|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$13.10
|
|
|
Service Code
|
NDC 9629513276
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: ASR ASR |
$12.71
|
| Rate for Payer: BCBS Trust/PPO |
$10.16
|
| Rate for Payer: BCN Commercial |
$10.16
|
| Rate for Payer: Cash Price |
$10.48
|
| Rate for Payer: Cofinity Commercial |
$12.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.48
|
| Rate for Payer: Healthscope Commercial |
$13.10
|
| Rate for Payer: Healthscope Whirlpool |
$12.71
|
| Rate for Payer: Mclaren Commercial |
$11.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.53
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$22.18
|
|
|
Service Code
|
NDC 8019652856
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.53 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: Aetna Commercial |
$19.96
|
| Rate for Payer: ASR ASR |
$21.51
|
| Rate for Payer: BCBS Trust/PPO |
$17.20
|
| Rate for Payer: BCN Commercial |
$17.20
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$20.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.74
|
| Rate for Payer: Healthscope Commercial |
$22.18
|
| Rate for Payer: Healthscope Whirlpool |
$21.51
|
| Rate for Payer: Mclaren Commercial |
$19.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.52
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM
|
Facility
|
IP
|
$37.33
|
|
|
Service Code
|
NDC 6373644263
|
| Hospital Charge Code |
5040
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.13 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Aetna Commercial |
$33.60
|
| Rate for Payer: ASR ASR |
$36.21
|
| Rate for Payer: BCBS Trust/PPO |
$28.94
|
| Rate for Payer: BCN Commercial |
$28.94
|
| Rate for Payer: Cash Price |
$29.86
|
| Rate for Payer: Cofinity Commercial |
$35.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.86
|
| Rate for Payer: Healthscope Commercial |
$37.33
|
| Rate for Payer: Healthscope Whirlpool |
$36.21
|
| Rate for Payer: Mclaren Commercial |
$33.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.85
|
|
|
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 |
$715.10 |
| Max. Negotiated Rate |
$1,021.57 |
| Rate for Payer: Aetna Commercial |
$919.41
|
| Rate for Payer: ASR ASR |
$990.92
|
| Rate for Payer: BCBS Trust/PPO |
$792.02
|
| Rate for Payer: BCN Commercial |
$792.02
|
| Rate for Payer: Cash Price |
$817.26
|
| Rate for Payer: Cofinity Commercial |
$960.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$817.26
|
| Rate for Payer: Healthscope Commercial |
$1,021.57
|
| Rate for Payer: Healthscope Whirlpool |
$990.92
|
| Rate for Payer: Mclaren Commercial |
$919.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$868.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$715.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$898.98
|
|
|
MICROFIBRILLAR COLLAGEN HEMOSTAT TOPICAL POWDER IN PACKET
|
Facility
|
IP
|
$509.49
|
|
|
Service Code
|
NDC 53276-1010-01
|
| Hospital Charge Code |
159416
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$356.64 |
| Max. Negotiated Rate |
$509.49 |
| Rate for Payer: Aetna Commercial |
$458.54
|
| Rate for Payer: ASR ASR |
$494.21
|
| Rate for Payer: BCBS Trust/PPO |
$395.01
|
| Rate for Payer: BCN Commercial |
$395.01
|
| Rate for Payer: Cash Price |
$407.59
|
| Rate for Payer: Cofinity Commercial |
$478.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$407.59
|
| Rate for Payer: Healthscope Commercial |
$509.49
|
| Rate for Payer: Healthscope Whirlpool |
$494.21
|
| Rate for Payer: Mclaren Commercial |
$458.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$433.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$356.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$448.35
|
|
|
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
|
$39.80
|
|
|
Service Code
|
NDC 68094-764-59
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.86 |
| Max. Negotiated Rate |
$39.80 |
| Rate for Payer: Aetna Commercial |
$35.82
|
| Rate for Payer: ASR ASR |
$38.61
|
| Rate for Payer: BCBS Trust/PPO |
$30.86
|
| Rate for Payer: BCN Commercial |
$30.86
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$39.80
|
