|
MIDAZOLAM 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$13.93
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$13.93 |
| Rate for Payer: Aetna Commercial |
$12.54
|
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Commercial |
$21.47
|
| Rate for Payer: Aetna Commercial |
$13.71
|
| Rate for Payer: Aetna Commercial |
$16.08
|
| Rate for Payer: Aetna Medicare |
$7.62
|
| Rate for Payer: Aetna Medicare |
$8.94
|
| Rate for Payer: Aetna Medicare |
$6.96
|
| Rate for Payer: Aetna Medicare |
$11.93
|
| Rate for Payer: Aetna Medicare |
$11.10
|
| Rate for Payer: ASR ASR |
$23.14
|
| Rate for Payer: ASR ASR |
$17.33
|
| 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 Commercial |
$23.14
|
| Rate for Payer: ASR Commercial |
$14.77
|
| Rate for Payer: ASR Commercial |
$17.33
|
| Rate for Payer: ASR Commercial |
$21.53
|
| Rate for Payer: ASR Commercial |
$13.51
|
| Rate for Payer: BCBS Complete |
$9.54
|
| 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 Complete |
$5.57
|
| Rate for Payer: BCBS Trust/PPO |
$18.18
|
| Rate for Payer: BCBS Trust/PPO |
$11.41
|
| Rate for Payer: BCBS Trust/PPO |
$12.47
|
| Rate for Payer: BCBS Trust/PPO |
$14.63
|
| Rate for Payer: BCBS Trust/PPO |
$19.54
|
| Rate for Payer: BCN Commercial |
$18.50
|
| Rate for Payer: BCN Commercial |
$17.21
|
| Rate for Payer: BCN Commercial |
$11.81
|
| Rate for Payer: BCN Commercial |
$10.80
|
| Rate for Payer: BCN Commercial |
$13.85
|
| 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 |
$14.30
|
| Rate for Payer: Cash Price |
$11.15
|
| Rate for Payer: Cofinity Commercial |
$22.43
|
| Rate for Payer: Cofinity Commercial |
$20.87
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$14.32
|
| Rate for Payer: Cofinity Commercial |
$13.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.76
|
| Rate for Payer: Healthscope Commercial |
$17.87
|
| Rate for Payer: Healthscope Commercial |
$22.20
|
| Rate for Payer: Healthscope Commercial |
$23.86
|
| Rate for Payer: Healthscope Commercial |
$13.93
|
| Rate for Payer: Healthscope Commercial |
$15.23
|
| Rate for Payer: Healthscope Whirlpool |
$21.53
|
| Rate for Payer: Healthscope Whirlpool |
$17.33
|
| Rate for Payer: Healthscope Whirlpool |
$14.77
|
| Rate for Payer: Healthscope Whirlpool |
$13.51
|
| Rate for Payer: Healthscope Whirlpool |
$23.14
|
| Rate for Payer: Mclaren Commercial |
$21.47
|
| Rate for Payer: Mclaren Commercial |
$16.08
|
| Rate for Payer: Mclaren Commercial |
$13.71
|
| Rate for Payer: Mclaren Commercial |
$19.98
|
| Rate for Payer: Mclaren Commercial |
$12.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.19
|
| 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 |
$20.28
|
| Rate for Payer: Nomi Health Commercial |
$18.20
|
| 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: Priority Health Cigna Priority Health |
$11.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.91
|
| Rate for Payer: Priority Health Narrow Network |
$16.73
|
| Rate for Payer: Priority Health Narrow Network |
$15.56
|
| Rate for Payer: Priority Health Narrow Network |
$10.68
|
| Rate for Payer: Priority Health Narrow Network |
$9.76
|
| Rate for Payer: Priority Health Narrow Network |
$12.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.00
|
| 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 |
$12.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.73
|
|
|
MIDAZOLAM 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$20.61
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$20.61 |
| Rate for Payer: Aetna Commercial |
$18.55
|
| Rate for Payer: Aetna Commercial |
$20.06
|
| Rate for Payer: Aetna Medicare |
$10.30
|
| Rate for Payer: Aetna Medicare |
$11.14
|
| Rate for Payer: ASR ASR |
$19.99
|
| Rate for Payer: ASR ASR |
$21.62
|
| Rate for Payer: ASR Commercial |
$21.62
|
| Rate for Payer: ASR Commercial |
$19.99
|
| Rate for Payer: BCBS Complete |
$8.24
|
| Rate for Payer: BCBS Complete |
$8.92
|
| Rate for Payer: BCBS Trust/PPO |
$16.88
|
| Rate for Payer: BCBS Trust/PPO |
$18.25
|
| Rate for Payer: BCN Commercial |
$17.28
|
| Rate for Payer: BCN Commercial |
$15.98
|
| Rate for Payer: Cash Price |
$16.49
|
| 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 |
$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 |
$18.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.52
|
| 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: Priority Health HMO/PPO/Tiered Network |
$18.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.53
|
| Rate for Payer: Priority Health Narrow Network |
$15.63
|
| Rate for Payer: Priority Health Narrow Network |
$14.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.14
|
|
|
