|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$27.97
|
|
|
Service Code
|
NDC 11701003816
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.62 |
| Max. Negotiated Rate |
$25.17 |
| Rate for Payer: Aetna Commercial |
$23.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.18
|
| Rate for Payer: Cash Price |
$22.38
|
| Rate for Payer: Cofinity Advantage |
$19.58
|
| Rate for Payer: Cofinity Commercial |
$24.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.38
|
| Rate for Payer: Healthscope Commercial |
$25.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.98
|
| Rate for Payer: PHP Commercial |
$23.77
|
| Rate for Payer: Priority Health SBD |
$17.62
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM
|
Facility
|
OP
|
$23.70
|
|
|
Service Code
|
NDC 51672203506
|
| Hospital Charge Code |
5040
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$21.33 |
| Rate for Payer: Aetna Commercial |
$20.14
|
| Rate for Payer: Aetna Medicare |
$11.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.40
|
| Rate for Payer: BCBS Complete |
$9.48
|
| Rate for Payer: Cash Price |
$18.96
|
| Rate for Payer: Cofinity Advantage |
$16.59
|
| Rate for Payer: Cofinity Commercial |
$20.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.96
|
| Rate for Payer: Healthscope Commercial |
$21.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.77
|
| Rate for Payer: PHP Commercial |
$20.14
|
| Rate for Payer: Priority Health SBD |
$14.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.40
|
| Rate for Payer: UHC Core |
$12.35
|
| Rate for Payer: UHC Exchange |
$9.31
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM
|
Facility
|
IP
|
$23.70
|
|
|
Service Code
|
NDC 51672203506
|
| Hospital Charge Code |
5040
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.93 |
| Max. Negotiated Rate |
$21.33 |
| Rate for Payer: Aetna Commercial |
$20.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.40
|
| Rate for Payer: Cash Price |
$18.96
|
| Rate for Payer: Cofinity Advantage |
$16.59
|
| Rate for Payer: Cofinity Commercial |
$20.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.96
|
| Rate for Payer: Healthscope Commercial |
$21.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.77
|
| Rate for Payer: PHP Commercial |
$20.14
|
| Rate for Payer: Priority Health SBD |
$14.93
|
|
|
MICRODERMABRASION
|
Professional
|
Both
|
$105.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Aetna Medicare |
$52.50
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
|
|
MICRO NEEDLING
|
Professional
|
Both
|
$210.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Medicare |
$105.00
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$136.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
OP
|
$38.61
|
|
|
Service Code
|
NDC 60687057686
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.17 |
| Max. Negotiated Rate |
$34.75 |
| Rate for Payer: Aetna Commercial |
$32.82
|
| Rate for Payer: Aetna Medicare |
$19.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.10
|
| Rate for Payer: BCBS Complete |
$15.44
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cofinity Advantage |
$27.03
|
| Rate for Payer: Cofinity Commercial |
$33.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.89
|
| Rate for Payer: Healthscope Commercial |
$34.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.96
|
| Rate for Payer: PHP Commercial |
$32.82
|
| Rate for Payer: Priority Health SBD |
$24.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.10
|
| Rate for Payer: UHC Core |
$20.12
|
| Rate for Payer: UHC Exchange |
$15.17
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
IP
|
$38.61
|
|
|
Service Code
|
NDC 60687057686
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.32 |
| Max. Negotiated Rate |
$34.75 |
| Rate for Payer: Aetna Commercial |
$32.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.10
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cofinity Advantage |
$27.03
|
| Rate for Payer: Cofinity Commercial |
$33.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.89
|
| Rate for Payer: Healthscope Commercial |
$34.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.96
|
| Rate for Payer: PHP Commercial |
$32.82
|
| Rate for Payer: Priority Health SBD |
$24.32
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
IP
|
$38.61
|
|
|
Service Code
|
NDC 60687057640
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.32 |
| Max. Negotiated Rate |
$34.75 |
| Rate for Payer: Aetna Commercial |
$32.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.10
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cofinity Advantage |
$27.03
|
