Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET

Facility

$32.38

Service Code	NDC 59762330403
Hospital Charge Code	5604
Hospital Revenue Code	637
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$29.14
Rate for Payer: Aetna Commercial	$27.52
Rate for Payer: Aetna New Business (MI Preferred)	$21.05
Rate for Payer: Cash Price	$25.90
Rate for Payer: Cofinity Commercial	$22.67
Rate for Payer: Cofinity Commercial	$27.85
Rate for Payer: Cofinity Medicare Advantage	$22.67
Rate for Payer: Encore Health Key Benefits Commercial	$25.90
Rate for Payer: Healthscope Commercial	$29.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.52
Rate for Payer: PHP Commercial	$27.52
Rate for Payer: Priority Health Cigna Priority Health	$21.05
Rate for Payer: Priority Health SBD	$20.40

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET

Facility

$32.38

Service Code	NDC 59762330403
Hospital Charge Code	5604
Hospital Revenue Code	637
Min. Negotiated Rate	$12.95
Max. Negotiated Rate	$29.14
Rate for Payer: Aetna Commercial	$27.52
Rate for Payer: Aetna Medicare	$16.19
Rate for Payer: Aetna New Business (MI Preferred)	$21.05
Rate for Payer: BCBS Complete	$12.95
Rate for Payer: Cash Price	$25.90
Rate for Payer: Cofinity Commercial	$22.67
Rate for Payer: Cofinity Commercial	$27.85
Rate for Payer: Cofinity Medicare Advantage	$22.67
Rate for Payer: Encore Health Key Benefits Commercial	$25.90
Rate for Payer: Healthscope Commercial	$29.14
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.52
Rate for Payer: PHP Commercial	$27.52
Rate for Payer: Priority Health Cigna Priority Health	$21.05
Rate for Payer: Priority Health SBD	$20.40

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET

Facility

$74.37

Service Code	NDC 43598043635
Hospital Charge Code	5604
Hospital Revenue Code	637
Min. Negotiated Rate	$29.75
Max. Negotiated Rate	$66.93
Rate for Payer: Aetna Commercial	$63.21
Rate for Payer: Aetna Medicare	$37.19
Rate for Payer: Aetna New Business (MI Preferred)	$48.34
Rate for Payer: BCBS Complete	$29.75
Rate for Payer: Cash Price	$59.50
Rate for Payer: Cofinity Commercial	$52.06
Rate for Payer: Cofinity Commercial	$63.96
Rate for Payer: Cofinity Medicare Advantage	$52.06
Rate for Payer: Encore Health Key Benefits Commercial	$59.50
Rate for Payer: Healthscope Commercial	$66.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$63.21
Rate for Payer: PHP Commercial	$63.21
Rate for Payer: Priority Health Cigna Priority Health	$48.34
Rate for Payer: Priority Health SBD	$46.85

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET

Facility

$74.37

Service Code	NDC 43598043611
Hospital Charge Code	5604
Hospital Revenue Code	637
Min. Negotiated Rate	$29.75
Max. Negotiated Rate	$66.93
Rate for Payer: Aetna Commercial	$63.21
Rate for Payer: Aetna Medicare	$37.19
Rate for Payer: Aetna New Business (MI Preferred)	$48.34
Rate for Payer: BCBS Complete	$29.75
Rate for Payer: Cash Price	$59.50
Rate for Payer: Cofinity Commercial	$52.06
Rate for Payer: Cofinity Commercial	$63.96
Rate for Payer: Cofinity Medicare Advantage	$52.06
Rate for Payer: Encore Health Key Benefits Commercial	$59.50
Rate for Payer: Healthscope Commercial	$66.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$63.21
Rate for Payer: PHP Commercial	$63.21
Rate for Payer: Priority Health Cigna Priority Health	$48.34
Rate for Payer: Priority Health SBD	$46.85

