|
MIDAZOLAM 5 MG/ML INJECTION. [40810608]
|
Facility
|
OP
|
$3.64
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
1758498
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.18
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.43
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.50
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.83
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.83
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.18
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.50
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.43
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.83
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.43
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.04
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.73
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.62
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.54
|
|
|
MIDAZOLAM 5 MG/ML INJECTION. [40810608]
|
Facility
|
OP
|
$1.27
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
1737045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.76
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.76
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.95
|
|
|
MIDAZOLAM 5 MG/ML INJECTION. [40810608]
|
Facility
|
IP
|
$1.54
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
1730185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.23
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.16
|
|
|
MIDAZOLAM 5 MG/ML INJECTION. [40810608]
|
Facility
|
OP
|
$1.54
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
1730185
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.92
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.92
|
| Rate for Payer: Cash Price |
$0.69
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.85
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.16
|
|
|
MIDAZOLAM 5 MG/ML INJECTION SOLUTION [10608]
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
1758498
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.54 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.43
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.43
|
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.54
|
|
|
MIDAZOLAM 5 MG/ML INJECTION SOLUTION [10608]
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
1758498
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Cash Price |
$0.32
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.58
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.54
|
|
|
MIDAZOLAM 5 MG/ML INTRANASAL (KIT) WITH A MUCOSAL ATOMIZER (MAD) DEVICE [4081775]
|
Facility
|
IP
|
$0.73
|
|
|
Service Code
|
NDC 9994-1817-75
|
| Hospital Charge Code |
NDC4081775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.58 |
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.58
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.55
|
|
|
MIDAZOLAM 5 MG/ML INTRANASAL (KIT) WITH A MUCOSAL ATOMIZER (MAD) DEVICE [4081775]
|
Facility
|
OP
|
$0.73
|
|
|
Service Code
|
NDC 9994-1817-75
|
| Hospital Charge Code |
NDC4081775
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.44
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.44
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.55
|
|
|
MIDAZOLAM CONTINUOUS INFUSION (STRAIGHT DRUG) 5 MG/ML [4081034]
|
Facility
|
OP
|
$0.83
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
1758498
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.62 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.50
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.18
|
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.54
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.50
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.18
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.54
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.50
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.18
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.68
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.62
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.73
|
|
|
MIDAZOLAM CONTINUOUS INFUSION (STRAIGHT DRUG) 5 MG/ML [4081034]
|
Facility
|
OP
|
$3.38
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
1737042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$2.54 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$2.03
|
| Rate for Payer: Aetna of CA Government/Medicare |
$2.03
|
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.54
|
|
|
MIDAZOLAM CONTINUOUS INFUSION (STRAIGHT DRUG) 5 MG/ML [4081034]
|
Facility
|
IP
|
$3.38
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
1737042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$2.70 |
| Rate for Payer: Cash Price |
$1.52
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.70
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.86
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.54
|
|
|
MIDAZOLAM CONTINUOUS INFUSION (STRAIGHT DRUG) 5 MG/ML [4081034]
|
Facility
|
IP
|
$3.64
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
1758498
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cash Price |
$0.37
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.72
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2.91
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.66
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.50
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.54
|
| Rate for Payer: Health Smart Auto/Commercial |
$2.18
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.46
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.62
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.68
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$2.73
|
|
|
MIDAZOLAM (PF) 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [211683]
|
Facility
|
OP
|
$0.36
|
|
|
Service Code
|
CPT J2251
|
| Hospital Charge Code |
NDC211683
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.22
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.22
|
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.27
|
|
|
MIDAZOLAM (PF) 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLUTION [211683]
|
Facility
|
IP
|
$0.36
|
|
|
Service Code
|
CPT J2251
|
| Hospital Charge Code |
NDC211683
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.29 |
| Rate for Payer: Cash Price |
$0.16
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.29
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.27
|
|
|
MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION [204177]
|
Facility
|
IP
|
$0.59
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
1737056
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.47 |
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.47
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.44
|
|
|
MIDAZOLAM (PF) 1 MG/ML INJECTION SOLUTION [204177]
|
Facility
|
OP
|
$0.59
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
1737056
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.35
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.35
|
| Rate for Payer: Cash Price |
$0.27
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.32
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.44
|
|
|
MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION [204176]
|
Facility
|
IP
|
$1.27
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
1737045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$1.02 |
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.02
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.95
|
|
|
MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION [204176]
|
Facility
|
OP
|
$0.74
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
1737042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.44
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.44
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.56
|
|
|
MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION [204176]
|
Facility
|
OP
|
$1.27
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
1737045
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.76
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.76
|
| Rate for Payer: Cash Price |
$0.57
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.70
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.95
|
|
|
MIDAZOLAM (PF) 5 MG/ML INJECTION SOLUTION [204176]
|
Facility
|
IP
|
$0.74
|
|
|
Service Code
|
CPT J2250
|
| Hospital Charge Code |
1737042
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.59
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.56
|
|
|
MIDODRINE 10 MG TABLET [33083]
|
Facility
|
OP
|
$1.69
|
|
|
Service Code
|
NDC 60687-409-25
|
| Hospital Charge Code |
1711948
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$1.01
|
| Rate for Payer: Aetna of CA Government/Medicare |
$1.01
|
| Rate for Payer: Cash Price |
$0.76
|
| Rate for Payer: Health Smart Auto/Commercial |
$1.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.93
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.27
|
|
|
MIDODRINE 10 MG TABLET [33083]
|
Facility
|
OP
|
$1.50
|
|
|
Service Code
|
NDC 0245-0213-11
|
| Hospital Charge Code |
1711948
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.12 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.90
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.90
|
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.12
|
|
|
MIDODRINE 10 MG TABLET [33083]
|
Facility
|
IP
|
$0.90
|
|
|
Service Code
|
NDC 68382-739-01
|
| Hospital Charge Code |
1711948
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Cigna of CA HMO/PPO |
$0.72
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.68
|
|
|
MIDODRINE 10 MG TABLET [33083]
|
Facility
|
OP
|
$0.90
|
|
|
Service Code
|
NDC 68382-739-01
|
| Hospital Charge Code |
1711948
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.68 |
| Rate for Payer: Aetna of CA EPO/HMO/POS/PPO |
$0.54
|
| Rate for Payer: Aetna of CA Government/Medicare |
$0.54
|
| Rate for Payer: Cash Price |
$0.41
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage |
$0.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.50
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$0.68
|
|
|
MIDODRINE 10 MG TABLET [33083]
|
Facility
|
IP
|
$1.50
|
|
|
Service Code
|
NDC 0245-0213-11
|
| Hospital Charge Code |
1711948
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Cash Price |
$0.68
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1.20
|
| Rate for Payer: Health Smart Auto/Commercial |
$0.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.83
|
| Rate for Payer: Multiplan Beech St/Commercial/PHCS |
$1.12
|
|