| Rate for Payer: Healthscope Whirlpool |
$38.61
|
| Rate for Payer: Mclaren Commercial |
$35.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.02
|
|
|
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 |
$27.86 |
| Max. Negotiated Rate |
$39.80 |
| Rate for Payer: Aetna Commercial |
$35.82
|
| Rate for Payer: ASR ASR |
$38.61
|
| Rate for Payer: BCBS Trust/PPO |
$30.86
|
| Rate for Payer: BCN Commercial |
$30.86
|
| Rate for Payer: Cash Price |
$31.84
|
| Rate for Payer: Cofinity Commercial |
$37.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.84
|
| Rate for Payer: Healthscope Commercial |
$39.80
|
| Rate for Payer: Healthscope Whirlpool |
$38.61
|
| Rate for Payer: Mclaren Commercial |
$35.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.02
|
|
|
MIDAZOLAM 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$11.25
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.88 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Aetna Commercial |
$10.12
|
| Rate for Payer: Aetna Commercial |
$16.08
|
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna Commercial |
$13.34
|
| Rate for Payer: Aetna Commercial |
$17.48
|
| Rate for Payer: Aetna Commercial |
$12.54
|
| Rate for Payer: ASR ASR |
$23.14
|
| Rate for Payer: ASR ASR |
$18.84
|
| Rate for Payer: ASR ASR |
$14.38
|
| Rate for Payer: ASR ASR |
$17.33
|
| Rate for Payer: ASR ASR |
$10.91
|
| Rate for Payer: ASR ASR |
$13.51
|
| Rate for Payer: BCBS Trust/PPO |
$11.49
|
| Rate for Payer: BCBS Trust/PPO |
$10.80
|
| Rate for Payer: BCBS Trust/PPO |
$15.06
|
| Rate for Payer: BCBS Trust/PPO |
$18.50
|
| Rate for Payer: BCBS Trust/PPO |
$8.72
|
| Rate for Payer: BCBS Trust/PPO |
$13.85
|
| Rate for Payer: BCN Commercial |
$15.06
|
| Rate for Payer: BCN Commercial |
$8.72
|
| Rate for Payer: BCN Commercial |
$10.80
|
| Rate for Payer: BCN Commercial |
$11.49
|
| Rate for Payer: BCN Commercial |
$13.85
|
| Rate for Payer: BCN Commercial |
$18.50
|
| Rate for Payer: Cash Price |
$11.86
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$11.15
|
| Rate for Payer: Cash Price |
$15.54
|
| Rate for Payer: Cash Price |
$19.09
|
| Rate for Payer: Cofinity Commercial |
$18.25
|
| Rate for Payer: Cofinity Commercial |
$13.09
|
| Rate for Payer: Cofinity Commercial |
$13.93
|
| Rate for Payer: Cofinity Commercial |
$22.43
|
| Rate for Payer: Cofinity Commercial |
$10.58
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.30
|
| Rate for Payer: Healthscope Commercial |
$17.87
|
| Rate for Payer: Healthscope Commercial |
$11.25
|
| Rate for Payer: Healthscope Commercial |
$19.42
|
| Rate for Payer: Healthscope Commercial |
$13.93
|
| Rate for Payer: Healthscope Commercial |
$23.86
|
| Rate for Payer: Healthscope Commercial |
$14.82
|
| Rate for Payer: Healthscope Whirlpool |
$10.91
|
| Rate for Payer: Healthscope Whirlpool |
$14.38
|
| Rate for Payer: Healthscope Whirlpool |
$17.33
|
| Rate for Payer: Healthscope Whirlpool |
$18.84
|
| Rate for Payer: Healthscope Whirlpool |
$23.14
|
| Rate for Payer: Healthscope Whirlpool |
$13.51
|
| Rate for Payer: Mclaren Commercial |
$21.47
|
| Rate for Payer: Mclaren Commercial |
$17.48
|
| Rate for Payer: Mclaren Commercial |
$13.34
|
| Rate for Payer: Mclaren Commercial |
$16.08
|
| Rate for Payer: Mclaren Commercial |
$12.54
|
| Rate for Payer: Mclaren Commercial |
$10.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.00
|
|
|
MIDAZOLAM 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$21.83
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$21.83 |
| Rate for Payer: Aetna Commercial |
$19.65
|
| Rate for Payer: Aetna Commercial |
$18.55
|
| Rate for Payer: Aetna Commercial |
$9.72
|
| Rate for Payer: ASR ASR |
$21.18
|
| Rate for Payer: ASR ASR |
$10.48
|
| Rate for Payer: ASR ASR |
$19.99
|
| Rate for Payer: BCBS Trust/PPO |
$15.98
|
| Rate for Payer: BCBS Trust/PPO |
$8.37
|
| Rate for Payer: BCBS Trust/PPO |
$16.92
|
| Rate for Payer: BCN Commercial |
$16.92
|
| Rate for Payer: BCN Commercial |
$8.37
|
| Rate for Payer: BCN Commercial |
$15.98
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Cash Price |
$17.46
|
| Rate for Payer: Cofinity Commercial |
$20.52
