|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
OP
|
$27.97
|
|
|
Service Code
|
NDC 11701003816
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$27.96 |
| Rate for Payer: Aetna Commercial |
$25.17
|
| Rate for Payer: Aetna Medicare |
$10.35
|
| Rate for Payer: ASR ASR |
$27.13
|
| Rate for Payer: BCBS Complete |
$11.19
|
| Rate for Payer: BCBS Trust/PPO |
$23.06
|
| Rate for Payer: BCN Commercial |
$23.06
|
| Rate for Payer: Cash Price |
$22.37
|
| Rate for Payer: Cofinity Commercial |
$26.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.37
|
| Rate for Payer: Healthscope Commercial |
$27.13
|
| Rate for Payer: Healthscope Whirlpool |
$27.96
|
| Rate for Payer: Mclaren Commercial |
$25.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.77
|
| Rate for Payer: Nomi Health Commercial |
$22.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$24.50
|
| Rate for Payer: Priority Health Narrow Network |
$19.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.61
|
|
|
MICONAZOLE NITRATE 2 % TOPICAL POWDER
|
Facility
|
OP
|
$22.19
|
|
|
Service Code
|
NDC 80196052856
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.21 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: Aetna Commercial |
$19.97
|
| Rate for Payer: Aetna Medicare |
$8.21
|
| Rate for Payer: ASR ASR |
$21.52
|
| Rate for Payer: BCBS Complete |
$8.87
|
| Rate for Payer: BCBS Trust/PPO |
$18.29
|
| Rate for Payer: BCN Commercial |
$18.29
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cofinity Commercial |
$20.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.75
|
| Rate for Payer: Healthscope Commercial |
$21.52
|
| Rate for Payer: Healthscope Whirlpool |
$22.18
|
| Rate for Payer: Mclaren Commercial |
$19.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.86
|
| Rate for Payer: Nomi Health Commercial |
$18.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$19.44
|
| 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
|
$16.93
|
|
|
Service Code
|
NDC 9629514350
|
| Hospital Charge Code |
10599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$16.93 |
| Rate for Payer: Aetna Commercial |
$15.24
|
| Rate for Payer: Aetna Medicare |
$6.27
|
| Rate for Payer: ASR ASR |
$16.43
|
| Rate for Payer: BCBS Complete |
$6.77
|
| Rate for Payer: BCBS Trust/PPO |
$13.96
|
| Rate for Payer: BCN Commercial |
$13.96
|
| Rate for Payer: Cash Price |
$13.55
|
| Rate for Payer: Cofinity Commercial |
$15.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.55
|
| Rate for Payer: Healthscope Commercial |
$16.43
|
| Rate for Payer: Healthscope Whirlpool |
$16.93
|
| Rate for Payer: Mclaren Commercial |
$15.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.39
|
| Rate for Payer: Nomi Health Commercial |
$13.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$14.84
|
| Rate for Payer: Priority Health Narrow Network |
$11.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.90
|
|
|
MICONAZOLE NITRATE 2 % VAGINAL CREAM
|
Facility
|
OP
|
$37.33
|
|
|
Service Code
|
NDC 63736044263
|
| Hospital Charge Code |
5040
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Aetna Commercial |
$33.60
|
| Rate for Payer: Aetna Medicare |
$13.81
|
| Rate for Payer: ASR ASR |
$36.21
|
| Rate for Payer: BCBS Complete |
$14.93
|
| Rate for Payer: BCBS Trust/PPO |
$30.78
|
| Rate for Payer: BCN Commercial |
$30.78
|
| 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 |
$36.21
|
| Rate for Payer: Healthscope Whirlpool |
$37.33
|
| Rate for Payer: Mclaren Commercial |
$33.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.73
|
| Rate for Payer: Nomi Health Commercial |
$30.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.00
|
| Rate for Payer: Priority Health Cigna 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 |
$28.00 |
| Max. Negotiated Rate |
$37.33 |
| Rate for Payer: Aetna Commercial |
$33.60
|
| Rate for Payer: ASR ASR |
$36.21
|
| Rate for Payer: BCBS Trust/PPO |
$30.65
|
| Rate for Payer: BCN Commercial |
$30.65
|
| 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 |
$36.21
|
| Rate for Payer: Healthscope Whirlpool |
$37.33
|
| 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: Opus (Opus Packaging Group) HMA |
