|
METOLAZONE 2.5 MG ORAL TAB
|
Facility
|
IP
|
$19.59
|
|
|
Service Code
|
NDC 51079002320
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$18.21 |
| Rate for Payer: Aetna Commercial |
$16.92
|
| Rate for Payer: Cash Price |
$11.75
|
| Rate for Payer: Cigna All Commercial |
$16.90
|
| Rate for Payer: CORVEL All Commercial |
$18.21
|
| Rate for Payer: Coventry All Commercial |
$17.24
|
| Rate for Payer: Encore All Commercial |
$18.03
|
| Rate for Payer: Frontpath All Commercial |
$18.02
|
| Rate for Payer: Humana ChoiceCare |
$16.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.63
|
| Rate for Payer: PHCS All Commercial |
$14.69
|
| Rate for Payer: PHP All Commercial |
$14.85
|
| Rate for Payer: Sagamore Health Network All Products |
$15.12
|
| Rate for Payer: Signature Care EPO |
$16.26
|
| Rate for Payer: Signature Care PPO |
$17.24
|
| Rate for Payer: United Healthcare Commercial |
$15.43
|
|
|
METOPROLOL SUCCINATE 25 MG ORAL TB24
|
Facility
|
IP
|
$2.85
|
|
|
Service Code
|
NDC 00904632261
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna Commercial |
$2.46
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cigna All Commercial |
$2.46
|
| Rate for Payer: CORVEL All Commercial |
$2.65
|
| Rate for Payer: Coventry All Commercial |
$2.51
|
| Rate for Payer: Encore All Commercial |
$2.62
|
| Rate for Payer: Frontpath All Commercial |
$2.62
|
| Rate for Payer: Humana ChoiceCare |
$2.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.56
|
| Rate for Payer: PHCS All Commercial |
$2.14
|
| Rate for Payer: PHP All Commercial |
$2.16
|
| Rate for Payer: Sagamore Health Network All Products |
$2.20
|
| Rate for Payer: Signature Care EPO |
$2.36
|
| Rate for Payer: Signature Care PPO |
$2.51
|
| Rate for Payer: United Healthcare Commercial |
$2.25
|
|
|
METOPROLOL SUCCINATE 25 MG ORAL TB24
|
Facility
|
OP
|
$2.85
|
|
|
Service Code
|
NDC 00904632261
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Aetna Commercial |
$2.40
|
| Rate for Payer: Aetna Medicare |
$0.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.00
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Centivo All Commercial |
$1.55
|
| Rate for Payer: Cigna All Commercial |
$2.46
|
| Rate for Payer: CORVEL All Commercial |
$2.65
|
| Rate for Payer: Coventry All Commercial |
$2.51
|
| Rate for Payer: Encore All Commercial |
$2.62
|
| Rate for Payer: Frontpath All Commercial |
$2.62
|
| Rate for Payer: Humana ChoiceCare |
$2.46
|
| Rate for Payer: Humana Medicare |
$0.91
|
| Rate for Payer: Lucent All Commercial |
$1.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.56
|
| Rate for Payer: PHCS All Commercial |
$2.14
|
| Rate for Payer: PHP All Commercial |
$2.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.11
|
| Rate for Payer: Sagamore Health Network All Products |
$2.20
|
| Rate for Payer: Signature Care EPO |
$2.36
|
| Rate for Payer: Signature Care PPO |
$2.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.42
|
| Rate for Payer: United Healthcare Commercial |
$2.25
|
| Rate for Payer: United Healthcare Medicare |
$0.91
|
|
|
METOPROLOL SUCCINATE 50 MG ORAL TB24
|
Facility
|
OP
|
$3.23
|
|
|
Service Code
|
NDC 00904632361
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna Commercial |
$2.72
|
| Rate for Payer: Aetna Medicare |
$1.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.14
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Centivo All Commercial |
$1.76
|
| Rate for Payer: Cigna All Commercial |
$2.78
|
| Rate for Payer: CORVEL All Commercial |
$3.00
|
| Rate for Payer: Coventry All Commercial |
$2.84
|
| Rate for Payer: Encore All Commercial |
$2.97
|
| Rate for Payer: Frontpath All Commercial |
$2.97
|
| Rate for Payer: Humana ChoiceCare |
$2.79
|
| Rate for Payer: Humana Medicare |
$1.03
|
| Rate for Payer: Lucent All Commercial |
$1.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.90
|
| Rate for Payer: PHCS All Commercial |
$2.42
|
| Rate for Payer: PHP All Commercial |
$2.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.26
|
| Rate for Payer: Sagamore Health Network All Products |
$2.49
|
| Rate for Payer: Signature Care EPO |
