|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
116809
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: Aetna Commercial |
$14.21
|
| Rate for Payer: Aetna Commercial |
$14.32
|
| Rate for Payer: Aetna Commercial |
$12.38
|
| Rate for Payer: Aetna Medicare |
$3.79
|
| Rate for Payer: Aetna Medicare |
$3.64
|
| Rate for Payer: Aetna Medicare |
$4.35
|
| Rate for Payer: Aetna Medicare |
$4.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.38
|
| Rate for Payer: BCBS Complete |
$3.12
|
| Rate for Payer: BCBS Complete |
$2.70
|
| Rate for Payer: BCBS Complete |
$2.59
|
| Rate for Payer: BCBS Complete |
$3.09
|
| Rate for Payer: BCBS MAPPO |
$3.50
|
| Rate for Payer: BCBS MAPPO |
$3.64
|
| Rate for Payer: BCBS MAPPO |
$4.21
|
| Rate for Payer: BCBS MAPPO |
$4.18
|
| Rate for Payer: BCBS Trust/PPO |
$13.75
|
| Rate for Payer: BCBS Trust/PPO |
$11.51
|
| Rate for Payer: BCBS Trust/PPO |
$13.85
|
| Rate for Payer: BCBS Trust/PPO |
$11.97
|
| Rate for Payer: BCN Commercial |
$13.75
|
| Rate for Payer: BCN Commercial |
$13.85
|
| Rate for Payer: BCN Commercial |
$11.97
|
| Rate for Payer: BCN Commercial |
$11.51
|
| Rate for Payer: BCN Medicare Advantage |
$4.18
|
| Rate for Payer: BCN Medicare Advantage |
$3.64
|
| Rate for Payer: BCN Medicare Advantage |
$4.21
|
| Rate for Payer: BCN Medicare Advantage |
$3.50
|
| Rate for Payer: Cash Price |
$13.48
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.65
|
| Rate for Payer: Cofinity Commercial |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.18
|
| Rate for Payer: Healthscope Commercial |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$15.16
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$13.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.50
|
| Rate for Payer: Mclaren Medicaid |
$2.95
|
| Rate for Payer: Mclaren Medicaid |
$2.57
|
| Rate for Payer: Mclaren Medicaid |
$2.47
|
| Rate for Payer: Mclaren Medicaid |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.67
|
| Rate for Payer: Meridian Medicaid |
$2.59
|
| Rate for Payer: Meridian Medicaid |
$3.09
|
| Rate for Payer: Meridian Medicaid |
$3.12
|
| Rate for Payer: Meridian Medicaid |
$2.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.32
|
| Rate for Payer: Nomi Health Commercial |
$13.71
|
| Rate for Payer: Nomi Health Commercial |
$11.48
|
| Rate for Payer: Nomi Health Commercial |
$11.94
|
| Rate for Payer: Nomi Health Commercial |
$13.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.50
|
| Rate for Payer: PACE Senior Care Partners |
$3.97
|
| Rate for Payer: PACE Senior Care Partners |
$4.00
|
| Rate for Payer: PACE Senior Care Partners |
$3.33
|
| Rate for Payer: PACE Senior Care Partners |
$3.46
|
| Rate for Payer: PACE SWMI |
$3.50
|
| Rate for Payer: PACE SWMI |
$4.21
|
| Rate for Payer: PACE SWMI |
$3.64
|
| Rate for Payer: PACE SWMI |
$4.18
|
| Rate for Payer: PHP Commercial |
$11.90
|
| Rate for Payer: PHP Commercial |
$12.38
|
| Rate for Payer: PHP Commercial |
$14.21
|
| Rate for Payer: PHP Commercial |
$14.32
|
| Rate for Payer: PHP Medicare Advantage |
$3.50
|
| Rate for Payer: PHP Medicare Advantage |
$4.21
|
| Rate for Payer: PHP Medicare Advantage |
$3.64
|
| Rate for Payer: PHP Medicare Advantage |
$4.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$14.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.18
|
| Rate for Payer: Priority Health Medicare |
$3.68
|
| Rate for Payer: Priority Health Medicare |
$3.54
|
| Rate for Payer: Priority Health Medicare |
$4.22
|
| Rate for Payer: Priority Health Medicare |
$4.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.74
|
| Rate for Payer: Railroad Medicare Medicare |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$3.50
|
| Rate for Payer: Railroad Medicare Medicare |
$4.21
|
| Rate for Payer: Railroad Medicare Medicare |
$3.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.83
|
| Rate for Payer: UHC Core |
$11.69
|
| Rate for Payer: UHC Core |
$13.96
|
| Rate for Payer: UHC Core |
$12.16
|
| Rate for Payer: UHC Core |
$14.07
|
| Rate for Payer: UHC Exchange |
$4.18
|
| Rate for Payer: UHC Exchange |
$3.64
|
| Rate for Payer: UHC Exchange |
$4.21
|
| Rate for Payer: UHC Exchange |
$3.50
|
| Rate for Payer: UHC Medicaid |
$2.47
|
| Rate for Payer: UHC Medicaid |
$2.57
|
| Rate for Payer: UHC Medicaid |
$2.95
|