$28.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$32.85
|
|
|
MICRODERMABRASION
|
Professional
|
Both
|
$105.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
|
|
MICROFIBRILLAR COLLAGEN HEMOSTAT POWDER
|
Facility
|
OP
|
$1,025.97
|
|
|
Service Code
|
NDC 53276101002
|
| Hospital Charge Code |
10606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$379.61 |
| Max. Negotiated Rate |
$1,025.97 |
| Rate for Payer: Aetna Commercial |
$923.38
|
| Rate for Payer: Aetna Medicare |
$379.61
|
| Rate for Payer: ASR ASR |
$995.19
|
| Rate for Payer: BCBS Complete |
$410.39
|
| Rate for Payer: BCBS Trust/PPO |
$845.91
|
| Rate for Payer: BCN Commercial |
$845.91
|
| Rate for Payer: Cash Price |
$820.78
|
| Rate for Payer: Cofinity Commercial |
$964.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$820.78
|
| Rate for Payer: Healthscope Commercial |
$995.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,025.97
|
| Rate for Payer: Mclaren Commercial |
$923.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$820.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$872.08
|
| Rate for Payer: Nomi Health Commercial |
$841.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$769.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$898.96
|
| Rate for Payer: Priority Health Narrow Network |
$719.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$902.86
|
|
|
MICROFIBRILLAR COLLAGEN HEMOSTAT POWDER
|
Facility
|
IP
|
$1,025.97
|
|
|
Service Code
|
NDC 53276101002
|
| Hospital Charge Code |
10606
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$769.48 |
| Max. Negotiated Rate |
$1,025.97 |
| Rate for Payer: Aetna Commercial |
$923.38
|
| Rate for Payer: ASR ASR |
$995.19
|
| Rate for Payer: BCBS Trust/PPO |
$842.53
|
| Rate for Payer: BCN Commercial |
$842.53
|
| Rate for Payer: Cash Price |
$820.78
|
| Rate for Payer: Cofinity Commercial |
$964.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$820.78
|
| Rate for Payer: Healthscope Commercial |
$995.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,025.97
|
| Rate for Payer: Mclaren Commercial |
$923.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$872.08
|
| Rate for Payer: Nomi Health Commercial |
$841.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$769.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$902.86
|
|
|
MICROFIBRILLAR COLLAGEN HEMOSTAT TOPICAL POWDER IN PACKET
|
Facility
|
IP
|
$511.54
|
|
|
Service Code
|
NDC 53276101001
|
| Hospital Charge Code |
159416
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$383.66 |
| Max. Negotiated Rate |
$511.54 |
| Rate for Payer: Aetna Commercial |
$460.39
|
| Rate for Payer: ASR ASR |
$496.20
|
| Rate for Payer: BCBS Trust/PPO |
$420.08
|
| Rate for Payer: BCN Commercial |
$420.08
|
| Rate for Payer: Cash Price |
$409.24
|
| Rate for Payer: Cofinity Commercial |
$480.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$409.24
|
| Rate for Payer: Healthscope Commercial |
$496.20
|
| Rate for Payer: Healthscope Whirlpool |
$511.54
|
| Rate for Payer: Mclaren Commercial |
$460.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.81
|
| Rate for Payer: Nomi Health Commercial |
$419.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$383.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$450.16
|
|
|
MICROFIBRILLAR COLLAGEN HEMOSTAT TOPICAL POWDER IN PACKET
|
Facility
|
OP
|
$511.54
|
|
|
Service Code
|
NDC 53276101001
|
| Hospital Charge Code |
159416
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$189.27 |
| Max. Negotiated Rate |
$511.54 |
| Rate for Payer: Aetna Commercial |
$460.39
|
| Rate for Payer: Aetna Medicare |
$189.27
|
| Rate for Payer: ASR ASR |
$496.20
|
| Rate for Payer: BCBS Complete |
$204.62
|
| Rate for Payer: BCBS Trust/PPO |
$421.77
|
| Rate for Payer: BCN Commercial |
$421.77
|
| Rate for Payer: Cash Price |
$409.24
|
| Rate for Payer: Cofinity Commercial |
$480.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$409.24
|
| Rate for Payer: Healthscope Commercial |
$496.20
|
| Rate for Payer: Healthscope Whirlpool |
$511.54
|
| Rate for Payer: Mclaren Commercial |
