|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$72.86
|
|
|
Service Code
|
NDC 66794023042
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.36 |
| Max. Negotiated Rate |
$65.57 |
| Rate for Payer: Aetna Commercial |
$61.93
|
| Rate for Payer: BCBS Trust/PPO |
$59.48
|
| Rate for Payer: BCN Commercial |
$56.31
|
| Rate for Payer: Cash Price |
$58.29
|
| Rate for Payer: Cofinity Commercial |
$62.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.29
|
| Rate for Payer: Healthscope Commercial |
$65.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.93
|
| Rate for Payer: Nomi Health Commercial |
$59.75
|
| Rate for Payer: PHP Commercial |
$61.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.36
|
| Rate for Payer: Priority Health HMO/PPO |
$63.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.12
|
| Rate for Payer: UHC Core |
$60.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$72.86
|
|
|
Service Code
|
NDC 66794023342
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.36 |
| Max. Negotiated Rate |
$65.57 |
| Rate for Payer: Aetna Commercial |
$61.93
|
| Rate for Payer: BCBS Trust/PPO |
$59.48
|
| Rate for Payer: BCN Commercial |
$56.31
|
| Rate for Payer: Cash Price |
$58.29
|
| Rate for Payer: Cofinity Commercial |
$62.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.29
|
| Rate for Payer: Healthscope Commercial |
$65.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.93
|
| Rate for Payer: Nomi Health Commercial |
$59.75
|
| Rate for Payer: PHP Commercial |
$61.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.36
|
| Rate for Payer: Priority Health HMO/PPO |
$63.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.12
|
| Rate for Payer: UHC Core |
$60.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$63.07
|
|
|
Service Code
|
NDC 55150020902
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.98 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna Commercial |
$53.61
|
| Rate for Payer: Aetna Medicare |
$16.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.71
|
| Rate for Payer: BCBS Complete |
$25.23
|
| Rate for Payer: BCBS MAPPO |
$15.77
|
| Rate for Payer: BCBS Trust/PPO |
$51.85
|
| Rate for Payer: BCN Commercial |
$49.04
|
| Rate for Payer: BCN Medicare Advantage |
$15.77
|
| Rate for Payer: Cash Price |
$50.46
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.77
|
| Rate for Payer: Healthscope Commercial |
$56.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.61
|
| Rate for Payer: Nomi Health Commercial |
$51.72
|
| Rate for Payer: PACE Senior Care Partners |
$14.98
|
| Rate for Payer: PACE SWMI |
$15.77
|
| Rate for Payer: PHP Commercial |
$53.61
|
| Rate for Payer: PHP Medicare Advantage |
$15.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.00
|
| Rate for Payer: Priority Health HMO/PPO |
$54.87
|
| Rate for Payer: Priority Health Medicare |
$15.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.26
|
| Rate for Payer: Railroad Medicare Medicare |
$15.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.50
|
| Rate for Payer: UHC Core |
$52.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.77
|
| Rate for Payer: UHC Exchange |
$15.77
|
| Rate for Payer: UHC Medicare Advantage |
$15.77
|
| Rate for Payer: VA VA |
$15.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.30
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$80.11
|
|
|
Service Code
|
NDC 71288050502
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.07 |
| Max. Negotiated Rate |
$72.10 |
| Rate for Payer: Aetna Commercial |
$68.09
|
| Rate for Payer: BCBS Trust/PPO |
$65.39
|
| Rate for Payer: BCN Commercial |
$61.91
|
| Rate for Payer: Cash Price |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$68.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.09
|
| Rate for Payer: Healthscope Commercial |
$72.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.09
|
| Rate for Payer: Nomi Health Commercial |
$65.69
|
| Rate for Payer: PHP Commercial |
$68.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.07
|
| Rate for Payer: Priority Health HMO/PPO |
$69.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.50
|
| Rate for Payer: UHC Core |
$66.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.08
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$63.07
|
|
|
Service Code
|
NDC 55150020902
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna Commercial |
$53.61
|
| Rate for Payer: BCBS Trust/PPO |
$51.48
|
| Rate for Payer: BCN Commercial |
$48.74
|
| Rate for Payer: Cash Price |