| Rate for Payer: UHC Medicaid |
$2.97
|
| Rate for Payer: UHC Medicare Advantage |
$3.64
|
| Rate for Payer: UHC Medicare Advantage |
$3.50
|
| Rate for Payer: UHC Medicare Advantage |
$4.21
|
| Rate for Payer: UHC Medicare Advantage |
$4.18
|
| Rate for Payer: UHCCP Medicaid |
$2.95
|
| Rate for Payer: UHCCP Medicaid |
$2.97
|
| Rate for Payer: UHCCP Medicaid |
$2.57
|
| Rate for Payer: UHCCP Medicaid |
$2.47
|
| Rate for Payer: VA VA |
$3.50
|
| Rate for Payer: VA VA |
$4.21
|
| Rate for Payer: VA VA |
$4.18
|
| Rate for Payer: VA VA |
$3.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.64
|
|
|
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 |
$12.85 |
| 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 |
$13.49
|
| Rate for Payer: BCBS MAPPO |
$18.21
|
| Rate for Payer: BCBS Trust/PPO |
$59.90
|
| Rate for Payer: BCN Commercial |
$59.90
|
| Rate for Payer: BCN Medicare Advantage |
$18.21
|
| 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 |
$18.21
|
| Rate for Payer: Healthscope Commercial |
$65.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.65
|
| Rate for Payer: Mclaren Medicaid |
$12.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.13
|
| Rate for Payer: Meridian Medicaid |
$13.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.93
|
| Rate for Payer: Nomi Health Commercial |
$59.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.65
|
| Rate for Payer: PACE Senior Care Partners |
$17.30
|
| Rate for Payer: PACE SWMI |
$18.21
|
| Rate for Payer: PHP Commercial |
$61.93
|
| Rate for Payer: PHP Medicare Advantage |
$18.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.39
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.71
|
| Rate for Payer: Railroad Medicare Medicare |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.12
|
| Rate for Payer: UHC Core |
$60.84
|
| Rate for Payer: UHC Exchange |
$18.21
|
| Rate for Payer: UHC Medicaid |
$12.85
|
| Rate for Payer: UHC Medicare Advantage |
$18.21
|
| Rate for Payer: UHCCP Medicaid |
$12.85
|
| Rate for Payer: VA VA |
$18.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.65
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$72.86
|
|
|
Service Code
|
NDC 66794023342
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.85 |
| 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 |
$13.49
|
| Rate for Payer: BCBS MAPPO |
$18.21
|
| Rate for Payer: BCBS Trust/PPO |
$59.90
|
| Rate for Payer: BCN Commercial |
$59.90
|
| Rate for Payer: BCN Medicare Advantage |
$18.21
|
| 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 |
$18.21
|
| Rate for Payer: Healthscope Commercial |
$65.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.65
|
| Rate for Payer: Mclaren Medicaid |
$12.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.13
|
| Rate for Payer: Meridian Medicaid |
$13.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.93
|
| Rate for Payer: Nomi Health Commercial |
$59.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.65
|
| Rate for Payer: PACE Senior Care Partners |
$17.30
|
| Rate for Payer: PACE SWMI |
$18.21
|
| Rate for Payer: PHP Commercial |
$61.93
|
| Rate for Payer: PHP Medicare Advantage |
$18.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.39
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.71
|
| Rate for Payer: Railroad Medicare Medicare |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.12
|
| Rate for Payer: UHC Core |
$60.84
|
| Rate for Payer: UHC Exchange |
$18.21
|
| Rate for Payer: UHC Medicaid |
$12.85
|
| Rate for Payer: UHC Medicare Advantage |
$18.21
|
| Rate for Payer: UHCCP Medicaid |
$12.85
|
| Rate for Payer: VA VA |
$18.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.65
|
|
|
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 |
$50.71 |
| Max. Negotiated Rate |
$65.57 |
| Rate for Payer: Aetna Commercial |
$61.93
|
| Rate for Payer: BCBS Trust/PPO |
$60.18
|
| Rate for Payer: BCN Commercial |
$60.18
|
| 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 |
$54.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.93
|
| Rate for Payer: Nomi Health Commercial |
$59.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.65
|
| Rate for Payer: PHP Commercial |
$61.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.71
|
| 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 |