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 |
$19.99
|
| Rate for Payer: ASR ASR |
$21.62
|
| 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 |
$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 |
$13.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.49
|
| 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 |
$12.55
|
| Rate for Payer: ASR ASR |
$13.53
|
| Rate for Payer: ASR ASR |
$14.18
|
| 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 |
$14.18
|
| Rate for Payer: Healthscope Whirlpool |
$13.53
|
| Rate for Payer: Mclaren Commercial |
$12.55
|
| 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 |
$9.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.50
|
| 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
|
$13.95
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
168786
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$13.95 |
| Rate for Payer: Aetna Commercial |
$12.55
|
| Rate for Payer: Aetna Commercial |
$13.16
|
| Rate for Payer: Aetna Medicare |
$6.97
|
| Rate for Payer: Aetna Medicare |
$7.31
|
| Rate for Payer: ASR ASR |
$13.53
|
| Rate for Payer: ASR ASR |
$14.18
|
| Rate for Payer: ASR Commercial |
$14.18
|
| Rate for Payer: ASR Commercial |
$13.53
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS Complete |
$5.85
|
| Rate for Payer: BCBS Trust/PPO |
$11.42
|
| Rate for Payer: BCBS Trust/PPO |
$11.97
|
| Rate for Payer: BCN Commercial |
$11.33
|
| Rate for Payer: BCN Commercial |
$10.82
|
| Rate for Payer: Cash Price |
$11.16
|
| 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 |
$11.16
|
| 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 |
$12.55
|
| 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 |
$11.44
|
| 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: Priority Health HMO/PPO/Tiered Network |
$12.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.81
|
| Rate for Payer: Priority Health Narrow Network |
$10.25
|
| Rate for Payer: Priority Health Narrow Network |
$9.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.28
|
|
|
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 |
$6.19 |
| 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: 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 |
$13.56
|
| Rate for Payer: Priority Health Narrow Network |
$10.85
|
| 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
|
$3.37
|
|
|
Service Code
|
NDC 00245021289
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: Aetna Medicare |
$1.69
|
| Rate for Payer: ASR ASR |
$3.27
|
| Rate for Payer: ASR Commercial |
$3.27
|
| Rate for Payer: BCBS Complete |
$1.35
|
| Rate for Payer: BCBS Trust/PPO |
$2.76
|
| Rate for Payer: BCN Commercial |
$2.61
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.37
|
| Rate for Payer: Healthscope Whirlpool |
$3.27
|
| Rate for Payer: Mclaren Commercial |
$3.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Nomi Health Commercial |
$2.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.95
|
| Rate for Payer: Priority Health Narrow Network |
$2.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.97
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$338.88
|
|
|
Service Code
|
NDC 51079045320
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$338.88 |
| Rate for Payer: Aetna Commercial |
$304.99
|
| Rate for Payer: Aetna Medicare |
$169.44
|
| Rate for Payer: ASR ASR |
$328.71
|
| Rate for Payer: ASR Commercial |
$328.71
|
| Rate for Payer: BCBS Complete |
$135.55
|
| Rate for Payer: BCBS Trust/PPO |
$277.51
|
| Rate for Payer: BCN Commercial |
$262.73
|
| Rate for Payer: Cash Price |
$271.10
|
| Rate for Payer: Cofinity Commercial |
$318.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.10
|
| Rate for Payer: Healthscope Commercial |
$338.88
|
| Rate for Payer: Healthscope Whirlpool |
$328.71
|
| Rate for Payer: Mclaren Commercial |
$304.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.05
|
| Rate for Payer: Nomi Health Commercial |
$277.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$296.93
|
| Rate for Payer: Priority Health Narrow Network |
$237.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.21
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$217.55
|
|
|
Service Code
|
NDC 00245021211
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$141.41 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Aetna Commercial |
$195.79
|
| Rate for Payer: ASR ASR |
$211.02
|
| Rate for Payer: ASR Commercial |
$211.02
|
| Rate for Payer: BCBS Trust/PPO |
$177.28
|
| 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 |
$195.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.92
|
| Rate for Payer: Nomi Health Commercial |
$178.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.44