|
| Rate for Payer: Cofinity Commercial |
$10.15
|
| Rate for Payer: Cofinity Commercial |
$19.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.46
|
| Rate for Payer: Healthscope Commercial |
$10.80
|
| Rate for Payer: Healthscope Commercial |
$20.61
|
| Rate for Payer: Healthscope Commercial |
$21.83
|
| Rate for Payer: Healthscope Whirlpool |
$19.99
|
| Rate for Payer: Healthscope Whirlpool |
$10.48
|
| Rate for Payer: Healthscope Whirlpool |
$21.18
|
| Rate for Payer: Mclaren Commercial |
$19.65
|
| Rate for Payer: Mclaren Commercial |
$18.55
|
| Rate for Payer: Mclaren Commercial |
$9.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.14
|
|
|
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 |
$8.91 |
| Max. Negotiated Rate |
$12.73 |
| Rate for Payer: Aetna Commercial |
$11.46
|
| Rate for Payer: Aetna Commercial |
$13.16
|
| Rate for Payer: ASR ASR |
$12.35
|
| Rate for Payer: ASR ASR |
$14.18
|
| Rate for Payer: BCBS Trust/PPO |
$9.87
|
| Rate for Payer: BCBS Trust/PPO |
$11.33
|
| Rate for Payer: BCN Commercial |
$11.33
|
| Rate for Payer: BCN Commercial |
$9.87
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cash Price |
$11.69
|
| Rate for Payer: Cofinity Commercial |
$11.97
|
| Rate for Payer: Cofinity Commercial |
$13.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.18
|
| Rate for Payer: Healthscope Commercial |
$12.73
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Healthscope Whirlpool |
$14.18
|
| Rate for Payer: Healthscope Whirlpool |
$12.35
|
| Rate for Payer: Mclaren Commercial |
$11.46
|
| Rate for Payer: Mclaren Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$12.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.87
|
|
|
MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$15.48
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
168785
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.84 |
| Max. Negotiated Rate |
$15.48 |
| Rate for Payer: Aetna Commercial |
$13.93
|
| Rate for Payer: ASR ASR |
$15.02
|
| Rate for Payer: BCBS Trust/PPO |
$12.00
|
| Rate for Payer: BCN Commercial |
$12.00
|
| Rate for Payer: Cash Price |
$12.39
|
| Rate for Payer: Cofinity Commercial |
$14.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.38
|
| Rate for Payer: Healthscope Commercial |
$15.48
|
| Rate for Payer: Healthscope Whirlpool |
$15.02
|
| Rate for Payer: Mclaren Commercial |
$13.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.62
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$4.71
|
|
|
Service Code
|
NDC 50268-562-11
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$4.71 |
| Rate for Payer: Aetna Commercial |
$4.24
|
| Rate for Payer: ASR ASR |
$4.57
|
| Rate for Payer: BCBS Trust/PPO |
$3.65
|
| Rate for Payer: BCN Commercial |
$3.65
|
| Rate for Payer: Cash Price |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$4.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.77
|
| Rate for Payer: Healthscope Commercial |
$4.71
|
| Rate for Payer: Healthscope Whirlpool |
$4.57
|
| Rate for Payer: Mclaren Commercial |
$4.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.14
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$235.60
|
|
|
Service Code
|
NDC 50268-562-15
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.92 |
| Max. Negotiated Rate |
$235.60 |
| Rate for Payer: Aetna Commercial |
$212.04
|
| Rate for Payer: ASR ASR |
$228.53
|
| Rate for Payer: BCBS Trust/PPO |
$182.66
|
| Rate for Payer: BCN Commercial |
$182.66
|
| Rate for Payer: Cash Price |
$188.48
|
| Rate for Payer: Cofinity Commercial |
$221.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.48
|
| Rate for Payer: Healthscope Commercial |
$235.60
|
| Rate for Payer: Healthscope Whirlpool |
$228.53
|
| Rate for Payer: Mclaren Commercial |
$212.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.33
|
|
|
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 |
$252.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$324.00
|
| Rate for Payer: ASR ASR |
$349.20
|
| Rate for Payer: BCBS Trust/PPO |
$279.11
|
| Rate for Payer: BCN Commercial |
$279.11
|
| Rate for Payer: Cash Price |
$288.00
|
| Rate for Payer: Cofinity Commercial |