$54.65
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$60.77
|
|
|
Service Code
|
NDC 71288050503
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$54.69 |
| Rate for Payer: Aetna Commercial |
$51.65
|
| Rate for Payer: BCBS Trust/PPO |
$50.19
|
| Rate for Payer: BCN Commercial |
$50.19
|
| Rate for Payer: Cash Price |
$48.62
|
| Rate for Payer: Cofinity Commercial |
$52.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.62
|
| Rate for Payer: Healthscope Commercial |
$54.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.65
|
| Rate for Payer: Nomi Health Commercial |
$49.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.58
|
| Rate for Payer: PHP Commercial |
$51.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$52.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.48
|
| Rate for Payer: UHC Core |
$50.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.58
|
|
|
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 |
$50.71 |
| Max. Negotiated Rate |
$65.57 |
| Rate for Payer: Aetna Commercial |
$61.93
|
| Rate for Payer: BCBS Trust/PPO |
$60.18
|
| Rate for Payer: BCN Commercial |
$60.18
|
| 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 |
$54.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.93
|
| Rate for Payer: Nomi Health Commercial |
$59.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.65
|
| Rate for Payer: PHP Commercial |
$61.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.71
|
| 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 |
$54.65
|
|
|
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 |
$43.90 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna Commercial |
$53.61
|
| Rate for Payer: BCBS Trust/PPO |
$52.09
|
| Rate for Payer: BCN Commercial |
$52.09
|
| 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: Opus (Opus Packaging Group) HMA |
$47.30
|
| Rate for Payer: PHP Commercial |
$53.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$54.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.90
|
| 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
|
$72.86
|
|
|
Service Code
|
NDC 66794023302
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.85 |
| 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 |
$13.49
|
| Rate for Payer: BCBS MAPPO |
$18.21
|
| Rate for Payer: BCBS Trust/PPO |
$59.90
|
| Rate for Payer: BCN Commercial |
$59.90
|
| Rate for Payer: BCN Medicare Advantage |
$18.21
|
| 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 |
$18.21
|
| Rate for Payer: Healthscope Commercial |
$65.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.65
|
| Rate for Payer: Mclaren Medicaid |
$12.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.13
|
| Rate for Payer: Meridian Medicaid |
$13.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.93
|
| Rate for Payer: Nomi Health Commercial |
$59.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.65
|
| Rate for Payer: PACE Senior Care Partners |
$17.30
|
| Rate for Payer: PACE SWMI |
$18.21
|
| Rate for Payer: PHP Commercial |
$61.93
|
| Rate for Payer: PHP Medicare Advantage |
$18.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.39
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.71
|
| Rate for Payer: Railroad Medicare Medicare |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.12
|
| Rate for Payer: UHC Core |
$60.84
|
| Rate for Payer: UHC Exchange |
$18.21
|
| Rate for Payer: UHC Medicaid |
$12.85
|
| Rate for Payer: UHC Medicare Advantage |
$18.21
|
| Rate for Payer: UHCCP Medicaid |
$12.85
|
| Rate for Payer: VA VA |
$18.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.65
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$72.86
|
|
|
Service Code
|
NDC 66794023002
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.71 |
| Max. Negotiated Rate |
$65.57 |
| Rate for Payer: Aetna Commercial |
$61.93
|
| Rate for Payer: BCBS Trust/PPO |
$60.18
|
| Rate for Payer: BCN Commercial |
$60.18
|
| 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 |
$54.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.93
|
| Rate for Payer: Nomi Health Commercial |
$59.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.65
|
| Rate for Payer: PHP Commercial |
$61.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.71
|
| 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 |