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$306.85
|
|
|
Service Code
|
NDC 00904681861
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.45 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Aetna Commercial |
$276.17
|
| Rate for Payer: ASR ASR |
$297.64
|
| Rate for Payer: ASR Commercial |
$297.64
|
| Rate for Payer: BCBS Trust/PPO |
$250.05
|
| Rate for Payer: BCN Commercial |
$237.90
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Commercial |
$288.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$306.85
|
| Rate for Payer: Healthscope Whirlpool |
$297.64
|
| Rate for Payer: Mclaren Commercial |
$276.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: Nomi Health Commercial |
$251.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.03
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$338.88
|
|
|
Service Code
|
NDC 51079045320
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.27 |
| Max. Negotiated Rate |
$338.88 |
| Rate for Payer: Aetna Commercial |
$304.99
|
| Rate for Payer: ASR ASR |
$328.71
|
| Rate for Payer: ASR Commercial |
$328.71
|
| Rate for Payer: BCBS Trust/PPO |
$276.15
|
| Rate for Payer: BCN Commercial |
$262.73
|
| Rate for Payer: Cash Price |
$271.10
|
| Rate for Payer: Cofinity Commercial |
$318.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.10
|
| Rate for Payer: Healthscope Commercial |
$338.88
|
| Rate for Payer: Healthscope Whirlpool |
$328.71
|
| Rate for Payer: Mclaren Commercial |
$304.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.05
|
| Rate for Payer: Nomi Health Commercial |
$277.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.21
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$4.72
|
|
|
Service Code
|
NDC 50268056211
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Aetna Commercial |
$4.25
|
| Rate for Payer: ASR ASR |
$4.58
|
| Rate for Payer: ASR Commercial |
$4.58
|
| Rate for Payer: BCBS Trust/PPO |
$3.85
|
| Rate for Payer: BCN Commercial |
$3.66
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cofinity Commercial |
$4.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.78
|
| Rate for Payer: Healthscope Commercial |
$4.72
|
| Rate for Payer: Healthscope Whirlpool |
$4.58
|
| Rate for Payer: Mclaren Commercial |
$4.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.01
|
| Rate for Payer: Nomi Health Commercial |
$3.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.15
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$4.72
|
|
|
Service Code
|
NDC 50268056211
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: Aetna Commercial |
$4.25
|
| Rate for Payer: Aetna Medicare |
$2.36
|
| Rate for Payer: ASR ASR |
$4.58
|
| Rate for Payer: ASR Commercial |
$4.58
|
| Rate for Payer: BCBS Complete |
$1.89
|
| Rate for Payer: BCBS Trust/PPO |
$3.87
|
| Rate for Payer: BCN Commercial |
$3.66
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Cofinity Commercial |
$4.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.78
|
| Rate for Payer: Healthscope Commercial |
$4.72
|
| Rate for Payer: Healthscope Whirlpool |
$4.58
|
| Rate for Payer: Mclaren Commercial |
$4.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.01
|
| Rate for Payer: Nomi Health Commercial |
$3.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.14
|
| Rate for Payer: Priority Health Narrow Network |
$3.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.15
|
|
|
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 |
$317.01
|
| 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 |
$276.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.78
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$217.55
|
|
|
Service Code
|
NDC 00245021211
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.02 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Aetna Commercial |
$195.79
|
| Rate for Payer: Aetna Medicare |
$108.78
|
| Rate for Payer: ASR ASR |
$211.02
|
| Rate for Payer: ASR Commercial |
$211.02
|
| Rate for Payer: BCBS Complete |
$87.02
|
| Rate for Payer: BCBS Trust/PPO |
$178.15
|
| 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 |
$195.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$184.92
|
| Rate for Payer: Nomi Health Commercial |
$178.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$190.62
|
| Rate for Payer: Priority Health Narrow Network |
$152.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$191.44
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$306.85
|
|
|
Service Code
|
NDC 00904681861
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.74 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Aetna Commercial |
$276.17
|
| Rate for Payer: Aetna Medicare |
