|
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
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$317.76
|
|
|
Service Code
|
NDC 51079045320
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.32 |
| Max. Negotiated Rate |
$317.76 |
| Rate for Payer: Aetna Commercial |
$285.98
|
| Rate for Payer: ASR ASR |
$308.23
|
| Rate for Payer: BCBS Trust/PPO |
$260.94
|
| Rate for Payer: BCN Commercial |
$260.94
|
| Rate for Payer: Cash Price |
$254.21
|
| Rate for Payer: Cofinity Commercial |
$298.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.21
|
| Rate for Payer: Healthscope Commercial |
$308.23
|
| Rate for Payer: Healthscope Whirlpool |
$317.76
|
| Rate for Payer: Mclaren Commercial |
$285.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.10
|
| Rate for Payer: Nomi Health Commercial |
$260.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$279.63
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$3.18
|
|
|
Service Code
|
NDC 51079045301
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: ASR ASR |
$3.08
|
| Rate for Payer: BCBS Trust/PPO |
$2.61
|
| Rate for Payer: BCN Commercial |
$2.61
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cofinity Commercial |
$2.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.54
|
| Rate for Payer: Healthscope Commercial |
$3.08
|
| Rate for Payer: Healthscope Whirlpool |
$3.18
|
| Rate for Payer: Mclaren Commercial |
$2.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.70
|
| Rate for Payer: Nomi Health Commercial |
$2.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.80
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$3.87
|
|
|
Service Code
|
NDC 245021289
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.90 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: ASR ASR |
$3.75
|
| Rate for Payer: BCBS Trust/PPO |
$3.18
|
| Rate for Payer: BCN Commercial |
$3.18
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.75
|
| Rate for Payer: Healthscope Whirlpool |
$3.87
|
| Rate for Payer: Mclaren Commercial |
$3.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.29
|
| Rate for Payer: Nomi Health Commercial |
$3.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.40
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$2.46
|
|
|
Service Code
|
NDC 50268056211
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: Aetna Commercial |
$2.21
|
| Rate for Payer: Aetna Medicare |
$0.91
|
| Rate for Payer: ASR ASR |
$2.38
|
| Rate for Payer: BCBS Complete |
$0.98
|
| Rate for Payer: BCBS Trust/PPO |
$2.03
|
| Rate for Payer: BCN Commercial |
$2.03
|
| 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: MI Amish Medical Board Commercial |
$1.97
|
| 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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.15
|
| Rate for Payer: Priority Health Narrow Network |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.16
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$386.88
|
|
|
Service Code
|
NDC 245021201
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$143.15 |
| Max. Negotiated Rate |
$386.88 |
| Rate for Payer: Aetna Commercial |
$348.19
|
| Rate for Payer: Aetna Medicare |
$143.15
|
| Rate for Payer: ASR ASR |
$375.27
|
| Rate for Payer: BCBS Complete |
$154.75
|
| Rate for Payer: BCBS Trust/PPO |
$318.98
|
| Rate for Payer: BCN Commercial |
$318.98
|
| Rate for Payer: Cash Price |
$309.50
|
| Rate for Payer: Cofinity Commercial |
$363.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.50
|
| Rate for Payer: Healthscope Commercial |
$375.27
|
| Rate for Payer: Healthscope Whirlpool |
$386.88
|
| Rate for Payer: Mclaren Commercial |
$348.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$309.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.85
|
| Rate for Payer: Nomi Health Commercial |
$317.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$338.98
|
| Rate for Payer: Priority Health Narrow Network |
