|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$67.27
|
|
|
Service Code
|
NDC 16729023993
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$60.54 |
| Rate for Payer: Aetna Commercial |
$57.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.73
|
| Rate for Payer: Cash Price |
$53.82
|
| Rate for Payer: Cofinity Advantage |
$47.09
|
| Rate for Payer: Cofinity Commercial |
$57.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.82
|
| Rate for Payer: Healthscope Commercial |
$60.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.45
|
| Rate for Payer: PHP Commercial |
$57.18
|
| Rate for Payer: Priority Health SBD |
$42.38
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$102.38
|
|
|
Service Code
|
NDC 70121138907
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.24 |
| Max. Negotiated Rate |
$92.14 |
| Rate for Payer: Aetna Commercial |
$87.02
|
| Rate for Payer: Aetna Medicare |
$51.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.55
|
| Rate for Payer: BCBS Complete |
$40.95
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cofinity Advantage |
$71.67
|
| Rate for Payer: Cofinity Commercial |
$88.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.90
|
| Rate for Payer: Healthscope Commercial |
$92.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.78
|
| Rate for Payer: PHP Commercial |
$87.02
|
| Rate for Payer: Priority Health SBD |
$64.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.55
|
| Rate for Payer: UHC Core |
$53.34
|
| Rate for Payer: UHC Exchange |
$40.24
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$90.86
|
|
|
Service Code
|
NDC 70121171201
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.71 |
| Max. Negotiated Rate |
$81.77 |
| Rate for Payer: Aetna Commercial |
$77.23
|
| Rate for Payer: Aetna Medicare |
$45.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.06
|
| Rate for Payer: BCBS Complete |
$36.34
|
| Rate for Payer: Cash Price |
$72.69
|
| Rate for Payer: Cofinity Advantage |
$63.60
|
| Rate for Payer: Cofinity Commercial |
$78.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.69
|
| Rate for Payer: Healthscope Commercial |
$81.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.14
|
| Rate for Payer: PHP Commercial |
$77.23
|
| Rate for Payer: Priority Health SBD |
$57.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.06
|
| Rate for Payer: UHC Core |
$47.34
|
| Rate for Payer: UHC Exchange |
$35.71
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$102.38
|
|
|
Service Code
|
NDC 70121138901
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$92.14 |
| Rate for Payer: Aetna Commercial |
$87.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.55
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cofinity Advantage |
$71.67
|
| Rate for Payer: Cofinity Commercial |
$88.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.90
|
| Rate for Payer: Healthscope Commercial |
$92.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.78
|
| Rate for Payer: PHP Commercial |
$87.02
|
| Rate for Payer: Priority Health SBD |
$64.50
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$89.32
|
|
|
Service Code
|
NDC 09900001136
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.10 |
| Max. Negotiated Rate |
$80.39 |
| Rate for Payer: Aetna Commercial |
$75.92
|
| Rate for Payer: Aetna Medicare |
$44.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.06
|
| Rate for Payer: BCBS Complete |
$35.73
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cofinity Advantage |
$62.52
|
| Rate for Payer: Cofinity Commercial |
$76.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.46
|
| Rate for Payer: Healthscope Commercial |
$80.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.99
|
| Rate for Payer: PHP Commercial |
$75.92
|
| Rate for Payer: Priority Health SBD |
$56.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.06
|
| Rate for Payer: UHC Core |
$46.54
|
| Rate for Payer: UHC Exchange |
$35.10
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$115.67
|
|
|
Service Code
|
NDC 55150029701
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.87 |
| Max. Negotiated Rate |
$104.10 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.19
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cofinity Advantage |
$80.97
|
| Rate for Payer: Cofinity Commercial |
$99.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.54
|
| Rate for Payer: Healthscope Commercial |
$104.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.75
|
| Rate for Payer: PHP Commercial |
$98.32
|
| Rate for Payer: Priority Health SBD |
$72.87
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$90.86
|
|
|
Service Code
|
NDC 70121171201
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.24 |
| Max. Negotiated Rate |
$81.77 |
| Rate for Payer: Aetna Commercial |
$77.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.06
|
| Rate for Payer: Cash Price |
