|
NON-HYPOVOLEMIC SODIUM DISORDERS
|
Facility
|
IP
|
$11,467.72
|
|
|
Service Code
|
APR-DRG 4264
|
| Min. Negotiated Rate |
$10,921.64 |
| Max. Negotiated Rate |
$11,467.72 |
| Rate for Payer: BCBS Complete |
$11,467.72
|
| Rate for Payer: Mclaren Medicaid |
$10,921.64
|
| Rate for Payer: Meridian Medicaid |
$11,467.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,921.64
|
| Rate for Payer: UHC Medicaid |
$10,921.64
|
| Rate for Payer: UHCCP Medicaid |
$10,921.64
|
|
|
NON-HYPOVOLEMIC SODIUM DISORDERS
|
Facility
|
IP
|
$4,170.18
|
|
|
Service Code
|
APR-DRG 4262
|
| Min. Negotiated Rate |
$3,971.60 |
| Max. Negotiated Rate |
$4,170.18 |
| Rate for Payer: BCBS Complete |
$4,170.18
|
| Rate for Payer: Mclaren Medicaid |
$3,971.60
|
| Rate for Payer: Meridian Medicaid |
$4,170.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,971.60
|
| Rate for Payer: UHC Medicaid |
$3,971.60
|
| Rate for Payer: UHCCP Medicaid |
$3,971.60
|
|
|
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC
|
Facility
|
IP
|
$16,978.08
|
|
|
Service Code
|
MSDRG 600
|
| Min. Negotiated Rate |
$8,197.28 |
| Max. Negotiated Rate |
$16,978.08 |
| Rate for Payer: Aetna Medicare |
$8,973.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10,785.90
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10,785.90
|
| Rate for Payer: BCBS MAPPO |
$8,628.72
|
| Rate for Payer: BCBS Trust/PPO |
$13,616.43
|
| Rate for Payer: BCN Commercial |
$13,616.43
|
| Rate for Payer: BCN Medicare Advantage |
$8,628.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8,628.72
|
| Rate for Payer: Mclaren Medicare |
$8,628.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9,060.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9,923.03
|
| Rate for Payer: Molina Medicare/Medicaid |
$9,491.59
|
| Rate for Payer: Nomi Health Commercial |
$13,436.64
|
| Rate for Payer: PACE Medicare |
$8,197.28
|
| Rate for Payer: PACE SWMI |
$8,628.72
|
| Rate for Payer: PHP Medicare Advantage |
$8,628.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16,792.82
|
| Rate for Payer: Priority Health Medicare |
$8,628.72
|
| Rate for Payer: Priority Health Tiered Network |
$13,434.25
|
| Rate for Payer: Railroad Medicare Medicare |
$8,628.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16,978.08
|
| Rate for Payer: UHC Core |
$14,204.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8,628.72
|
| Rate for Payer: UHC Exchange |
$11,600.30
|
| Rate for Payer: VA VA |
$8,628.72
|
|
|
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$9,861.50
|
|
|
Service Code
|
MSDRG 601
|
| Min. Negotiated Rate |
$4,991.84 |
| Max. Negotiated Rate |
$9,861.50 |
| Rate for Payer: Aetna Medicare |
$5,464.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6,568.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6,568.21
|
| Rate for Payer: BCBS MAPPO |
$5,254.57
|
| Rate for Payer: BCBS Trust/PPO |
$7,572.49
|
| Rate for Payer: BCN Commercial |
$7,572.49
|
| Rate for Payer: BCN Medicare Advantage |
$5,254.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5,254.57
|
| Rate for Payer: Mclaren Medicare |
$5,254.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5,517.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6,042.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$5,780.03
|
| Rate for Payer: Nomi Health Commercial |
$7,804.50
|
| Rate for Payer: PACE Medicare |
$4,991.84
|
| Rate for Payer: PACE SWMI |
$5,254.57
|
| Rate for Payer: PHP Medicare Advantage |
$5,254.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$9,753.89
|
| Rate for Payer: Priority Health Medicare |
$5,254.57
|
| Rate for Payer: Priority Health Tiered Network |
$7,803.11
|
| Rate for Payer: Railroad Medicare Medicare |
$5,254.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9,861.50
|
| Rate for Payer: UHC Core |
$8,250.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5,254.57
|
| Rate for Payer: UHC Exchange |
$6,737.89
|
| Rate for Payer: VA VA |
$5,254.57
|
|
|
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION
|
Facility
|
IP
|
$5,601.14
|
|
|
Service Code
|
APR-DRG 0461