$271.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$340.45
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$317.76
|
|
|
Service Code
|
NDC 51079045320
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.57 |
| Max. Negotiated Rate |
$317.76 |
| Rate for Payer: Aetna Commercial |
$285.98
|
| Rate for Payer: Aetna Medicare |
$117.57
|
| Rate for Payer: ASR ASR |
$308.23
|
| Rate for Payer: BCBS Complete |
$127.10
|
| Rate for Payer: BCBS Trust/PPO |
$261.99
|
| Rate for Payer: BCN Commercial |
$261.99
|
| Rate for Payer: Cash Price |
$254.21
|
| Rate for Payer: Cofinity Commercial |
$298.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.21
|
| Rate for Payer: Healthscope Commercial |
$308.23
|
| Rate for Payer: Healthscope Whirlpool |
$317.76
|
| Rate for Payer: Mclaren Commercial |
$285.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.10
|
| Rate for Payer: Nomi Health Commercial |
$260.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$278.42
|
| Rate for Payer: Priority Health Narrow Network |
$222.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$279.63
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$318.25
|
|
|
Service Code
|
NDC 245021211
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.75 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Aetna Commercial |
$286.43
|
| Rate for Payer: Aetna Medicare |
$117.75
|
| Rate for Payer: ASR ASR |
$308.70
|
| Rate for Payer: BCBS Complete |
$127.30
|
| Rate for Payer: BCBS Trust/PPO |
$262.40
|
| Rate for Payer: BCN Commercial |
$262.40
|
| Rate for Payer: Cash Price |
$254.60
|
| Rate for Payer: Cofinity Commercial |
$299.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.60
|
| Rate for Payer: Healthscope Commercial |
$308.70
|
| Rate for Payer: Healthscope Whirlpool |
$318.25
|
| Rate for Payer: Mclaren Commercial |
$286.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$254.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.51
|
| Rate for Payer: Nomi Health Commercial |
$260.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$278.85
|
| Rate for Payer: Priority Health Narrow Network |
$223.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$280.06
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$3.18
|
|
|
Service Code
|
NDC 51079045301
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$3.18 |
| Rate for Payer: Aetna Commercial |
$2.86
|
| Rate for Payer: Aetna Medicare |
$1.18
|
| Rate for Payer: ASR ASR |
$3.08
|
| Rate for Payer: BCBS Complete |
$1.27
|
| Rate for Payer: BCBS Trust/PPO |
$2.62
|
| Rate for Payer: BCN Commercial |
$2.62
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Cofinity Commercial |
$2.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.54
|
| Rate for Payer: Healthscope Commercial |
$3.08
|
| Rate for Payer: Healthscope Whirlpool |
$3.18
|
| Rate for Payer: Mclaren Commercial |
$2.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.70
|
| Rate for Payer: Nomi Health Commercial |
$2.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2.78
|
| Rate for Payer: Priority Health Narrow Network |
$2.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.80
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$386.88
|
|
|
Service Code
|
NDC 245021201
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$290.16 |
| Max. Negotiated Rate |
$386.88 |
| Rate for Payer: Aetna Commercial |
$348.19
|
| Rate for Payer: ASR ASR |
$375.27
|
| Rate for Payer: BCBS Trust/PPO |
$317.71
|
| Rate for Payer: BCN Commercial |
$317.71
|
| Rate for Payer: Cash Price |
$309.50
|
| Rate for Payer: Cofinity Commercial |
$363.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.50
|
| Rate for Payer: Healthscope Commercial |
$375.27
|
| Rate for Payer: Healthscope Whirlpool |
$386.88
|
| Rate for Payer: Mclaren Commercial |
$348.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$328.85
|
| Rate for Payer: Nomi Health Commercial |
$317.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$340.45
