|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$9.16
|
|
|
Service Code
|
NDC 61269-735-14
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.59 |
| Max. Negotiated Rate |
$8.24 |
| Rate for Payer: Aetna Commercial |
$7.79
|
| Rate for Payer: BCBS Trust/PPO |
$7.08
|
| Rate for Payer: BCN Commercial |
$7.08
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: Cofinity Commercial |
$7.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.33
|
| Rate for Payer: Healthscope Commercial |
$8.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.79
|
| Rate for Payer: PHP Commercial |
$7.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.06
|
| Rate for Payer: UHC Core |
$7.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.87
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
NDC 43553-0003-5
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna Commercial |
$32.30
|
| Rate for Payer: BCBS Trust/PPO |
$29.37
|
| Rate for Payer: BCN Commercial |
$29.37
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$32.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.40
|
| Rate for Payer: Healthscope Commercial |
$34.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$28.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.30
|
| Rate for Payer: PHP Commercial |
$32.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$23.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$33.44
|
| Rate for Payer: UHC Core |
$31.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$28.50
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$27.08
|
|
|
Service Code
|
NDC 11701-038-16
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$24.37 |
| Rate for Payer: Aetna Commercial |
$23.02
|
| Rate for Payer: BCBS Trust/PPO |
$20.93
|
| Rate for Payer: BCN Commercial |
$20.93
|
| Rate for Payer: Cash Price |
$21.66
|
| Rate for Payer: Cofinity Commercial |
$23.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.66
|
| Rate for Payer: Healthscope Commercial |
$24.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.02
|
| Rate for Payer: PHP Commercial |
$23.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.83
|
| Rate for Payer: UHC Core |
$22.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.31
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
NDC 1101725030
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.03 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Aetna Commercial |
$19.55
|
| Rate for Payer: BCBS Trust/PPO |
$17.77
|
| Rate for Payer: BCN Commercial |
$17.77
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$19.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.40
|
| Rate for Payer: Healthscope Commercial |
$20.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.55
|
| Rate for Payer: PHP Commercial |
$19.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.24
|
| Rate for Payer: UHC Core |
$19.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.25
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$19.51
|
|
|
Service Code
|
NDC 0316-0225-30
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Aetna Commercial |
$16.58
|
| Rate for Payer: BCBS Trust/PPO |
$15.08
|
| Rate for Payer: BCN Commercial |
$15.08
|
| Rate for Payer: Cash Price |
$15.61
|
| Rate for Payer: Cofinity Commercial |
$16.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.61
|
| Rate for Payer: Healthscope Commercial |
$17.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.58
|
| Rate for Payer: PHP Commercial |
$16.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.17
|
| Rate for Payer: UHC Core |
$16.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.63
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$22.19
|
|
|
Service Code
|
NDC 8019652856
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$19.97 |
| Rate for Payer: Aetna Commercial |
$18.86
|
| Rate for Payer: BCBS Trust/PPO |
$17.15
|
| Rate for Payer: BCN Commercial |
$17.15
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$19.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.75
|
| Rate for Payer: Healthscope Commercial |
$19.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.86
|
| Rate for Payer: PHP Commercial |
$18.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.53
|
| Rate for Payer: UHC Core |
$18.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.64
|
|
|
MICRODERMABRASION
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 00173
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
|
|
MICROFIBRILLAR COLLAGEN HEMOSTAT POWDER
|
Facility
|
IP
|
$1,021.57
|
|
|
Service Code
|
NDC 53276-1010-02
|
| Hospital Charge Code |
10606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$623.06 |
| Max. Negotiated Rate |
$919.41 |
| Rate for Payer: Aetna Commercial |
$868.33
|
| Rate for Payer: BCBS Trust/PPO |
$789.47
|
| Rate for Payer: BCN Commercial |
$789.47
|
| Rate for Payer: Cash Price |
$817.26
|
| Rate for Payer: Cofinity Commercial |
$878.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$817.26
|
| Rate for Payer: Healthscope Commercial |