$54.65
|
|
|
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 |
$11.12 |
| 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 |
$11.67
|
| Rate for Payer: BCBS MAPPO |
$15.77
|
| Rate for Payer: BCBS Trust/PPO |
$51.85
|
| Rate for Payer: BCN Commercial |
$51.85
|
| 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: Mclaren Medicaid |
$11.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.56
|
| Rate for Payer: Meridian Medicaid |
$11.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.13
|
| Rate for Payer: Molina Medicare/Medicaid |
$17.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.61
|
| Rate for Payer: Nomi Health Commercial |
$51.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.30
|
| 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 Choice Medicaid |
$11.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$54.87
|
| Rate for Payer: Priority Health Medicare |
$15.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.90
|
| 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 Exchange |
$15.77
|
| Rate for Payer: UHC Medicaid |
$11.12
|
| Rate for Payer: UHC Medicare Advantage |
$15.77
|
| Rate for Payer: UHCCP Medicaid |
$11.12
|
| 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
|
$60.77
|
|
|
Service Code
|
NDC 71288050502
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$54.69 |
| Rate for Payer: Aetna Commercial |
$51.65
|
| Rate for Payer: BCBS Trust/PPO |
$50.19
|
| Rate for Payer: BCN Commercial |
$50.19
|
| Rate for Payer: Cash Price |
$48.62
|
| Rate for Payer: Cofinity Commercial |
$52.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.62
|
| Rate for Payer: Healthscope Commercial |
$54.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.65
|
| Rate for Payer: Nomi Health Commercial |
$49.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.58
|
| Rate for Payer: PHP Commercial |
$51.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$52.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.48
|
| Rate for Payer: UHC Core |
$50.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.58
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$60.77
|
|
|
Service Code
|
NDC 71288050503
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$54.69 |
| Rate for Payer: Aetna Commercial |
$51.65
|
| Rate for Payer: Aetna Medicare |
$15.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.99
|
| Rate for Payer: BCBS Complete |
$11.25
|
| Rate for Payer: BCBS MAPPO |
$15.19
|
| Rate for Payer: BCBS Trust/PPO |
$49.96
|
| Rate for Payer: BCN Commercial |
$49.96
|
| Rate for Payer: BCN Medicare Advantage |
$15.19
|
| Rate for Payer: Cash Price |
$48.62
|
| Rate for Payer: Cofinity Commercial |
$52.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.19
|
| Rate for Payer: Healthscope Commercial |
$54.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.58
|
| Rate for Payer: Mclaren Medicaid |
$10.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.95
|
| Rate for Payer: Meridian Medicaid |
$11.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.65
|
| Rate for Payer: Nomi Health Commercial |
$49.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.58
|
| Rate for Payer: PACE Senior Care Partners |
$14.43
|
| Rate for Payer: PACE SWMI |
$15.19
|
| Rate for Payer: PHP Commercial |
$51.65
|
| Rate for Payer: PHP Medicare Advantage |
$15.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$52.87
|
| Rate for Payer: Priority Health Medicare |
$15.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.30
|
| Rate for Payer: Railroad Medicare Medicare |
$15.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.48
|
| Rate for Payer: UHC Core |
$50.74
|
| Rate for Payer: UHC Exchange |
$15.19
|
| Rate for Payer: UHC Medicaid |
$10.71
|
| Rate for Payer: UHC Medicare Advantage |
$15.19
|
| Rate for Payer: UHCCP Medicaid |
$10.71
|
| Rate for Payer: VA VA |
$15.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.58
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$72.86
|
|
|
Service Code
|
NDC 66794023302
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.71 |
| Max. Negotiated Rate |
$65.57 |
| Rate for Payer: Aetna Commercial |
$61.93
|
| Rate for Payer: BCBS Trust/PPO |
$60.18
|
| Rate for Payer: BCN Commercial |
$60.18
|
| 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 |