|
| Min. Negotiated Rate |
$5,334.42 |
| Max. Negotiated Rate |
$5,601.14 |
| Rate for Payer: BCBS Complete |
$5,601.14
|
| Rate for Payer: Mclaren Medicaid |
$5,334.42
|
| Rate for Payer: Meridian Medicaid |
$5,601.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,334.42
|
| Rate for Payer: UHC Medicaid |
$5,334.42
|
| Rate for Payer: UHCCP Medicaid |
$5,334.42
|
|
|
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION
|
Facility
|
IP
|
$6,911.70
|
|
|
Service Code
|
APR-DRG 0462
|
| Min. Negotiated Rate |
$6,582.58 |
| Max. Negotiated Rate |
$6,911.70 |
| Rate for Payer: BCBS Complete |
$6,911.70
|
| Rate for Payer: Mclaren Medicaid |
$6,582.58
|
| Rate for Payer: Meridian Medicaid |
$6,911.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,582.58
|
| Rate for Payer: UHC Medicaid |
$6,582.58
|
| Rate for Payer: UHCCP Medicaid |
$6,582.58
|
|
|
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION
|
Facility
|
IP
|
$8,957.24
|
|
|
Service Code
|
APR-DRG 0463
|
| Min. Negotiated Rate |
$8,530.70 |
| Max. Negotiated Rate |
$8,957.24 |
| Rate for Payer: BCBS Complete |
$8,957.24
|
| Rate for Payer: Mclaren Medicaid |
$8,530.70
|
| Rate for Payer: Meridian Medicaid |
$8,957.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,530.70
|
| Rate for Payer: UHC Medicaid |
$8,530.70
|
| Rate for Payer: UHCCP Medicaid |
$8,530.70
|
|
|
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION
|
Facility
|
IP
|
$15,425.78
|
|
|
Service Code
|
APR-DRG 0464
|
| Min. Negotiated Rate |
$14,691.22 |
| Max. Negotiated Rate |
$15,425.78 |
| Rate for Payer: BCBS Complete |
$15,425.78
|
| Rate for Payer: Mclaren Medicaid |
$14,691.22
|
| Rate for Payer: Meridian Medicaid |
$15,425.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$14,691.22
|
| Rate for Payer: UHC Medicaid |
$14,691.22
|
| Rate for Payer: UHCCP Medicaid |
$14,691.22
|
|
|
NONTRAUMATIC STUPOR AND COMA WITH MCC
|
Facility
|
IP
|
$29,503.00
|
|
|
Service Code
|
MSDRG 080
|
| Min. Negotiated Rate |
$13,838.75 |
| Max. Negotiated Rate |
$29,503.00 |
| Rate for Payer: Aetna Medicare |
$15,149.78
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,208.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,208.88
|
| Rate for Payer: BCBS MAPPO |
$14,567.10
|
| Rate for Payer: BCBS Trust/PPO |
$25,470.24
|
| Rate for Payer: BCN Commercial |
$25,470.24
|
| Rate for Payer: BCN Medicare Advantage |
$14,567.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,567.10
|
| Rate for Payer: Mclaren Medicare |
$14,567.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,295.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,752.17
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,023.81
|
| Rate for Payer: Nomi Health Commercial |
$23,349.00
|
| Rate for Payer: PACE Medicare |
$13,838.75
|
| Rate for Payer: PACE SWMI |
$14,567.10
|
| Rate for Payer: PHP Medicare Advantage |
$14,567.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$29,181.07
|
| Rate for Payer: Priority Health Medicare |
$14,567.10
|
| Rate for Payer: Priority Health Tiered Network |
$23,344.86
|
| Rate for Payer: Railroad Medicare Medicare |
$14,567.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,503.00
|
| Rate for Payer: UHC Core |
$24,682.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,567.10
|
| Rate for Payer: UHC Exchange |
$20,157.97
|
| Rate for Payer: VA VA |
$14,567.10
|
|
|
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC
|
Facility
|
IP
|
$21,348.10
|
|
|
Service Code
|
MSDRG 081
|
| Min. Negotiated Rate |
$7,125.39 |
| Max. Negotiated Rate |
$21,348.10 |
| Rate for Payer: Aetna Medicare |
$7,800.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,375.51
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,375.51
|
| Rate for Payer: BCBS MAPPO |
$7,500.41
|
| Rate for Payer: BCBS Trust/PPO |
$21,348.10
|
| Rate for Payer: BCN Commercial |
$21,348.10
|
| Rate for Payer: BCN Medicare Advantage |
$7,500.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,500.41
|
| Rate for Payer: Mclaren Medicare |