$2.68
|
| Rate for Payer: Signature Care PPO |
$2.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.74
|
| Rate for Payer: United Healthcare Commercial |
$2.54
|
| Rate for Payer: United Healthcare Medicare |
$1.03
|
|
|
METOPROLOL SUCCINATE 50 MG ORAL TB24
|
Facility
|
IP
|
$3.23
|
|
|
Service Code
|
NDC 00904632361
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna Commercial |
$2.79
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Cigna All Commercial |
$2.78
|
| Rate for Payer: CORVEL All Commercial |
$3.00
|
| Rate for Payer: Coventry All Commercial |
$2.84
|
| Rate for Payer: Encore All Commercial |
$2.97
|
| Rate for Payer: Frontpath All Commercial |
$2.97
|
| Rate for Payer: Humana ChoiceCare |
$2.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.90
|
| Rate for Payer: PHCS All Commercial |
$2.42
|
| Rate for Payer: PHP All Commercial |
$2.45
|
| Rate for Payer: Sagamore Health Network All Products |
$2.49
|
| Rate for Payer: Signature Care EPO |
$2.68
|
| Rate for Payer: Signature Care PPO |
$2.84
|
| Rate for Payer: United Healthcare Commercial |
$2.54
|
|
|
METOPROLOL TARTRATE 25 MG ORAL TAB
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 51079025520
|
| Hospital Charge Code |
37637
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare |
$0.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.35
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Centivo All Commercial |
$0.54
|
| Rate for Payer: Cigna All Commercial |
$0.86
|
| Rate for Payer: CORVEL All Commercial |
$0.93
|
| Rate for Payer: Coventry All Commercial |
$0.88
|
| Rate for Payer: Encore All Commercial |
$0.92
|
| Rate for Payer: Frontpath All Commercial |
$0.92
|
| Rate for Payer: Humana ChoiceCare |
$0.86
|
| Rate for Payer: Humana Medicare |
$0.32
|
| Rate for Payer: Lucent All Commercial |
$0.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.90
|
| Rate for Payer: PHCS All Commercial |
$0.75
|
| Rate for Payer: PHP All Commercial |
$0.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.39
|
| Rate for Payer: Sagamore Health Network All Products |
$0.77
|
| Rate for Payer: Signature Care EPO |
$0.83
|
| Rate for Payer: Signature Care PPO |
$0.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
| Rate for Payer: United Healthcare Medicare |
$0.32
|
|
|
METOPROLOL TARTRATE 25 MG ORAL TAB
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 51079025520
|
| Hospital Charge Code |
37637
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna All Commercial |
$0.86
|
| Rate for Payer: CORVEL All Commercial |
$0.93
|
| Rate for Payer: Coventry All Commercial |
$0.88
|
| Rate for Payer: Encore All Commercial |
$0.92
|
| Rate for Payer: Frontpath All Commercial |
$0.92
|
| Rate for Payer: Humana ChoiceCare |
$0.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.90
|
| Rate for Payer: PHCS All Commercial |
$0.75
|
| Rate for Payer: PHP All Commercial |
$0.76
|
| Rate for Payer: Sagamore Health Network All Products |
$0.77
|
| Rate for Payer: Signature Care EPO |
$0.83
|
| Rate for Payer: Signature Care PPO |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
|
|
METOPROLOL TARTRATE 50 MG ORAL TAB
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 51079080120
|
| Hospital Charge Code |
5009
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna All Commercial |
$0.86
|
| Rate for Payer: CORVEL All Commercial |
$0.93
|
| Rate for Payer: Coventry All Commercial |
$0.88
|
| Rate for Payer: Encore All Commercial |
$0.92
|
| Rate for Payer: Frontpath All Commercial |
$0.92
|
| Rate for Payer: Humana ChoiceCare |
$0.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.90
|
| Rate for Payer: PHCS All Commercial |
$0.75
|
| Rate for Payer: PHP All Commercial |
$0.76
|
| Rate for Payer: Sagamore Health Network All Products |
$0.77
|
| Rate for Payer: Signature Care EPO |
$0.83
|
| Rate for Payer: Signature Care PPO |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
|
|
METOPROLOL TARTRATE 50 MG ORAL TAB
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 51079080120
|
| Hospital Charge Code |
5009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare |
