|
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
|
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 |
$276.16
|
| 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 |
$276.16
|
| 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
|
$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
|
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 |
$317.02
|
| 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: 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
|
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
|
$3.37
|
|
|
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 |
$1.68
|
| 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
|
$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
|
$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
|
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 |
$195.80
|
| 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 |
$195.80
|
| 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 |
$276.16
|
| Rate for Payer: Aetna Medicare |
$153.42
|
| 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 |
$276.16
|
| 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
|
$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
|
$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 |
$195.80
|
| 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 |
$195.80
|
| 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
|
|
|
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 |
$1.30 |
| 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: 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 |
$1.63
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| 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
|
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
|
|
|
MINERAL OIL ENEMA
|
Facility
|
IP
|
$46.88
|
|
|
Service Code
|
NDC 96295012753
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.47 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Aetna Commercial |
$42.19
|
| Rate for Payer: ASR ASR |
$45.47
|
| Rate for Payer: ASR Commercial |
$45.47
|
| Rate for Payer: BCBS Trust/PPO |
$38.20
|
| Rate for Payer: BCN Commercial |
$36.35
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$44.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.50
|
| Rate for Payer: Healthscope Commercial |
$46.88
|
| Rate for Payer: Healthscope Whirlpool |
$45.47
|
| Rate for Payer: Mclaren Commercial |
$42.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.85
|
| Rate for Payer: Nomi Health Commercial |
$38.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.25
|
|
|
MINERAL OIL ENEMA
|
Facility
|
OP
|
$46.88
|
|
|
Service Code
|
NDC 96295012753
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Aetna Commercial |
$42.19
|
| Rate for Payer: Aetna Medicare |
$23.44
|
| Rate for Payer: ASR ASR |
$45.47
|
| Rate for Payer: ASR Commercial |
$45.47
|
| Rate for Payer: BCBS Complete |
$18.75
|
| Rate for Payer: BCBS Trust/PPO |
$38.39
|
| Rate for Payer: BCN Commercial |
$36.35
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$44.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.50
|
| Rate for Payer: Healthscope Commercial |
$46.88
|
| Rate for Payer: Healthscope Whirlpool |
$45.47
|
| Rate for Payer: Mclaren Commercial |
$42.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.85
|
| Rate for Payer: Nomi Health Commercial |
$38.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.08
|
| Rate for Payer: Priority Health Narrow Network |
$32.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.25
|
|
|
MINERAL OIL ORAL
|
Facility
|
IP
|
$8.10
|
|
|
Service Code
|
NDC 48433020230
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna Commercial |
$7.29
|
| Rate for Payer: ASR ASR |
$7.86
|
| Rate for Payer: ASR Commercial |
$7.86
|
| Rate for Payer: BCBS Trust/PPO |
$6.60
|
| Rate for Payer: BCN Commercial |
$6.28
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cofinity Commercial |
$7.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.48
|
| Rate for Payer: Healthscope Commercial |
$8.10
|
| Rate for Payer: Healthscope Whirlpool |
$7.86
|
| Rate for Payer: Mclaren Commercial |
$7.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.88
|
| Rate for Payer: Nomi Health Commercial |
$6.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.13
|
|
|
MINERAL OIL ORAL
|
Facility
|
OP
|
$8.10
|
|
|
Service Code
|
NDC 48433020230
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$8.10 |
| Rate for Payer: Aetna Commercial |
$7.29
|
| Rate for Payer: Aetna Medicare |
$4.05
|
| Rate for Payer: ASR ASR |
$7.86
|
| Rate for Payer: ASR Commercial |
$7.86
|
| Rate for Payer: BCBS Complete |
$3.24
|
| Rate for Payer: BCBS Trust/PPO |
$6.63
|
| Rate for Payer: BCN Commercial |
$6.28
|
| Rate for Payer: Cash Price |
$6.48
|
| Rate for Payer: Cofinity Commercial |
$7.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.48
|
| Rate for Payer: Healthscope Commercial |
$8.10
|
| Rate for Payer: Healthscope Whirlpool |
$7.86
|
| Rate for Payer: Mclaren Commercial |
$7.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.88
|
| Rate for Payer: Nomi Health Commercial |
$6.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.10
|