| Rate for Payer: Cofinity Commercial |
$33.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.89
|
| Rate for Payer: Healthscope Commercial |
$34.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.96
|
| Rate for Payer: PHP Commercial |
$32.82
|
| Rate for Payer: Priority Health SBD |
$24.32
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
OP
|
$38.61
|
|
|
Service Code
|
NDC 60687057640
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.17 |
| Max. Negotiated Rate |
$34.75 |
| Rate for Payer: Aetna Commercial |
$32.82
|
| Rate for Payer: Aetna Medicare |
$19.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.10
|
| Rate for Payer: BCBS Complete |
$15.44
|
| Rate for Payer: Cash Price |
$30.89
|
| Rate for Payer: Cofinity Advantage |
$27.03
|
| Rate for Payer: Cofinity Commercial |
$33.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.89
|
| Rate for Payer: Healthscope Commercial |
$34.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.96
|
| Rate for Payer: PHP Commercial |
$32.82
|
| Rate for Payer: Priority Health SBD |
$24.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.10
|
| Rate for Payer: UHC Core |
$20.12
|
| Rate for Payer: UHC Exchange |
$15.17
|
|
|
MIDAZOLAM 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$15.39
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$13.85 |
| Rate for Payer: Aetna Commercial |
$13.08
|
| Rate for Payer: Aetna Commercial |
$13.16
|
| Rate for Payer: Aetna Commercial |
$9.23
|
| Rate for Payer: Aetna Commercial |
$9.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.06
|
| Rate for Payer: Cash Price |
$12.31
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cash Price |
$8.69
|
| Rate for Payer: Cofinity Advantage |
$10.77
|
| Rate for Payer: Cofinity Advantage |
$7.60
|
| Rate for Payer: Cofinity Advantage |
$10.84
|
| Rate for Payer: Cofinity Advantage |
$8.17
|
| Rate for Payer: Cofinity Commercial |
$13.31
|
| Rate for Payer: Cofinity Commercial |
$13.24
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$9.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.31
|
| Rate for Payer: Healthscope Commercial |
$13.85
|
| Rate for Payer: Healthscope Commercial |
$13.93
|
| Rate for Payer: Healthscope Commercial |
$9.77
|
| Rate for Payer: Healthscope Commercial |
$10.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.75
|
| Rate for Payer: PHP Commercial |
$13.08
|
| Rate for Payer: PHP Commercial |
$9.92
|
| Rate for Payer: PHP Commercial |
$9.23
|
| Rate for Payer: PHP Commercial |
$13.16
|
| Rate for Payer: Priority Health SBD |
$7.35
|
| Rate for Payer: Priority Health SBD |
$9.75
|
| Rate for Payer: Priority Health SBD |
$9.70
|
| Rate for Payer: Priority Health SBD |
$6.84
|
|
|
MIDAZOLAM 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$11.67
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Aetna Commercial |
$9.92
|
| Rate for Payer: Aetna Commercial |
$13.16
|
| Rate for Payer: Aetna Commercial |
$13.08
|
| Rate for Payer: Aetna Commercial |
$9.23
|
| Rate for Payer: Aetna Medicare |
$5.83
|
| Rate for Payer: Aetna Medicare |
$7.74
|
| Rate for Payer: Aetna Medicare |
$7.70
|
| Rate for Payer: Aetna Medicare |
$5.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.59
|
| Rate for Payer: BCBS Complete |
$6.19
|
| Rate for Payer: BCBS Complete |
$4.67
|
| Rate for Payer: BCBS Complete |
$4.34
|
| Rate for Payer: BCBS Complete |
$6.16
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cash Price |
$12.31
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Cash Price |
$12.31
|
| Rate for Payer: Cash Price |
$8.69
|
| Rate for Payer: Cash Price |
$8.69
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Cash Price |
$9.34
|
| Rate for Payer: Cofinity Advantage |
$10.84
|
| Rate for Payer: Cofinity Advantage |
$7.60
|
| Rate for Payer: Cofinity Advantage |
$10.77
|
| Rate for Payer: Cofinity Advantage |
$8.17
|
| Rate for Payer: Cofinity Commercial |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$13.31
|
| Rate for Payer: Cofinity Commercial |
$10.04
|
| Rate for Payer: Cofinity Commercial |
$13.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.34
|
| Rate for Payer: Healthscope Commercial |
$13.85
|
| Rate for Payer: Healthscope Commercial |
$9.77
|
| Rate for Payer: Healthscope Commercial |
$13.93
|
| Rate for Payer: Healthscope Commercial |
$10.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.61
|
| Rate for Payer: PHP Commercial |
$13.08
|
| Rate for Payer: PHP Commercial |
$9.92
|
| Rate for Payer: PHP Commercial |
$13.16
|
| Rate for Payer: PHP Commercial |
$9.23
|
| Rate for Payer: Priority Health SBD |
$6.84
|
| Rate for Payer: Priority Health SBD |