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$3.87
|
|
|
Service Code
|
NDC 245021289
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna Medicare |
$1.43
|
| Rate for Payer: ASR ASR |
$3.75
|
| Rate for Payer: BCBS Complete |
$1.55
|
| Rate for Payer: BCBS Trust/PPO |
$3.19
|
| Rate for Payer: BCN Commercial |
$3.19
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Cofinity Commercial |
$3.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.10
|
| Rate for Payer: Healthscope Commercial |
$3.75
|
| Rate for Payer: Healthscope Whirlpool |
$3.87
|
| Rate for Payer: Mclaren Commercial |
$3.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.29
|
| Rate for Payer: Nomi Health Commercial |
$3.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.39
|
| Rate for Payer: Priority Health Narrow Network |
$2.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.40
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
OP
|
$452.20
|
|
|
Service Code
|
NDC 904681861
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.31 |
| Max. Negotiated Rate |
$452.20 |
| Rate for Payer: Aetna Commercial |
$406.98
|
| Rate for Payer: Aetna Medicare |
$167.31
|
| Rate for Payer: ASR ASR |
$438.63
|
| Rate for Payer: BCBS Complete |
$180.88
|
| Rate for Payer: BCBS Trust/PPO |
$372.84
|
| Rate for Payer: BCN Commercial |
$372.84
|
| Rate for Payer: Cash Price |
$361.76
|
| Rate for Payer: Cofinity Commercial |
$425.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.76
|
| Rate for Payer: Healthscope Commercial |
$438.63
|
| Rate for Payer: Healthscope Whirlpool |
$452.20
|
| Rate for Payer: Mclaren Commercial |
$406.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$361.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.37
|
| Rate for Payer: Nomi Health Commercial |
$370.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$396.22
|
| Rate for Payer: Priority Health Narrow Network |
$316.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.94
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$452.20
|
|
|
Service Code
|
NDC 904681861
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$339.15 |
| Max. Negotiated Rate |
$452.20 |
| Rate for Payer: Aetna Commercial |
$406.98
|
| Rate for Payer: ASR ASR |
$438.63
|
| Rate for Payer: BCBS Trust/PPO |
$371.35
|
| Rate for Payer: BCN Commercial |
$371.35
|
| Rate for Payer: Cash Price |
$361.76
|
| Rate for Payer: Cofinity Commercial |
$425.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$361.76
|
| Rate for Payer: Healthscope Commercial |
$438.63
|
| Rate for Payer: Healthscope Whirlpool |
$452.20
|
| Rate for Payer: Mclaren Commercial |
$406.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$384.37
|
| Rate for Payer: Nomi Health Commercial |
$370.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.94
|
|
|
MIDODRINE 5 MG TABLET
|
Facility
|
IP
|
$318.25
|
|
|
Service Code
|
NDC 245021211
|
| Hospital Charge Code |
10610
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$238.69 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Aetna Commercial |
$286.43
|
| Rate for Payer: ASR ASR |
$308.70
|
| Rate for Payer: BCBS Trust/PPO |
$261.35
|
| Rate for Payer: BCN Commercial |
$261.35
|
| Rate for Payer: Cash Price |
$254.60
|
| Rate for Payer: Cofinity Commercial |
$299.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$254.60
|
| Rate for Payer: Healthscope Commercial |
$308.70
|
| Rate for Payer: Healthscope Whirlpool |
$318.25
|
| Rate for Payer: Mclaren Commercial |
$286.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$270.51
|
| Rate for Payer: Nomi Health Commercial |
$260.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$238.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$280.06
|
|
|
MIGRAINE AND OTHER HEADACHES
|
Facility
|
IP
|
$4,953.05
|
|
|
Service Code
|
APR-DRG 0542
|
| Min. Negotiated Rate |
$4,478.15 |
| Max. Negotiated Rate |
$4,953.05 |