$0.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.35
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Centivo All Commercial |
$0.54
|
| Rate for Payer: Cigna All Commercial |
$0.86
|
| Rate for Payer: CORVEL All Commercial |
$0.93
|
| Rate for Payer: Coventry All Commercial |
$0.88
|
| Rate for Payer: Encore All Commercial |
$0.92
|
| Rate for Payer: Frontpath All Commercial |
$0.92
|
| Rate for Payer: Humana ChoiceCare |
$0.86
|
| Rate for Payer: Humana Medicare |
$0.32
|
| Rate for Payer: Lucent All Commercial |
$0.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.90
|
| Rate for Payer: PHCS All Commercial |
$0.75
|
| Rate for Payer: PHP All Commercial |
$0.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.39
|
| Rate for Payer: Sagamore Health Network All Products |
$0.77
|
| Rate for Payer: Signature Care EPO |
$0.83
|
| Rate for Payer: Signature Care PPO |
$0.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
| Rate for Payer: United Healthcare Medicare |
$0.32
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J0616
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.34
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Centivo All Commercial |
$9.79
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$5.76
|
| Rate for Payer: Lucent All Commercial |
$9.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.76
|
|
|
METOPROLOL TARTRATE 5 MG/5 ML IV SOLN
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J0616
|
| Hospital Charge Code |
5007
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
METRONIDAZOLE 250 MG ORAL TAB
|
Facility
|
IP
|
$1.95
|
|
|
Service Code
|
NDC 00904715661
|
| Hospital Charge Code |
5015
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna Commercial |
$1.69
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna All Commercial |
$1.69
|
| Rate for Payer: CORVEL All Commercial |
$1.82
|
| Rate for Payer: Coventry All Commercial |
$1.72
|
| Rate for Payer: Encore All Commercial |
$1.80
|
| Rate for Payer: Frontpath All Commercial |
$1.80
|
| Rate for Payer: Humana ChoiceCare |
$1.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.76
|
| Rate for Payer: PHCS All Commercial |
$1.46
|
| Rate for Payer: PHP All Commercial |
$1.48
|
| Rate for Payer: Sagamore Health Network All Products |
$1.51
|
| Rate for Payer: Signature Care EPO |
$1.62
|
| Rate for Payer: Signature Care PPO |
$1.72
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
|
|
METRONIDAZOLE 250 MG ORAL TAB
|
Facility
|
OP
|
$1.95
|
|
|
Service Code
|
NDC 00904715661
|
| Hospital Charge Code |
5015
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$1.82 |
| Rate for Payer: Aetna Commercial |
$1.65
|
| Rate for Payer: Aetna Medicare |
$0.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.69
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Centivo All Commercial |
$1.06
|
| Rate for Payer: Cigna All Commercial |
$1.69
|
| Rate for Payer: CORVEL All Commercial |
$1.82
|
| Rate for Payer: Coventry All Commercial |
$1.72
|
| Rate for Payer: Encore All Commercial |
$1.80
|
| Rate for Payer: Frontpath All Commercial |
$1.80
|
| Rate for Payer: Humana ChoiceCare |
$1.69
|
| Rate for Payer: Humana Medicare |
$0.62
|
| Rate for Payer: Lucent All Commercial |
$1.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.76
|
| Rate for Payer: PHCS All Commercial |
$1.46
|
| Rate for Payer: PHP All Commercial |
$1.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.76
|
| Rate for Payer: Sagamore Health Network All Products |
$1.51
|
| Rate for Payer: Signature Care EPO |
$1.62
|
| Rate for Payer: Signature Care PPO |
$1.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.66
|
| Rate for Payer: United Healthcare Commercial |
$1.54
|
| Rate for Payer: United Healthcare Medicare |
$0.62
|
|
|
METRONIDAZOLE 500 MG ORAL TAB
|
Facility
|
OP
|
$3.44
|
|
|
Service Code
|
NDC 00904712661
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: Aetna Medicare |
$1.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.21
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Centivo All Commercial |
$1.87
|
| Rate for Payer: Cigna All Commercial |