$72.69
|
| Rate for Payer: Cofinity Advantage |
$63.60
|
| Rate for Payer: Cofinity Commercial |
$78.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.69
|
| Rate for Payer: Healthscope Commercial |
$81.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.14
|
| Rate for Payer: PHP Commercial |
$77.23
|
| Rate for Payer: Priority Health SBD |
$57.24
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$102.38
|
|
|
Service Code
|
NDC 70121138901
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.24 |
| Max. Negotiated Rate |
$92.14 |
| Rate for Payer: Aetna Commercial |
$87.02
|
| Rate for Payer: Aetna Medicare |
$51.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.55
|
| Rate for Payer: BCBS Complete |
$40.95
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cofinity Advantage |
$71.67
|
| Rate for Payer: Cofinity Commercial |
$88.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.90
|
| Rate for Payer: Healthscope Commercial |
$92.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$81.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.78
|
| Rate for Payer: PHP Commercial |
$87.02
|
| Rate for Payer: Priority Health SBD |
$64.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.55
|
| Rate for Payer: UHC Core |
$53.34
|
| Rate for Payer: UHC Exchange |
$40.24
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$115.67
|
|
|
Service Code
|
NDC 55150029710
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$72.87 |
| Max. Negotiated Rate |
$104.10 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.19
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cofinity Advantage |
$80.97
|
| Rate for Payer: Cofinity Commercial |
$99.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.54
|
| Rate for Payer: Healthscope Commercial |
$104.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.75
|
| Rate for Payer: PHP Commercial |
$98.32
|
| Rate for Payer: Priority Health SBD |
$72.87
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$115.67
|
|
|
Service Code
|
NDC 55150029701
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.46 |
| Max. Negotiated Rate |
$104.10 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: Aetna Medicare |
$57.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.19
|
| Rate for Payer: BCBS Complete |
$46.27
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cofinity Advantage |
$80.97
|
| Rate for Payer: Cofinity Commercial |
$99.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.54
|
| Rate for Payer: Healthscope Commercial |
$104.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.75
|
| Rate for Payer: PHP Commercial |
$98.32
|
| Rate for Payer: Priority Health SBD |
$72.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.19
|
| Rate for Payer: UHC Core |
$60.26
|
| Rate for Payer: UHC Exchange |
$45.46
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$113.23
|
|
|
Service Code
|
NDC 00409166010
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.50 |
| Max. Negotiated Rate |
$101.91 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Aetna Medicare |
$56.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.60
|
| Rate for Payer: BCBS Complete |
$45.29
|
| Rate for Payer: Cash Price |
$90.58
|
| Rate for Payer: Cofinity Advantage |
$79.26
|
| Rate for Payer: Cofinity Commercial |
$97.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.58
|
| Rate for Payer: Healthscope Commercial |
$101.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.92
|
| Rate for Payer: PHP Commercial |
$96.25
|
| Rate for Payer: Priority Health SBD |
$71.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.60
|
| Rate for Payer: UHC Core |
$58.99
|
| Rate for Payer: UHC Exchange |
$44.50
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$90.86
|
|
|
Service Code
|
NDC 70121171202
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.24 |
| Max. Negotiated Rate |
$81.77 |
| Rate for Payer: Aetna Commercial |
$77.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.06
|
| Rate for Payer: Cash Price |
$72.69
|
| Rate for Payer: Cofinity Advantage |
$63.60
|
| Rate for Payer: Cofinity Commercial |
$78.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.69
|
| Rate for Payer: Healthscope Commercial |
$81.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.14
|
| Rate for Payer: PHP Commercial |
$77.23
|
| Rate for Payer: Priority Health SBD |
$57.24
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$111.20
|
|
|
Service Code
|
NDC 43066055712
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.70 |
| Max. Negotiated Rate |
$100.08 |
| Rate for Payer: Aetna Commercial |
$94.52
|
| Rate for Payer: Aetna Medicare |
$55.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.28
|
| Rate for Payer: BCBS Complete |
$44.48
|
| Rate for Payer: Cash Price |
$88.96
|
| Rate for Payer: Cofinity Advantage |
$77.84
|
| Rate for Payer: Cofinity Commercial |