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET

Facility

$132.46

Service Code	NDC 00071041813
Hospital Charge Code	5604
Hospital Revenue Code	637
Min. Negotiated Rate	$83.45
Max. Negotiated Rate	$119.21
Rate for Payer: Aetna Commercial	$112.59
Rate for Payer: Aetna New Business (MI Preferred)	$86.10
Rate for Payer: Cash Price	$105.97
Rate for Payer: Cofinity Commercial	$113.92
Rate for Payer: Cofinity Commercial	$92.72
Rate for Payer: Cofinity Medicare Advantage	$92.72
Rate for Payer: Encore Health Key Benefits Commercial	$105.97
Rate for Payer: Healthscope Commercial	$119.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.59
Rate for Payer: PHP Commercial	$112.59
Rate for Payer: Priority Health Cigna Priority Health	$86.10
Rate for Payer: Priority Health SBD	$83.45

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET

Facility

$132.46

Service Code	NDC 00071041813
Hospital Charge Code	5604
Hospital Revenue Code	637
Min. Negotiated Rate	$52.98
Max. Negotiated Rate	$119.21
Rate for Payer: Aetna Commercial	$112.59
Rate for Payer: Aetna Medicare	$66.23
Rate for Payer: Aetna New Business (MI Preferred)	$86.10
Rate for Payer: BCBS Complete	$52.98
Rate for Payer: Cash Price	$105.97
Rate for Payer: Cofinity Commercial	$113.92
Rate for Payer: Cofinity Commercial	$92.72
Rate for Payer: Cofinity Medicare Advantage	$92.72
Rate for Payer: Encore Health Key Benefits Commercial	$105.97
Rate for Payer: Healthscope Commercial	$119.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$112.59
Rate for Payer: PHP Commercial	$112.59
Rate for Payer: Priority Health Cigna Priority Health	$86.10
Rate for Payer: Priority Health SBD	$83.45

NITROGLYCERIN 0.4 MG SUBLINGUAL TABLET

Facility

$74.37

Service Code	NDC 43598043611
Hospital Charge Code	5604
Hospital Revenue Code	637
Min. Negotiated Rate	$46.85
Max. Negotiated Rate	$66.93
Rate for Payer: Aetna Commercial	$63.21
Rate for Payer: Aetna New Business (MI Preferred)	$48.34
Rate for Payer: Cash Price	$59.50
Rate for Payer: Cofinity Commercial	$52.06
Rate for Payer: Cofinity Commercial	$63.96
Rate for Payer: Cofinity Medicare Advantage	$52.06
Rate for Payer: Encore Health Key Benefits Commercial	$59.50
Rate for Payer: Healthscope Commercial	$66.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$63.21
Rate for Payer: PHP Commercial	$63.21
Rate for Payer: Priority Health Cigna Priority Health	$48.34
Rate for Payer: Priority Health SBD	$46.85

NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$110.60

Service Code	NDC 00378911693
Hospital Charge Code	27475
Hospital Revenue Code	637
Min. Negotiated Rate	$69.68
Max. Negotiated Rate	$99.54
Rate for Payer: Aetna Commercial	$94.01
Rate for Payer: Aetna New Business (MI Preferred)	$71.89
Rate for Payer: Cash Price	$88.48
Rate for Payer: Cofinity Commercial	$77.42
Rate for Payer: Cofinity Commercial	$95.12
Rate for Payer: Cofinity Medicare Advantage	$77.42
Rate for Payer: Encore Health Key Benefits Commercial	$88.48
Rate for Payer: Healthscope Commercial	$99.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$94.01
Rate for Payer: PHP Commercial	$94.01
Rate for Payer: Priority Health Cigna Priority Health	$71.89
Rate for Payer: Priority Health SBD	$69.68

NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$110.60

Service Code	NDC 00378911693
Hospital Charge Code	27475
Hospital Revenue Code	637
Min. Negotiated Rate	$44.24
Max. Negotiated Rate	$99.54
Rate for Payer: Aetna Commercial	$94.01
Rate for Payer: Aetna Medicare	$55.30
Rate for Payer: Aetna New Business (MI Preferred)	$71.89
Rate for Payer: BCBS Complete	$44.24
Rate for Payer: Cash Price	$88.48
Rate for Payer: Cofinity Commercial	$77.42
Rate for Payer: Cofinity Commercial	$95.12
Rate for Payer: Cofinity Medicare Advantage	$77.42
Rate for Payer: Encore Health Key Benefits Commercial	$88.48
Rate for Payer: Healthscope Commercial	$99.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$94.01
Rate for Payer: PHP Commercial	$94.01
Rate for Payer: Priority Health Cigna Priority Health	$71.89
Rate for Payer: Priority Health SBD	$69.68

NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$102.10

Service Code	NDC 49730011330
Hospital Charge Code	27475
Hospital Revenue Code	637
Min. Negotiated Rate	$64.32
Max. Negotiated Rate	$91.89
Rate for Payer: Aetna Commercial	$86.78
Rate for Payer: Aetna New Business (MI Preferred)	$66.36
Rate for Payer: Cash Price	$81.68
Rate for Payer: Cofinity Commercial	$71.47
Rate for Payer: Cofinity Commercial	$87.81
Rate for Payer: Cofinity Medicare Advantage	$71.47
Rate for Payer: Encore Health Key Benefits Commercial	$81.68
Rate for Payer: Healthscope Commercial	$91.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.78
Rate for Payer: PHP Commercial	$86.78
Rate for Payer: Priority Health Cigna Priority Health	$66.36
Rate for Payer: Priority Health SBD	$64.32

NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$102.10

Service Code	NDC 49730011330
Hospital Charge Code	27475
Hospital Revenue Code	637
Min. Negotiated Rate	$40.84
Max. Negotiated Rate	$91.89
Rate for Payer: Aetna Commercial	$86.78
Rate for Payer: Aetna Medicare	$51.05
Rate for Payer: Aetna New Business (MI Preferred)	$66.36
Rate for Payer: BCBS Complete	$40.84
Rate for Payer: Cash Price	$81.68
Rate for Payer: Cofinity Commercial	$71.47
Rate for Payer: Cofinity Commercial	$87.81
Rate for Payer: Cofinity Medicare Advantage	$71.47
Rate for Payer: Encore Health Key Benefits Commercial	$81.68
Rate for Payer: Healthscope Commercial	$91.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$86.78
Rate for Payer: PHP Commercial	$86.78
Rate for Payer: Priority Health Cigna Priority Health	$66.36
Rate for Payer: Priority Health SBD	$64.32

NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$3.69

Service Code	NDC 00378911616
Hospital Charge Code	27475
Hospital Revenue Code	637
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$3.32
Rate for Payer: Aetna Commercial	$3.14
Rate for Payer: Aetna New Business (MI Preferred)	$2.40
Rate for Payer: Cash Price	$2.95
Rate for Payer: Cofinity Commercial	$2.58
Rate for Payer: Cofinity Commercial	$3.17
Rate for Payer: Cofinity Medicare Advantage	$2.58
Rate for Payer: Encore Health Key Benefits Commercial	$2.95
Rate for Payer: Healthscope Commercial	$3.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.14
Rate for Payer: PHP Commercial	$3.14
Rate for Payer: Priority Health Cigna Priority Health	$2.40
Rate for Payer: Priority Health SBD	$2.32

NITROGLYCERIN 0.6 MG/HR TRANSDERMAL 24 HOUR PATCH

Facility

$3.69

Service Code	NDC 00378911616
Hospital Charge Code	27475
Hospital Revenue Code	637
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$3.32
Rate for Payer: Aetna Commercial	$3.14
Rate for Payer: Aetna Medicare	$1.84
Rate for Payer: Aetna New Business (MI Preferred)	$2.40
Rate for Payer: BCBS Complete	$1.48
Rate for Payer: Cash Price	$2.95
Rate for Payer: Cofinity Commercial	$2.58
Rate for Payer: Cofinity Commercial	$3.17
Rate for Payer: Cofinity Medicare Advantage	$2.58
Rate for Payer: Encore Health Key Benefits Commercial	$2.95
Rate for Payer: Healthscope Commercial	$3.32
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.14
Rate for Payer: PHP Commercial	$3.14
Rate for Payer: Priority Health Cigna Priority Health	$2.40
Rate for Payer: Priority Health SBD	$2.32