$338.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$288.00
|
| Rate for Payer: Healthscope Commercial |
$360.00
|
| Rate for Payer: Healthscope Whirlpool |
$349.20
|
| Rate for Payer: Mclaren Commercial |
$324.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$306.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.80
|
|
|
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 |
$2.52 |
| Max. Negotiated Rate |
$3.60 |
| Rate for Payer: Aetna Commercial |
$3.24
|
| Rate for Payer: ASR ASR |
$3.49
|
| Rate for Payer: BCBS Trust/PPO |
$2.79
|
| Rate for Payer: BCN Commercial |
$2.79
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Cofinity Commercial |
$3.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.88
|
| Rate for Payer: Healthscope Commercial |
$3.60
|
| Rate for Payer: Healthscope Whirlpool |
$3.49
|
| Rate for Payer: Mclaren Commercial |
$3.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.17
|
|
|
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 |
$226.13 |
| Max. Negotiated Rate |
$323.04 |
| Rate for Payer: Aetna Commercial |
$290.74
|
| Rate for Payer: ASR ASR |
$313.35
|
| Rate for Payer: BCBS Trust/PPO |
$250.45
|
| Rate for Payer: BCN Commercial |
$250.45
|
| Rate for Payer: Cash Price |
$258.43
|
| Rate for Payer: Cofinity Commercial |
$303.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$258.43
|
| Rate for Payer: Healthscope Commercial |
$323.04
|
| Rate for Payer: Healthscope Whirlpool |
$313.35
|
| Rate for Payer: Mclaren Commercial |
$290.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$274.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$284.28
|
|
|
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 |
$152.28 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Aetna Commercial |
$195.80
|
| Rate for Payer: ASR ASR |
$211.02
|
| Rate for Payer: BCBS Trust/PPO |
$168.67
|
| Rate for Payer: BCN Commercial |
$168.67
|
| Rate for Payer: Cash Price |
$174.04
|
| Rate for Payer: Cofinity Commercial |
$204.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$174.04
|
| Rate for Payer: Healthscope Commercial |
$217.55
|
| Rate for Payer: Healthscope Whirlpool |
$211.02
|
| Rate for Payer: Mclaren Commercial |
$195.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$184.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.44
|
|
|
MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK
|
Facility
|
IP
|
$70.18
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
14961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.13 |
| Max. Negotiated Rate |
$70.18 |
| Rate for Payer: Aetna Commercial |
$63.16
|
| Rate for Payer: ASR ASR |
$68.07
|
| Rate for Payer: BCBS Trust/PPO |
$54.41
|
| Rate for Payer: BCN Commercial |
$54.41
|
| Rate for Payer: Cash Price |
$56.14
|
| Rate for Payer: Cofinity Commercial |
$65.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.14
|
| Rate for Payer: Healthscope Commercial |
$70.18
|
| Rate for Payer: Healthscope Whirlpool |
$68.07
|
| Rate for Payer: Mclaren Commercial |
$63.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.76
|
|
|
MINERAL OIL ENEMA
|
Facility
|
IP
|
$46.88
|
|
|
Service Code
|
NDC 9629512753
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.82 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Aetna Commercial |
$42.19
|
| Rate for Payer: ASR ASR |
$45.47
|
| Rate for Payer: BCBS Trust/PPO |
$36.35
|
| Rate for Payer: BCN Commercial |
$36.35
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$44.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.50
|
| Rate for Payer: Healthscope Commercial |
$46.88
|
| Rate for Payer: Healthscope Whirlpool |
$45.47
|
| Rate for Payer: Mclaren Commercial |
$42.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$39.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.25
|
|
|
MINERAL OIL ORAL
|
Facility
|
IP
|
$7.77
|
|
|
Service Code
|
NDC 48433-202-30
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.44 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Aetna Commercial |
$6.99
|
| Rate for Payer: ASR ASR |
$7.54
|
| Rate for Payer: BCBS Trust/PPO |
$6.02
|
| Rate for Payer: BCN Commercial |