$95.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.96
|
| Rate for Payer: Healthscope Commercial |
$100.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.40
|
| Rate for Payer: PHP Commercial |
$94.52
|
| Rate for Payer: Priority Health SBD |
$70.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.28
|
| Rate for Payer: UHC Core |
$57.94
|
| Rate for Payer: UHC Exchange |
$43.70
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$102.38
|
|
|
Service Code
|
NDC 70121138907
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.50 |
| Max. Negotiated Rate |
$92.14 |
| Rate for Payer: Aetna Commercial |
$87.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.55
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cofinity Advantage |
$71.67
|
| Rate for Payer: Cofinity Commercial |
$88.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.90
|
| Rate for Payer: Healthscope Commercial |
$92.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.78
|
| Rate for Payer: PHP Commercial |
$87.02
|
| Rate for Payer: Priority Health SBD |
$64.50
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$115.67
|
|
|
Service Code
|
NDC 55150029710
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.46 |
| Max. Negotiated Rate |
$104.10 |
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: Aetna Medicare |
$57.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.19
|
| Rate for Payer: BCBS Complete |
$46.27
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cofinity Advantage |
$80.97
|
| Rate for Payer: Cofinity Commercial |
$99.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.54
|
| Rate for Payer: Healthscope Commercial |
$104.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.75
|
| Rate for Payer: PHP Commercial |
$98.32
|
| Rate for Payer: Priority Health SBD |
$72.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.19
|
| Rate for Payer: UHC Core |
$60.26
|
| Rate for Payer: UHC Exchange |
$45.46
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$90.86
|
|
|
Service Code
|
NDC 70121171202
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.71 |
| Max. Negotiated Rate |
$81.77 |
| Rate for Payer: Aetna Commercial |
$77.23
|
| Rate for Payer: Aetna Medicare |
$45.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.06
|
| Rate for Payer: BCBS Complete |
$36.34
|
| Rate for Payer: Cash Price |
$72.69
|
| Rate for Payer: Cofinity Advantage |
$63.60
|
| Rate for Payer: Cofinity Commercial |
$78.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.69
|
| Rate for Payer: Healthscope Commercial |
$81.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$72.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.14
|
| Rate for Payer: PHP Commercial |
$77.23
|
| Rate for Payer: Priority Health SBD |
$57.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.06
|
| Rate for Payer: UHC Core |
$47.34
|
| Rate for Payer: UHC Exchange |
$35.71
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$89.32
|
|
|
Service Code
|
NDC 09900001136
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.27 |
| Max. Negotiated Rate |
$80.39 |
| Rate for Payer: Aetna Commercial |
$75.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.06
|
| Rate for Payer: Cash Price |
$71.46
|
| Rate for Payer: Cofinity Advantage |
$62.52
|
| Rate for Payer: Cofinity Commercial |
$76.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.46
|
| Rate for Payer: Healthscope Commercial |
$80.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.99
|
| Rate for Payer: PHP Commercial |
$75.92
|
| Rate for Payer: Priority Health SBD |
$56.27
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$113.23
|
|
|
Service Code
|
NDC 00409166010
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.33 |
| Max. Negotiated Rate |
$101.91 |
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.60
|
| Rate for Payer: Cash Price |
$90.58
|
| Rate for Payer: Cofinity Advantage |
$79.26
|
| Rate for Payer: Cofinity Commercial |
$97.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.58
|
| Rate for Payer: Healthscope Commercial |
$101.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.92
|
| Rate for Payer: PHP Commercial |
$96.25
|
| Rate for Payer: Priority Health SBD |
$71.33
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$111.20
|
|
|
Service Code
|
NDC 43066055712
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$70.06 |
| Max. Negotiated Rate |
$100.08 |
| Rate for Payer: Aetna Commercial |
$94.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.28
|
| Rate for Payer: Cash Price |
$88.96
|
| Rate for Payer: Cofinity Advantage |
$77.84
|
| Rate for Payer: Cofinity Commercial |
$95.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.96
|
| Rate for Payer: Healthscope Commercial |
$100.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.40
|
| Rate for Payer: PHP Commercial |
$94.52
|
| Rate for Payer: Priority Health SBD |
$70.06
|
|
|
DEXMEDETOMIDINE 4 MCG/ML IV PUSH SOLUTION