NITROGLYCERIN 2 % TRANSDERMAL OINTMENT

Facility

$110.88

Service Code	NDC 00281032630
Hospital Charge Code	5606
Hospital Revenue Code	637
Min. Negotiated Rate	$69.85
Max. Negotiated Rate	$99.79
Rate for Payer: Aetna Commercial	$94.25
Rate for Payer: Aetna New Business (MI Preferred)	$72.07
Rate for Payer: Cash Price	$88.70
Rate for Payer: Cofinity Commercial	$77.62
Rate for Payer: Cofinity Commercial	$95.36
Rate for Payer: Cofinity Medicare Advantage	$77.62
Rate for Payer: Encore Health Key Benefits Commercial	$88.70
Rate for Payer: Healthscope Commercial	$99.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$94.25
Rate for Payer: PHP Commercial	$94.25
Rate for Payer: Priority Health Cigna Priority Health	$72.07
Rate for Payer: Priority Health SBD	$69.85

NITROGLYCERIN 2 % TRANSDERMAL OINTMENT

Facility

$110.88

Service Code	NDC 00281032630
Hospital Charge Code	5606
Hospital Revenue Code	637
Min. Negotiated Rate	$44.35
Max. Negotiated Rate	$99.79
Rate for Payer: Aetna Commercial	$94.25
Rate for Payer: Aetna Medicare	$55.44
Rate for Payer: Aetna New Business (MI Preferred)	$72.07
Rate for Payer: BCBS Complete	$44.35
Rate for Payer: Cash Price	$88.70
Rate for Payer: Cofinity Commercial	$77.62
Rate for Payer: Cofinity Commercial	$95.36
Rate for Payer: Cofinity Medicare Advantage	$77.62
Rate for Payer: Encore Health Key Benefits Commercial	$88.70
Rate for Payer: Healthscope Commercial	$99.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$94.25
Rate for Payer: PHP Commercial	$94.25
Rate for Payer: Priority Health Cigna Priority Health	$72.07
Rate for Payer: Priority Health SBD	$69.85

NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS

Facility

$89.51

Service Code	HCPCS J2305
Hospital Charge Code	15859
Hospital Revenue Code	636
Min. Negotiated Rate	$35.80
Max. Negotiated Rate	$80.56
Rate for Payer: Aetna Commercial	$76.08
Rate for Payer: Aetna Medicare	$44.76
Rate for Payer: Aetna New Business (MI Preferred)	$58.18
Rate for Payer: BCBS Complete	$35.80
Rate for Payer: Cash Price	$71.61
Rate for Payer: Cofinity Commercial	$62.66
Rate for Payer: Cofinity Commercial	$76.98
Rate for Payer: Cofinity Medicare Advantage	$62.66
Rate for Payer: Encore Health Key Benefits Commercial	$71.61
Rate for Payer: Healthscope Commercial	$80.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$76.08
Rate for Payer: PHP Commercial	$76.08
Rate for Payer: Priority Health Cigna Priority Health	$58.18
Rate for Payer: Priority Health SBD	$56.39

NITROGLYCERIN 50 MG/250 ML (200 MCG/ML) IN 5 % DEXTROSE INTRAVENOUS

Facility

$89.51

Service Code	HCPCS J2305
Hospital Charge Code	15859
Hospital Revenue Code	636
Min. Negotiated Rate	$56.39
Max. Negotiated Rate	$80.56
Rate for Payer: Aetna Commercial	$76.08
Rate for Payer: Aetna New Business (MI Preferred)	$58.18
Rate for Payer: Cash Price	$71.61
Rate for Payer: Cofinity Commercial	$62.66
Rate for Payer: Cofinity Commercial	$76.98
Rate for Payer: Cofinity Medicare Advantage	$62.66
Rate for Payer: Encore Health Key Benefits Commercial	$71.61
Rate for Payer: Healthscope Commercial	$80.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$76.08
Rate for Payer: PHP Commercial	$76.08
Rate for Payer: Priority Health Cigna Priority Health	$58.18
Rate for Payer: Priority Health SBD	$56.39

NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION

Facility

$14,568.75

Service Code	HCPCS J9299
Hospital Charge Code	173434
Hospital Revenue Code	636
Min. Negotiated Rate	$9,178.31
Max. Negotiated Rate	$13,111.88
Rate for Payer: Aetna Commercial	$12,383.44
Rate for Payer: Aetna New Business (MI Preferred)	$9,469.69
Rate for Payer: Cash Price	$11,655.00
Rate for Payer: Cofinity Commercial	$10,198.12
Rate for Payer: Cofinity Commercial	$12,529.12
Rate for Payer: Cofinity Medicare Advantage	$10,198.12
Rate for Payer: Encore Health Key Benefits Commercial	$11,655.00
Rate for Payer: Healthscope Commercial	$13,111.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12,383.44
Rate for Payer: PHP Commercial	$12,383.44
Rate for Payer: Priority Health Cigna Priority Health	$9,469.69
Rate for Payer: Priority Health SBD	$9,178.31

NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION

Facility

$14,568.75

Service Code	HCPCS J9299
Hospital Charge Code	173434
Hospital Revenue Code	636
Min. Negotiated Rate	$17.67
Max. Negotiated Rate	$13,111.88
Rate for Payer: Aetna Commercial	$12,383.44
Rate for Payer: Aetna Medicare	$34.28
Rate for Payer: Aetna New Business (MI Preferred)	$9,469.69
Rate for Payer: Allen County Amish Medical Aid Commercial	$41.20
Rate for Payer: Amish Plain Church Group Commercial	$41.20
Rate for Payer: BCBS Complete	$18.55
Rate for Payer: BCBS MAPPO	$32.96
Rate for Payer: BCN Medicare Advantage	$32.96
Rate for Payer: Cash Price	$11,655.00
Rate for Payer: Cash Price	$11,655.00
Rate for Payer: Cofinity Commercial	$12,529.12
Rate for Payer: Cofinity Commercial	$10,198.12
Rate for Payer: Cofinity Medicare Advantage	$10,198.12
Rate for Payer: Encore Health Key Benefits Commercial	$11,655.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$32.96
Rate for Payer: Healthscope Commercial	$13,111.88
Rate for Payer: Mclaren Medicaid	$17.67
Rate for Payer: Mclaren Medicare	$32.96
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$34.61
Rate for Payer: Meridian Medicaid	$18.55
Rate for Payer: MI Amish Medical Board Commercial	$37.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12,383.44
Rate for Payer: PACE Medicare	$31.31
Rate for Payer: PACE SWMI	$32.96
Rate for Payer: PHP Commercial	$12,383.44
Rate for Payer: PHP Medicare Advantage	$32.96
Rate for Payer: Priority Health Choice Medicaid	$17.67
Rate for Payer: Priority Health Cigna Priority Health	$9,469.69
Rate for Payer: Priority Health Medicare	$32.96
Rate for Payer: Priority Health SBD	$9,178.31
Rate for Payer: Railroad Medicare Medicare	$32.96
Rate for Payer: UHC All Payor (Choice/PPO)	$92.78
Rate for Payer: UHC Dual Complete DSNP	$32.96
Rate for Payer: UHC Medicare Advantage	$32.96
Rate for Payer: UHCCP Medicaid	$18.56
Rate for Payer: VA VA	$32.96

NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION

Facility

$24,919.45

Service Code	HCPCS J9299
Hospital Charge Code	185666
Hospital Revenue Code	636
Min. Negotiated Rate	$17.67
Max. Negotiated Rate	$22,427.51
Rate for Payer: Aetna Commercial	$21,181.53
Rate for Payer: Aetna Medicare	$34.28
Rate for Payer: Aetna New Business (MI Preferred)	$16,197.64
Rate for Payer: Allen County Amish Medical Aid Commercial	$41.20
Rate for Payer: Amish Plain Church Group Commercial	$41.20
Rate for Payer: BCBS Complete	$18.55
Rate for Payer: BCBS MAPPO	$32.96
Rate for Payer: BCN Medicare Advantage	$32.96
Rate for Payer: Cash Price	$19,935.56
Rate for Payer: Cash Price	$19,935.56
Rate for Payer: Cofinity Commercial	$17,443.62
Rate for Payer: Cofinity Commercial	$21,430.73
Rate for Payer: Cofinity Medicare Advantage	$17,443.62
Rate for Payer: Encore Health Key Benefits Commercial	$19,935.56
Rate for Payer: Health Alliance Plan Medicare Advantage	$32.96
Rate for Payer: Healthscope Commercial	$22,427.51
Rate for Payer: Mclaren Medicaid	$17.67
Rate for Payer: Mclaren Medicare	$32.96
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$34.61
Rate for Payer: Meridian Medicaid	$18.55
Rate for Payer: MI Amish Medical Board Commercial	$37.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21,181.53
Rate for Payer: PACE Medicare	$31.31
Rate for Payer: PACE SWMI	$32.96
Rate for Payer: PHP Commercial	$21,181.53
Rate for Payer: PHP Medicare Advantage	$32.96
Rate for Payer: Priority Health Choice Medicaid	$17.67
Rate for Payer: Priority Health Cigna Priority Health	$16,197.64
Rate for Payer: Priority Health Medicare	$32.96
Rate for Payer: Priority Health SBD	$15,699.25
Rate for Payer: Railroad Medicare Medicare	$32.96
Rate for Payer: UHC All Payor (Choice/PPO)	$92.78
Rate for Payer: UHC Dual Complete DSNP	$32.96
Rate for Payer: UHC Medicare Advantage	$32.96
Rate for Payer: UHCCP Medicaid	$18.56
Rate for Payer: VA VA	$32.96

NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION

Facility

$5,827.54

Service Code	HCPCS J9299
Hospital Charge Code	173433
Hospital Revenue Code	636
Min. Negotiated Rate	$17.67
Max. Negotiated Rate	$5,244.79
Rate for Payer: Aetna Commercial	$4,953.41
Rate for Payer: Aetna Medicare	$34.28
Rate for Payer: Aetna New Business (MI Preferred)	$3,787.90
Rate for Payer: Allen County Amish Medical Aid Commercial	$41.20
Rate for Payer: Amish Plain Church Group Commercial	$41.20
Rate for Payer: BCBS Complete	$18.55
Rate for Payer: BCBS MAPPO	$32.96
Rate for Payer: BCN Medicare Advantage	$32.96
Rate for Payer: Cash Price	$4,662.03
Rate for Payer: Cash Price	$4,662.03
Rate for Payer: Cofinity Commercial	$4,079.28
Rate for Payer: Cofinity Commercial	$5,011.68
Rate for Payer: Cofinity Medicare Advantage	$4,079.28
Rate for Payer: Encore Health Key Benefits Commercial	$4,662.03
Rate for Payer: Health Alliance Plan Medicare Advantage	$32.96
Rate for Payer: Healthscope Commercial	$5,244.79
Rate for Payer: Mclaren Medicaid	$17.67
Rate for Payer: Mclaren Medicare	$32.96
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$34.61
Rate for Payer: Meridian Medicaid	$18.55
Rate for Payer: MI Amish Medical Board Commercial	$37.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,953.41
Rate for Payer: PACE Medicare	$31.31
Rate for Payer: PACE SWMI	$32.96
Rate for Payer: PHP Commercial	$4,953.41
Rate for Payer: PHP Medicare Advantage	$32.96
Rate for Payer: Priority Health Choice Medicaid	$17.67
Rate for Payer: Priority Health Cigna Priority Health	$3,787.90
Rate for Payer: Priority Health Medicare	$32.96
Rate for Payer: Priority Health SBD	$3,671.35
Rate for Payer: Railroad Medicare Medicare	$32.96
Rate for Payer: UHC All Payor (Choice/PPO)	$92.78
Rate for Payer: UHC Dual Complete DSNP	$32.96
Rate for Payer: UHC Medicare Advantage	$32.96
Rate for Payer: UHCCP Medicaid	$18.56
Rate for Payer: VA VA	$32.96

