospital Revenue Code	636
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$1.76
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.76
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

MIDAZOLAM HCL 25MG/5ML VIAL

Facility

$7.27

Hospital Charge Code	6063943265
Hospital Revenue Code	636
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$3.63
Rate for Payer: Aetna Commercial	$2.18
Rate for Payer: Aetna Medicare Advantage	$2.18
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.85
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.85
Rate for Payer: Cigna Commercial	$3.63
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.76
Rate for Payer: Qualcare PPO/HMO/WC	$1.09

MIDAZOLAM INJ 5MG/1ML

Facility

$69.01

Service Code	HCPCS J2250
Hospital Charge Code	60627850
Hospital Revenue Code	636
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna Commercial	$20.70
Rate for Payer: Aetna Medicare Advantage	$20.70
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$17.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$17.60
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$17.60
Rate for Payer: Cigna Commercial	$0.17
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.70
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

MIDAZOLAM INJ 5MG/1ML

Facility

$69.01

Service Code	HCPCS J2250
Hospital Charge Code	60627850
Hospital Revenue Code	636
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$16.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$16.70
Rate for Payer: Qualcare PPO/HMO/WC	$10.35

MIDAZOLAM IVCI 5MG/50ML

Facility

$62.75

Hospital Charge Code	60628651
Hospital Revenue Code	250
Min. Negotiated Rate	$8.16
Max. Negotiated Rate	$31.38
Rate for Payer: Aetna Commercial	$18.82
Rate for Payer: Aetna Medicare Advantage	$18.82
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$16.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$16.00
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$16.00
Rate for Payer: Cigna Commercial	$31.38
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$8.16
Rate for Payer: Oxford Commercial	$31.38
Rate for Payer: Qualcare PPO/HMO/WC	$9.41
Rate for Payer: UnitedHealthcare Commercial	$31.38

MIDAZOLAM IVCI 5MG/50ML

Facility

$62.75

Hospital Charge Code	60628651
Hospital Revenue Code	250
Min. Negotiated Rate	$9.41
Max. Negotiated Rate	$9.41
Rate for Payer: Qualcare PPO/HMO/WC	$9.41

MIDAZOLAN

Facility

$47.35

Hospital Charge Code	270656759
Hospital Revenue Code	270
Min. Negotiated Rate	$7.10
Max. Negotiated Rate	$7.10
Rate for Payer: Qualcare PPO/HMO/WC	$7.10

MIDAZOLAN

Facility

$47.35

Hospital Charge Code	270656759
Hospital Revenue Code	270
Min. Negotiated Rate	$6.16
Max. Negotiated Rate	$23.68
Rate for Payer: Aetna Commercial	$14.21
Rate for Payer: Aetna Medicare Advantage	$14.21
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$12.07
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$12.07
Rate for Payer: Cigna Commercial	$23.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$6.16
Rate for Payer: Oxford Commercial	$23.68
Rate for Payer: Qualcare PPO/HMO/WC	$7.10
Rate for Payer: UnitedHealthcare Commercial	$23.68

MIDAZOLOAM 5MG/1ML INJ (5ML)

Facility

$181.75

Hospital Charge Code	6063943138
Hospital Revenue Code	636
Min. Negotiated Rate	$27.26
Max. Negotiated Rate	$43.98
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.98
Rate for Payer: Qualcare PPO/HMO/WC	$27.26

MIDAZOLOAM 5MG/1ML INJ (5ML)

Facility

$181.75

Hospital Charge Code	6063943138
Hospital Revenue Code	636
Min. Negotiated Rate	$27.26
Max. Negotiated Rate	$90.88
Rate for Payer: Aetna Commercial	$54.52
Rate for Payer: Aetna Medicare Advantage	$54.52
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$46.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$46.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$46.35
Rate for Payer: Cigna Commercial	$90.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.98
Rate for Payer: Qualcare PPO/HMO/WC	$27.26

MIDFOOT FUSU-PLT RT ORT 3DI PL

Facility

$22,036.85

Service Code	HCPCS C1713
Hospital Charge Code	270703974
Hospital Revenue Code	278
Min. Negotiated Rate	$3,305.53
Max. Negotiated Rate	$11,018.42
Rate for Payer: Aetna Commercial	$6,611.06
Rate for Payer: Aetna Medicare Advantage	$6,611.06
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$5,619.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$5,619.40
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,407.37
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$5,619.40
Rate for Payer: Cigna Commercial	$11,018.42
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,332.92
Rate for Payer: Qualcare PPO/HMO/WC	$3,305.53