$919.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$766.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$868.33
|
| Rate for Payer: PHP Commercial |
$868.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$715.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$888.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$623.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$898.98
|
| Rate for Payer: UHC Core |
$853.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$766.18
|
|
|
MICRO NEEDLING
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 00171
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: BCBS Complete |
$80.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.00
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
IP
|
$34.20
|
|
|
Service Code
|
NDC 0904-7113-41
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$30.78 |
| Rate for Payer: Aetna Commercial |
$29.07
|
| Rate for Payer: BCBS Trust/PPO |
$26.43
|
| Rate for Payer: BCN Commercial |
$26.43
|
| Rate for Payer: Cash Price |
$27.36
|
| Rate for Payer: Cofinity Commercial |
$29.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.36
|
| Rate for Payer: Healthscope Commercial |
$30.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.07
|
| Rate for Payer: PHP Commercial |
$29.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.10
|
| Rate for Payer: UHC Core |
$28.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.65
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
IP
|
$39.38
|
|
|
Service Code
|
NDC 60687-576-46
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.02 |
| Max. Negotiated Rate |
$35.44 |
| Rate for Payer: Aetna Commercial |
$33.47
|
| Rate for Payer: BCBS Trust/PPO |
$30.43
|
| Rate for Payer: BCN Commercial |
$30.43
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cofinity Commercial |
$33.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.50
|
| Rate for Payer: Healthscope Commercial |
$35.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.47
|
| Rate for Payer: PHP Commercial |
$33.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.65
|
| Rate for Payer: UHC Core |
$32.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.54
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
IP
|
$34.20
|
|
|
Service Code
|
NDC 0904-7113-93
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$30.78 |
| Rate for Payer: Aetna Commercial |
$29.07
|
| Rate for Payer: BCBS Trust/PPO |
$26.43
|
| Rate for Payer: BCN Commercial |
$26.43
|
| Rate for Payer: Cash Price |
$27.36
|
| Rate for Payer: Cofinity Commercial |
$29.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$27.36
|
| Rate for Payer: Healthscope Commercial |
$30.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$25.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$29.07
|
| Rate for Payer: PHP Commercial |
$29.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$20.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.10
|
| Rate for Payer: UHC Core |
$28.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$25.65
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
IP
|
$39.80
|
|
|
Service Code
|
NDC 68094-764-62
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.27 |
| Max. Negotiated Rate |
$35.82 |
| Rate for Payer: Aetna Commercial |
$33.83
|
| Rate for Payer: BCBS Trust/PPO |
$30.76
|
| Rate for Payer: BCN Commercial |
$30.76
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$35.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.83
|
| Rate for Payer: PHP Commercial |
$33.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.02
|
| Rate for Payer: UHC Core |
$33.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.85
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
IP
|
$39.38
|
|
|
Service Code
|
NDC 60687-576-40
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.02 |
| Max. Negotiated Rate |
$35.44 |
| Rate for Payer: Aetna Commercial |
$33.47
|
| Rate for Payer: BCBS Trust/PPO |
$30.43
|
| Rate for Payer: BCN Commercial |
$30.43
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cofinity Commercial |
$33.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.50
|
| Rate for Payer: Healthscope Commercial |
$35.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.47
|
| Rate for Payer: PHP Commercial |
$33.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$34.65
|
| Rate for Payer: UHC Core |
$32.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.54
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
IP
|
$39.80
|
|
|
Service Code
|
NDC 68094-764-59
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.27 |
| Max. Negotiated Rate |
$35.82 |
| Rate for Payer: Aetna Commercial |
$33.83
|
| Rate for Payer: BCBS Trust/PPO |
$30.76
|
| Rate for Payer: BCN Commercial |
$30.76
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Commercial |
$34.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$35.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.83
|
| Rate for Payer: PHP Commercial |
$33.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.02
|
| Rate for Payer: UHC Core |