$7,500.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7,875.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,625.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$8,250.45
|
| Rate for Payer: Nomi Health Commercial |
$11,553.24
|
| Rate for Payer: PACE Medicare |
$7,125.39
|
| Rate for Payer: PACE SWMI |
$7,500.41
|
| Rate for Payer: PHP Medicare Advantage |
$7,500.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$14,438.99
|
| Rate for Payer: Priority Health Medicare |
$7,500.41
|
| Rate for Payer: Priority Health Tiered Network |
$11,551.19
|
| Rate for Payer: Railroad Medicare Medicare |
$7,500.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,598.28
|
| Rate for Payer: UHC Core |
$12,213.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$7,500.41
|
| Rate for Payer: UHC Exchange |
$9,974.30
|
| Rate for Payer: VA VA |
$7,500.41
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.54
|
|
|
Service Code
|
NDC 65145013310
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$21.19 |
| Rate for Payer: Aetna Commercial |
$20.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.30
|
| Rate for Payer: Cash Price |
$18.83
|
| Rate for Payer: Cofinity Advantage |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$20.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.83
|
| Rate for Payer: Healthscope Commercial |
$21.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.66
|
| Rate for Payer: PHP Commercial |
$20.01
|
| Rate for Payer: Priority Health SBD |
$14.83
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.83
|
|
|
Service Code
|
NDC 70121157607
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.01 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Commercial |
$20.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.49
|
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: Cofinity Advantage |
$16.68
|
| Rate for Payer: Cofinity Commercial |
$20.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.06
|
| Rate for Payer: Healthscope Commercial |
$21.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.87
|
| Rate for Payer: PHP Commercial |
$20.26
|
| Rate for Payer: Priority Health SBD |
$15.01
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14.92
|
|
|
Service Code
|
NDC 67457085204
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.86 |
| Max. Negotiated Rate |
$13.43 |
| Rate for Payer: Aetna Commercial |
$12.68
|
| Rate for Payer: Aetna Medicare |
$7.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.70
|
| Rate for Payer: BCBS Complete |
$5.97
|
| Rate for Payer: Cash Price |
$11.94
|
| Rate for Payer: Cofinity Advantage |
$10.44
|
| Rate for Payer: Cofinity Commercial |
$12.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.94
|
| Rate for Payer: Healthscope Commercial |
$13.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.19
|
| Rate for Payer: PHP Commercial |
$12.68
|
| Rate for Payer: Priority Health SBD |
$9.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.70
|
| Rate for Payer: UHC Core |
$7.77
|
| Rate for Payer: UHC Exchange |
$5.86
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.54
|
|
|
Service Code
|
NDC 65145013301
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.83 |
| Max. Negotiated Rate |
$21.19 |
| Rate for Payer: Aetna Commercial |
$20.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.30
|
| Rate for Payer: Cash Price |
$18.83
|
| Rate for Payer: Cofinity Advantage |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$20.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.83
|
| Rate for Payer: Healthscope Commercial |
$21.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.66
|
| Rate for Payer: PHP Commercial |
$20.01
|
| Rate for Payer: Priority Health SBD |
$14.83
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.83
|
|
|
Service Code
|
NDC 70121157601
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna Commercial |
$20.26
|
| Rate for Payer: Aetna Medicare |
$11.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.49
|
| Rate for Payer: BCBS Complete |
$9.53
|
| Rate for Payer: Cash Price |
$19.06
|
| Rate for Payer: Cofinity Advantage |
$16.68
