|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
OP
|
$13.10
|
|
|
Service Code
|
NDC 96295013276
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: Aetna Medicare |
$6.55
|
| Rate for Payer: ASR ASR |
$12.71
|
| Rate for Payer: ASR Commercial |
$12.71
|
| Rate for Payer: BCBS Complete |
$5.24
|
| Rate for Payer: BCBS Trust/PPO |
$10.73
|
| 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 Commercial |
$11.14
|
| Rate for Payer: Nomi Health Commercial |
$10.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.48
|
| Rate for Payer: Priority Health Narrow Network |
$9.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.53
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$13.10
|
|
|
Service Code
|
NDC 96295013276
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$13.10 |
| Rate for Payer: Aetna Commercial |
$11.79
|
| Rate for Payer: ASR ASR |
$12.71
|
| Rate for Payer: ASR Commercial |
$12.71
|
| Rate for Payer: BCBS Trust/PPO |
$10.68
|
| 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 Commercial |
$11.14
|
| Rate for Payer: Nomi Health Commercial |
$10.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.53
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM
|
Facility
|
OP
|
$37.33
|
|
|
Service Code
|
NDC 63736044263
|
| Hospital Charge Code |
5040
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.93 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Aetna Commercial |
$33.60
|
| Rate for Payer: Aetna Medicare |
$18.66
|
| Rate for Payer: ASR ASR |
$36.21
|
| Rate for Payer: ASR Commercial |
$36.21
|
| Rate for Payer: BCBS Complete |
$14.93
|
| Rate for Payer: BCBS Trust/PPO |
$30.57
|
| 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 Commercial |
$31.73
|
| Rate for Payer: Nomi Health Commercial |
$30.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$32.71
|
| Rate for Payer: Priority Health Narrow Network |
$26.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.85
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM
|
Facility
|
IP
|
$37.33
|
|
|
Service Code
|
NDC 63736044263
|
| Hospital Charge Code |
5040
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.26 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Aetna Commercial |
$33.60
|
| Rate for Payer: ASR ASR |
$36.21
|
| Rate for Payer: ASR Commercial |
$36.21
|
| Rate for Payer: BCBS Trust/PPO |
$30.42
|
| 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 Commercial |
$31.73
|
| Rate for Payer: Nomi Health Commercial |
$30.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.85
|
|
|
MICRODERMABRASION
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 00173
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$66.30 |
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
|
|
MICROFIBRILLAR COLLAGEN HEMOSTAT POWDER
|
Facility
|
OP
|
$996.03
|
|
|
Service Code
|
NDC 53276101002
|
| Hospital Charge Code |
10606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$398.41 |
| Max. Negotiated Rate |
$996.03 |
| Rate for Payer: Aetna Commercial |
$896.43
|
| Rate for Payer: Aetna Medicare |
$498.02
|
| Rate for Payer: ASR ASR |
$966.15
|
| Rate for Payer: ASR Commercial |
$966.15
|
| Rate for Payer: BCBS Complete |
$398.41
|
| Rate for Payer: BCBS Trust/PPO |
$815.65
|
| Rate for Payer: BCN Commercial |
$772.22
|
| Rate for Payer: Cash Price |
$796.83
|
| Rate for Payer: Cofinity Commercial |
$936.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$796.82
|
| Rate for Payer: Healthscope Commercial |
$996.03
|
| Rate for Payer: Healthscope Whirlpool |
$966.15
|
| Rate for Payer: Mclaren Commercial |
$896.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$846.63
|
| Rate for Payer: Nomi Health Commercial |
$816.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$647.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$872.72