$9.70
|
| Rate for Payer: Priority Health SBD |
$9.75
|
| Rate for Payer: Priority Health SBD |
$7.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
|
|
MIDAZOLAM 2 MG/ML ORAL SYRUP
|
Facility
|
OP
|
$829.31
|
|
|
Service Code
|
NDC 00054356699
|
| Hospital Charge Code |
24176
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$325.92 |
| Max. Negotiated Rate |
$746.38 |
| Rate for Payer: Aetna Commercial |
$704.91
|
| Rate for Payer: Aetna Medicare |
$414.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$539.05
|
| Rate for Payer: BCBS Complete |
$331.72
|
| Rate for Payer: Cash Price |
$663.45
|
| Rate for Payer: Cofinity Advantage |
$580.52
|
| Rate for Payer: Cofinity Commercial |
$713.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$663.45
|
| Rate for Payer: Healthscope Commercial |
$746.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$663.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$704.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$621.98
|
| Rate for Payer: PHP Commercial |
$704.91
|
| Rate for Payer: Priority Health SBD |
$522.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$539.05
|
| Rate for Payer: UHC Core |
$432.07
|
| Rate for Payer: UHC Exchange |
$325.92
|
|
|
MIDAZOLAM 2 MG/ML ORAL SYRUP
|
Facility
|
IP
|
$44.37
|
|
|
Service Code
|
NDC 09999001903
|
| Hospital Charge Code |
24176
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.95 |
| Max. Negotiated Rate |
$39.93 |
| Rate for Payer: Aetna Commercial |
$37.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.84
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cofinity Advantage |
$31.06
|
| Rate for Payer: Cofinity Commercial |
$38.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.50
|
| Rate for Payer: Healthscope Commercial |
$39.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.28
|
| Rate for Payer: PHP Commercial |
$37.71
|
| Rate for Payer: Priority Health SBD |
$27.95
|
|
|
MIDAZOLAM 2 MG/ML ORAL SYRUP
|
Facility
|
IP
|
$829.31
|
|
|
Service Code
|
NDC 00054356699
|
| Hospital Charge Code |
24176
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$522.47 |
| Max. Negotiated Rate |
$746.38 |
| Rate for Payer: Aetna Commercial |
$704.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$539.05
|
| Rate for Payer: Cash Price |
$663.45
|
| Rate for Payer: Cofinity Advantage |
$580.52
|
| Rate for Payer: Cofinity Commercial |
$713.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$663.45
|
| Rate for Payer: Healthscope Commercial |
$746.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$704.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$621.98
|
| Rate for Payer: PHP Commercial |
$704.91
|
| Rate for Payer: Priority Health SBD |
$522.47
|
|
|
MIDAZOLAM 2 MG/ML ORAL SYRUP
|
Facility
|
OP
|
$44.37
|
|
|
Service Code
|
NDC 09999001903
|
| Hospital Charge Code |
24176
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$39.93 |
| Rate for Payer: Aetna Commercial |
$37.71
|
| Rate for Payer: Aetna Medicare |
$22.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.84
|
| Rate for Payer: BCBS Complete |
$17.75
|
| Rate for Payer: Cash Price |
$35.50
|
| Rate for Payer: Cofinity Advantage |
$31.06
|
| Rate for Payer: Cofinity Commercial |
$38.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$35.50
|
| Rate for Payer: Healthscope Commercial |
$39.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$35.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$37.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.28
|
| Rate for Payer: PHP Commercial |
$37.71
|
| Rate for Payer: Priority Health SBD |
$27.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.84
|
| Rate for Payer: UHC Core |
$23.12
|
| Rate for Payer: UHC Exchange |
$17.44
|
|
|
MIDAZOLAM 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$21.46
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$19.31 |
| Rate for Payer: Aetna Commercial |
$18.24
|
| Rate for Payer: Aetna Commercial |
$24.85
|
| Rate for Payer: Aetna Commercial |
$49.51
|
| Rate for Payer: Aetna Commercial |
$17.52
|
| Rate for Payer: Aetna Commercial |
$32.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.48
|
| Rate for Payer: Cash Price |
$46.60
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cash Price |
$17.17
|
| Rate for Payer: Cash Price |
$23.38
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cofinity Advantage |
$14.43
|
| Rate for Payer: Cofinity Advantage |
$15.02
|
| Rate for Payer: Cofinity Advantage |
$26.36
|
| Rate for Payer: Cofinity Advantage |
$20.46
|
| Rate for Payer: Cofinity Advantage |
$40.77
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Cofinity Commercial |