|
| Rate for Payer: Cofinity Commercial |
$20.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.06
|
| Rate for Payer: Healthscope Commercial |
$21.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.87
|
| Rate for Payer: PHP Commercial |
$20.26
|
| Rate for Payer: Priority Health SBD |
$15.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.49
|
| Rate for Payer: UHC Core |
$12.42
|
| Rate for Payer: UHC Exchange |
$9.37
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.71
|
|
|
Service Code
|
NDC 43066099710
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$18.64 |
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Cash Price |
$16.57
|
| Rate for Payer: Cofinity Advantage |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$17.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.57
|
| Rate for Payer: Healthscope Commercial |
$18.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: PHP Commercial |
$17.60
|
| Rate for Payer: Priority Health SBD |
$13.05
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$74.59
|
|
|
Service Code
|
NDC 00703115303
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.99 |
| Max. Negotiated Rate |
$67.13 |
| Rate for Payer: Aetna Commercial |
$63.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.48
|
| Rate for Payer: Cash Price |
$59.67
|
| Rate for Payer: Cofinity Advantage |
$52.21
|
| Rate for Payer: Cofinity Commercial |
$64.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.67
|
| Rate for Payer: Healthscope Commercial |
$67.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.94
|
| Rate for Payer: PHP Commercial |
$63.40
|
| Rate for Payer: Priority Health SBD |
$46.99
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.62
|
|
|
Service Code
|
NDC 00409337504
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$16.76 |
| Rate for Payer: Aetna Commercial |
$15.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.10
|
| Rate for Payer: Cash Price |
$14.90
|
| Rate for Payer: Cofinity Advantage |
$13.03
|
| Rate for Payer: Cofinity Commercial |
$16.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.90
|
| Rate for Payer: Healthscope Commercial |
$16.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.96
|
| Rate for Payer: PHP Commercial |
$15.83
|
| Rate for Payer: Priority Health SBD |
$11.73
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.59
|
|
|
Service Code
|
NDC 00703115303
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.31 |
| Max. Negotiated Rate |
$67.13 |
| Rate for Payer: Aetna Commercial |
$63.40
|
| Rate for Payer: Aetna Medicare |
$37.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.48
|
| Rate for Payer: BCBS Complete |
$29.84
|
| Rate for Payer: Cash Price |
$59.67
|
| Rate for Payer: Cofinity Advantage |
$52.21
|
| Rate for Payer: Cofinity Commercial |
$64.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.67
|
| Rate for Payer: Healthscope Commercial |
$67.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.94
|
| Rate for Payer: PHP Commercial |
$63.40
|
| Rate for Payer: Priority Health SBD |
$46.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.48
|
| Rate for Payer: UHC Core |
$38.86
|
| Rate for Payer: UHC Exchange |
$29.31
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.25
|
|
|
Service Code
|
NDC 36000016210
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.96 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: Aetna Commercial |
$17.21
|
| Rate for Payer: Aetna Medicare |
$10.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.16
|
| Rate for Payer: BCBS Complete |
$8.10
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cofinity Advantage |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$17.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.20
|
| Rate for Payer: Healthscope Commercial |
$18.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.19
|
| Rate for Payer: PHP Commercial |
$17.21
|
| Rate for Payer: Priority Health SBD |
$12.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.16
|
| Rate for Payer: UHC Core |
$10.55
|
| Rate for Payer: UHC Exchange |