|
Facility
|
OP
|
$191.17
|
|
|
Service Code
|
NDC 09900001120
|
| Hospital Charge Code |
300091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$75.13 |
| Max. Negotiated Rate |
$172.05 |
| Rate for Payer: Aetna Commercial |
$162.49
|
| Rate for Payer: Aetna Medicare |
$95.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.26
|
| Rate for Payer: BCBS Complete |
$76.47
|
| Rate for Payer: Cash Price |
$152.94
|
| Rate for Payer: Cofinity Advantage |
$133.82
|
| Rate for Payer: Cofinity Commercial |
$164.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.94
|
| Rate for Payer: Healthscope Commercial |
$172.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.38
|
| Rate for Payer: PHP Commercial |
$162.49
|
| Rate for Payer: Priority Health SBD |
$120.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.26
|
| Rate for Payer: UHC Core |
$99.60
|
| Rate for Payer: UHC Exchange |
$75.13
|
|
|
DEXMEDETOMIDINE 4 MCG/ML IV PUSH SOLUTION
|
Facility
|
IP
|
$191.17
|
|
|
Service Code
|
NDC 09900001120
|
| Hospital Charge Code |
300091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$120.44 |
| Max. Negotiated Rate |
$172.05 |
| Rate for Payer: Aetna Commercial |
$162.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.26
|
| Rate for Payer: Cash Price |
$152.94
|
| Rate for Payer: Cofinity Advantage |
$133.82
|
| Rate for Payer: Cofinity Commercial |
$164.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.94
|
| Rate for Payer: Healthscope Commercial |
$172.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.38
|
| Rate for Payer: PHP Commercial |
$162.49
|
| Rate for Payer: Priority Health SBD |
$120.44
|
|
|
DEXMEDETOMIDINE 80 MCG/20 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$75.62
|
|
|
Service Code
|
NDC 00781349395
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.72 |
| Max. Negotiated Rate |
$68.06 |
| Rate for Payer: Aetna Commercial |
$64.28
|
| Rate for Payer: Aetna Medicare |
$37.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.15
|
| Rate for Payer: BCBS Complete |
$30.25
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cofinity Advantage |
$52.93
|
| Rate for Payer: Cofinity Commercial |
$65.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.50
|
| Rate for Payer: Healthscope Commercial |
$68.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.72
|
| Rate for Payer: PHP Commercial |
$64.28
|
| Rate for Payer: Priority Health SBD |
$47.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.15
|
| Rate for Payer: UHC Core |
$39.40
|
| Rate for Payer: UHC Exchange |
$29.72
|
|
|
DEXMEDETOMIDINE 80 MCG/20 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$75.62
|
|
|
Service Code
|
NDC 00781349395
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.64 |
| Max. Negotiated Rate |
$68.06 |
| Rate for Payer: Aetna Commercial |
$64.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.15
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cofinity Advantage |
$52.93
|
| Rate for Payer: Cofinity Commercial |
$65.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.50
|
| Rate for Payer: Healthscope Commercial |
$68.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.72
|
| Rate for Payer: PHP Commercial |
$64.28
|
| Rate for Payer: Priority Health SBD |
$47.64
|
|
|
DEXMEDETOMIDINE 80 MCG/20 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$91.39
|
|
|
Service Code
|
NDC 00409166020
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.92 |
| Max. Negotiated Rate |
$82.25 |
| Rate for Payer: Aetna Commercial |
$77.68
|
| Rate for Payer: Aetna Medicare |
$45.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.40
|
| Rate for Payer: BCBS Complete |
$36.56
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: Cofinity Advantage |
$63.97
|
| Rate for Payer: Cofinity Commercial |
$78.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.11
|
| Rate for Payer: Healthscope Commercial |
$82.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.54
|
| Rate for Payer: PHP Commercial |
$77.68
|
| Rate for Payer: Priority Health SBD |
$57.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.40
|
| Rate for Payer: UHC Core |
$47.61
|
| Rate for Payer: UHC Exchange |
$35.92
|
|
|
DEXMEDETOMIDINE 80 MCG/20 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$75.62
|
|
|
Service Code
|
NDC 00781349380
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.64 |
| Max. Negotiated Rate |
$68.06 |
| Rate for Payer: Aetna Commercial |
$64.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.15
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cofinity Advantage |
$52.93
|
| Rate for Payer: Cofinity Commercial |
$65.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.50
|
| Rate for Payer: Healthscope Commercial |
$68.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.72
|
| Rate for Payer: PHP Commercial |
$64.28
|
| Rate for Payer: Priority Health SBD |
$47.64
|
|