| Rate for Payer: Priority Health Narrow Network |
$5.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.13
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
OP
|
$401.85
|
|
|
Service Code
|
NDC 49884025701
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.74 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna Commercial |
$361.66
|
| Rate for Payer: Aetna Medicare |
$200.92
|
| Rate for Payer: ASR ASR |
$389.79
|
| Rate for Payer: ASR Commercial |
$389.79
|
| Rate for Payer: BCBS Complete |
$160.74
|
| Rate for Payer: BCBS Trust/PPO |
$329.07
|
| Rate for Payer: BCN Commercial |
$311.55
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Commercial |
$377.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Healthscope Whirlpool |
$389.79
|
| Rate for Payer: Mclaren Commercial |
$361.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.57
|
| Rate for Payer: Nomi Health Commercial |
$329.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$352.10
|
| Rate for Payer: Priority Health Narrow Network |
$281.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$353.63
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
OP
|
$2.68
|
|
|
Service Code
|
NDC 68084020511
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: Aetna Medicare |
$1.34
|
| Rate for Payer: ASR ASR |
$2.60
|
| Rate for Payer: ASR Commercial |
$2.60
|
| Rate for Payer: BCBS Complete |
$1.07
|
| Rate for Payer: BCBS Trust/PPO |
$2.19
|
| Rate for Payer: BCN Commercial |
$2.08
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.68
|
| Rate for Payer: Healthscope Whirlpool |
$2.60
|
| Rate for Payer: Mclaren Commercial |
$2.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.35
|
| Rate for Payer: Priority Health Narrow Network |
$1.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.36
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$401.85
|
|
|
Service Code
|
NDC 49884025701
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$261.20 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna Commercial |
$361.66
|
| Rate for Payer: ASR ASR |
$389.79
|
| Rate for Payer: ASR Commercial |
$389.79
|
| Rate for Payer: BCBS Trust/PPO |
$327.47
|
| Rate for Payer: BCN Commercial |
$311.55
|
| Rate for Payer: Cash Price |
$321.48
|
| Rate for Payer: Cofinity Commercial |
$377.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$321.48
|
| Rate for Payer: Healthscope Commercial |
$401.85
|
| Rate for Payer: Healthscope Whirlpool |
$389.79
|
| Rate for Payer: Mclaren Commercial |
$361.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$341.57
|
| Rate for Payer: Nomi Health Commercial |
$329.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$261.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$353.63
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$410.40
|
|
|
Service Code
|
NDC 00591564301
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$266.76 |
| Max. Negotiated Rate |
$410.40 |
| Rate for Payer: Aetna Commercial |
$369.36
|
| Rate for Payer: ASR ASR |
$398.09
|
| Rate for Payer: ASR Commercial |
$398.09
|
| Rate for Payer: BCBS Trust/PPO |
$334.43
|
| Rate for Payer: BCN Commercial |
$318.18
|
| Rate for Payer: Cash Price |
$328.32
|
| Rate for Payer: Cofinity Commercial |
$385.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$328.32
|
| Rate for Payer: Healthscope Commercial |
$410.40
|
| Rate for Payer: Healthscope Whirlpool |
$398.09
|
| Rate for Payer: Mclaren Commercial |
$369.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.84
|
| Rate for Payer: Nomi Health Commercial |
$336.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$266.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$361.15
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$2.68
|
|
|
Service Code
|
NDC 68084020511
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Aetna Commercial |
$2.41
|
| Rate for Payer: ASR ASR |
$2.60
|
| Rate for Payer: ASR Commercial |
$2.60
|
| Rate for Payer: BCBS Trust/PPO |
$2.18
|
| Rate for Payer: BCN Commercial |
$2.08
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cofinity Commercial |
$2.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$2.68
|
| Rate for Payer: Healthscope Whirlpool |
$2.60
|
| Rate for Payer: Mclaren Commercial |
$2.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.36
|
|
|
MINOXIDIL 10 MG TABLET
|
Facility
|
IP
|
$267.84
|
|
|
Service Code
|
NDC 68084020501
|
| Hospital Charge Code |
5114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.10 |
| Max. Negotiated Rate |
$267.84 |
| Rate for Payer: Aetna Commercial |
$241.06
|
| Rate for Payer: ASR ASR |
$259.80
|
| Rate for Payer: ASR Commercial |
$259.80
|
| Rate for Payer: BCBS Trust/PPO |
$218.26
|
| Rate for Payer: BCN Commercial |
$207.66
|
| Rate for Payer: Cash Price |
$214.27
|
| Rate for Payer: Cofinity Commercial |
$251.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$214.27
|
| Rate for Payer: Healthscope Commercial |
$267.84
|
| Rate for Payer: Healthscope Whirlpool |
$259.80
|
| Rate for Payer: Mclaren Commercial |
$241.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$227.66
|
| Rate for Payer: Nomi Health Commercial |
$219.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$235.70
|
|