$2.97
|
| Rate for Payer: CORVEL All Commercial |
$3.20
|
| Rate for Payer: Coventry All Commercial |
$3.02
|
| Rate for Payer: Encore All Commercial |
$3.16
|
| Rate for Payer: Frontpath All Commercial |
$3.16
|
| Rate for Payer: Humana ChoiceCare |
$2.97
|
| Rate for Payer: Humana Medicare |
$1.10
|
| Rate for Payer: Lucent All Commercial |
$1.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.09
|
| Rate for Payer: PHCS All Commercial |
$2.58
|
| Rate for Payer: PHP All Commercial |
$2.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.34
|
| Rate for Payer: Sagamore Health Network All Products |
$2.65
|
| Rate for Payer: Signature Care EPO |
$2.85
|
| Rate for Payer: Signature Care PPO |
$3.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.92
|
| Rate for Payer: United Healthcare Commercial |
$2.71
|
| Rate for Payer: United Healthcare Medicare |
$1.10
|
|
|
METRONIDAZOLE 500 MG ORAL TAB
|
Facility
|
IP
|
$3.44
|
|
|
Service Code
|
NDC 00904712661
|
| Hospital Charge Code |
5016
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.58 |
| Max. Negotiated Rate |
$3.20 |
| Rate for Payer: Aetna Commercial |
$2.97
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cigna All Commercial |
$2.97
|
| Rate for Payer: CORVEL All Commercial |
$3.20
|
| Rate for Payer: Coventry All Commercial |
$3.02
|
| Rate for Payer: Encore All Commercial |
$3.16
|
| Rate for Payer: Frontpath All Commercial |
$3.16
|
| Rate for Payer: Humana ChoiceCare |
$2.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.09
|
| Rate for Payer: PHCS All Commercial |
$2.58
|
| Rate for Payer: PHP All Commercial |
$2.61
|
| Rate for Payer: Sagamore Health Network All Products |
$2.65
|
| Rate for Payer: Signature Care EPO |
$2.85
|
| Rate for Payer: Signature Care PPO |
$3.02
|
| Rate for Payer: United Healthcare Commercial |
$2.71
|
|
|
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
5018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J1836
|
| Hospital Charge Code |
5018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.34
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Centivo All Commercial |
$9.79
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$5.76
|
| Rate for Payer: Lucent All Commercial |
$9.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.76
|
|
|
MICAFUNGIN 100 MG IV SOLR
|
Facility
|
IP
|
$157.15
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
77685
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$117.86 |
| Max. Negotiated Rate |
$146.15 |
| Rate for Payer: Aetna Commercial |
$135.78
|
| Rate for Payer: Aetna Commercial |
$135.51
|
| Rate for Payer: Cash Price |
$94.29
|
| Rate for Payer: Cash Price |
$94.11
|
| Rate for Payer: Cigna All Commercial |
$135.62
|
| Rate for Payer: Cigna All Commercial |
$135.35
|
| Rate for Payer: CORVEL All Commercial |
$145.86
|
| Rate for Payer: CORVEL All Commercial |
$146.15
|
| Rate for Payer: Coventry All Commercial |
$138.02
|
| Rate for Payer: Coventry All Commercial |
$138.29
|
| Rate for Payer: Encore All Commercial |
$144.66
|
| Rate for Payer: Encore All Commercial |
$144.37
|
| Rate for Payer: Frontpath All Commercial |
$144.29
|
| Rate for Payer: Frontpath All Commercial |
$144.58
|
| Rate for Payer: Humana ChoiceCare |
$135.73
|
| Rate for Payer: Humana ChoiceCare |
$135.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$141.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$141.16
|
| Rate for Payer: PHCS All Commercial |
$117.63
|
| Rate for Payer: PHCS All Commercial |
$117.86
|
| Rate for Payer: PHP All Commercial |
$118.95
|
| Rate for Payer: PHP All Commercial |
$119.18
|
| Rate for Payer: Sagamore Health Network All Products |
$121.08
|
| Rate for Payer: Sagamore Health Network All Products |
$121.32
|
| Rate for Payer: Signature Care EPO |
$130.18
|
| Rate for Payer: Signature Care EPO |
$130.43
|
| Rate for Payer: Signature Care PPO |
$138.29
|
| Rate for Payer: Signature Care PPO |
$138.02
|
| Rate for Payer: United Healthcare Commercial |
$123.59
|
| Rate for Payer: United Healthcare Commercial |
$123.83
|
|
|
MICAFUNGIN 100 MG IV SOLR
|
Facility
|
OP
|