$54.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.93
|
| Rate for Payer: Nomi Health Commercial |
$59.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.65
|
| Rate for Payer: PHP Commercial |
$61.93
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.71
|
| 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 |
$54.65
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$60.77
|
|
|
Service Code
|
NDC 71288050502
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.71 |
| Max. Negotiated Rate |
$54.69 |
| Rate for Payer: Aetna Commercial |
$51.65
|
| Rate for Payer: Aetna Medicare |
$15.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18.99
|
| Rate for Payer: BCBS Complete |
$11.25
|
| Rate for Payer: BCBS MAPPO |
$15.19
|
| Rate for Payer: BCBS Trust/PPO |
$49.96
|
| Rate for Payer: BCN Commercial |
$49.96
|
| Rate for Payer: BCN Medicare Advantage |
$15.19
|
| Rate for Payer: Cash Price |
$48.62
|
| Rate for Payer: Cofinity Commercial |
$52.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.19
|
| Rate for Payer: Healthscope Commercial |
$54.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.58
|
| Rate for Payer: Mclaren Medicaid |
$10.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.95
|
| Rate for Payer: Meridian Medicaid |
$11.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$16.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.65
|
| Rate for Payer: Nomi Health Commercial |
$49.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.58
|
| Rate for Payer: PACE Senior Care Partners |
$14.43
|
| Rate for Payer: PACE SWMI |
$15.19
|
| Rate for Payer: PHP Commercial |
$51.65
|
| Rate for Payer: PHP Medicare Advantage |
$15.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$52.87
|
| Rate for Payer: Priority Health Medicare |
$15.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.30
|
| Rate for Payer: Railroad Medicare Medicare |
$15.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.48
|
| Rate for Payer: UHC Core |
$50.74
|
| Rate for Payer: UHC Exchange |
$15.19
|
| Rate for Payer: UHC Medicaid |
$10.71
|
| Rate for Payer: UHC Medicare Advantage |
$15.19
|
| Rate for Payer: UHCCP Medicaid |
$10.71
|
| Rate for Payer: VA VA |
$15.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.58
|
|
|
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 |
$12.85 |
| 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 |
$13.49
|
| Rate for Payer: BCBS MAPPO |
$18.21
|
| Rate for Payer: BCBS Trust/PPO |
$59.90
|
| Rate for Payer: BCN Commercial |
$59.90
|
| Rate for Payer: BCN Medicare Advantage |
$18.21
|
| 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 |
$18.21
|
| Rate for Payer: Healthscope Commercial |
$65.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.65
|
| Rate for Payer: Mclaren Medicaid |
$12.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$19.13
|
| Rate for Payer: Meridian Medicaid |
$13.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$20.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.93
|
| Rate for Payer: Nomi Health Commercial |
$59.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.65
|
| Rate for Payer: PACE Senior Care Partners |
$17.30
|
| Rate for Payer: PACE SWMI |
$18.21
|
| Rate for Payer: PHP Commercial |
$61.93
|
| Rate for Payer: PHP Medicare Advantage |
$18.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$12.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$63.39
|
| Rate for Payer: Priority Health Medicare |
$18.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.71
|
| Rate for Payer: Railroad Medicare Medicare |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.12
|
| Rate for Payer: UHC Core |
$60.84
|
| Rate for Payer: UHC Exchange |
$18.21
|
| Rate for Payer: UHC Medicaid |
$12.85
|
| Rate for Payer: UHC Medicare Advantage |
$18.21
|
| Rate for Payer: UHCCP Medicaid |
$12.85
|
| Rate for Payer: VA VA |
$18.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.65
|
|
|
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 |
$18.05 |
| 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 |
$18.95
|
| Rate for Payer: BCBS MAPPO |
$25.59
|
| Rate for Payer: BCBS Trust/PPO |
$84.17
|
| Rate for Payer: BCN Commercial |
$84.17
|
| Rate for Payer: BCN Medicare Advantage |
$25.59
|
| 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 |