$7.96
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.71
|
|
|
Service Code
|
NDC 43066099701
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$18.64 |
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: Cash Price |
$16.57
|
| Rate for Payer: Cofinity Advantage |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$17.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.57
|
| Rate for Payer: Healthscope Commercial |
$18.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: PHP Commercial |
$17.60
|
| Rate for Payer: Priority Health SBD |
$13.05
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.97
|
|
|
Service Code
|
NDC 00143931810
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$24.27 |
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna Medicare |
$13.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
| Rate for Payer: BCBS Complete |
$10.79
|
| Rate for Payer: Cash Price |
$21.58
|
| Rate for Payer: Cofinity Advantage |
$18.88
|
| Rate for Payer: Cofinity Commercial |
$23.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.58
|
| Rate for Payer: Healthscope Commercial |
$24.27
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.23
|
| Rate for Payer: PHP Commercial |
$22.92
|
| Rate for Payer: Priority Health SBD |
$16.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.53
|
| Rate for Payer: UHC Core |
$14.05
|
| Rate for Payer: UHC Exchange |
$10.60
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.59
|
|
|
Service Code
|
NDC 00703115301
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.31 |
| Max. Negotiated Rate |
$67.13 |
| Rate for Payer: Aetna Commercial |
$63.40
|
| Rate for Payer: Aetna Medicare |
$37.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.48
|
| Rate for Payer: BCBS Complete |
$29.84
|
| Rate for Payer: Cash Price |
$59.67
|
| Rate for Payer: Cofinity Advantage |
$52.21
|
| Rate for Payer: Cofinity Commercial |
$64.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.67
|
| Rate for Payer: Healthscope Commercial |
$67.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.94
|
| Rate for Payer: PHP Commercial |
$63.40
|
| Rate for Payer: Priority Health SBD |
$46.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.48
|
| Rate for Payer: UHC Core |
$38.86
|
| Rate for Payer: UHC Exchange |
$29.31
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.71
|
|
|
Service Code
|
NDC 43066099701
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.14 |
| Max. Negotiated Rate |
$18.64 |
| Rate for Payer: Aetna Commercial |
$17.60
|
| Rate for Payer: Aetna Medicare |
$10.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.46
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: Cash Price |
$16.57
|
| Rate for Payer: Cofinity Advantage |
$14.50
|
| Rate for Payer: Cofinity Commercial |
$17.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.57
|
| Rate for Payer: Healthscope Commercial |
$18.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: PHP Commercial |
$17.60
|
| Rate for Payer: Priority Health SBD |
$13.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.46
|
| Rate for Payer: UHC Core |
$10.79
|
| Rate for Payer: UHC Exchange |
$8.14
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.54
|
|
|
Service Code
|
NDC 65145013310
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.25 |
| Max. Negotiated Rate |
$21.19 |
| Rate for Payer: Aetna Commercial |
$20.01
|
| Rate for Payer: Aetna Medicare |
$11.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.30
|
| Rate for Payer: BCBS Complete |
$9.42
|
| Rate for Payer: Cash Price |
$18.83
|
| Rate for Payer: Cofinity Advantage |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$20.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.83
|
| Rate for Payer: Healthscope Commercial |
$21.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.66
|
| Rate for Payer: PHP Commercial |
$20.01
|
| Rate for Payer: Priority Health SBD |
$14.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.30
|
| Rate for Payer: UHC Core |
$12.26
|
| Rate for Payer: UHC Exchange |
$9.25
|
|