$32.39
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Cofinity Commercial |
$25.14
|
| Rate for Payer: Cofinity Commercial |
$50.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.60
|
| Rate for Payer: Healthscope Commercial |
$19.31
|
| Rate for Payer: Healthscope Commercial |
$18.55
|
| Rate for Payer: Healthscope Commercial |
$52.42
|
| Rate for Payer: Healthscope Commercial |
$33.89
|
| Rate for Payer: Healthscope Commercial |
$26.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.46
|
| Rate for Payer: PHP Commercial |
$49.51
|
| Rate for Payer: PHP Commercial |
$32.01
|
| Rate for Payer: PHP Commercial |
$24.85
|
| Rate for Payer: PHP Commercial |
$18.24
|
| Rate for Payer: PHP Commercial |
$17.52
|
| Rate for Payer: Priority Health SBD |
$13.52
|
| Rate for Payer: Priority Health SBD |
$36.70
|
| Rate for Payer: Priority Health SBD |
$23.73
|
| Rate for Payer: Priority Health SBD |
$12.98
|
| Rate for Payer: Priority Health SBD |
$18.41
|
|
|
MIDAZOLAM 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$58.25
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$52.42 |
| Rate for Payer: Aetna Commercial |
$49.51
|
| Rate for Payer: Aetna Commercial |
$24.85
|
| Rate for Payer: Aetna Commercial |
$18.24
|
| Rate for Payer: Aetna Commercial |
$32.01
|
| Rate for Payer: Aetna Commercial |
$17.52
|
| Rate for Payer: Aetna Medicare |
$10.30
|
| Rate for Payer: Aetna Medicare |
$10.73
|
| Rate for Payer: Aetna Medicare |
$14.62
|
| Rate for Payer: Aetna Medicare |
$29.12
|
| Rate for Payer: Aetna Medicare |
$18.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.40
|
| Rate for Payer: BCBS Complete |
$23.30
|
| Rate for Payer: BCBS Complete |
$8.58
|
| Rate for Payer: BCBS Complete |
$11.69
|
| Rate for Payer: BCBS Complete |
$8.24
|
| Rate for Payer: BCBS Complete |
$15.06
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cash Price |
$17.17
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cash Price |
$23.38
|
| Rate for Payer: Cash Price |
$17.17
|
| Rate for Payer: Cash Price |
$23.38
|
| Rate for Payer: Cash Price |
$30.13
|
| Rate for Payer: Cash Price |
$46.60
|
| Rate for Payer: Cash Price |
$46.60
|
| Rate for Payer: Cofinity Advantage |
$40.77
|
| Rate for Payer: Cofinity Advantage |
$26.36
|
| Rate for Payer: Cofinity Advantage |
$15.02
|
| Rate for Payer: Cofinity Advantage |
$14.43
|
| Rate for Payer: Cofinity Advantage |
$20.46
|
| Rate for Payer: Cofinity Commercial |
$25.14
|
| Rate for Payer: Cofinity Commercial |
$18.46
|
| Rate for Payer: Cofinity Commercial |
$32.39
|
| Rate for Payer: Cofinity Commercial |
$50.09
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.38
|
| 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 |
$16.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.17
|
| Rate for Payer: Healthscope Commercial |
$19.31
|
| Rate for Payer: Healthscope Commercial |
$52.42
|
| Rate for Payer: Healthscope Commercial |
$33.89
|
| Rate for Payer: Healthscope Commercial |
$26.31
|
| Rate for Payer: Healthscope Commercial |
$18.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.25
|
| Rate for Payer: PHP Commercial |
$24.85
|
| Rate for Payer: PHP Commercial |
$18.24
|
| Rate for Payer: PHP Commercial |
$17.52
|
| Rate for Payer: PHP Commercial |
$49.51
|
| Rate for Payer: PHP Commercial |
$32.01
|
| Rate for Payer: Priority Health SBD |
$18.41
|
| Rate for Payer: Priority Health SBD |
$23.73
|
| Rate for Payer: Priority Health SBD |
$36.70
|
| Rate for Payer: Priority Health SBD |
$13.52
|
| Rate for Payer: Priority Health SBD |
$12.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
|
|
MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$13.95
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
168786
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Medicare |
$6.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Advantage |
$9.77
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: Priority Health SBD |
$8.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
|
|
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 |
$8.79 |
| Max. Negotiated Rate |
$12.55 |
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.07
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Advantage |
$9.77
|
| Rate for Payer: Cofinity Commercial |
$12.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$12.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: PHP Commercial |
$11.86
|
| Rate for Payer: Priority Health SBD |
$8.79
|
|
|
MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$15.49
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
168785