|
| Rate for Payer: Priority Health Narrow Network |
$698.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$876.51
|
|
|
MICROFIBRILLAR COLLAGEN HEMOSTAT POWDER
|
Facility
|
IP
|
$996.03
|
|
|
Service Code
|
NDC 53276101002
|
| Hospital Charge Code |
10606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$647.42 |
| Max. Negotiated Rate |
$996.03 |
| Rate for Payer: Aetna Commercial |
$896.43
|
| Rate for Payer: ASR ASR |
$966.15
|
| Rate for Payer: ASR Commercial |
$966.15
|
| Rate for Payer: BCBS Trust/PPO |
$811.66
|
| Rate for Payer: BCN Commercial |
$772.22
|
| Rate for Payer: Cash Price |
$796.83
|
| Rate for Payer: Cofinity Commercial |
$936.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$796.82
|
| Rate for Payer: Healthscope Commercial |
$996.03
|
| Rate for Payer: Healthscope Whirlpool |
$966.15
|
| Rate for Payer: Mclaren Commercial |
$896.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$846.63
|
| Rate for Payer: Nomi Health Commercial |
$816.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$647.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$876.51
|
|
|
MICROFIBRILLAR COLLAGEN HEMOSTAT TOPICAL POWDER IN PACKET
|
Facility
|
OP
|
$496.76
|
|
|
Service Code
|
NDC 53276101001
|
| Hospital Charge Code |
159416
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$198.70 |
| Max. Negotiated Rate |
$496.76 |
| Rate for Payer: Aetna Commercial |
$447.08
|
| Rate for Payer: Aetna Medicare |
$248.38
|
| Rate for Payer: ASR ASR |
$481.86
|
| Rate for Payer: ASR Commercial |
$481.86
|
| Rate for Payer: BCBS Complete |
$198.70
|
| Rate for Payer: BCBS Trust/PPO |
$406.80
|
| Rate for Payer: BCN Commercial |
$385.14
|
| Rate for Payer: Cash Price |
$397.40
|
| Rate for Payer: Cofinity Commercial |
$466.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.41
|
| Rate for Payer: Healthscope Commercial |
$496.76
|
| Rate for Payer: Healthscope Whirlpool |
$481.86
|
| Rate for Payer: Mclaren Commercial |
$447.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$422.25
|
| Rate for Payer: Nomi Health Commercial |
$407.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.26
|
| Rate for Payer: Priority Health Narrow Network |
$348.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$437.15
|
|
|
MICROFIBRILLAR COLLAGEN HEMOSTAT TOPICAL POWDER IN PACKET
|
Facility
|
IP
|
$496.76
|
|
|
Service Code
|
NDC 53276101001
|
| Hospital Charge Code |
159416
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$322.89 |
| Max. Negotiated Rate |
$496.76 |
| Rate for Payer: Aetna Commercial |
$447.08
|
| Rate for Payer: ASR ASR |
$481.86
|
| Rate for Payer: ASR Commercial |
$481.86
|
| Rate for Payer: BCBS Trust/PPO |
$404.81
|
| Rate for Payer: BCN Commercial |
$385.14
|
| Rate for Payer: Cash Price |
$397.40
|
| Rate for Payer: Cofinity Commercial |
$466.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$397.41
|
| Rate for Payer: Healthscope Commercial |
$496.76
|
| Rate for Payer: Healthscope Whirlpool |
$481.86
|
| Rate for Payer: Mclaren Commercial |
$447.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$422.25
|
| Rate for Payer: Nomi Health Commercial |
$407.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$322.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$437.15
|
|
|
MICRO NEEDLING
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 00171
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$81.60
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
IP
|
$40.15
|
|
|
Service Code
|
NDC 68094076462
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$40.15 |
| Rate for Payer: Aetna Commercial |
$36.14
|
| Rate for Payer: ASR ASR |
$38.95
|
| Rate for Payer: ASR Commercial |
$38.95
|
| Rate for Payer: BCBS Trust/PPO |
$32.72
|
| Rate for Payer: BCN Commercial |
$31.13
|
| Rate for Payer: Cash Price |
$32.12
|