$460.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$409.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$434.81
|
| Rate for Payer: Nomi Health Commercial |
$419.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$383.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$448.21
|
| Rate for Payer: Priority Health Narrow Network |
$358.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$450.16
|
|
|
MICRO NEEDLING
|
Professional
|
Both
|
$210.00
|
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
OP
|
$42.46
|
|
|
Service Code
|
NDC 68094076462
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.71 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.21
|
| Rate for Payer: Aetna Medicare |
$15.71
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Complete |
$16.98
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Mclaren Commercial |
$38.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.09
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37.20
|
| Rate for Payer: Priority Health Narrow Network |
$29.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
OP
|
$42.46
|
|
|
Service Code
|
NDC 68094076459
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.71 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.21
|
| Rate for Payer: Aetna Medicare |
$15.71
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Complete |
$16.98
|
| Rate for Payer: BCBS Trust/PPO |
$35.00
|
| Rate for Payer: BCN Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Mclaren Commercial |
$38.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.09
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$37.20
|
| Rate for Payer: Priority Health Narrow Network |
$29.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
IP
|
$42.46
|
|
|
Service Code
|
NDC 68094076462
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.21
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Trust/PPO |
$34.86
|
| Rate for Payer: BCN Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Mclaren Commercial |
$38.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.09
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
|
MIDAZOLAM 10 MG/5 ML (2 MG/ML) ORAL SYRUP
|
Facility
|
IP
|
$42.46
|
|
|
Service Code
|
NDC 68094076459
|
| Hospital Charge Code |
120031
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$42.45 |
| Rate for Payer: Aetna Commercial |
$38.21
|
| Rate for Payer: ASR ASR |
$41.18
|
| Rate for Payer: BCBS Trust/PPO |
$34.86
|
| Rate for Payer: BCN Commercial |
$34.86
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.96
|
| Rate for Payer: Healthscope Commercial |
$41.18
|
| Rate for Payer: Healthscope Whirlpool |
$42.45
|
| Rate for Payer: Mclaren Commercial |
$38.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.09
|
| Rate for Payer: Nomi Health Commercial |
$34.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.36
|
|
|
MIDAZOLAM 1 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$17.87
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$17.87 |
| Rate for Payer: Aetna Commercial |
$16.08
|
| Rate for Payer: Aetna Commercial |
$21.48
|
| Rate for Payer: Aetna Commercial |
$13.85
|
| Rate for Payer: Aetna Commercial |
$12.54
|
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Medicare |
$8.83
|
| Rate for Payer: Aetna Medicare |
$5.15
|
| Rate for Payer: Aetna Medicare |
$8.21
|
| Rate for Payer: Aetna Medicare |
$6.61
|
| Rate for Payer: Aetna Medicare |
$5.69
|
| Rate for Payer: ASR ASR |
$17.33
|
| Rate for Payer: ASR ASR |
$23.15
|
| Rate for Payer: ASR ASR |
$21.53
|
| Rate for Payer: ASR ASR |
$14.93
|
| Rate for Payer: ASR ASR |
$13.51
|
| Rate for Payer: BCBS Complete |
$8.88
|
| Rate for Payer: BCBS Complete |
$5.57
|
| Rate for Payer: BCBS Complete |
$9.55
|
| Rate for Payer: BCBS Complete |
$7.15
|
| Rate for Payer: BCBS Complete |
$6.16
|
| Rate for Payer: BCBS Trust/PPO |
$11.49
|
| Rate for Payer: BCBS Trust/PPO |
$12.69
|
| Rate for Payer: BCBS Trust/PPO |
$18.30
|
| Rate for Payer: BCBS Trust/PPO |
$19.68
|
| Rate for Payer: BCBS Trust/PPO |
$14.73
|
| Rate for Payer: BCN Commercial |
$18.30
|
| Rate for Payer: BCN Commercial |
$12.69
|