$33.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.85
|
|
|
MIDAZOLAM 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$10.86
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.62 |
| Max. Negotiated Rate |
$9.77 |
| Rate for Payer: Aetna Commercial |
$9.23
|
| Rate for Payer: Aetna Commercial |
$12.61
|
| Rate for Payer: Aetna Commercial |
$12.14
|
| Rate for Payer: Aetna Commercial |
$13.16
|
| Rate for Payer: Aetna Commercial |
$20.29
|
| Rate for Payer: BCBS Trust/PPO |
$11.96
|
| Rate for Payer: BCBS Trust/PPO |
$18.45
|
| Rate for Payer: BCBS Trust/PPO |
$11.04
|
| Rate for Payer: BCBS Trust/PPO |
$11.46
|
| Rate for Payer: BCBS Trust/PPO |
$8.39
|
| Rate for Payer: BCN Commercial |
$11.96
|
| Rate for Payer: BCN Commercial |
$8.39
|
| Rate for Payer: BCN Commercial |
$18.45
|
| Rate for Payer: BCN Commercial |
$11.46
|
| Rate for Payer: BCN Commercial |
$11.04
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Cash Price |
$8.69
|
| Rate for Payer: Cash Price |
$19.10
|
| Rate for Payer: Cash Price |
$11.42
|
| Rate for Payer: Cash Price |
$11.86
|
| Rate for Payer: Cofinity Commercial |
$12.75
|
| Rate for Payer: Cofinity Commercial |
$9.34
|
| Rate for Payer: Cofinity Commercial |
$12.28
|
| Rate for Payer: Cofinity Commercial |
$20.53
|
| Rate for Payer: Cofinity Commercial |
$13.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.42
|
| Rate for Payer: Healthscope Commercial |
$21.48
|
| Rate for Payer: Healthscope Commercial |
$13.93
|
| Rate for Payer: Healthscope Commercial |
$9.77
|
| Rate for Payer: Healthscope Commercial |
$13.35
|
| Rate for Payer: Healthscope Commercial |
$12.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.16
|
| Rate for Payer: PHP Commercial |
$9.23
|
| Rate for Payer: PHP Commercial |
$12.61
|
| Rate for Payer: PHP Commercial |
$13.16
|
| Rate for Payer: PHP Commercial |
$12.14
|
| Rate for Payer: PHP Commercial |
$20.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.56
|
| Rate for Payer: UHC Core |
$12.93
|
| Rate for Payer: UHC Core |
$12.38
|
| Rate for Payer: UHC Core |
$9.07
|
| Rate for Payer: UHC Core |
$11.92
|
| Rate for Payer: UHC Core |
$19.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.90
|
|
|
MIDAZOLAM 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$20.61
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$18.55 |
| Rate for Payer: Aetna Commercial |
$17.52
|
| Rate for Payer: Aetna Commercial |
$15.83
|
| Rate for Payer: Aetna Commercial |
$15.77
|
| Rate for Payer: BCBS Trust/PPO |
$15.93
|
| Rate for Payer: BCBS Trust/PPO |
$14.34
|
| Rate for Payer: BCBS Trust/PPO |
$14.39
|
| Rate for Payer: BCN Commercial |
$15.93
|
| Rate for Payer: BCN Commercial |
$14.34
|
| Rate for Payer: BCN Commercial |
$14.39
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cash Price |
$14.84
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$16.01
|
| Rate for Payer: Cofinity Commercial |
$15.95
|
| Rate for Payer: Cofinity Commercial |
$17.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$18.55
|
| Rate for Payer: Healthscope Commercial |
$16.70
|
| Rate for Payer: Healthscope Commercial |
$16.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.52
|
| Rate for Payer: PHP Commercial |
$17.52
|
| Rate for Payer: PHP Commercial |
$15.83
|
| Rate for Payer: PHP Commercial |
$15.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.14
|
| Rate for Payer: UHC Core |
$15.49
|
| Rate for Payer: UHC Core |
$15.55
|
| Rate for Payer: UHC Core |
$17.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.46
|
|
|
MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$12.73
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
168786
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.76 |
| Max. Negotiated Rate |
$11.46 |
| Rate for Payer: Aetna Commercial |
$10.82
|
| Rate for Payer: Aetna Commercial |
$12.27
|
| Rate for Payer: BCBS Trust/PPO |
$9.84
|
| Rate for Payer: BCBS Trust/PPO |
$11.15
|
| Rate for Payer: BCN Commercial |
$11.15
|
| Rate for Payer: BCN Commercial |
$9.84
|
| Rate for Payer: Cash Price |
$11.54
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Cofinity Commercial |
$10.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$12.99
|
| Rate for Payer: Healthscope Commercial |
$11.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.82
|
| Rate for Payer: PHP Commercial |
$12.27
|
| Rate for Payer: PHP Commercial |
$10.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.70
|
| Rate for Payer: UHC Core |
$10.63
|
| Rate for Payer: UHC Core |
$12.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.82
|
|
|
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 |
$9.45 |
| Max. Negotiated Rate |
$13.94 |
| Rate for Payer: Aetna Commercial |
$13.17
|
| Rate for Payer: BCBS Trust/PPO |
$11.97
|
| Rate for Payer: BCN Commercial |
$11.97
|
| Rate for Payer: Cash Price |
$12.39
|
| 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: Lakeland Regional Health Systems Commercial |
$11.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.17
|
| Rate for Payer: PHP Commercial |
$13.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.63