$153.43
|
| Rate for Payer: ASR ASR |
$297.64
|
| Rate for Payer: ASR Commercial |
$297.64
|
| Rate for Payer: BCBS Complete |
$122.74
|
| Rate for Payer: BCBS Trust/PPO |
$251.28
|
| Rate for Payer: BCN Commercial |
$237.90
|
| Rate for Payer: Cash Price |
$245.48
|
| Rate for Payer: Cofinity Commercial |
$288.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.48
|
| Rate for Payer: Healthscope Commercial |
$306.85
|
| Rate for Payer: Healthscope Whirlpool |
$297.64
|
| Rate for Payer: Mclaren Commercial |
$276.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.82
|
| Rate for Payer: Nomi Health Commercial |
$251.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$268.86
|
| Rate for Payer: Priority Health Narrow Network |
$215.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$270.03
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$3.39
|
|
|
Service Code
|
NDC 51079045301
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Aetna Commercial |
$3.05
|
| Rate for Payer: ASR ASR |
$3.29
|
| Rate for Payer: ASR Commercial |
$3.29
|
| Rate for Payer: BCBS Trust/PPO |
$2.76
|
| 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: UHC All Payor (Choice/PPO) + Core |
$2.98
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$3.37
|
|
|
Service Code
|
NDC 00245021289
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$3.03
|
| Rate for Payer: ASR ASR |
$3.27
|
| Rate for Payer: ASR Commercial |
$3.27
|
| Rate for Payer: BCBS Trust/PPO |
$2.75
|
| Rate for Payer: BCN Commercial |
$2.61
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$3.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.70
|
| Rate for Payer: Healthscope Commercial |
$3.37
|
| Rate for Payer: Healthscope Whirlpool |
$3.27
|
| Rate for Payer: Mclaren Commercial |
$3.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.86
|
| Rate for Payer: Nomi Health Commercial |
$2.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.97
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$236.07
|
|
|
Service Code
|
NDC 50268056215
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.45 |
| Max. Negotiated Rate |
$236.07 |
| Rate for Payer: Aetna Commercial |
$212.46
|
| Rate for Payer: ASR ASR |
$228.99
|
| Rate for Payer: ASR Commercial |
$228.99
|
| Rate for Payer: BCBS Trust/PPO |
$192.37
|
| 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: UHC All Payor (Choice/PPO) + Core |
$207.74
|
|
|
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
|
$337.25
|
|
|
Service Code
|
NDC 00245021201
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.90 |
| Max. Negotiated Rate |
$337.25 |
| Rate for Payer: Aetna Commercial |
$303.52
|
| Rate for Payer: Aetna Medicare |
$168.62
|
| Rate for Payer: ASR ASR |
$327.13
|
| Rate for Payer: ASR Commercial |
$327.13
|
| Rate for Payer: BCBS Complete |
$134.90
|
| Rate for Payer: BCBS Trust/PPO |
$276.17
|
| Rate for Payer: BCN Commercial |
$261.47
|
| Rate for Payer: Cash Price |
$269.80
|
| Rate for Payer: Cofinity Commercial |
$317.01
|
| 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 |
$276.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$295.50
|
| Rate for Payer: Priority Health Narrow Network |
$236.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$296.78
|
|
|
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 |
$118.03
|
| 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
|
|
|
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 |
$45.62 |
| Max. Negotiated Rate |
$70.18 |
| Rate for Payer: Aetna Commercial |
$63.16
|
| Rate for Payer: ASR ASR |
$68.07
|
| Rate for Payer: ASR Commercial |
$68.07
|
| Rate for Payer: BCBS Trust/PPO |
$57.19
|
| 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 Commercial |
$59.65
|
| Rate for Payer: Nomi Health Commercial |
$57.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.76
|
|
|
MILRINONE 20 MG/100 ML(200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS PIGGYBK
|
Facility
|
OP
|
$70.18
|
|
|
Service Code
|
HCPCS J2260
|
| Hospital Charge Code |
14961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$70.18 |
| Rate for Payer: Aetna Commercial |
$63.16
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: ASR ASR |
$68.07
|
| Rate for Payer: ASR Commercial |
$68.07
|
| Rate for Payer: BCBS Complete |
$28.07
|
| Rate for Payer: BCBS Trust/PPO |
$57.47
|
| 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 Commercial |
$59.65
|
| Rate for Payer: Nomi Health Commercial |
$57.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.62
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.49
|
| Rate for Payer: Priority Health Narrow Network |
$49.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.76
|
|