| Rate for Payer: BCN Commercial |
$11.49
|
| Rate for Payer: BCN Commercial |
$19.68
|
| Rate for Payer: BCN Commercial |
$14.73
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$11.15
|
| Rate for Payer: Cash Price |
$12.31
|
| Rate for Payer: Cash Price |
$12.31
|
| Rate for Payer: Cash Price |
$11.15
|
| 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 |
$19.09
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$22.43
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$20.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.15
|
| 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 |
$12.31
|
| Rate for Payer: Healthscope Commercial |
$13.51
|
| Rate for Payer: Healthscope Commercial |
$14.93
|
| Rate for Payer: Healthscope Commercial |
$23.15
|
| Rate for Payer: Healthscope Commercial |
$17.33
|
| Rate for Payer: Healthscope Commercial |
$21.53
|
| Rate for Payer: Healthscope Whirlpool |
$17.87
|
| Rate for Payer: Healthscope Whirlpool |
$13.93
|
| Rate for Payer: Healthscope Whirlpool |
$15.39
|
| Rate for Payer: Healthscope Whirlpool |
$23.86
|
| Rate for Payer: Healthscope Whirlpool |
$22.20
|
| Rate for Payer: Mclaren Commercial |
$13.85
|
| Rate for Payer: Mclaren Commercial |
$12.54
|
| Rate for Payer: Mclaren Commercial |
$21.48
|
| Rate for Payer: Mclaren Commercial |
$19.98
|
| Rate for Payer: Mclaren Commercial |
$16.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.19
|
| Rate for Payer: Nomi Health Commercial |
$12.62
|
| Rate for Payer: Nomi Health Commercial |
$11.42
|
| 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: Opus (Opus Packaging Group) HMA |
$16.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.15
|
| Rate for Payer: Priority Health Narrow Network |
$0.12
|
| Rate for Payer: Priority Health Narrow Network |
$0.12
|
| Rate for Payer: Priority Health Narrow Network |
$0.12
|
| Rate for Payer: Priority Health Narrow Network |
$0.12
|
| Rate for Payer: Priority Health Narrow Network |
$0.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.54
|
| 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 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$23.87
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$23.86 |
| Rate for Payer: Aetna Commercial |
$21.48
|
| Rate for Payer: Aetna Commercial |
$16.08
|
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Commercial |
$13.85
|
| Rate for Payer: Aetna Commercial |
$12.54
|
| Rate for Payer: ASR ASR |
$17.33
|
| Rate for Payer: ASR ASR |
$13.51
|
| Rate for Payer: ASR ASR |
$23.15
|
| Rate for Payer: ASR ASR |
$14.93
|
| Rate for Payer: ASR ASR |
$21.53
|
| Rate for Payer: BCBS Trust/PPO |
$19.60
|
| Rate for Payer: BCBS Trust/PPO |
$12.64
|
| Rate for Payer: BCBS Trust/PPO |
$11.44
|
| Rate for Payer: BCBS Trust/PPO |
$18.23
|
| Rate for Payer: BCBS Trust/PPO |
$14.68
|
| Rate for Payer: BCN Commercial |
$14.68
|
| Rate for Payer: BCN Commercial |
$12.64
|
| Rate for Payer: BCN Commercial |
$18.23
|
| Rate for Payer: BCN Commercial |
$19.60
|
| Rate for Payer: BCN Commercial |
$11.44
|
| Rate for Payer: Cash Price |
$11.15
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$17.76
|
| Rate for Payer: Cash Price |
$12.31
|
| Rate for Payer: Cash Price |
$19.09
|
| Rate for Payer: Cofinity Commercial |
$14.47
|
| Rate for Payer: Cofinity Commercial |
$20.87
|
| Rate for Payer: Cofinity Commercial |
$13.10
|
| Rate for Payer: Cofinity Commercial |
$16.80
|
| 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 |
$11.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.09
|
| Rate for Payer: Healthscope Commercial |
$17.33
|
| Rate for Payer: Healthscope Commercial |
$14.93
|
| Rate for Payer: Healthscope Commercial |
$21.53
|
| Rate for Payer: Healthscope Commercial |
$13.51
|
| Rate for Payer: Healthscope Commercial |
$23.15
|
| Rate for Payer: Healthscope Whirlpool |
$22.20
|
| Rate for Payer: Healthscope Whirlpool |
$23.86
|
| Rate for Payer: Healthscope Whirlpool |
$13.93
|
| Rate for Payer: Healthscope Whirlpool |
$15.39
|
| Rate for Payer: Healthscope Whirlpool |
$17.87
|
| Rate for Payer: Mclaren Commercial |
$13.85
|
| Rate for Payer: Mclaren Commercial |
$19.98
|