$50.46
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.46
|
| Rate for Payer: Healthscope Commercial |
$56.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.61
|
| Rate for Payer: Nomi Health Commercial |
$51.72
|
| Rate for Payer: PHP Commercial |
$53.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.00
|
| Rate for Payer: Priority Health HMO/PPO |
$54.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.50
|
| Rate for Payer: UHC Core |
$52.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.30
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$80.11
|
|
|
Service Code
|
NDC 71288050502
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.03 |
| Max. Negotiated Rate |
$72.10 |
| Rate for Payer: Aetna Commercial |
$68.09
|
| Rate for Payer: Aetna Medicare |
$20.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.03
|
| Rate for Payer: BCBS Complete |
$32.04
|
| Rate for Payer: BCBS MAPPO |
$20.03
|
| Rate for Payer: BCBS Trust/PPO |
$65.86
|
| Rate for Payer: BCN Commercial |
$62.29
|
| Rate for Payer: BCN Medicare Advantage |
$20.03
|
| Rate for Payer: Cash Price |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$68.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.03
|
| Rate for Payer: Healthscope Commercial |
$72.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.09
|
| Rate for Payer: Nomi Health Commercial |
$65.69
|
| Rate for Payer: PACE Senior Care Partners |
$19.03
|
| Rate for Payer: PACE SWMI |
$20.03
|
| Rate for Payer: PHP Commercial |
$68.09
|
| Rate for Payer: PHP Medicare Advantage |
$20.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.07
|
| Rate for Payer: Priority Health HMO/PPO |
$69.70
|
| Rate for Payer: Priority Health Medicare |
$20.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.67
|
| Rate for Payer: Railroad Medicare Medicare |
$20.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.50
|
| Rate for Payer: UHC Core |
$66.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.03
|
| Rate for Payer: UHC Exchange |
$20.03
|
| Rate for Payer: UHC Medicare Advantage |
$20.03
|
| Rate for Payer: VA VA |
$20.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.08
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$80.11
|
|
|
Service Code
|
NDC 71288050503
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.07 |
| Max. Negotiated Rate |
$72.10 |
| Rate for Payer: Aetna Commercial |
$68.09
|
| Rate for Payer: BCBS Trust/PPO |
$65.39
|
| Rate for Payer: BCN Commercial |
$61.91
|
| Rate for Payer: Cash Price |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$68.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.09
|
| Rate for Payer: Healthscope Commercial |
$72.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.09
|
| Rate for Payer: Nomi Health Commercial |
$65.69
|
| Rate for Payer: PHP Commercial |
$68.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.07
|
| Rate for Payer: Priority Health HMO/PPO |
$69.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.50
|
| Rate for Payer: UHC Core |
$66.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.08
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$72.86
|
|
|
Service Code
|
NDC 66794023042
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.30 |
| Max. Negotiated Rate |
$65.57 |
| Rate for Payer: Aetna Commercial |
$61.93
|
| Rate for Payer: Aetna Medicare |
$18.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.77
|
| Rate for Payer: BCBS Complete |
$29.14
|
| Rate for Payer: BCBS MAPPO |
$18.22
|
| Rate for Payer: BCBS Trust/PPO |
$59.90
|
| Rate for Payer: BCN Commercial |
$56.65
|
| Rate for Payer: BCN Medicare Advantage |
$18.22
|
| Rate for Payer: Cash Price |
$58.29
|
| Rate for Payer: Cofinity Commercial |
$62.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.22
|
| Rate for Payer: Healthscope Commercial |
$65.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.93
|
| Rate for Payer: Nomi Health Commercial |
$59.75
|
| Rate for Payer: PACE Senior Care Partners |
$17.30
|
| Rate for Payer: PACE SWMI |
$18.22
|
| Rate for Payer: PHP Commercial |
$61.93
|
| Rate for Payer: PHP Medicare Advantage |
$18.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.36
|
| Rate for Payer: Priority Health HMO/PPO |
$63.39
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.82
|
| Rate for Payer: Railroad Medicare Medicare |
$18.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.12
|
| Rate for Payer: UHC Core |
$60.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.22
|
| Rate for Payer: UHC Exchange |