$157.15
|
|
|
Service Code
|
HCPCS J2248
|
| Hospital Charge Code |
77685
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$146.15 |
| Rate for Payer: Aetna Commercial |
$132.63
|
| Rate for Payer: Aetna Commercial |
$132.37
|
| Rate for Payer: Aetna Medicare |
$50.29
|
| Rate for Payer: Aetna Medicare |
$50.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$0.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$0.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$90.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$90.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$98.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$98.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$0.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$0.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.21
|
| Rate for Payer: Cash Price |
$94.29
|
| Rate for Payer: Cash Price |
$94.11
|
| Rate for Payer: Cash Price |
$94.11
|
| Rate for Payer: Cash Price |
$94.29
|
| Rate for Payer: Centivo All Commercial |
$85.32
|
| Rate for Payer: Centivo All Commercial |
$85.49
|
| Rate for Payer: Cigna All Commercial |
$135.62
|
| Rate for Payer: Cigna All Commercial |
$135.35
|
| Rate for Payer: CORVEL All Commercial |
$146.15
|
| Rate for Payer: CORVEL All Commercial |
$145.86
|
| Rate for Payer: Coventry All Commercial |
$138.29
|
| Rate for Payer: Coventry All Commercial |
$138.02
|
| Rate for Payer: Encore All Commercial |
$144.66
|
| Rate for Payer: Encore All Commercial |
$144.37
|
| Rate for Payer: Frontpath All Commercial |
$144.29
|
| Rate for Payer: Frontpath All Commercial |
$144.58
|
| Rate for Payer: Humana ChoiceCare |
$135.73
|
| Rate for Payer: Humana ChoiceCare |
$135.46
|
| Rate for Payer: Humana Medicare |
$50.19
|
| Rate for Payer: Humana Medicare |
$50.29
|
| Rate for Payer: Lucent All Commercial |
$85.49
|
| Rate for Payer: Lucent All Commercial |
$85.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$141.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$141.16
|
| Rate for Payer: Managed Health Services Medicaid |
$0.37
|
| Rate for Payer: Managed Health Services Medicaid |
$0.37
|
| Rate for Payer: MDWise Medicaid |
$0.37
|
| Rate for Payer: MDWise Medicaid |
$0.37
|
| Rate for Payer: PHCS All Commercial |
$117.63
|
| Rate for Payer: PHCS All Commercial |
$117.86
|
| Rate for Payer: PHP All Commercial |
$119.18
|
| Rate for Payer: PHP All Commercial |
$118.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.29
|
| Rate for Payer: Sagamore Health Network All Products |
$121.08
|
| Rate for Payer: Sagamore Health Network All Products |
$121.32
|
| Rate for Payer: Signature Care EPO |
$130.43
|
| Rate for Payer: Signature Care EPO |
$130.18
|
| Rate for Payer: Signature Care PPO |
$138.02
|
| Rate for Payer: Signature Care PPO |
$138.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$133.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$133.32
|
| Rate for Payer: United Healthcare Commercial |
$123.59
|
| Rate for Payer: United Healthcare Commercial |
$123.83
|
| Rate for Payer: United Healthcare Medicare |
$50.19
|
| Rate for Payer: United Healthcare Medicare |
$50.29
|
|
|
MIDAZOLAM 1 MG/ML INJ SOLN
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
93519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.34
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Centivo All Commercial |
$9.79
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$5.76
|
| Rate for Payer: Lucent All Commercial |
$9.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.76
|
|
|
MIDAZOLAM 1 MG/ML INJ SOLN
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
93519
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
MIDAZOLAM 5 MG/ML INJ SOLN
|
Facility
|
OP
|
$45.22
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.02 |
| Max. Negotiated Rate |
$42.05 |
| Rate for Payer: Aetna Commercial |
$38.17
|
| Rate for Payer: Aetna Commercial |
$18.00
|
| Rate for Payer: Aetna Medicare |
$6.83
|
| Rate for Payer: Aetna Medicare |
$14.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.92
|
| Rate for Payer: Cash Price |
$27.13