$6.02
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Cofinity Commercial |
$7.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.22
|
| Rate for Payer: Healthscope Commercial |
$7.77
|
| Rate for Payer: Healthscope Whirlpool |
$7.54
|
| Rate for Payer: Mclaren Commercial |
$6.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.84
|
|
|
MINOR BLADDER PROCEDURES WITH CC
|
Facility
|
IP
|
$18,733.56
|
|
|
Service Code
|
MS-DRG 663
|
| Min. Negotiated Rate |
$13,331.73 |
| Max. Negotiated Rate |
$18,733.56 |
| Rate for Payer: Aetna Medicare |
$14,033.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,541.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,541.75
|
| Rate for Payer: BCBS MAPPO |
$14,033.40
|
| Rate for Payer: BCN Medicare Advantage |
$14,033.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,033.40
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,033.40
|
| Rate for Payer: Mclaren Medicare |
$14,033.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,735.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,138.41
|
| Rate for Payer: PACE Medicare |
$13,331.73
|
| Rate for Payer: PACE SWMI |
$14,033.40
|
| Rate for Payer: PHP Commercial |
$15,436.74
|
| Rate for Payer: PHP Medicare Advantage |
$14,033.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18,733.56
|
| Rate for Payer: Priority Health Medicare |
$14,033.40
|
| Rate for Payer: Priority Health Narrow Network |
$14,986.85
|
| Rate for Payer: Railroad Medicare Medicare |
$14,033.40
|
| Rate for Payer: UHC Medicare Advantage |
$14,454.40
|
| Rate for Payer: VA VA |
$14,033.40
|
|
|
MINOR BLADDER PROCEDURES WITH MCC
|
Facility
|
IP
|
$38,477.63
|
|
|
Service Code
|
MS-DRG 662
|
| Min. Negotiated Rate |
$25,699.59 |
| Max. Negotiated Rate |
$38,477.63 |
| Rate for Payer: Aetna Medicare |
$27,052.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33,815.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33,815.25
|
| Rate for Payer: BCBS MAPPO |
$27,052.20
|
| Rate for Payer: BCN Medicare Advantage |
$27,052.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27,052.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$27,052.20
|
| Rate for Payer: Mclaren Medicare |
$27,052.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28,404.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31,110.03
|
| Rate for Payer: PACE Medicare |
$25,699.59
|
| Rate for Payer: PACE SWMI |
$27,052.20
|
| Rate for Payer: PHP Commercial |
$29,757.42
|
| Rate for Payer: PHP Medicare Advantage |
$27,052.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38,477.63
|
| Rate for Payer: Priority Health Medicare |
$27,052.20
|
| Rate for Payer: Priority Health Narrow Network |
$30,782.10
|
| Rate for Payer: Railroad Medicare Medicare |
$27,052.20
|
| Rate for Payer: UHC Medicare Advantage |
$27,863.77
|
| Rate for Payer: VA VA |
$27,052.20
|
|
|
MINOR BLADDER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$13,630.94
|
|
|
Service Code
|
MS-DRG 664
|
| Min. Negotiated Rate |
$10,135.44 |
| Max. Negotiated Rate |
$13,630.94 |
| Rate for Payer: Aetna Medicare |
$10,668.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,336.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,336.10
|
| Rate for Payer: BCBS MAPPO |
$10,668.88
|
| Rate for Payer: BCN Medicare Advantage |
$10,668.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,668.88
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,668.88
|
| Rate for Payer: Mclaren Medicare |
$10,668.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,202.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,269.21
|
| Rate for Payer: PACE Medicare |
$10,135.44
|
| Rate for Payer: PACE SWMI |
$10,668.88
|
| Rate for Payer: PHP Commercial |
$11,735.77
|
| Rate for Payer: PHP Medicare Advantage |
$10,668.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,630.94
|
| Rate for Payer: Priority Health Medicare |
$10,668.88
|
| Rate for Payer: Priority Health Narrow Network |
$10,904.75
|
| Rate for Payer: Railroad Medicare Medicare |
$10,668.88
|
| Rate for Payer: UHC Medicare Advantage |
$10,988.95
|
| Rate for Payer: VA VA |
$10,668.88
|
|