| Rate for Payer: BCBS Complete |
$4,953.05
|
| Rate for Payer: Mclaren Medicaid |
$4,717.19
|
| Rate for Payer: Meridian Medicaid |
$4,953.05
|
| Rate for Payer: PHP Medicaid |
$4,478.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,717.19
|
| Rate for Payer: UHC Medicaid |
$4,717.19
|
| Rate for Payer: UHCCP Medicaid |
$4,717.19
|
|
|
MIGRAINE AND OTHER HEADACHES
|
Facility
|
IP
|
$9,733.90
|
|
|
Service Code
|
APR-DRG 0544
|
| Min. Negotiated Rate |
$8,800.61 |
| Max. Negotiated Rate |
$9,733.90 |
| Rate for Payer: BCBS Complete |
$9,733.90
|
| Rate for Payer: Mclaren Medicaid |
$9,270.38
|
| Rate for Payer: Meridian Medicaid |
$9,733.90
|
| Rate for Payer: PHP Medicaid |
$8,800.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$9,270.38
|
| Rate for Payer: UHC Medicaid |
$9,270.38
|
| Rate for Payer: UHCCP Medicaid |
$9,270.38
|
|
|
MIGRAINE AND OTHER HEADACHES
|
Facility
|
IP
|
$6,373.74
|
|
|
Service Code
|
APR-DRG 0543
|
| Min. Negotiated Rate |
$5,762.62 |
| Max. Negotiated Rate |
$6,373.74 |
| Rate for Payer: BCBS Complete |
$6,373.74
|
| Rate for Payer: Mclaren Medicaid |
$6,070.22
|
| Rate for Payer: Meridian Medicaid |
$6,373.74
|
| Rate for Payer: PHP Medicaid |
$5,762.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,070.22
|
| Rate for Payer: UHC Medicaid |
$6,070.22
|
| Rate for Payer: UHCCP Medicaid |
$6,070.22
|
|
|
MIGRAINE AND OTHER HEADACHES
|
Facility
|
IP
|
$4,020.64
|
|
|
Service Code
|
APR-DRG 0541
|
| Min. Negotiated Rate |
$3,635.14 |
| Max. Negotiated Rate |
$4,020.64 |
| Rate for Payer: BCBS Complete |
$4,020.64
|
| Rate for Payer: Mclaren Medicaid |
$3,829.18
|
| Rate for Payer: Meridian Medicaid |
$4,020.64
|
| Rate for Payer: PHP Medicaid |
$3,635.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,829.18
|
| Rate for Payer: UHC Medicaid |
$3,829.18
|
| Rate for Payer: UHCCP Medicaid |
$3,829.18
|
|
|
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 |
$52.63 |
| Max. Negotiated Rate |
$70.18 |
| Rate for Payer: Aetna Commercial |
$63.16
|
| Rate for Payer: ASR ASR |
$68.07
|
| Rate for Payer: BCBS Trust/PPO |
$57.63
|
| Rate for Payer: BCN Commercial |
$57.63
|
| 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 |
$68.07
|
| Rate for Payer: Healthscope Whirlpool |
$70.18
|
| 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: Opus (Opus Packaging Group) HMA |
$52.63
|
| 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 |
$1.12 |
| Max. Negotiated Rate |
$70.18 |
| Rate for Payer: Aetna Commercial |
$63.16
|
| Rate for Payer: Aetna Medicare |
$25.97
|
| Rate for Payer: ASR ASR |
$68.07
|
| Rate for Payer: BCBS Complete |
$28.07
|
| Rate for Payer: BCBS Trust/PPO |
$57.86
|
| Rate for Payer: BCN Commercial |
$57.86
|
| 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 |
$68.07
|
| Rate for Payer: Healthscope Whirlpool |
$70.18
|
| Rate for Payer: Mclaren Commercial |
$63.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.65
|
| Rate for Payer: Nomi Health Commercial |
$57.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.40
|
| Rate for Payer: Priority Health Narrow Network |
$1.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.76
|
|
|
MINERAL OIL ENEMA
|
Facility
|
OP
|
$46.88
|
|
|
Service Code
|
NDC 96295012753
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Aetna Commercial |
$42.19
|
| Rate for Payer: Aetna Medicare |
$17.35
|
| Rate for Payer: ASR ASR |
$45.48
|
| Rate for Payer: BCBS Complete |
$18.75
|
| Rate for Payer: BCBS Trust/PPO |
$38.66
|
| Rate for Payer: BCN Commercial |
$38.66
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$44.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.51
|
| Rate for Payer: Healthscope Commercial |
$45.48
|
| Rate for Payer: Healthscope Whirlpool |
$46.88
|
| Rate for Payer: Mclaren Commercial |
$42.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.85
|
| Rate for Payer: Nomi Health Commercial |
$38.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.16