| Rate for Payer: Cofinity Commercial |
$37.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.12
|
| Rate for Payer: Healthscope Commercial |
$40.15
|
| Rate for Payer: Healthscope Whirlpool |
$38.95
|
| Rate for Payer: Mclaren Commercial |
$36.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.13
|
| Rate for Payer: Nomi Health Commercial |
$32.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.33
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
OP
|
$40.15
|
|
|
Service Code
|
NDC 68094076462
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$40.15 |
| Rate for Payer: Aetna Commercial |
$36.14
|
| Rate for Payer: Aetna Medicare |
$20.08
|
| Rate for Payer: ASR ASR |
$38.95
|
| Rate for Payer: ASR Commercial |
$38.95
|
| Rate for Payer: BCBS Complete |
$16.06
|
| Rate for Payer: BCBS Trust/PPO |
$32.88
|
| Rate for Payer: BCN Commercial |
$31.13
|
| Rate for Payer: Cash Price |
$32.12
|
| Rate for Payer: Cofinity Commercial |
$37.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.12
|
| Rate for Payer: Healthscope Commercial |
$40.15
|
| Rate for Payer: Healthscope Whirlpool |
$38.95
|
| Rate for Payer: Mclaren Commercial |
$36.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.13
|
| Rate for Payer: Nomi Health Commercial |
$32.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.18
|
| Rate for Payer: Priority Health Narrow Network |
$28.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.33
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
IP
|
$40.15
|
|
|
Service Code
|
NDC 68094076459
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$40.15 |
| Rate for Payer: Aetna Commercial |
$36.14
|
| Rate for Payer: ASR ASR |
$38.95
|
| Rate for Payer: ASR Commercial |
$38.95
|
| Rate for Payer: BCBS Trust/PPO |
$32.72
|
| Rate for Payer: BCN Commercial |
$31.13
|
| Rate for Payer: Cash Price |
$32.12
|
| Rate for Payer: Cofinity Commercial |
$37.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.12
|
| Rate for Payer: Healthscope Commercial |
$40.15
|
| Rate for Payer: Healthscope Whirlpool |
$38.95
|
| Rate for Payer: Mclaren Commercial |
$36.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.13
|
| Rate for Payer: Nomi Health Commercial |
$32.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.33
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
OP
|
$40.15
|
|
|
Service Code
|
NDC 68094076459
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$40.15 |
| Rate for Payer: Aetna Commercial |
$36.14
|
| Rate for Payer: Aetna Medicare |
$20.08
|
| Rate for Payer: ASR ASR |
$38.95
|
| Rate for Payer: ASR Commercial |
$38.95
|
| Rate for Payer: BCBS Complete |
$16.06
|
| Rate for Payer: BCBS Trust/PPO |
$32.88
|
| Rate for Payer: BCN Commercial |
$31.13
|
| Rate for Payer: Cash Price |
$32.12
|
| Rate for Payer: Cofinity Commercial |
$37.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.12
|
| Rate for Payer: Healthscope Commercial |
$40.15
|
| Rate for Payer: Healthscope Whirlpool |
$38.95
|
| Rate for Payer: Mclaren Commercial |
$36.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.13
|
| Rate for Payer: Nomi Health Commercial |
$32.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.18
|
| Rate for Payer: Priority Health Narrow Network |
$28.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.33
|
|
|
MIDAZOLAM 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$15.23
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$15.23 |
| Rate for Payer: Aetna Commercial |
$13.71
|
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna Commercial |
$16.08
|
| Rate for Payer: Aetna Commercial |
$12.54
|
| Rate for Payer: ASR ASR |
$23.14
|
| Rate for Payer: ASR ASR |
$21.53
|
| Rate for Payer: ASR ASR |
$17.33
|
| Rate for Payer: ASR ASR |
$14.77
|
| Rate for Payer: ASR ASR |
$13.51
|
| Rate for Payer: ASR Commercial |
