Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION

Facility

$50.73

Service Code	NDC 57664059650
Hospital Charge Code	27103
Hospital Revenue Code	250
Min. Negotiated Rate	$31.96
Max. Negotiated Rate	$45.66
Rate for Payer: Aetna Commercial	$43.12
Rate for Payer: Aetna New Business (MI Preferred)	$32.97
Rate for Payer: Cash Price	$40.58
Rate for Payer: Cofinity Commercial	$35.51
Rate for Payer: Cofinity Commercial	$43.63
Rate for Payer: Cofinity Medicare Advantage	$35.51
Rate for Payer: Encore Health Key Benefits Commercial	$40.58
Rate for Payer: Healthscope Commercial	$45.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.12
Rate for Payer: PHP Commercial	$43.12
Rate for Payer: Priority Health Cigna Priority Health	$32.97
Rate for Payer: Priority Health SBD	$31.96

DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION

Facility

$84.57

Service Code	NDC 00409163802
Hospital Charge Code	27103
Hospital Revenue Code	250
Min. Negotiated Rate	$33.83
Max. Negotiated Rate	$76.11
Rate for Payer: Aetna Commercial	$71.88
Rate for Payer: Aetna Medicare	$42.28
Rate for Payer: Aetna New Business (MI Preferred)	$54.97
Rate for Payer: BCBS Complete	$33.83
Rate for Payer: Cash Price	$67.66
Rate for Payer: Cofinity Commercial	$59.20
Rate for Payer: Cofinity Commercial	$72.73
Rate for Payer: Cofinity Medicare Advantage	$59.20
Rate for Payer: Encore Health Key Benefits Commercial	$67.66
Rate for Payer: Healthscope Commercial	$76.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$71.88
Rate for Payer: PHP Commercial	$71.88
Rate for Payer: Priority Health Cigna Priority Health	$54.97
Rate for Payer: Priority Health SBD	$53.28

DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION

Facility

$63.07

Service Code	NDC 16729023930
Hospital Charge Code	27103
Hospital Revenue Code	250
Min. Negotiated Rate	$39.73
Max. Negotiated Rate	$56.76
Rate for Payer: Aetna Commercial	$53.61
Rate for Payer: Aetna New Business (MI Preferred)	$41.00
Rate for Payer: Cash Price	$50.46
Rate for Payer: Cofinity Commercial	$44.15
Rate for Payer: Cofinity Commercial	$54.24
Rate for Payer: Cofinity Medicare Advantage	$44.15
Rate for Payer: Encore Health Key Benefits Commercial	$50.46
Rate for Payer: Healthscope Commercial	$56.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.61
Rate for Payer: PHP Commercial	$53.61
Rate for Payer: Priority Health Cigna Priority Health	$41.00
Rate for Payer: Priority Health SBD	$39.73

DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION

Facility

$68.32

Service Code	NDC 83634060002
Hospital Charge Code	27103
Hospital Revenue Code	250
Min. Negotiated Rate	$43.04
Max. Negotiated Rate	$61.49
Rate for Payer: Aetna Commercial	$58.07
Rate for Payer: Aetna New Business (MI Preferred)	$44.41
Rate for Payer: Cash Price	$54.66
Rate for Payer: Cofinity Commercial	$47.82
Rate for Payer: Cofinity Commercial	$58.76
Rate for Payer: Cofinity Medicare Advantage	$47.82
Rate for Payer: Encore Health Key Benefits Commercial	$54.66
Rate for Payer: Healthscope Commercial	$61.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.07
Rate for Payer: PHP Commercial	$58.07
Rate for Payer: Priority Health Cigna Priority Health	$44.41
Rate for Payer: Priority Health SBD	$43.04

DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION

Facility

$84.57

Service Code	NDC 00409163802
Hospital Charge Code	27103
Hospital Revenue Code	250
Min. Negotiated Rate	$53.28
Max. Negotiated Rate	$76.11
Rate for Payer: Aetna Commercial	$71.88
Rate for Payer: Aetna New Business (MI Preferred)	$54.97
Rate for Payer: Cash Price	$67.66
Rate for Payer: Cofinity Commercial	$59.20
Rate for Payer: Cofinity Commercial	$72.73
Rate for Payer: Cofinity Medicare Advantage	$59.20
Rate for Payer: Encore Health Key Benefits Commercial	$67.66
Rate for Payer: Healthscope Commercial	$76.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$71.88
Rate for Payer: PHP Commercial	$71.88
Rate for Payer: Priority Health Cigna Priority Health	$54.97
Rate for Payer: Priority Health SBD	$53.28

DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION

Facility

$68.32

Service Code	NDC 83634060041
Hospital Charge Code	27103
Hospital Revenue Code	250
Min. Negotiated Rate	$43.04
Max. Negotiated Rate	$61.49
Rate for Payer: Aetna Commercial	$58.07
Rate for Payer: Aetna New Business (MI Preferred)	$44.41
Rate for Payer: Cash Price	$54.66
Rate for Payer: Cofinity Commercial	$47.82
Rate for Payer: Cofinity Commercial	$58.76
Rate for Payer: Cofinity Medicare Advantage	$47.82
Rate for Payer: Encore Health Key Benefits Commercial	$54.66
Rate for Payer: Healthscope Commercial	$61.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.07
Rate for Payer: PHP Commercial	$58.07
Rate for Payer: Priority Health Cigna Priority Health	$44.41
Rate for Payer: Priority Health SBD	$43.04

DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION

Facility

$63.07

Service Code	NDC 55150020902
Hospital Charge Code	27103
Hospital Revenue Code	250
Min. Negotiated Rate	$25.23
Max. Negotiated Rate	$56.76
Rate for Payer: Aetna Commercial	$53.61
Rate for Payer: Aetna Medicare	$31.54
Rate for Payer: Aetna New Business (MI Preferred)	$41.00
Rate for Payer: BCBS Complete	$25.23
Rate for Payer: Cash Price	$50.46
Rate for Payer: Cofinity Commercial	$44.15
Rate for Payer: Cofinity Commercial	$54.24
Rate for Payer: Cofinity Medicare Advantage	$44.15
Rate for Payer: Encore Health Key Benefits Commercial	$50.46
Rate for Payer: Healthscope Commercial	$56.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.61
Rate for Payer: PHP Commercial	$53.61
Rate for Payer: Priority Health Cigna Priority Health	$41.00
Rate for Payer: Priority Health SBD	$39.73

DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION

Facility

$68.32

Service Code	NDC 83634060041
Hospital Charge Code	27103
Hospital Revenue Code	250
Min. Negotiated Rate	$27.33
Max. Negotiated Rate	$61.49
Rate for Payer: Aetna Commercial	$58.07
Rate for Payer: Aetna Medicare	$34.16
Rate for Payer: Aetna New Business (MI Preferred)	$44.41
Rate for Payer: BCBS Complete	$27.33
Rate for Payer: Cash Price	$54.66
Rate for Payer: Cofinity Commercial	$47.82
Rate for Payer: Cofinity Commercial	$58.76
Rate for Payer: Cofinity Medicare Advantage	$47.82
Rate for Payer: Encore Health Key Benefits Commercial	$54.66
Rate for Payer: Healthscope Commercial	$61.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.07
Rate for Payer: PHP Commercial	$58.07
Rate for Payer: Priority Health Cigna Priority Health	$44.41
Rate for Payer: Priority Health SBD	$43.04

DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION

Facility

$68.32

Service Code	NDC 83634060002
Hospital Charge Code	27103
Hospital Revenue Code	250
Min. Negotiated Rate	$27.33
Max. Negotiated Rate	$61.49
Rate for Payer: Aetna Commercial	$58.07
Rate for Payer: Aetna Medicare	$34.16
Rate for Payer: Aetna New Business (MI Preferred)	$44.41
Rate for Payer: BCBS Complete	$27.33
Rate for Payer: Cash Price	$54.66
Rate for Payer: Cofinity Commercial	$47.82
Rate for Payer: Cofinity Commercial	$58.76
Rate for Payer: Cofinity Medicare Advantage	$47.82
Rate for Payer: Encore Health Key Benefits Commercial	$54.66
Rate for Payer: Healthscope Commercial	$61.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$58.07
Rate for Payer: PHP Commercial	$58.07
Rate for Payer: Priority Health Cigna Priority Health	$44.41
Rate for Payer: Priority Health SBD	$43.04

DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION

Facility

$63.07

Service Code	NDC 16729023930
Hospital Charge Code	27103
Hospital Revenue Code	250
Min. Negotiated Rate	$25.23
Max. Negotiated Rate	$56.76
Rate for Payer: Aetna Commercial	$53.61
Rate for Payer: Aetna Medicare	$31.54
Rate for Payer: Aetna New Business (MI Preferred)	$41.00
Rate for Payer: BCBS Complete	$25.23
Rate for Payer: Cash Price	$50.46
Rate for Payer: Cofinity Commercial	$44.15
Rate for Payer: Cofinity Commercial	$54.24
Rate for Payer: Cofinity Medicare Advantage	$44.15
Rate for Payer: Encore Health Key Benefits Commercial	$50.46
Rate for Payer: Healthscope Commercial	$56.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.61
Rate for Payer: PHP Commercial	$53.61
Rate for Payer: Priority Health Cigna Priority Health	$41.00
Rate for Payer: Priority Health SBD	$39.73

DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION

Facility

$50.73

Service Code	NDC 57664059650
Hospital Charge Code	27103
Hospital Revenue Code	250
Min. Negotiated Rate	$20.29
Max. Negotiated Rate	$45.66
Rate for Payer: Aetna Commercial	$43.12
Rate for Payer: Aetna Medicare	$25.36
Rate for Payer: Aetna New Business (MI Preferred)	$32.97
Rate for Payer: BCBS Complete	$20.29
Rate for Payer: Cash Price	$40.58
Rate for Payer: Cofinity Commercial	$35.51
Rate for Payer: Cofinity Commercial	$43.63
Rate for Payer: Cofinity Medicare Advantage	$35.51
Rate for Payer: Encore Health Key Benefits Commercial	$40.58
Rate for Payer: Healthscope Commercial	$45.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$43.12
Rate for Payer: PHP Commercial	$43.12
Rate for Payer: Priority Health Cigna Priority Health	$32.97
Rate for Payer: Priority Health SBD	$31.96

DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION

Facility

$63.07

Service Code	NDC 55150020902
Hospital Charge Code	27103
Hospital Revenue Code	250
Min. Negotiated Rate	$39.73
Max. Negotiated Rate	$56.76
Rate for Payer: Aetna Commercial	$53.61
Rate for Payer: Aetna New Business (MI Preferred)	$41.00
Rate for Payer: Cash Price	$50.46
Rate for Payer: Cofinity Commercial	$44.15
Rate for Payer: Cofinity Commercial	$54.24
Rate for Payer: Cofinity Medicare Advantage	$44.15
Rate for Payer: Encore Health Key Benefits Commercial	$50.46
Rate for Payer: Healthscope Commercial	$56.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.61
Rate for Payer: PHP Commercial	$53.61
Rate for Payer: Priority Health Cigna Priority Health	$41.00
Rate for Payer: Priority Health SBD	$39.73

DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION

Facility

$63.07

Service Code	NDC 16729023993
Hospital Charge Code	27103
Hospital Revenue Code	250
Min. Negotiated Rate	$25.23
Max. Negotiated Rate	$56.76
Rate for Payer: Aetna Commercial	$53.61
Rate for Payer: Aetna Medicare	$31.54
Rate for Payer: Aetna New Business (MI Preferred)	$41.00
Rate for Payer: BCBS Complete	$25.23
Rate for Payer: Cash Price	$50.46
Rate for Payer: Cofinity Commercial	$44.15
Rate for Payer: Cofinity Commercial	$54.24
Rate for Payer: Cofinity Medicare Advantage	$44.15
Rate for Payer: Encore Health Key Benefits Commercial	$50.46
Rate for Payer: Healthscope Commercial	$56.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$53.61
Rate for Payer: PHP Commercial	$53.61
Rate for Payer: Priority Health Cigna Priority Health	$41.00
Rate for Payer: Priority Health SBD	$39.73

DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV

Facility

$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 Commercial	$62.52
Rate for Payer: Cofinity Commercial	$76.82
Rate for Payer: Cofinity Medicare Advantage	$62.52
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: PHP Commercial	$75.92
Rate for Payer: Priority Health Cigna Priority Health	$58.06
Rate for Payer: Priority Health SBD	$56.27

DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV

Facility

$168.15

Service Code	NDC 70121171202
Hospital Charge Code	166083
Hospital Revenue Code	250
Min. Negotiated Rate	$67.26
Max. Negotiated Rate	$151.34
Rate for Payer: Aetna Commercial	$142.93
Rate for Payer: Aetna Medicare	$84.08
Rate for Payer: Aetna New Business (MI Preferred)	$109.30
Rate for Payer: BCBS Complete	$67.26
Rate for Payer: Cash Price	$134.52
Rate for Payer: Cofinity Commercial	$117.70
Rate for Payer: Cofinity Commercial	$144.61
Rate for Payer: Cofinity Medicare Advantage	$117.70
Rate for Payer: Encore Health Key Benefits Commercial	$134.52
Rate for Payer: Healthscope Commercial	$151.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$142.93
Rate for Payer: PHP Commercial	$142.93
Rate for Payer: Priority Health Cigna Priority Health	$109.30
Rate for Payer: Priority Health SBD	$105.93

DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV

Facility

$89.32

Service Code	NDC 09900001136
Hospital Charge Code	166083
Hospital Revenue Code	250
Min. Negotiated Rate	$35.73
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 Commercial	$62.52
Rate for Payer: Cofinity Commercial	$76.82
Rate for Payer: Cofinity Medicare Advantage	$62.52
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: PHP Commercial	$75.92
Rate for Payer: Priority Health Cigna Priority Health	$58.06
Rate for Payer: Priority Health SBD	$56.27

DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV

Facility

$102.38

Service Code	NDC 70121138901
Hospital Charge Code	166083
Hospital Revenue Code	250
Min. Negotiated Rate	$40.95
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 Commercial	$71.67
Rate for Payer: Cofinity Commercial	$88.05
Rate for Payer: Cofinity Medicare Advantage	$71.67
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: PHP Commercial	$87.02
Rate for Payer: Priority Health Cigna Priority Health	$66.55
Rate for Payer: Priority Health SBD	$64.50

DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV

Facility

$113.23

Service Code	NDC 00409166010
Hospital Charge Code	166083
Hospital Revenue Code	250
Min. Negotiated Rate	$45.29
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 Commercial	$79.26
Rate for Payer: Cofinity Commercial	$97.38
Rate for Payer: Cofinity Medicare Advantage	$79.26
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: PHP Commercial	$96.25
Rate for Payer: Priority Health Cigna Priority Health	$73.60
Rate for Payer: Priority Health SBD	$71.33

DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV

Facility

$97.64

Service Code	NDC 55150029710
Hospital Charge Code	166083
Hospital Revenue Code	250
Min. Negotiated Rate	$61.51
Max. Negotiated Rate	$87.88
Rate for Payer: Aetna Commercial	$82.99
Rate for Payer: Aetna New Business (MI Preferred)	$63.47
Rate for Payer: Cash Price	$78.11
Rate for Payer: Cofinity Commercial	$68.35
Rate for Payer: Cofinity Commercial	$83.97
Rate for Payer: Cofinity Medicare Advantage	$68.35
Rate for Payer: Encore Health Key Benefits Commercial	$78.11
Rate for Payer: Healthscope Commercial	$87.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$82.99
Rate for Payer: PHP Commercial	$82.99
Rate for Payer: Priority Health Cigna Priority Health	$63.47
Rate for Payer: Priority Health SBD	$61.51

DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV

Facility

$97.64

Service Code	NDC 55150029701
Hospital Charge Code	166083
Hospital Revenue Code	250
Min. Negotiated Rate	$61.51
Max. Negotiated Rate	$87.88
Rate for Payer: Aetna Commercial	$82.99
Rate for Payer: Aetna New Business (MI Preferred)	$63.47
Rate for Payer: Cash Price	$78.11
Rate for Payer: Cofinity Commercial	$68.35
Rate for Payer: Cofinity Commercial	$83.97
Rate for Payer: Cofinity Medicare Advantage	$68.35
Rate for Payer: Encore Health Key Benefits Commercial	$78.11
Rate for Payer: Healthscope Commercial	$87.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$82.99
Rate for Payer: PHP Commercial	$82.99
Rate for Payer: Priority Health Cigna Priority Health	$63.47
Rate for Payer: Priority Health SBD	$61.51

DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV

Facility

$102.38

Service Code	NDC 70121138907
Hospital Charge Code	166083
Hospital Revenue Code	250
Min. Negotiated Rate	$40.95
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 Commercial	$71.67
Rate for Payer: Cofinity Commercial	$88.05
Rate for Payer: Cofinity Medicare Advantage	$71.67
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: PHP Commercial	$87.02
Rate for Payer: Priority Health Cigna Priority Health	$66.55
Rate for Payer: Priority Health SBD	$64.50

DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV

Facility

$97.64

Service Code	NDC 55150029710
Hospital Charge Code	166083
Hospital Revenue Code	250
Min. Negotiated Rate	$39.06
Max. Negotiated Rate	$87.88
Rate for Payer: Aetna Commercial	$82.99
Rate for Payer: Aetna Medicare	$48.82
Rate for Payer: Aetna New Business (MI Preferred)	$63.47
Rate for Payer: BCBS Complete	$39.06
Rate for Payer: Cash Price	$78.11
Rate for Payer: Cofinity Commercial	$68.35
Rate for Payer: Cofinity Commercial	$83.97
Rate for Payer: Cofinity Medicare Advantage	$68.35
Rate for Payer: Encore Health Key Benefits Commercial	$78.11
Rate for Payer: Healthscope Commercial	$87.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$82.99
Rate for Payer: PHP Commercial	$82.99
Rate for Payer: Priority Health Cigna Priority Health	$63.47
Rate for Payer: Priority Health SBD	$61.51

DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV

Facility

$168.15

Service Code	NDC 70121171201
Hospital Charge Code	166083
Hospital Revenue Code	250
Min. Negotiated Rate	$67.26
Max. Negotiated Rate	$151.34
Rate for Payer: Aetna Commercial	$142.93
Rate for Payer: Aetna Medicare	$84.08
Rate for Payer: Aetna New Business (MI Preferred)	$109.30
Rate for Payer: BCBS Complete	$67.26
Rate for Payer: Cash Price	$134.52
Rate for Payer: Cofinity Commercial	$117.70
Rate for Payer: Cofinity Commercial	$144.61
Rate for Payer: Cofinity Medicare Advantage	$117.70
Rate for Payer: Encore Health Key Benefits Commercial	$134.52
Rate for Payer: Healthscope Commercial	$151.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$142.93
Rate for Payer: PHP Commercial	$142.93
Rate for Payer: Priority Health Cigna Priority Health	$109.30
Rate for Payer: Priority Health SBD	$105.93

DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV

Facility

$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 Commercial	$71.67
Rate for Payer: Cofinity Commercial	$88.05
Rate for Payer: Cofinity Medicare Advantage	$71.67
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: PHP Commercial	$87.02
Rate for Payer: Priority Health Cigna Priority Health	$66.55
Rate for Payer: Priority Health SBD	$64.50

DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV

Facility

$168.15

Service Code	NDC 70121171201
Hospital Charge Code	166083
Hospital Revenue Code	250
Min. Negotiated Rate	$105.93
Max. Negotiated Rate	$151.34
Rate for Payer: Aetna Commercial	$142.93
Rate for Payer: Aetna New Business (MI Preferred)	$109.30
Rate for Payer: Cash Price	$134.52
Rate for Payer: Cofinity Commercial	$117.70
Rate for Payer: Cofinity Commercial	$144.61
Rate for Payer: Cofinity Medicare Advantage	$117.70
Rate for Payer: Encore Health Key Benefits Commercial	$134.52
Rate for Payer: Healthscope Commercial	$151.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$142.93
Rate for Payer: PHP Commercial	$142.93
Rate for Payer: Priority Health Cigna Priority Health	$109.30
Rate for Payer: Priority Health SBD	$105.93

Know your out-of-pocket cost for care.

All Charges