$18.22
|
| Rate for Payer: UHC Medicare Advantage |
$18.22
|
| Rate for Payer: VA VA |
$18.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$72.86
|
|
|
Service Code
|
NDC 66794023302
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.30 |
| Max. Negotiated Rate |
$65.57 |
| Rate for Payer: Aetna Commercial |
$61.93
|
| Rate for Payer: Aetna Medicare |
$18.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.77
|
| Rate for Payer: BCBS Complete |
$29.14
|
| Rate for Payer: BCBS MAPPO |
$18.22
|
| Rate for Payer: BCBS Trust/PPO |
$59.90
|
| Rate for Payer: BCN Commercial |
$56.65
|
| Rate for Payer: BCN Medicare Advantage |
$18.22
|
| Rate for Payer: Cash Price |
$58.29
|
| Rate for Payer: Cofinity Commercial |
$62.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.22
|
| Rate for Payer: Healthscope Commercial |
$65.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.93
|
| Rate for Payer: Nomi Health Commercial |
$59.75
|
| Rate for Payer: PACE Senior Care Partners |
$17.30
|
| Rate for Payer: PACE SWMI |
$18.22
|
| Rate for Payer: PHP Commercial |
$61.93
|
| Rate for Payer: PHP Medicare Advantage |
$18.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.36
|
| Rate for Payer: Priority Health HMO/PPO |
$63.39
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.82
|
| Rate for Payer: Railroad Medicare Medicare |
$18.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.12
|
| Rate for Payer: UHC Core |
$60.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.22
|
| Rate for Payer: UHC Exchange |
$18.22
|
| Rate for Payer: UHC Medicare Advantage |
$18.22
|
| Rate for Payer: VA VA |
$18.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$80.11
|
|
|
Service Code
|
NDC 71288050503
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.03 |
| Max. Negotiated Rate |
$72.10 |
| Rate for Payer: Aetna Commercial |
$68.09
|
| Rate for Payer: Aetna Medicare |
$20.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.03
|
| Rate for Payer: BCBS Complete |
$32.04
|
| Rate for Payer: BCBS MAPPO |
$20.03
|
| Rate for Payer: BCBS Trust/PPO |
$65.86
|
| Rate for Payer: BCN Commercial |
$62.29
|
| Rate for Payer: BCN Medicare Advantage |
$20.03
|
| Rate for Payer: Cash Price |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$68.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.03
|
| Rate for Payer: Healthscope Commercial |
$72.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.09
|
| Rate for Payer: Nomi Health Commercial |
$65.69
|
| Rate for Payer: PACE Senior Care Partners |
$19.03
|
| Rate for Payer: PACE SWMI |
$20.03
|
| Rate for Payer: PHP Commercial |
$68.09
|
| Rate for Payer: PHP Medicare Advantage |
$20.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.07
|
| Rate for Payer: Priority Health HMO/PPO |
$69.70
|
| Rate for Payer: Priority Health Medicare |
$20.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.67
|
| Rate for Payer: Railroad Medicare Medicare |
$20.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.50
|
| Rate for Payer: UHC Core |
$66.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.03
|
| Rate for Payer: UHC Exchange |
$20.03
|
| Rate for Payer: UHC Medicare Advantage |
$20.03
|
| Rate for Payer: VA VA |
$20.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.08
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$72.86
|
|
|
Service Code
|
NDC 66794023002
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.30 |
| Max. Negotiated Rate |
$65.57 |
| Rate for Payer: Aetna Commercial |
$61.93
|
| Rate for Payer: Aetna Medicare |
$18.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22.77
|
| Rate for Payer: BCBS Complete |
$29.14
|
| Rate for Payer: BCBS MAPPO |
$18.22
|
| Rate for Payer: BCBS Trust/PPO |
$59.90
|
| Rate for Payer: BCN Commercial |
$56.65
|
| Rate for Payer: BCN Medicare Advantage |
$18.22
|
| Rate for Payer: Cash Price |
$58.29
|
| Rate for Payer: Cofinity Commercial |
$62.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.22
|
| Rate for Payer: Healthscope Commercial |
$65.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.93
|
| Rate for Payer: Nomi Health Commercial |
$59.75
|
| Rate for Payer: PACE Senior Care Partners |
$17.30
|
| Rate for Payer: PACE SWMI |
$18.22
|
| Rate for Payer: PHP Commercial |
$61.93
|
| Rate for Payer: PHP Medicare Advantage |
$18.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.36
|
| Rate for Payer: Priority Health HMO/PPO |
$63.39
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.82
|
| Rate for Payer: Railroad Medicare Medicare |