$17.33
|
| Rate for Payer: ASR Commercial |
$23.14
|
| Rate for Payer: ASR Commercial |
$21.53
|
| Rate for Payer: ASR Commercial |
$14.77
|
| Rate for Payer: ASR Commercial |
$13.51
|
| Rate for Payer: BCBS Trust/PPO |
$19.44
|
| Rate for Payer: BCBS Trust/PPO |
$11.35
|
| Rate for Payer: BCBS Trust/PPO |
$12.41
|
| Rate for Payer: BCBS Trust/PPO |
$18.09
|
| Rate for Payer: BCBS Trust/PPO |
$14.56
|
| Rate for Payer: BCN Commercial |
$11.81
|
| Rate for Payer: BCN Commercial |
$18.50
|
| Rate for Payer: BCN Commercial |
$10.80
|
| Rate for Payer: BCN Commercial |
$13.85
|
| Rate for Payer: BCN Commercial |
$17.21
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$19.09
|
| Rate for Payer: Cash Price |
$11.15
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$13.09
|
| Rate for Payer: Cofinity Commercial |
$20.87
|
| Rate for Payer: Cofinity Commercial |
$22.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.18
|
| Rate for Payer: Healthscope Commercial |
$17.87
|
| Rate for Payer: Healthscope Commercial |
$22.20
|
| Rate for Payer: Healthscope Commercial |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$13.93
|
| Rate for Payer: Healthscope Commercial |
$23.86
|
| Rate for Payer: Healthscope Whirlpool |
$23.14
|
| Rate for Payer: Healthscope Whirlpool |
$13.51
|
| Rate for Payer: Healthscope Whirlpool |
$17.33
|
| Rate for Payer: Healthscope Whirlpool |
$14.77
|
| Rate for Payer: Healthscope Whirlpool |
$21.53
|
| Rate for Payer: Mclaren Commercial |
$13.71
|
| Rate for Payer: Mclaren Commercial |
$16.08
|
| Rate for Payer: Mclaren Commercial |
$12.54
|
| Rate for Payer: Mclaren Commercial |
$19.98
|
| Rate for Payer: Mclaren Commercial |
$21.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.19
|
| Rate for Payer: Nomi Health Commercial |
$14.65
|
| Rate for Payer: Nomi Health Commercial |
$11.42
|
| Rate for Payer: Nomi Health Commercial |
$12.49
|
| Rate for Payer: Nomi Health Commercial |
$19.57
|
| Rate for Payer: Nomi Health Commercial |
$18.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.54
|
|
|
MIDAZOLAM 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$15.23
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$15.23 |
| Rate for Payer: Aetna Commercial |
$13.71
|
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Commercial |
$12.54
|
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna Commercial |
$16.08
|
| Rate for Payer: Aetna Medicare |
$8.94
|
| Rate for Payer: Aetna Medicare |
$6.96
|
| Rate for Payer: Aetna Medicare |
$7.62
|
| Rate for Payer: Aetna Medicare |
$11.10
|
| Rate for Payer: Aetna Medicare |
$11.93
|
| Rate for Payer: ASR ASR |
$13.51
|
| Rate for Payer: ASR ASR |
$21.53
|
| Rate for Payer: ASR ASR |
$14.77
|
| Rate for Payer: ASR ASR |
$17.33
|
| Rate for Payer: ASR ASR |
$23.14
|
| Rate for Payer: ASR Commercial |
$13.51
|
| Rate for Payer: ASR Commercial |
$14.77
|
| Rate for Payer: ASR Commercial |
$23.14
|
| Rate for Payer: ASR Commercial |
$21.53
|
| Rate for Payer: ASR Commercial |
$17.33
|
| Rate for Payer: BCBS Complete |
$9.54
|
| Rate for Payer: BCBS Complete |
$5.57
|
| Rate for Payer: BCBS Complete |
$6.09
|
| Rate for Payer: BCBS Complete |
$7.15
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: BCBS Trust/PPO |
$18.18
|
| Rate for Payer: BCBS Trust/PPO |
$14.63
|
| Rate for Payer: BCBS Trust/PPO |
$11.41
|
| Rate for Payer: BCBS Trust/PPO |
$12.47
|
| Rate for Payer: BCBS Trust/PPO |
$19.54
|
| Rate for Payer: BCN Commercial |
$17.21
|
| Rate for Payer: BCN Commercial |
$10.80
|
| Rate for Payer: BCN Commercial |
$11.81
|
| Rate for Payer: BCN Commercial |
$13.85
|
| Rate for Payer: BCN Commercial |
$18.50
|
| Rate for Payer: Cash Price |
$19.09
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$11.15
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$11.15