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$13.94 |
| Rate for Payer: Aetna Commercial |
$13.17
|
| Rate for Payer: Aetna Medicare |
$7.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.07
|
| Rate for Payer: BCBS Complete |
$6.20
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$12.39
|
| Rate for Payer: Cash Price |
$12.39
|
| Rate for Payer: Cofinity Advantage |
$10.84
|
| Rate for Payer: Cofinity Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.39
|
| Rate for Payer: Healthscope Commercial |
$13.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.62
|
| Rate for Payer: PHP Commercial |
$13.17
|
| Rate for Payer: Priority Health SBD |
$9.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
|
|
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 |
$9.76 |
| Max. Negotiated Rate |
$13.94 |
| Rate for Payer: Aetna Commercial |
$13.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.07
|
| Rate for Payer: Cash Price |
$12.39
|
| Rate for Payer: Cofinity Advantage |
$10.84
|
| Rate for Payer: Cofinity Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.39
|
| Rate for Payer: Healthscope Commercial |
$13.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.62
|
| Rate for Payer: PHP Commercial |
$13.17
|
| Rate for Payer: Priority Health SBD |
$9.76
|
|
|
MIDODRINE 10 MG TABLET
|
Facility
|
OP
|
$333.70
|
|
|
Service Code
|
NDC 72888011401
|
| Hospital Charge Code |
33083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.14 |
| Max. Negotiated Rate |
$300.33 |
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: Aetna Medicare |
$166.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.91
|
| Rate for Payer: BCBS Complete |
$133.48
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Advantage |
$233.59
|
| Rate for Payer: Cofinity Commercial |
$286.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Healthscope Commercial |
$300.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$266.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.28
|
| Rate for Payer: PHP Commercial |
$283.64
|
| Rate for Payer: Priority Health SBD |
$210.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.91
|
| Rate for Payer: UHC Core |
$173.86
|
| Rate for Payer: UHC Exchange |
$131.14
|
|
|
MIDODRINE 10 MG TABLET
|
Facility
|
IP
|
$111.60
|
|
|
Service Code
|
NDC 00904681907
|
| Hospital Charge Code |
33083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.31 |
| Max. Negotiated Rate |
$100.44 |
| Rate for Payer: Aetna Commercial |
$94.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.54
|
| Rate for Payer: Cash Price |
$89.28
|
| Rate for Payer: Cofinity Advantage |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$95.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.28
|
| Rate for Payer: Healthscope Commercial |
$100.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.70
|
| Rate for Payer: PHP Commercial |
$94.86
|
| Rate for Payer: Priority Health SBD |
$70.31
|
|
|
MIDODRINE 10 MG TABLET
|
Facility
|
IP
|
$333.70
|
|
|
Service Code
|
NDC 72888011401
|
| Hospital Charge Code |
33083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.23 |
| Max. Negotiated Rate |
$300.33 |
| Rate for Payer: Aetna Commercial |
$283.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.91
|
| Rate for Payer: Cash Price |
$266.96
|
| Rate for Payer: Cofinity Advantage |
$233.59
|
| Rate for Payer: Cofinity Commercial |
$286.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.96
|
| Rate for Payer: Healthscope Commercial |
$300.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.28
|
| Rate for Payer: PHP Commercial |
$283.64
|
| Rate for Payer: Priority Health SBD |
$210.23
|
|
|
MIDODRINE 10 MG TABLET
|
Facility
|
OP
|
$111.60
|
|
|
Service Code
|
NDC 00904681907
|
| Hospital Charge Code |
33083
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.86 |
| Max. Negotiated Rate |
$100.44 |
| Rate for Payer: Aetna Commercial |
$94.86
|
| Rate for Payer: Aetna Medicare |
$55.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.54
|
| Rate for Payer: BCBS Complete |
$44.64
|
| Rate for Payer: Cash Price |
$89.28
|
| Rate for Payer: Cofinity Advantage |
$78.12
|
| Rate for Payer: Cofinity Commercial |
$95.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.28
|
| Rate for Payer: Healthscope Commercial |
$100.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$89.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.70
|
| Rate for Payer: PHP Commercial |
$94.86
|
| Rate for Payer: Priority Health SBD |
$70.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.54
|
| Rate for Payer: UHC Core |
$58.14
|
| Rate for Payer: UHC Exchange |
$43.86
|
|
