|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$15.53
|
|
|
Service Code
|
NDC 51672200102
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.21 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: Aetna Commercial |
$13.98
|
| Rate for Payer: Aetna Medicare |
$7.76
|
| Rate for Payer: ASR ASR |
$15.06
|
| Rate for Payer: ASR Commercial |
$15.06
|
| Rate for Payer: BCBS Complete |
$6.21
|
| Rate for Payer: BCBS Trust/PPO |
$12.72
|
| Rate for Payer: BCN Commercial |
$12.04
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cofinity Commercial |
$14.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.42
|
| Rate for Payer: Healthscope Commercial |
$15.53
|
| Rate for Payer: Healthscope Whirlpool |
$15.06
|
| Rate for Payer: Mclaren Commercial |
$13.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.20
|
| Rate for Payer: Nomi Health Commercial |
$12.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.61
|
| Rate for Payer: Priority Health Narrow Network |
$10.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.67
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$15.53
|
|
|
Service Code
|
NDC 51672200102
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.09 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: Aetna Commercial |
$13.98
|
| Rate for Payer: ASR ASR |
$15.06
|
| Rate for Payer: ASR Commercial |
$15.06
|
| Rate for Payer: BCBS Trust/PPO |
$12.66
|
| Rate for Payer: BCN Commercial |
$12.04
|
| Rate for Payer: Cash Price |
$12.42
|
| Rate for Payer: Cofinity Commercial |
$14.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.42
|
| Rate for Payer: Healthscope Commercial |
$15.53
|
| Rate for Payer: Healthscope Whirlpool |
$15.06
|
| Rate for Payer: Mclaren Commercial |
$13.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.20
|
| Rate for Payer: Nomi Health Commercial |
$12.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.67
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$9.20
|
|
|
Service Code
|
NDC 61269073556
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$8.28
|
| Rate for Payer: ASR ASR |
$8.92
|
| Rate for Payer: ASR Commercial |
$8.92
|
| Rate for Payer: BCBS Trust/PPO |
$7.50
|
| Rate for Payer: BCN Commercial |
$7.13
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$8.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.36
|
| Rate for Payer: Healthscope Commercial |
$9.20
|
| Rate for Payer: Healthscope Whirlpool |
$8.92
|
| Rate for Payer: Mclaren Commercial |
$8.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.82
|
| Rate for Payer: Nomi Health Commercial |
$7.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.10
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$9.20
|
|
|
Service Code
|
NDC 61269073556
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$8.28
|
| Rate for Payer: Aetna Medicare |
$4.60
|
| Rate for Payer: ASR ASR |
$8.92
|
| Rate for Payer: ASR Commercial |
$8.92
|
| Rate for Payer: BCBS Complete |
$3.68
|
| Rate for Payer: BCBS Trust/PPO |
$7.53
|
| Rate for Payer: BCN Commercial |
$7.13
|
| Rate for Payer: Cash Price |
$7.36
|
| Rate for Payer: Cofinity Commercial |
$8.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.36
|
| Rate for Payer: Healthscope Commercial |
$9.20
|
| Rate for Payer: Healthscope Whirlpool |
$8.92
|
| Rate for Payer: Mclaren Commercial |
$8.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.82
|
| Rate for Payer: Nomi Health Commercial |
$7.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.06
|
| Rate for Payer: Priority Health Narrow Network |
$6.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.10
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
OP
|
$11.03
|
|
|
Service Code
|
NDC 11701004523
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$11.03 |
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: Aetna Medicare |
$5.51
|
| Rate for Payer: ASR ASR |
$10.70
|
| Rate for Payer: ASR Commercial |
$10.70
|
| Rate for Payer: BCBS Complete |
$4.41
|
| Rate for Payer: BCBS Trust/PPO |
$9.03
|
| Rate for Payer: BCN Commercial |
$8.55
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cofinity Commercial |
$10.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.82
|
| Rate for Payer: Healthscope Commercial |
$11.03
|
| Rate for Payer: Healthscope Whirlpool |
$10.70
|
| Rate for Payer: Mclaren Commercial |
$9.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.38
|
| Rate for Payer: Nomi Health Commercial |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.66
|
| Rate for Payer: Priority Health Narrow Network |
$7.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.71
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL CREAM
|
Facility
|
IP
|
$11.03
|
|
|
Service Code
|
NDC 11701004523
|
| Hospital Charge Code |
5039
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$11.03 |
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: ASR ASR |
$10.70
|
| Rate for Payer: ASR Commercial |
$10.70
|
| Rate for Payer: BCBS Trust/PPO |
$8.99
|
| Rate for Payer: BCN Commercial |
$8.55
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cofinity Commercial |
$10.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.82