|
| Rate for Payer: Cash Price |
$19.09
|
| Rate for Payer: Cash Price |
$12.18
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$20.87
|
| Rate for Payer: Cofinity Commercial |
$22.43
|
| Rate for Payer: Cofinity Commercial |
$13.09
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.30
|
| Rate for Payer: Healthscope Commercial |
$22.20
|
| Rate for Payer: Healthscope Commercial |
$17.87
|
| Rate for Payer: Healthscope Commercial |
$15.23
|
| Rate for Payer: Healthscope Commercial |
$23.86
|
| Rate for Payer: Healthscope Commercial |
$13.93
|
| Rate for Payer: Healthscope Whirlpool |
$23.14
|
| Rate for Payer: Healthscope Whirlpool |
$14.77
|
| Rate for Payer: Healthscope Whirlpool |
$13.51
|
| Rate for Payer: Healthscope Whirlpool |
$21.53
|
| Rate for Payer: Healthscope Whirlpool |
$17.33
|
| Rate for Payer: Mclaren Commercial |
$19.98
|
| Rate for Payer: Mclaren Commercial |
$12.54
|
| Rate for Payer: Mclaren Commercial |
$13.71
|
| Rate for Payer: Mclaren Commercial |
$16.08
|
| Rate for Payer: Mclaren Commercial |
$21.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.19
|
| Rate for Payer: Nomi Health Commercial |
$11.42
|
| Rate for Payer: Nomi Health Commercial |
$12.49
|
| Rate for Payer: Nomi Health Commercial |
$19.57
|
| Rate for Payer: Nomi Health Commercial |
$18.20
|
| Rate for Payer: Nomi Health Commercial |
$14.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.13
|
| Rate for Payer: Priority Health Narrow Network |
$0.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.73
|
|
|
MIDAZOLAM 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$22.29
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$22.29 |
| Rate for Payer: Aetna Commercial |
$20.06
|
| Rate for Payer: Aetna Commercial |
$18.55
|
| Rate for Payer: Aetna Medicare |
$10.30
|
| Rate for Payer: Aetna Medicare |
$11.14
|
| Rate for Payer: ASR ASR |
$21.62
|
| Rate for Payer: ASR ASR |
$19.99
|
| Rate for Payer: ASR Commercial |
$19.99
|
| Rate for Payer: ASR Commercial |
$21.62
|
| Rate for Payer: BCBS Complete |
$8.92
|
| Rate for Payer: BCBS Complete |
$8.24
|
| Rate for Payer: BCBS Trust/PPO |
$18.25
|
| Rate for Payer: BCBS Trust/PPO |
$16.88
|
| Rate for Payer: BCN Commercial |
$15.98
|
| Rate for Payer: BCN Commercial |
$17.28
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cash Price |
$17.83
|
| Rate for Payer: Cash Price |
$17.83
|
| Rate for Payer: Cofinity Commercial |
$19.37
|
| Rate for Payer: Cofinity Commercial |
$20.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.49
|
| Rate for Payer: Healthscope Commercial |
$22.29
|
| Rate for Payer: Healthscope Commercial |
$20.61
|
| Rate for Payer: Healthscope Whirlpool |
$21.62
|
| Rate for Payer: Healthscope Whirlpool |
$19.99
|
| Rate for Payer: Mclaren Commercial |
$18.55
|
| Rate for Payer: Mclaren Commercial |
$20.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.52
|
| Rate for Payer: Nomi Health Commercial |
$18.28
|
| Rate for Payer: Nomi Health Commercial |
$16.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.13
|
| Rate for Payer: Priority Health Narrow Network |
$0.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.62
|
|
|
MIDAZOLAM 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$22.29
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.49 |
| Max. Negotiated Rate |
$22.29 |
| Rate for Payer: Aetna Commercial |
$20.06
|
| Rate for Payer: Aetna Commercial |
$18.55
|
| Rate for Payer: ASR ASR |
$21.62
|
| Rate for Payer: ASR ASR |
$19.99
|
| Rate for Payer: ASR Commercial |
$19.99
|
| Rate for Payer: ASR Commercial |
$21.62
|
| Rate for Payer: BCBS Trust/PPO |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$18.16
|
| Rate for Payer: BCN Commercial |
$17.28
|
| Rate for Payer: BCN Commercial |
$15.98
|
| Rate for Payer: Cash Price |
$17.83