$18.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.12
|
| Rate for Payer: UHC Core |
$60.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.22
|
| Rate for Payer: UHC Exchange |
$18.22
|
| Rate for Payer: UHC Medicare Advantage |
$18.22
|
| Rate for Payer: VA VA |
$18.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$102.38
|
|
|
Service Code
|
NDC 70121138901
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.32 |
| Max. Negotiated Rate |
$92.14 |
| Rate for Payer: Aetna Commercial |
$87.02
|
| Rate for Payer: Aetna Medicare |
$26.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.99
|
| Rate for Payer: BCBS Complete |
$40.95
|
| Rate for Payer: BCBS MAPPO |
$25.60
|
| Rate for Payer: BCBS Trust/PPO |
$84.17
|
| Rate for Payer: BCN Commercial |
$79.60
|
| Rate for Payer: BCN Medicare Advantage |
$25.60
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cofinity Commercial |
$88.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.60
|
| Rate for Payer: Healthscope Commercial |
$92.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.02
|
| Rate for Payer: Nomi Health Commercial |
$83.95
|
| Rate for Payer: PACE Senior Care Partners |
$24.32
|
| Rate for Payer: PACE SWMI |
$25.60
|
| Rate for Payer: PHP Commercial |
$87.02
|
| Rate for Payer: PHP Medicare Advantage |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.55
|
| Rate for Payer: Priority Health HMO/PPO |
$89.07
|
| Rate for Payer: Priority Health Medicare |
$25.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.59
|
| Rate for Payer: Railroad Medicare Medicare |
$25.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.09
|
| Rate for Payer: UHC Core |
$85.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.60
|
| Rate for Payer: UHC Exchange |
$25.60
|
| Rate for Payer: UHC Medicare Advantage |
$25.60
|
| Rate for Payer: VA VA |
$25.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.78
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$102.38
|
|
|
Service Code
|
NDC 70121138901
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$66.55 |
| Max. Negotiated Rate |
$92.14 |
| Rate for Payer: Aetna Commercial |
$87.02
|
| Rate for Payer: BCBS Trust/PPO |
$83.57
|
| Rate for Payer: BCN Commercial |
$79.12
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cofinity Commercial |
$88.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.90
|
| Rate for Payer: Healthscope Commercial |
$92.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.02
|
| Rate for Payer: Nomi Health Commercial |
$83.95
|
| Rate for Payer: PHP Commercial |
$87.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.55
|
| Rate for Payer: Priority Health HMO/PPO |
$89.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.09
|
| Rate for Payer: UHC Core |
$85.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.78
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$102.38
|
|
|
Service Code
|
NDC 70121138907
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.32 |
| Max. Negotiated Rate |
$92.14 |
| Rate for Payer: Aetna Commercial |
$87.02
|
| Rate for Payer: Aetna Medicare |
$26.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.99
|
| Rate for Payer: BCBS Complete |
$40.95
|
| Rate for Payer: BCBS MAPPO |
$25.60
|
| Rate for Payer: BCBS Trust/PPO |
$84.17
|
| Rate for Payer: BCN Commercial |
$79.60
|
| Rate for Payer: BCN Medicare Advantage |
$25.60
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cofinity Commercial |
$88.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.60
|
| Rate for Payer: Healthscope Commercial |
$92.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.02
|
| Rate for Payer: Nomi Health Commercial |
$83.95
|
| Rate for Payer: PACE Senior Care Partners |
$24.32
|
| Rate for Payer: PACE SWMI |
$25.60
|
| Rate for Payer: PHP Commercial |
$87.02
|
| Rate for Payer: PHP Medicare Advantage |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.55
|
| Rate for Payer: Priority Health HMO/PPO |
$89.07
|
| Rate for Payer: Priority Health Medicare |
$25.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.59
|
| Rate for Payer: Railroad Medicare Medicare |
$25.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.09
|
| Rate for Payer: UHC Core |
$85.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$25.60
|
| Rate for Payer: UHC Exchange |
$25.60
|
| Rate for Payer: UHC Medicare Advantage |
$25.60
|
| Rate for Payer: VA VA |
$25.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.78
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$102.38
|