$25.59
|
| Rate for Payer: Healthscope Commercial |
$92.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.78
|
| Rate for Payer: Mclaren Medicaid |
$18.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.87
|
| Rate for Payer: Meridian Medicaid |
$18.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.02
|
| Rate for Payer: Nomi Health Commercial |
$83.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.78
|
| Rate for Payer: PACE Senior Care Partners |
$24.32
|
| Rate for Payer: PACE SWMI |
$25.59
|
| Rate for Payer: PHP Commercial |
$87.02
|
| Rate for Payer: PHP Medicare Advantage |
$25.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$89.07
|
| Rate for Payer: Priority Health Medicare |
$25.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.26
|
| Rate for Payer: Railroad Medicare Medicare |
$25.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.09
|
| Rate for Payer: UHC Core |
$85.49
|
| Rate for Payer: UHC Exchange |
$25.59
|
| Rate for Payer: UHC Medicaid |
$18.05
|
| Rate for Payer: UHC Medicare Advantage |
$25.59
|
| Rate for Payer: UHCCP Medicaid |
$18.05
|
| Rate for Payer: VA VA |
$25.59
|
| 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 |
$71.26 |
| Max. Negotiated Rate |
$92.14 |
| Rate for Payer: Aetna Commercial |
$87.02
|
| Rate for Payer: BCBS Trust/PPO |
$84.56
|
| Rate for Payer: BCN Commercial |
$84.56
|
| 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: Opus (Opus Packaging Group) HMA |
$76.78
|
| Rate for Payer: PHP Commercial |
$87.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$89.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.26
|
| 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 70121138901
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.05 |
| 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 |
$18.95
|
| Rate for Payer: BCBS MAPPO |
$25.59
|
| Rate for Payer: BCBS Trust/PPO |
$84.17
|
| Rate for Payer: BCN Commercial |
$84.17
|
| Rate for Payer: BCN Medicare Advantage |
$25.59
|
| 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 |
$25.59
|
| Rate for Payer: Healthscope Commercial |
$92.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.78
|
| Rate for Payer: Mclaren Medicaid |
$18.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.87
|
| Rate for Payer: Meridian Medicaid |
$18.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.02
|
| Rate for Payer: Nomi Health Commercial |
$83.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.78
|
| Rate for Payer: PACE Senior Care Partners |
$24.32
|
| Rate for Payer: PACE SWMI |
$25.59
|
| Rate for Payer: PHP Commercial |
$87.02
|
| Rate for Payer: PHP Medicare Advantage |
$25.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$89.07
|
| Rate for Payer: Priority Health Medicare |
$25.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.26
|
| Rate for Payer: Railroad Medicare Medicare |
$25.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.09
|
| Rate for Payer: UHC Core |
$85.49
|
| Rate for Payer: UHC Exchange |
$25.59
|
| Rate for Payer: UHC Medicaid |
$18.05
|
| Rate for Payer: UHC Medicare Advantage |
$25.59
|
| Rate for Payer: UHCCP Medicaid |
$18.05
|
| Rate for Payer: VA VA |
$25.59
|
| 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 |
$71.26 |
| Max. Negotiated Rate |
$92.14 |
| Rate for Payer: Aetna Commercial |
$87.02
|
| Rate for Payer: BCBS Trust/PPO |
$84.56
|
| Rate for Payer: BCN Commercial |
$84.56
|
| 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: Opus (Opus Packaging Group) HMA |
$76.78
|
| Rate for Payer: PHP Commercial |
$87.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$89.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.26
|
| 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 00409330110
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.11 |
| 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 |
$16.92
|
| Rate for Payer: BCBS MAPPO |
$22.85
|
| Rate for Payer: BCBS Trust/PPO |
$75.13
|
| Rate for Payer: BCN Commercial |
$75.13
|
| 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: Mclaren Medicaid |
$16.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.99
|
| Rate for Payer: Meridian Medicaid |
$16.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.68
|
| Rate for Payer: Nomi Health Commercial |