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Centivo All Commercial |
$24.60
|
| Rate for Payer: Centivo All Commercial |
$11.60
|
| Rate for Payer: Cigna All Commercial |
$18.41
|
| Rate for Payer: Cigna All Commercial |
$39.02
|
| Rate for Payer: CORVEL All Commercial |
$19.84
|
| Rate for Payer: CORVEL All Commercial |
$42.05
|
| Rate for Payer: Coventry All Commercial |
$18.77
|
| Rate for Payer: Coventry All Commercial |
$39.79
|
| Rate for Payer: Encore All Commercial |
$19.63
|
| Rate for Payer: Encore All Commercial |
$41.63
|
| Rate for Payer: Frontpath All Commercial |
$41.60
|
| Rate for Payer: Frontpath All Commercial |
$19.62
|
| Rate for Payer: Humana ChoiceCare |
$39.06
|
| Rate for Payer: Humana ChoiceCare |
$18.42
|
| Rate for Payer: Humana Medicare |
$14.47
|
| Rate for Payer: Humana Medicare |
$6.83
|
| Rate for Payer: Lucent All Commercial |
$11.60
|
| Rate for Payer: Lucent All Commercial |
$24.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.20
|
| Rate for Payer: PHCS All Commercial |
$33.91
|
| Rate for Payer: PHCS All Commercial |
$16.00
|
| Rate for Payer: PHP All Commercial |
$16.18
|
| Rate for Payer: PHP All Commercial |
$34.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.64
|
| Rate for Payer: Sagamore Health Network All Products |
$16.47
|
| Rate for Payer: Sagamore Health Network All Products |
$34.91
|
| Rate for Payer: Signature Care EPO |
$37.53
|
| Rate for Payer: Signature Care EPO |
$17.70
|
| Rate for Payer: Signature Care PPO |
$18.77
|
| Rate for Payer: Signature Care PPO |
$39.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$38.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.13
|
| Rate for Payer: United Healthcare Commercial |
$16.81
|
| Rate for Payer: United Healthcare Commercial |
$35.63
|
| Rate for Payer: United Healthcare Medicare |
$6.83
|
| Rate for Payer: United Healthcare Medicare |
$14.47
|
|
|
MIDAZOLAM 5 MG/ML INJ SOLN
|
Facility
|
IP
|
$45.22
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
10608
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.91 |
| Max. Negotiated Rate |
$42.05 |
| Rate for Payer: Aetna Commercial |
$39.07
|
| Rate for Payer: Aetna Commercial |
$18.43
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$27.13
|
| Rate for Payer: Cigna All Commercial |
$18.41
|
| Rate for Payer: Cigna All Commercial |
$39.02
|
| Rate for Payer: CORVEL All Commercial |
$19.84
|
| Rate for Payer: CORVEL All Commercial |
$42.05
|
| Rate for Payer: Coventry All Commercial |
$39.79
|
| Rate for Payer: Coventry All Commercial |
$18.77
|
| Rate for Payer: Encore All Commercial |
$41.63
|
| Rate for Payer: Encore All Commercial |
$19.63
|
| Rate for Payer: Frontpath All Commercial |
$19.62
|
| Rate for Payer: Frontpath All Commercial |
$41.60
|
| Rate for Payer: Humana ChoiceCare |
$18.42
|
| Rate for Payer: Humana ChoiceCare |
$39.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.70
|
| Rate for Payer: PHCS All Commercial |
$33.91
|
| Rate for Payer: PHCS All Commercial |
$16.00
|
| Rate for Payer: PHP All Commercial |
$16.18
|
| Rate for Payer: PHP All Commercial |
$34.29
|
| Rate for Payer: Sagamore Health Network All Products |
$34.91
|
| Rate for Payer: Sagamore Health Network All Products |
$16.47
|
| Rate for Payer: Signature Care EPO |
$37.53
|
| Rate for Payer: Signature Care EPO |
$17.70
|
| Rate for Payer: Signature Care PPO |
$18.77
|
| Rate for Payer: Signature Care PPO |
$39.79
|
| Rate for Payer: United Healthcare Commercial |
$16.81
|
| Rate for Payer: United Healthcare Commercial |
$35.63
|
|
|
MIDAZOLAM 5 MG/ML INJ SOLN S.O.
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
14010608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.34
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Centivo All Commercial |
$9.79
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$5.76
|
| Rate for Payer: Lucent All Commercial |
$9.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.76
|
|
|
MIDAZOLAM 5 MG/ML INJ SOLN S.O.
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2250
|
| Hospital Charge Code |
14010608
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