|
|
Service Code
|
NDC 70121138907
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$66.55 |
| Max. Negotiated Rate |
$92.14 |
| Rate for Payer: Aetna Commercial |
$87.02
|
| Rate for Payer: BCBS Trust/PPO |
$83.57
|
| Rate for Payer: BCN Commercial |
$79.12
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cofinity Commercial |
$88.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.90
|
| Rate for Payer: Healthscope Commercial |
$92.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.02
|
| Rate for Payer: Nomi Health Commercial |
$83.95
|
| Rate for Payer: PHP Commercial |
$87.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.55
|
| Rate for Payer: Priority Health HMO/PPO |
$89.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.09
|
| Rate for Payer: UHC Core |
$85.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.78
|
|
|
DEXMEDETOMIDINE 80 MCG/20 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$91.39
|
|
|
Service Code
|
NDC 00409330101
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$82.25 |
| Rate for Payer: Aetna Commercial |
$77.68
|
| Rate for Payer: Aetna Medicare |
$23.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.56
|
| Rate for Payer: BCBS Complete |
$36.56
|
| Rate for Payer: BCBS MAPPO |
$22.85
|
| Rate for Payer: BCBS Trust/PPO |
$75.13
|
| Rate for Payer: BCN Commercial |
$71.06
|
| Rate for Payer: BCN Medicare Advantage |
$22.85
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: Cofinity Commercial |
$78.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.85
|
| Rate for Payer: Healthscope Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.68
|
| Rate for Payer: Nomi Health Commercial |
$74.94
|
| Rate for Payer: PACE Senior Care Partners |
$21.71
|
| Rate for Payer: PACE SWMI |
$22.85
|
| Rate for Payer: PHP Commercial |
$77.68
|
| Rate for Payer: PHP Medicare Advantage |
$22.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.40
|
| Rate for Payer: Priority Health HMO/PPO |
$79.51
|
| Rate for Payer: Priority Health Medicare |
$23.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.23
|
| Rate for Payer: Railroad Medicare Medicare |
$22.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.42
|
| Rate for Payer: UHC Core |
$76.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.85
|
| Rate for Payer: UHC Exchange |
$22.85
|
| Rate for Payer: UHC Medicare Advantage |
$22.85
|
| Rate for Payer: VA VA |
$22.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.54
|
|
|
DEXMEDETOMIDINE 80 MCG/20 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$91.39
|
|
|
Service Code
|
NDC 00409166022
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$82.25 |
| Rate for Payer: Aetna Commercial |
$77.68
|
| Rate for Payer: BCBS Trust/PPO |
$74.60
|
| Rate for Payer: BCN Commercial |
$70.63
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: Cofinity Commercial |
$78.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.11
|
| Rate for Payer: Healthscope Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.68
|
| Rate for Payer: Nomi Health Commercial |
$74.94
|
| Rate for Payer: PHP Commercial |
$77.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.40
|
| Rate for Payer: Priority Health HMO/PPO |
$79.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.42
|
| Rate for Payer: UHC Core |
$76.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.54
|
|
|
DEXMEDETOMIDINE 80 MCG/20 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$91.39
|
|
|
Service Code
|
NDC 00409330110
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$82.25 |
| Rate for Payer: Aetna Commercial |
$77.68
|
| Rate for Payer: Aetna Medicare |
$23.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.56
|
| Rate for Payer: BCBS Complete |
$36.56
|
| Rate for Payer: BCBS MAPPO |
$22.85
|
| Rate for Payer: BCBS Trust/PPO |
$75.13
|
| Rate for Payer: BCN Commercial |
$71.06
|
| Rate for Payer: BCN Medicare Advantage |
$22.85
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: Cofinity Commercial |
$78.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.85
|
| Rate for Payer: Healthscope Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.68
|
| Rate for Payer: Nomi Health Commercial |
$74.94
|
| Rate for Payer: PACE Senior Care Partners |
$21.71
|
| Rate for Payer: PACE SWMI |
$22.85
|
| Rate for Payer: PHP Commercial |
$77.68
|
| Rate for Payer: PHP Medicare Advantage |
$22.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.40
|
| Rate for Payer: Priority Health HMO/PPO |
$79.51
|
| Rate for Payer: Priority Health Medicare |