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$19.37
|
| Rate for Payer: Cofinity Commercial |
$20.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.83
|
| Rate for Payer: Healthscope Commercial |
$20.61
|
| Rate for Payer: Healthscope Commercial |
$22.29
|
| Rate for Payer: Healthscope Whirlpool |
$19.99
|
| Rate for Payer: Healthscope Whirlpool |
$21.62
|
| Rate for Payer: Mclaren Commercial |
$18.55
|
| Rate for Payer: Mclaren Commercial |
$20.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.95
|
| Rate for Payer: Nomi Health Commercial |
$16.90
|
| Rate for Payer: Nomi Health Commercial |
$18.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.62
|
|
|
MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$14.62
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
168786
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.16
|
| Rate for Payer: Aetna Commercial |
$12.56
|
| Rate for Payer: ASR ASR |
$14.18
|
| Rate for Payer: ASR ASR |
$13.53
|
| Rate for Payer: ASR Commercial |
$13.53
|
| Rate for Payer: ASR Commercial |
$14.18
|
| Rate for Payer: BCBS Trust/PPO |
$11.37
|
| Rate for Payer: BCBS Trust/PPO |
$11.91
|
| Rate for Payer: BCN Commercial |
$11.33
|
| Rate for Payer: BCN Commercial |
$10.82
|
| Rate for Payer: Cash Price |
$11.69
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cofinity Commercial |
$13.11
|
| Rate for Payer: Cofinity Commercial |
$13.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.70
|
| Rate for Payer: Healthscope Commercial |
$13.95
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Healthscope Whirlpool |
$13.53
|
| Rate for Payer: Healthscope Whirlpool |
$14.18
|
| Rate for Payer: Mclaren Commercial |
$12.56
|
| Rate for Payer: Mclaren Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.43
|
| Rate for Payer: Nomi Health Commercial |
$11.44
|
| Rate for Payer: Nomi Health Commercial |
$11.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.87
|
|
|
MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$14.62
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
168786
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.16
|
| Rate for Payer: Aetna Commercial |
$12.56
|
| Rate for Payer: Aetna Medicare |
$6.98
|
| Rate for Payer: Aetna Medicare |
$7.31
|
| Rate for Payer: ASR ASR |
$14.18
|
| Rate for Payer: ASR ASR |
$13.53
|
| Rate for Payer: ASR Commercial |
$13.53
|
| Rate for Payer: ASR Commercial |
$14.18
|
| Rate for Payer: BCBS Complete |
$5.85
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS Trust/PPO |
$11.97
|
| Rate for Payer: BCBS Trust/PPO |
$11.42
|
| Rate for Payer: BCN Commercial |
$10.82
|
| Rate for Payer: BCN Commercial |
$11.33
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$11.69
|
| Rate for Payer: Cash Price |
$11.69
|
| Rate for Payer: Cofinity Commercial |
$13.11
|
| 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 |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Healthscope Commercial |
$13.95
|
| Rate for Payer: Healthscope Whirlpool |
$14.18
|
| Rate for Payer: Healthscope Whirlpool |
$13.53
|
| Rate for Payer: Mclaren Commercial |
$12.56
|
| Rate for Payer: Mclaren Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Nomi Health Commercial |
$11.99
|
| Rate for Payer: Nomi Health Commercial |
$11.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.13
|
| Rate for Payer: Priority Health Narrow Network |
$0.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.87
|
|
|
MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$15.48
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
168785
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$15.48 |
| Rate for Payer: Aetna Commercial |
$13.93
|
| Rate for Payer: Aetna Medicare |
$7.74
|
| Rate for Payer: ASR ASR |
$15.02
|
| Rate for Payer: ASR Commercial |
$15.02
|
| Rate for Payer: BCBS Complete |