| Rate for Payer: Mclaren Commercial |
$12.54
|
| Rate for Payer: Mclaren Commercial |
$21.48
|
| Rate for Payer: Mclaren Commercial |
$16.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.08
|
| 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 |
$20.29
|
| Rate for Payer: Nomi Health Commercial |
$18.20
|
| Rate for Payer: Nomi Health Commercial |
$14.65
|
| Rate for Payer: Nomi Health Commercial |
$12.62
|
| Rate for Payer: Nomi Health Commercial |
$11.42
|
| Rate for Payer: Nomi Health Commercial |
$19.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.26
|
|
|
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 |
$0.12 |
| Max. Negotiated Rate |
$20.61 |
| Rate for Payer: Aetna Commercial |
$18.55
|
| Rate for Payer: Aetna Medicare |
$7.63
|
| Rate for Payer: ASR ASR |
$19.99
|
| Rate for Payer: BCBS Complete |
$8.24
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCN Commercial |
$16.99
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$19.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.49
|
| Rate for Payer: Healthscope Commercial |
$19.99
|
| Rate for Payer: Healthscope Whirlpool |
$20.61
|
| Rate for Payer: Mclaren Commercial |
$18.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.52
|
| Rate for Payer: Nomi Health Commercial |
$16.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.15
|
| Rate for Payer: Priority Health Narrow Network |
$0.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.14
|
|
|
MIDAZOLAM 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$20.61
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.46 |
| Max. Negotiated Rate |
$20.61 |
| Rate for Payer: Aetna Commercial |
$18.55
|
| Rate for Payer: ASR ASR |
$19.99
|
| Rate for Payer: BCBS Trust/PPO |
$16.92
|
| Rate for Payer: BCN Commercial |
$16.92
|
| Rate for Payer: Cash Price |
$16.49
|
| Rate for Payer: Cofinity Commercial |
$19.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.49
|
| Rate for Payer: Healthscope Commercial |
$19.99
|
| Rate for Payer: Healthscope Whirlpool |
$20.61
|
| Rate for Payer: Mclaren Commercial |
$18.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.52
|
| Rate for Payer: Nomi Health Commercial |
$16.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.14
|
|
|
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 |
$0.12 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.15
|
| Rate for Payer: Aetna Commercial |
$12.55
|
| Rate for Payer: Aetna Medicare |
$5.16
|
| Rate for Payer: Aetna Medicare |
$5.41
|
| Rate for Payer: ASR ASR |
$14.18
|
| Rate for Payer: ASR ASR |
$13.53
|
| Rate for Payer: BCBS Complete |
$5.58
|
| Rate for Payer: BCBS Complete |
$5.85
|
| Rate for Payer: BCBS Trust/PPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$11.50
|
| Rate for Payer: BCN Commercial |
$11.50
|
| Rate for Payer: BCN Commercial |
$12.05
|
| Rate for Payer: Cash Price |
$11.69
|
| Rate for Payer: Cash Price |
$11.16
|
| 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 |
$11.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$14.18
|
| Rate for Payer: Healthscope Commercial |
$13.53
|
| Rate for Payer: Healthscope Whirlpool |
$14.62
|
| Rate for Payer: Healthscope Whirlpool |
$13.95
|
| Rate for Payer: Mclaren Commercial |
$13.15
|
| Rate for Payer: Mclaren Commercial |
$12.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.42
|
| Rate for Payer: Nomi Health Commercial |
$11.44
|
| Rate for Payer: Nomi Health Commercial |
$11.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.15
|
| Rate for Payer: Priority Health Narrow Network |
$0.12
|
| Rate for Payer: Priority Health Narrow Network |
$0.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.86
|
|
|
MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$13.95
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
168786
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$13.95 |
| Rate for Payer: Aetna Commercial |
$12.55
|
| Rate for Payer: Aetna Commercial |
$13.15
|
| Rate for Payer: ASR ASR |
$14.18
|
| Rate for Payer: ASR ASR |
$13.53
|
| Rate for Payer: BCBS Trust/PPO |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$11.45
|