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION

Facility

$25.46

Service Code	NDC 00143931801
Hospital Charge Code	10734
Hospital Revenue Code	250
Min. Negotiated Rate	$10.18
Max. Negotiated Rate	$22.91
Rate for Payer: Aetna Commercial	$21.64
Rate for Payer: Aetna Medicare	$12.73
Rate for Payer: Aetna New Business (MI Preferred)	$16.55
Rate for Payer: BCBS Complete	$10.18
Rate for Payer: Cash Price	$20.37
Rate for Payer: Cofinity Commercial	$17.82
Rate for Payer: Cofinity Commercial	$21.90
Rate for Payer: Cofinity Medicare Advantage	$17.82
Rate for Payer: Encore Health Key Benefits Commercial	$20.37
Rate for Payer: Healthscope Commercial	$22.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$21.64
Rate for Payer: PHP Commercial	$21.64
Rate for Payer: Priority Health Cigna Priority Health	$16.55
Rate for Payer: Priority Health SBD	$16.04

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION

Facility

$24.04

Service Code	NDC 70121157607
Hospital Charge Code	10734
Hospital Revenue Code	250
Min. Negotiated Rate	$9.62
Max. Negotiated Rate	$21.64
Rate for Payer: Aetna Commercial	$20.43
Rate for Payer: Aetna Medicare	$12.02
Rate for Payer: Aetna New Business (MI Preferred)	$15.63
Rate for Payer: BCBS Complete	$9.62
Rate for Payer: Cash Price	$19.23
Rate for Payer: Cofinity Commercial	$16.83
Rate for Payer: Cofinity Commercial	$20.67
Rate for Payer: Cofinity Medicare Advantage	$16.83
Rate for Payer: Encore Health Key Benefits Commercial	$19.23
Rate for Payer: Healthscope Commercial	$21.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.43
Rate for Payer: PHP Commercial	$20.43
Rate for Payer: Priority Health Cigna Priority Health	$15.63
Rate for Payer: Priority Health SBD	$15.15

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION

Facility

$24.04

Service Code	NDC 70121157607
Hospital Charge Code	10734
Hospital Revenue Code	250
Min. Negotiated Rate	$15.15
Max. Negotiated Rate	$21.64
Rate for Payer: Aetna Commercial	$20.43
Rate for Payer: Aetna New Business (MI Preferred)	$15.63
Rate for Payer: Cash Price	$19.23
Rate for Payer: Cofinity Commercial	$16.83
Rate for Payer: Cofinity Commercial	$20.67
Rate for Payer: Cofinity Medicare Advantage	$16.83
Rate for Payer: Encore Health Key Benefits Commercial	$19.23
Rate for Payer: Healthscope Commercial	$21.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.43
Rate for Payer: PHP Commercial	$20.43
Rate for Payer: Priority Health Cigna Priority Health	$15.63
Rate for Payer: Priority Health SBD	$15.15

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION

Facility

$24.04

Service Code	NDC 70121157601
Hospital Charge Code	10734
Hospital Revenue Code	250
Min. Negotiated Rate	$9.62
Max. Negotiated Rate	$21.64
Rate for Payer: Aetna Commercial	$20.43
Rate for Payer: Aetna Medicare	$12.02
Rate for Payer: Aetna New Business (MI Preferred)	$15.63
Rate for Payer: BCBS Complete	$9.62
Rate for Payer: Cash Price	$19.23
Rate for Payer: Cofinity Commercial	$16.83
Rate for Payer: Cofinity Commercial	$20.67
Rate for Payer: Cofinity Medicare Advantage	$16.83
Rate for Payer: Encore Health Key Benefits Commercial	$19.23
Rate for Payer: Healthscope Commercial	$21.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.43
Rate for Payer: PHP Commercial	$20.43
Rate for Payer: Priority Health Cigna Priority Health	$15.63
Rate for Payer: Priority Health SBD	$15.15

Know your out-of-pocket cost for care.

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