$23.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.23
|
| Rate for Payer: Railroad Medicare Medicare |
$22.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.42
|
| Rate for Payer: UHC Core |
$76.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.85
|
| Rate for Payer: UHC Exchange |
$22.85
|
| Rate for Payer: UHC Medicare Advantage |
$22.85
|
| Rate for Payer: VA VA |
$22.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.54
|
|
|
DEXMEDETOMIDINE 80 MCG/20 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$58.14
|
|
|
Service Code
|
NDC 00781349395
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.79 |
| Max. Negotiated Rate |
$52.33 |
| Rate for Payer: Aetna Commercial |
$49.42
|
| Rate for Payer: BCBS Trust/PPO |
$47.46
|
| Rate for Payer: BCN Commercial |
$44.93
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$50.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.51
|
| Rate for Payer: Healthscope Commercial |
$52.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.42
|
| Rate for Payer: Nomi Health Commercial |
$47.67
|
| Rate for Payer: PHP Commercial |
$49.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.79
|
| Rate for Payer: Priority Health HMO/PPO |
$50.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.16
|
| Rate for Payer: UHC Core |
$48.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.60
|
|
|
DEXMEDETOMIDINE 80 MCG/20 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$91.39
|
|
|
Service Code
|
NDC 00409166020
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$82.25 |
| Rate for Payer: Aetna Commercial |
$77.68
|
| Rate for Payer: BCBS Trust/PPO |
$74.60
|
| Rate for Payer: BCN Commercial |
$70.63
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: Cofinity Commercial |
$78.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.11
|
| Rate for Payer: Healthscope Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.68
|
| Rate for Payer: Nomi Health Commercial |
$74.94
|
| Rate for Payer: PHP Commercial |
$77.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.40
|
| Rate for Payer: Priority Health HMO/PPO |
$79.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.42
|
| Rate for Payer: UHC Core |
$76.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.54
|
|
|
DEXMEDETOMIDINE 80 MCG/20 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$58.14
|
|
|
Service Code
|
NDC 00781349395
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$52.33 |
| Rate for Payer: Aetna Commercial |
$49.42
|
| Rate for Payer: Aetna Medicare |
$15.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.17
|
| Rate for Payer: BCBS Complete |
$23.26
|
| Rate for Payer: BCBS MAPPO |
$14.54
|
| Rate for Payer: BCBS Trust/PPO |
$47.80
|
| Rate for Payer: BCN Commercial |
$45.20
|
| Rate for Payer: BCN Medicare Advantage |
$14.54
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$50.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.54
|
| Rate for Payer: Healthscope Commercial |
$52.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.42
|
| Rate for Payer: Nomi Health Commercial |
$47.67
|
| Rate for Payer: PACE Senior Care Partners |
$13.81
|
| Rate for Payer: PACE SWMI |
$14.54
|
| Rate for Payer: PHP Commercial |
$49.42
|
| Rate for Payer: PHP Medicare Advantage |
$14.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.79
|
| Rate for Payer: Priority Health HMO/PPO |
$50.58
|
| Rate for Payer: Priority Health Medicare |
$14.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.95
|
| Rate for Payer: Railroad Medicare Medicare |
$14.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.16
|
| Rate for Payer: UHC Core |
$48.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.54
|
| Rate for Payer: UHC Exchange |
$14.54
|
| Rate for Payer: UHC Medicare Advantage |
$14.54
|
| Rate for Payer: VA VA |
$14.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.60
|
|
|
DEXMEDETOMIDINE 80 MCG/20 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$91.39
|
|
|
Service Code
|
NDC 00409166022
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$82.25 |
| Rate for Payer: Aetna Commercial |
$77.68
|
| Rate for Payer: Aetna Medicare |
$23.76
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$28.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$28.56
|
| Rate for Payer: BCBS Complete |
$36.56
|
| Rate for Payer: BCBS MAPPO |
$22.85
|
| Rate for Payer: BCBS Trust/PPO |
$75.13
|
| Rate for Payer: BCN Commercial |
$71.06
|
| Rate for Payer: BCN Medicare Advantage |
$22.85