MIDFOOT FUSU-PLT RT ORT 3DI PL

Facility

$22,036.85

Service Code	HCPCS C1713
Hospital Charge Code	270703974
Hospital Revenue Code	278
Min. Negotiated Rate	$3,305.53
Max. Negotiated Rate	$5,332.92
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) NJ Health	$4,407.37
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$5,332.92
Rate for Payer: Qualcare PPO/HMO/WC	$3,305.53

MIDODRINE 10MGTAB

Facility

$33.37

Service Code	NDC 50268056615
Hospital Charge Code	60635680
Hospital Revenue Code	250
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$5.01
Rate for Payer: Qualcare PPO/HMO/WC	$5.01

MIDODRINE 10MGTAB

Facility

$33.37

Service Code	NDC 50268056615
Hospital Charge Code	60635680
Hospital Revenue Code	250
Min. Negotiated Rate	$4.34
Max. Negotiated Rate	$16.68
Rate for Payer: Aetna Commercial	$10.01
Rate for Payer: Aetna Medicare Advantage	$10.01
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$8.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$8.51
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$8.51
Rate for Payer: Cigna Commercial	$16.68
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$4.34
Rate for Payer: Oxford Commercial	$16.68
Rate for Payer: Qualcare PPO/HMO/WC	$5.01
Rate for Payer: UnitedHealthcare Commercial	$16.68

MIDODRINE 2.5 MG TAB

Facility

$17.76

Service Code	NDC 50268056415
Hospital Charge Code	60628534
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$8.88
Rate for Payer: Aetna Commercial	$5.33
Rate for Payer: Aetna Medicare Advantage	$5.33
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$4.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$4.53
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$4.53
Rate for Payer: Cigna Commercial	$8.88
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.31
Rate for Payer: Oxford Commercial	$8.88
Rate for Payer: Qualcare PPO/HMO/WC	$2.66
Rate for Payer: UnitedHealthcare Commercial	$8.88

MIDODRINE 2.5 MG TAB

Facility

$17.76

Service Code	NDC 50268056415
Hospital Charge Code	60628534
Hospital Revenue Code	250
Min. Negotiated Rate	$2.66
Max. Negotiated Rate	$2.66
Rate for Payer: Qualcare PPO/HMO/WC	$2.66

MIDODRINE 5 MG TAB

Facility

$27.87

Service Code	NDC 245021211
Hospital Charge Code	60628653
Hospital Revenue Code	250
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$13.94
Rate for Payer: Aetna Commercial	$8.36
Rate for Payer: Aetna Medicare Advantage	$8.36
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$7.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$7.11
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$7.11
Rate for Payer: Cigna Commercial	$13.94
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$3.62
Rate for Payer: Oxford Commercial	$13.94
Rate for Payer: Qualcare PPO/HMO/WC	$4.18
Rate for Payer: UnitedHealthcare Commercial	$13.94

MIDODRINE 5 MG TAB

Facility

$15.40

Hospital Charge Code	60628653R
Hospital Revenue Code	250
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$7.70
Rate for Payer: Aetna Commercial	$4.62
Rate for Payer: Aetna Medicare Advantage	$4.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$3.93
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$3.93
Rate for Payer: Cigna Commercial	$7.70
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.00
Rate for Payer: Oxford Commercial	$7.70
Rate for Payer: Qualcare PPO/HMO/WC	$2.31
Rate for Payer: UnitedHealthcare Commercial	$7.70

MIDODRINE 5 MG TAB

Facility

$15.40

Hospital Charge Code	60628653R
Hospital Revenue Code	250
Min. Negotiated Rate	$2.31
Max. Negotiated Rate	$2.31
Rate for Payer: Qualcare PPO/HMO/WC	$2.31

MIDODRINE 5 MG TAB

Facility

$27.87

Service Code	NDC 245021211
Hospital Charge Code	60628653
Hospital Revenue Code	250
Min. Negotiated Rate	$4.18
Max. Negotiated Rate	$4.18
Rate for Payer: Qualcare PPO/HMO/WC	$4.18

Know your out-of-pocket cost for care.

All Charges