$74.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.54
|
| 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 Choice Medicaid |
$16.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.51
|
| Rate for Payer: Priority Health Medicare |
$23.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.61
|
| 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 Exchange |
$22.85
|
| Rate for Payer: UHC Medicaid |
$16.11
|
| Rate for Payer: UHC Medicare Advantage |
$22.85
|
| Rate for Payer: UHCCP Medicaid |
$16.11
|
| 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
|
$75.62
|
|
|
Service Code
|
NDC 00781349395
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.63 |
| Max. Negotiated Rate |
$68.06 |
| Rate for Payer: Aetna Commercial |
$64.28
|
| Rate for Payer: BCBS Trust/PPO |
$62.45
|
| Rate for Payer: BCN Commercial |
$62.45
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cofinity Commercial |
$65.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.50
|
| Rate for Payer: Healthscope Commercial |
$68.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.28
|
| Rate for Payer: Nomi Health Commercial |
$62.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.72
|
| Rate for Payer: PHP Commercial |
$64.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.55
|
| Rate for Payer: UHC Core |
$63.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.72
|
|
|
DEXMEDETOMIDINE 80 MCG/20 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$91.39
|
|
|
Service Code
|
NDC 00409166020
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.11 |
| 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 |
$16.92
|
| Rate for Payer: BCBS MAPPO |
$22.85
|
| Rate for Payer: BCBS Trust/PPO |
$75.13
|
| Rate for Payer: BCN Commercial |
$75.13
|
| 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: Mclaren Medicaid |
$16.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.99
|
| Rate for Payer: Meridian Medicaid |
$16.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$26.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$25.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.68
|
| Rate for Payer: Nomi Health Commercial |
$74.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.54
|
| 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 Choice Medicaid |
$16.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.51
|
| Rate for Payer: Priority Health Medicare |
$23.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.61
|
| 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 Exchange |
$22.85
|
| Rate for Payer: UHC Medicaid |
$16.11
|
| Rate for Payer: UHC Medicare Advantage |
$22.85
|
| Rate for Payer: UHCCP Medicaid |
$16.11
|
| 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 00409330110
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.61 |
| Max. Negotiated Rate |
$82.25 |
| Rate for Payer: Aetna Commercial |
$77.68
|
| Rate for Payer: BCBS Trust/PPO |
$75.48
|
| Rate for Payer: BCN Commercial |
$75.48
|
| 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: Opus (Opus Packaging Group) HMA |
$68.54
|
| Rate for Payer: PHP Commercial |
$77.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.61
|
| 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
|
IP
|
$91.39
|
|
|
Service Code
|
NDC 00409166020
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.61 |
| Max. Negotiated Rate |
$82.25 |
| Rate for Payer: Aetna Commercial |
$77.68
|
| Rate for Payer: BCBS Trust/PPO |
$75.48
|
| Rate for Payer: BCN Commercial |
$75.48
|
| 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: Opus (Opus Packaging Group) HMA |
$68.54
|
| Rate for Payer: PHP Commercial |
$77.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.61
|
| 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
|
IP
|
$91.39
|
|
|
Service Code
|
NDC 00409330101
|
| Hospital Charge Code |
173991
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.61 |
| Max. Negotiated Rate |
$82.25 |
| Rate for Payer: Aetna Commercial |
$77.68
|
| Rate for Payer: BCBS Trust/PPO |
$75.48
|
| Rate for Payer: BCN Commercial |
$75.48
|
| 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: Opus (Opus Packaging Group) HMA |
$68.54
|
| Rate for Payer: PHP Commercial |
$77.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$63.61
|
| 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
|
|