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: Cofinity Commercial |
$78.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.85
|
| Rate for Payer: Healthscope Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.68
|
| Rate for Payer: Nomi Health Commercial |
$74.94
|
| Rate for Payer: PACE Senior Care Partners |
$21.71
|
| Rate for Payer: PACE SWMI |
$22.85
|
| Rate for Payer: PHP Commercial |
$77.68
|
| Rate for Payer: PHP Medicare Advantage |
$22.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.40
|
| Rate for Payer: Priority Health HMO/PPO |
$79.51
|
| Rate for Payer: Priority Health Medicare |
$23.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.23
|
| Rate for Payer: Railroad Medicare Medicare |
$22.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.42
|
| Rate for Payer: UHC Core |
$76.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.85
|
| Rate for Payer: UHC Exchange |
$22.85
|
| Rate for Payer: UHC Medicare Advantage |
$22.85
|
| Rate for Payer: VA VA |
$22.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.54
|
|
|
DEXMEDETOMIDINE 80 MCG/20 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$58.14
|
|
|
Service Code
|
NDC 00781349380
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.79 |
| Max. Negotiated Rate |
$52.33 |
| Rate for Payer: Aetna Commercial |
$49.42
|
| Rate for Payer: BCBS Trust/PPO |
$47.46
|
| Rate for Payer: BCN Commercial |
$44.93
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$50.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.51
|
| Rate for Payer: Healthscope Commercial |
$52.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.42
|
| Rate for Payer: Nomi Health Commercial |
$47.67
|
| Rate for Payer: PHP Commercial |
$49.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.79
|
| Rate for Payer: Priority Health HMO/PPO |
$50.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.16
|
| Rate for Payer: UHC Core |
$48.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.60
|
|
|
DEXMEDETOMIDINE 80 MCG/20 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$91.39
|
|
|
Service Code
|
NDC 00409330110
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$82.25 |
| Rate for Payer: Aetna Commercial |
$77.68
|
| Rate for Payer: BCBS Trust/PPO |
$74.60
|
| Rate for Payer: BCN Commercial |
$70.63
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: Cofinity Commercial |
$78.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.11
|
| Rate for Payer: Healthscope Commercial |
$82.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.68
|
| Rate for Payer: Nomi Health Commercial |
$74.94
|
| Rate for Payer: PHP Commercial |
$77.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.40
|
| Rate for Payer: Priority Health HMO/PPO |
$79.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.42
|
| Rate for Payer: UHC Core |
$76.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.54
|
|
|
DEXMEDETOMIDINE 80 MCG/20 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$58.14
|
|
|
Service Code
|
NDC 00781349380
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$52.33 |
| Rate for Payer: Aetna Commercial |
$49.42
|
| Rate for Payer: Aetna Medicare |
$15.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.17
|
| Rate for Payer: BCBS Complete |
$23.26
|
| Rate for Payer: BCBS MAPPO |
$14.54
|
| Rate for Payer: BCBS Trust/PPO |
$47.80
|
| Rate for Payer: BCN Commercial |
$45.20
|
| Rate for Payer: BCN Medicare Advantage |
$14.54
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Cofinity Commercial |
$50.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.54
|
| Rate for Payer: Healthscope Commercial |
$52.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.42
|
| Rate for Payer: Nomi Health Commercial |
$47.67
|
| Rate for Payer: PACE Senior Care Partners |
$13.81
|
| Rate for Payer: PACE SWMI |
$14.54
|
| Rate for Payer: PHP Commercial |
$49.42
|
| Rate for Payer: PHP Medicare Advantage |
$14.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.79
|
| Rate for Payer: Priority Health HMO/PPO |
$50.58
|
| Rate for Payer: Priority Health Medicare |
$14.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$38.95
|
| Rate for Payer: Railroad Medicare Medicare |
$14.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.16
|
| Rate for Payer: UHC Core |
$48.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.54
|
| Rate for Payer: UHC Exchange |
$14.54
|
| Rate for Payer: UHC Medicare Advantage |
$14.54
|
| Rate for Payer: VA VA |
$14.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.60
|
|