|
| Rate for Payer: Healthscope Commercial |
$11.03
|
| Rate for Payer: Healthscope Whirlpool |
$10.70
|
| Rate for Payer: Mclaren Commercial |
$9.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.38
|
| Rate for Payer: Nomi Health Commercial |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.71
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
OP
|
$23.91
|
|
|
Service Code
|
NDC 43553000302
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$23.91 |
| Rate for Payer: Aetna Commercial |
$21.52
|
| Rate for Payer: Aetna Medicare |
$11.96
|
| Rate for Payer: ASR ASR |
$23.19
|
| Rate for Payer: ASR Commercial |
$23.19
|
| Rate for Payer: BCBS Complete |
$9.56
|
| Rate for Payer: BCBS Trust/PPO |
$19.58
|
| Rate for Payer: BCN Commercial |
$18.54
|
| Rate for Payer: Cash Price |
$19.13
|
| Rate for Payer: Cofinity Commercial |
$22.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.13
|
| Rate for Payer: Healthscope Commercial |
$23.91
|
| Rate for Payer: Healthscope Whirlpool |
$23.19
|
| Rate for Payer: Mclaren Commercial |
$21.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.32
|
| Rate for Payer: Nomi Health Commercial |
$19.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.95
|
| Rate for Payer: Priority Health Narrow Network |
$16.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.04
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL OINTMENT
|
Facility
|
IP
|
$23.91
|
|
|
Service Code
|
NDC 43553000302
|
| Hospital Charge Code |
13651
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.54 |
| Max. Negotiated Rate |
$23.91 |
| Rate for Payer: Aetna Commercial |
$21.52
|
| Rate for Payer: ASR ASR |
$23.19
|
| Rate for Payer: ASR Commercial |
$23.19
|
| Rate for Payer: BCBS Trust/PPO |
$19.48
|
| Rate for Payer: BCN Commercial |
$18.54
|
| Rate for Payer: Cash Price |
$19.13
|
| Rate for Payer: Cofinity Commercial |
$22.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.13
|
| Rate for Payer: Healthscope Commercial |
$23.91
|
| Rate for Payer: Healthscope Whirlpool |
$23.19
|
| Rate for Payer: Mclaren Commercial |
$21.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.32
|
| Rate for Payer: Nomi Health Commercial |
$19.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.04
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
IP
|
$22.18
|
|
|
Service Code
|
NDC 80196052856
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: Aetna Commercial |
$19.96
|
| Rate for Payer: ASR ASR |
$21.51
|
| Rate for Payer: ASR Commercial |
$21.51
|
| Rate for Payer: BCBS Trust/PPO |
$18.07
|
| 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 Commercial |
$18.85
|
| Rate for Payer: Nomi Health Commercial |
$18.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.52
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
OP
|
$22.18
|
|
|
Service Code
|
NDC 80196052856
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: Aetna Commercial |
$19.96
|
| Rate for Payer: Aetna Medicare |
$11.09
|
| Rate for Payer: ASR ASR |
$21.51
|
| Rate for Payer: ASR Commercial |
$21.51
|
| Rate for Payer: BCBS Complete |
$8.87
|
| Rate for Payer: BCBS Trust/PPO |
$18.16
|
| 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 Commercial |
$18.85
|
| Rate for Payer: Nomi Health Commercial |
$18.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.43
|
| Rate for Payer: Priority Health Narrow Network |
$15.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.52
|
|
|
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 |
$11.13
|
| 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 |
$11.13
|
| 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
|
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
|
|
|
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
|
|
|
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
|
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 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 |
$498.01
|
| 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 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
|
|
|
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
|
|
|
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 68094076459
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$40.15 |
| Rate for Payer: Aetna Commercial |
$36.13
|
| 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 |
$36.13
|
| 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 |
$36.13
|
| Rate for Payer: Aetna Medicare |
$20.07
|
| 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 |
$36.13
|
| 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
|
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 |
$36.13
|
| Rate for Payer: Aetna Medicare |
$20.07
|
| 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 |
$36.13
|
| 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 68094076462
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.10 |
| Max. Negotiated Rate |
$40.15 |
| Rate for Payer: Aetna Commercial |
$36.13
|
| 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 |
$36.13
|
| 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 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
|
|