|
| Rate for Payer: Priority Health Cigna 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 |
$41.26
|
|
|
MINERAL OIL ENEMA
|
Facility
|
IP
|
$46.88
|
|
|
Service Code
|
NDC 96295012753
|
| Hospital Charge Code |
5087
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Aetna Commercial |
$42.19
|
| Rate for Payer: ASR ASR |
$45.48
|
| Rate for Payer: BCBS Trust/PPO |
$38.50
|
| Rate for Payer: BCN Commercial |
$38.50
|
| Rate for Payer: Cash Price |
$37.51
|
| Rate for Payer: Cofinity Commercial |
$44.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$37.51
|
| Rate for Payer: Healthscope Commercial |
$45.48
|
| Rate for Payer: Healthscope Whirlpool |
$46.88
|
| 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: Opus (Opus Packaging Group) HMA |
$35.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$41.26
|
|
|
MINERAL OIL ORAL
|
Facility
|
IP
|
$9.32
|
|
|
Service Code
|
NDC 48433020230
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$9.32 |
| Rate for Payer: Aetna Commercial |
$8.39
|
| Rate for Payer: ASR ASR |
$9.04
|
| Rate for Payer: BCBS Trust/PPO |
$7.66
|
| Rate for Payer: BCN Commercial |
$7.66
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$8.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.46
|
| Rate for Payer: Healthscope Commercial |
$9.04
|
| Rate for Payer: Healthscope Whirlpool |
$9.32
|
| Rate for Payer: Mclaren Commercial |
$8.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.93
|
| Rate for Payer: Nomi Health Commercial |
$7.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.21
|
|
|
MINERAL OIL ORAL
|
Facility
|
OP
|
$9.32
|
|
|
Service Code
|
NDC 48433020230
|
| Hospital Charge Code |
5086
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$9.32 |
| Rate for Payer: Aetna Commercial |
$8.39
|
| Rate for Payer: Aetna Medicare |
$3.45
|
| Rate for Payer: ASR ASR |
$9.04
|
| Rate for Payer: BCBS Complete |
$3.73
|
| Rate for Payer: BCBS Trust/PPO |
$7.69
|
| Rate for Payer: BCN Commercial |
$7.69
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$8.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.46
|
| Rate for Payer: Healthscope Commercial |
$9.04
|
| Rate for Payer: Healthscope Whirlpool |
$9.32
|
| Rate for Payer: Mclaren Commercial |
$8.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.93
|
| Rate for Payer: Nomi Health Commercial |
$7.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.17
|
| Rate for Payer: Priority Health Narrow Network |
$6.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.21
|
|
|
MINOR BLADDER PROCEDURES WITH CC
|
Facility
|
IP
|
$20,885.72
|
|
|
Service Code
|
MSDRG 663
|
| Min. Negotiated Rate |
$12,066.70 |
| Max. Negotiated Rate |
$20,885.72 |
| Rate for Payer: Aetna Medicare |
$12,701.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,877.24
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,877.24
|
| Rate for Payer: BCBS MAPPO |
$12,701.79
|
| Rate for Payer: BCN Medicare Advantage |
$12,701.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,701.79
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,701.79
|
| Rate for Payer: Mclaren Medicare |
$12,701.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13,336.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,607.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$13,971.97
|
| Rate for Payer: PACE Medicare |
$12,066.70
|
| Rate for Payer: PACE SWMI |
$12,701.79
|
| Rate for Payer: PHP Commercial |
$13,971.97
|
| Rate for Payer: PHP Medicare Advantage |
$12,701.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20,885.72
|
| Rate for Payer: Priority Health Medicare |
$12,701.79
|
| Rate for Payer: Priority Health Narrow Network |
$16,708.58
|
| Rate for Payer: Railroad Medicare Medicare |
$12,701.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$12,701.79
|
| Rate for Payer: UHC Exchange |
$19,687.77
|
| Rate for Payer: UHCCP DNSP |
$12,701.79
|
| Rate for Payer: VA VA |
$12,701.79
|
|