| Rate for Payer: BCN Commercial |
$12.00
|
| Rate for Payer: BCN Commercial |
$11.45
|
| 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 |
$11.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.16
|
| Rate for Payer: Healthscope Commercial |
$13.53
|
| Rate for Payer: Healthscope Commercial |
$14.18
|
| Rate for Payer: Healthscope Whirlpool |
$14.62
|
| Rate for Payer: Healthscope Whirlpool |
$13.95
|
| Rate for Payer: Mclaren Commercial |
$13.15
|
| Rate for Payer: Mclaren Commercial |
$12.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.86
|
| Rate for Payer: Nomi Health Commercial |
$11.98
|
| Rate for Payer: Nomi Health Commercial |
$11.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.86
|
|
|
MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$15.49
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
168785
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$15.48 |
| Rate for Payer: Aetna Commercial |
$13.94
|
| Rate for Payer: Aetna Medicare |
$5.73
|
| Rate for Payer: ASR ASR |
$15.02
|
| Rate for Payer: BCBS Complete |
$6.19
|
| Rate for Payer: BCBS Trust/PPO |
$12.77
|
| Rate for Payer: BCN Commercial |
$12.77
|
| Rate for Payer: Cash Price |
$12.39
|
| Rate for Payer: Cash Price |
$12.39
|
| Rate for Payer: Cofinity Commercial |
$14.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.39
|
| Rate for Payer: Healthscope Commercial |
$15.02
|
| Rate for Payer: Healthscope Whirlpool |
$15.48
|
| Rate for Payer: Mclaren Commercial |
$13.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.16
|
| Rate for Payer: Nomi Health Commercial |
$12.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.15
|
| Rate for Payer: Priority Health Narrow Network |
$0.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.63
|
|
|
MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$15.49
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
168785
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$15.48 |
| Rate for Payer: Aetna Commercial |
$13.94
|
| Rate for Payer: ASR ASR |
$15.02
|
| Rate for Payer: BCBS Trust/PPO |
$12.72
|
| Rate for Payer: BCN Commercial |
$12.72
|
| Rate for Payer: Cash Price |
$12.39
|
| Rate for Payer: Cofinity Commercial |
$14.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.39
|
| Rate for Payer: Healthscope Commercial |
$15.02
|
| Rate for Payer: Healthscope Whirlpool |
$15.48
|
| Rate for Payer: Mclaren Commercial |
$13.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.16
|
| Rate for Payer: Nomi Health Commercial |
$12.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.63
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$2.46
|
|
|
Service Code
|
NDC 50268056211
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: ASR ASR |
$2.38
|
| Rate for Payer: BCBS Trust/PPO |
$2.02
|
| Rate for Payer: BCN Commercial |
$2.02
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Cofinity Commercial |
$2.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.97
|
| Rate for Payer: Healthscope Commercial |
$2.38
|
| Rate for Payer: Healthscope Whirlpool |
$2.46
|
| Rate for Payer: Mclaren Commercial |
$2.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.09
|
| Rate for Payer: Nomi Health Commercial |
$2.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.16
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$122.88
|
|
|
Service Code
|
NDC 50268056215
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.16 |
| Max. Negotiated Rate |
$122.88 |
| Rate for Payer: Aetna Commercial |
$110.59
|
| Rate for Payer: ASR ASR |
$119.19
|
| Rate for Payer: BCBS Trust/PPO |
$100.91
|
| Rate for Payer: BCN Commercial |
$100.91
|
| Rate for Payer: Cash Price |
$98.30
|
| Rate for Payer: Cofinity Commercial |
$115.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$98.30
|
| Rate for Payer: Healthscope Commercial |
$119.19
|
| Rate for Payer: Healthscope Whirlpool |
$122.88
|
| Rate for Payer: Mclaren Commercial |
$110.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.45
|
| Rate for Payer: Nomi Health Commercial |
$100.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$92.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$108.13
|
|