$6.19
|
| Rate for Payer: BCBS Trust/PPO |
$12.68
|
| Rate for Payer: BCN Commercial |
$12.00
|
| Rate for Payer: Cash Price |
$12.39
|
| 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 Commercial |
$13.16
|
| Rate for Payer: Nomi Health Commercial |
$12.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.13
|
| Rate for Payer: Priority Health Narrow Network |
$0.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.62
|
|
|
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 |
$10.06 |
| Max. Negotiated Rate |
$15.48 |
| Rate for Payer: Aetna Commercial |
$13.93
|
| Rate for Payer: ASR ASR |
$15.02
|
| Rate for Payer: ASR Commercial |
$15.02
|
| Rate for Payer: BCBS Trust/PPO |
$12.61
|
| 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 Commercial |
$13.16
|
| Rate for Payer: Nomi Health Commercial |
$12.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.62
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$3.39
|
|
|
Service Code
|
NDC 51079045301
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Aetna Commercial |
$3.05
|
| Rate for Payer: Aetna Medicare |
$1.70
|
| Rate for Payer: ASR ASR |
$3.29
|
| Rate for Payer: ASR Commercial |
$3.29
|
| Rate for Payer: BCBS Complete |
$1.36
|
| Rate for Payer: BCBS Trust/PPO |
$2.78
|
| Rate for Payer: BCN Commercial |
$2.63
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cofinity Commercial |
$3.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.71
|
| Rate for Payer: Healthscope Commercial |
$3.39
|
| Rate for Payer: Healthscope Whirlpool |
$3.29
|
| Rate for Payer: Mclaren Commercial |
$3.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.88
|
| Rate for Payer: Nomi Health Commercial |
$2.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.97
|
| Rate for Payer: Priority Health Narrow Network |
$2.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.98
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$236.07
|
|
|
Service Code
|
NDC 50268056215
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.43 |
| Max. Negotiated Rate |
$236.07 |
| Rate for Payer: Aetna Commercial |
$212.46
|
| Rate for Payer: Aetna Medicare |
$118.04
|
| Rate for Payer: ASR ASR |
$228.99
|
| Rate for Payer: ASR Commercial |
$228.99
|
| Rate for Payer: BCBS Complete |
$94.43
|
| Rate for Payer: BCBS Trust/PPO |
$193.32
|
| Rate for Payer: BCN Commercial |
$183.03
|
| Rate for Payer: Cash Price |
$188.86
|
| Rate for Payer: Cofinity Commercial |
$221.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.86
|
| Rate for Payer: Healthscope Commercial |
$236.07
|
| Rate for Payer: Healthscope Whirlpool |
$228.99
|
| Rate for Payer: Mclaren Commercial |
$212.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.66
|
| Rate for Payer: Nomi Health Commercial |
$193.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.84
|
| Rate for Payer: Priority Health Narrow Network |
$165.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.74
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$337.25
|
|
|
Service Code
|
NDC 00245021201
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.21 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Aetna Commercial |
$303.52
|
| Rate for Payer: ASR ASR |
$327.13
|
| Rate for Payer: ASR Commercial |
$327.13
|
| Rate for Payer: BCBS Trust/PPO |
$274.83
|
| Rate for Payer: BCN Commercial |
$261.47
|
| Rate for Payer: Cash Price |
$269.80
|
| Rate for Payer: Cofinity Commercial |
$317.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$269.80
|
| Rate for Payer: Healthscope Commercial |
$337.25
|
| Rate for Payer: Healthscope Whirlpool |
$327.13
|
| Rate for Payer: Mclaren Commercial |
$303.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$286.66
|
| Rate for Payer: Nomi Health Commercial |
$276.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.78
|
|