|
| Rate for Payer: UHC Core |
$12.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.62
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$3.60
|
|
|
Service Code
|
NDC 51079-453-01
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Aetna Commercial |
$3.06
|
| Rate for Payer: BCBS Trust/PPO |
$2.78
|
| Rate for Payer: BCN Commercial |
$2.78
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cofinity Commercial |
$3.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.88
|
| Rate for Payer: Healthscope Commercial |
$3.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.06
|
| Rate for Payer: PHP Commercial |
$3.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.17
|
| Rate for Payer: UHC Core |
$3.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.70
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$323.04
|
|
|
Service Code
|
NDC 0904-6818-61
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.02 |
| Max. Negotiated Rate |
$290.74 |
| Rate for Payer: Aetna Commercial |
$274.58
|
| Rate for Payer: BCBS Trust/PPO |
$249.65
|
| Rate for Payer: BCN Commercial |
$249.65
|
| Rate for Payer: Cash Price |
$258.43
|
| Rate for Payer: Cofinity Commercial |
$277.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.43
|
| Rate for Payer: Healthscope Commercial |
$290.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$242.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.58
|
| Rate for Payer: PHP Commercial |
$274.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$281.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$197.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.28
|
| Rate for Payer: UHC Core |
$269.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$242.28
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
NDC 51079-453-20
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.56 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna Commercial |
$306.00
|
| Rate for Payer: BCBS Trust/PPO |
$278.21
|
| Rate for Payer: BCN Commercial |
$278.21
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cofinity Commercial |
$309.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.00
|
| Rate for Payer: Healthscope Commercial |
$324.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$270.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$306.00
|
| Rate for Payer: PHP Commercial |
$306.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$313.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.80
|
| Rate for Payer: UHC Core |
$300.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$270.00
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$217.55
|
|
|
Service Code
|
NDC 0245-0212-11
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$132.68 |
| Max. Negotiated Rate |
$195.80 |
| Rate for Payer: Aetna Commercial |
$184.92
|
| Rate for Payer: BCBS Trust/PPO |
$168.12
|
| Rate for Payer: BCN Commercial |
$168.12
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Commercial |
$187.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.04
|
| Rate for Payer: Healthscope Commercial |
$195.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$163.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$184.92
|
| Rate for Payer: PHP Commercial |
$184.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$132.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$191.44
|
| Rate for Payer: UHC Core |
$181.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$163.16
|
|
|
MINERAL OIL
|
Facility
|
IP
|
$60.28
|
|
|
Service Code
|
NDC 6332325410
|
| Hospital Charge Code |
109056
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.76 |
| Max. Negotiated Rate |
$54.25 |
| Rate for Payer: Aetna Commercial |
$51.24
|
| Rate for Payer: BCBS Trust/PPO |
$46.58
|
| Rate for Payer: BCN Commercial |
$46.58
|
| Rate for Payer: Cash Price |
$48.22
|
| Rate for Payer: Cofinity Commercial |
$51.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.22
|
| Rate for Payer: Healthscope Commercial |
$54.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.24
|
| Rate for Payer: PHP Commercial |
$51.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.05
|
| Rate for Payer: UHC Core |
$50.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.21
|
|
|
MINERAL OIL ENEMA
|
Facility
|
IP
|
$50.01
|
|
|
Service Code
|
NDC 132030140
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.50 |
| Max. Negotiated Rate |
$45.01 |
| Rate for Payer: Aetna Commercial |
$42.51
|
| Rate for Payer: BCBS Trust/PPO |
$38.65
|
| Rate for Payer: BCN Commercial |
$38.65
|
| Rate for Payer: Cash Price |
$40.01
|
| Rate for Payer: Cofinity Commercial |
$43.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.01
|
| Rate for Payer: Healthscope Commercial |
$45.01
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.51
|
| Rate for Payer: PHP Commercial |
$42.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$30.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.01
|
| Rate for Payer: UHC Core |
$41.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.51
|
|
