|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14.92
|
|
|
Service Code
|
NDC 67457085204
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$13.43 |
| Rate for Payer: Aetna Commercial |
$12.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.70
|
| 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: 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
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$16.26
|
|
|
Service Code
|
NDC 51991098399
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$14.63 |
| Rate for Payer: Aetna Commercial |
$13.82
|
| Rate for Payer: Aetna Medicare |
$8.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.57
|
| Rate for Payer: BCBS Complete |
$6.50
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Cofinity Advantage |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$13.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.01
|
| Rate for Payer: Healthscope Commercial |
$14.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.20
|
| Rate for Payer: PHP Commercial |
$13.82
|
| Rate for Payer: Priority Health SBD |
$10.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.57
|
| Rate for Payer: UHC Core |
$8.47
|
| Rate for Payer: UHC Exchange |
$6.39
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.25
|
|
|
Service Code
|
NDC 36000016210
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: Aetna Commercial |
$17.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.16
|
| 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: 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
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.83
|
|
|
Service Code
|
NDC 70121157601
|
| 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
|
$16.26
|
|
|
Service Code
|
NDC 51991098317
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$14.63 |
| Rate for Payer: Aetna Commercial |
$13.82
|
| Rate for Payer: Aetna Medicare |
$8.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.57
|
| Rate for Payer: BCBS Complete |
$6.50
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Cofinity Advantage |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$13.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.01
|
| Rate for Payer: Healthscope Commercial |
$14.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.20
|
| Rate for Payer: PHP Commercial |
$13.82
|
| Rate for Payer: Priority Health SBD |
$10.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.57
|
| Rate for Payer: UHC Core |
$8.47
|
| Rate for Payer: UHC Exchange |
$6.39
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$74.59
|
|
|
Service Code
|
NDC 00703115301
|
| 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
|
OP
|
$14.92
|
|
|
Service Code
|
NDC 67457085200
|
| 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
|
OP
|
$20.71
|
|
|
Service Code
|
NDC 43066099710
|
| 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
|
IP
|
$16.26
|
|
|
Service Code
|
NDC 51991098399
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$14.63 |
| Rate for Payer: Aetna Commercial |
$13.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.57
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Cofinity Advantage |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$13.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.01
|
| Rate for Payer: Healthscope Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.20
|
| Rate for Payer: PHP Commercial |
$13.82
|
| Rate for Payer: Priority Health SBD |
$10.24
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.97
|
|
|
Service Code
|
NDC 00143931810
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$24.27 |
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
| 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: 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
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$26.97
|
|
|
Service Code
|
NDC 00143931801
|
| 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
|
$18.62
|
|
|
Service Code
|
NDC 00409337504
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$16.76 |
| Rate for Payer: Aetna Commercial |
$15.83
|
| Rate for Payer: Aetna Medicare |
$9.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.10
|
| Rate for Payer: BCBS Complete |
$7.45
|
| 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: MI Amish Medical Board Commercial |
$14.90
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.10
|
| Rate for Payer: UHC Core |
$9.70
|
| Rate for Payer: UHC Exchange |
$7.32
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$16.26
|
|
|
Service Code
|
NDC 51991098317
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$14.63 |
| Rate for Payer: Aetna Commercial |
$13.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.57
|
| Rate for Payer: Cash Price |
$13.01
|
| Rate for Payer: Cofinity Advantage |
$11.38
|
| Rate for Payer: Cofinity Commercial |
$13.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.01
|
| Rate for Payer: Healthscope Commercial |
$14.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.20
|
| Rate for Payer: PHP Commercial |
$13.82
|
| Rate for Payer: Priority Health SBD |
$10.24
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$26.97
|
|
|
Service Code
|
NDC 00143931801
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.99 |
| Max. Negotiated Rate |
$24.27 |
| Rate for Payer: Aetna Commercial |
$22.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.53
|
| 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: 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
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.54
|
|
|
Service Code
|
NDC 65145013301
|
| 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
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.83
|
|
|
Service Code
|
NDC 70121157607
|
| 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
|
$14.92
|
|
|
Service Code
|
NDC 67457085200
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$13.43 |
| Rate for Payer: Aetna Commercial |
$12.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.70
|
| 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: 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
|
|
|
NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) INFUSION
|
Facility
|
OP
|
$21.50
|
|
|
Service Code
|
NDC 44567064110
|
| Hospital Charge Code |
119763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Aetna Commercial |
$18.27
|
| Rate for Payer: Aetna Medicare |
$10.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.97
|
| Rate for Payer: BCBS Complete |
$8.60
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cofinity Advantage |
$15.05
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.20
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.12
|
| Rate for Payer: PHP Commercial |
$18.27
|
| Rate for Payer: Priority Health SBD |
$13.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.97
|
| Rate for Payer: UHC Core |
$11.20
|
| Rate for Payer: UHC Exchange |
$8.45
|
|
|
NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) INFUSION
|
Facility
|
IP
|
$21.50
|
|
|
Service Code
|
NDC 44567064101
|
| Hospital Charge Code |
119763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Aetna Commercial |
$18.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.97
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cofinity Advantage |
$15.05
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.20
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.12
|
| Rate for Payer: PHP Commercial |
$18.27
|
| Rate for Payer: Priority Health SBD |
$13.54
|
|
|
NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) INFUSION
|
Facility
|
OP
|
$21.50
|
|
|
Service Code
|
NDC 44567064101
|
| Hospital Charge Code |
119763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Aetna Commercial |
$18.27
|
| Rate for Payer: Aetna Medicare |
$10.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.97
|
| Rate for Payer: BCBS Complete |
$8.60
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cofinity Advantage |
$15.05
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.20
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.12
|
| Rate for Payer: PHP Commercial |
$18.27
|
| Rate for Payer: Priority Health SBD |
$13.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.97
|
| Rate for Payer: UHC Core |
$11.20
|
| Rate for Payer: UHC Exchange |
$8.45
|
|
|
NOREPINEPHRINE BITARTRATE 8 MG/250 ML (32 MCG/ML) INFUSION
|
Facility
|
IP
|
$21.50
|
|
|
Service Code
|
NDC 44567064110
|
| Hospital Charge Code |
119763
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$19.35 |
| Rate for Payer: Aetna Commercial |
$18.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.97
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cofinity Advantage |
$15.05
|
| Rate for Payer: Cofinity Commercial |
$18.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.20
|
| Rate for Payer: Healthscope Commercial |
$19.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.12
|
| Rate for Payer: PHP Commercial |
$18.27
|
| Rate for Payer: Priority Health SBD |
$13.54
|
|
|
NORMAL NEWBORN
|
Facility
|
IP
|
$3,256.74
|
|
|
Service Code
|
MSDRG 795
|
| Min. Negotiated Rate |
$1,831.47 |
| Max. Negotiated Rate |
$3,256.74 |
| Rate for Payer: Aetna Medicare |
$2,208.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2,653.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2,653.88
|
| Rate for Payer: BCBS MAPPO |
$2,123.10
|
| Rate for Payer: BCBS Trust/PPO |
$2,570.20
|
| Rate for Payer: BCN Commercial |
$2,570.20
|
| Rate for Payer: BCN Medicare Advantage |
$2,123.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,123.10
|
| Rate for Payer: Mclaren Medicare |
$2,123.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,229.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,441.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,335.41
|
| Rate for Payer: Nomi Health Commercial |
$2,577.42
|
| Rate for Payer: PACE Medicare |
$2,016.94
|
| Rate for Payer: PACE SWMI |
$2,123.10
|
| Rate for Payer: PHP Medicare Advantage |
$2,123.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,289.34
|
| Rate for Payer: Priority Health Medicare |
$2,123.10
|
| Rate for Payer: Priority Health Tiered Network |
$1,831.47
|
| Rate for Payer: Railroad Medicare Medicare |
$2,123.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,256.74
|
| Rate for Payer: UHC Core |
$2,724.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,123.10
|
| Rate for Payer: UHC Exchange |
$2,225.17
|
| Rate for Payer: VA VA |
$2,123.10
|
|
|
NORTRIPTYLINE 10 MG CAPSULE
|
Facility
|
OP
|
$3.26
|
|
|
Service Code
|
NDC 60687028111
|
| Hospital Charge Code |
5674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$2.93 |
| Rate for Payer: Aetna Commercial |
$2.77
|
| Rate for Payer: Aetna Medicare |
$1.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.12
|
| Rate for Payer: BCBS Complete |
$1.30
|
| Rate for Payer: Cash Price |
$2.61
|
| Rate for Payer: Cofinity Advantage |
$2.28
|
| Rate for Payer: Cofinity Commercial |
$2.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.61
|
| Rate for Payer: Healthscope Commercial |
$2.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.44
|
| Rate for Payer: PHP Commercial |
$2.77
|
| Rate for Payer: Priority Health SBD |
$2.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.12
|
| Rate for Payer: UHC Core |
$1.70
|
| Rate for Payer: UHC Exchange |
$1.28
|
|
|
NORTRIPTYLINE 10 MG CAPSULE
|
Facility
|
OP
|
$324.30
|
|
|
Service Code
|
NDC 00093081001
|
| Hospital Charge Code |
5674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.45 |
| Max. Negotiated Rate |
$291.87 |
| Rate for Payer: Aetna Commercial |
$275.65
|
| Rate for Payer: Aetna Medicare |
$162.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.79
|
| Rate for Payer: BCBS Complete |
$129.72
|
| Rate for Payer: Cash Price |
$259.44
|
| Rate for Payer: Cofinity Advantage |
$227.01
|
| Rate for Payer: Cofinity Commercial |
$278.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.44
|
| Rate for Payer: Healthscope Commercial |
$291.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$259.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.22
|
| Rate for Payer: PHP Commercial |
$275.65
|
| Rate for Payer: Priority Health SBD |
$204.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.79
|
| Rate for Payer: UHC Core |
$168.96
|
| Rate for Payer: UHC Exchange |
$127.45
|
|
|
NORTRIPTYLINE 10 MG CAPSULE
|
Facility
|
IP
|
$173.38
|
|
|
Service Code
|
NDC 50268060315
|
| Hospital Charge Code |
5674
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.23 |
| Max. Negotiated Rate |
$156.04 |
| Rate for Payer: Aetna Commercial |
$147.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.70
|
| Rate for Payer: Cash Price |
$138.70
|
| Rate for Payer: Cofinity Advantage |
$121.37
|
| Rate for Payer: Cofinity Commercial |
$149.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.70
|
| Rate for Payer: Healthscope Commercial |
$156.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.03
|
| Rate for Payer: PHP Commercial |
$147.37
|
| Rate for Payer: Priority Health SBD |
$109.23
|
|
