|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$71.95
|
|
|
Service Code
|
NDC 70860060541
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.62 |
| Max. Negotiated Rate |
$64.75 |
| Rate for Payer: Aetna American Axle |
$46.77
|
| Rate for Payer: Aetna Commercial |
$61.16
|
| Rate for Payer: Aetna Medicare |
$35.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.77
|
| Rate for Payer: BCBS Complete |
$28.78
|
| Rate for Payer: Cash Price |
$57.56
|
| Rate for Payer: Cofinity Advantage |
$50.37
|
| Rate for Payer: Cofinity Commercial |
$61.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.56
|
| Rate for Payer: Healthscope Commercial |
$64.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.96
|
| Rate for Payer: PHP Commercial |
$61.16
|
| Rate for Payer: Priority Health SBD |
$45.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.77
|
| Rate for Payer: UHC Core |
$37.49
|
| Rate for Payer: UHC Exchange |
$28.28
|
| Rate for Payer: UMR Bronson Commercial |
$26.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.96
|
|
|
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 |
$32.06 |
| Max. Negotiated Rate |
$65.57 |
| Rate for Payer: Aetna American Axle |
$47.36
|
| Rate for Payer: Aetna Commercial |
$61.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.36
|
| Rate for Payer: Cash Price |
$58.29
|
| Rate for Payer: Cofinity Advantage |
$51.00
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$51.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.65
|
| Rate for Payer: PHP Commercial |
$61.93
|
| Rate for Payer: Priority Health SBD |
$45.90
|
| Rate for Payer: UMR Bronson Commercial |
$32.06
|
| 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 |
$27.75 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna American Axle |
$41.00
|
| Rate for Payer: Aetna Commercial |
$53.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.00
|
| Rate for Payer: Cash Price |
$50.46
|
| Rate for Payer: Cofinity Advantage |
$44.15
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$44.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.30
|
| Rate for Payer: PHP Commercial |
$53.61
|
| Rate for Payer: Priority Health SBD |
$39.73
|
| Rate for Payer: UMR Bronson Commercial |
$27.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.30
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$67.27
|
|
|
Service Code
|
NDC 16729023993
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$60.54 |
| Rate for Payer: Aetna American Axle |
$43.73
|
| Rate for Payer: Aetna Commercial |
$57.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.73
|
| Rate for Payer: Cash Price |
$53.82
|
| Rate for Payer: Cofinity Advantage |
$47.09
|
| Rate for Payer: Cofinity Commercial |
$57.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.82
|
| Rate for Payer: Healthscope Commercial |
$60.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.45
|
| Rate for Payer: PHP Commercial |
$57.18
|
| Rate for Payer: Priority Health SBD |
$42.38
|
| Rate for Payer: UMR Bronson Commercial |
$29.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.45
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$67.27
|
|
|
Service Code
|
NDC 16729023930
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$60.54 |
| Rate for Payer: Aetna American Axle |
$43.73
|
| Rate for Payer: Aetna Commercial |
$57.18
|
| Rate for Payer: Aetna Medicare |
$33.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.73
|
| Rate for Payer: BCBS Complete |
$26.91
|
| Rate for Payer: Cash Price |
$53.82
|
| Rate for Payer: Cofinity Advantage |
$47.09
|
| Rate for Payer: Cofinity Commercial |
$57.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.82
|
| Rate for Payer: Healthscope Commercial |
$60.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.45
|
| Rate for Payer: PHP Commercial |
$57.18
|
| Rate for Payer: Priority Health SBD |
$42.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.73
|
| Rate for Payer: UHC Core |
$35.05
|
| Rate for Payer: UHC Exchange |
$26.44
|
| Rate for Payer: UMR Bronson Commercial |
$24.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.45
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$71.95
|
|
|
Service Code
|
NDC 70860060541
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.66 |
| Max. Negotiated Rate |
$64.75 |
| Rate for Payer: Aetna American Axle |
$46.77
|
| Rate for Payer: Aetna Commercial |
$61.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.77
|
| Rate for Payer: Cash Price |
$57.56
|
| Rate for Payer: Cofinity Advantage |
$50.37
|
| Rate for Payer: Cofinity Commercial |
$61.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.56
|
| Rate for Payer: Healthscope Commercial |
$64.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.96
|
| Rate for Payer: PHP Commercial |
$61.16
|
| Rate for Payer: Priority Health SBD |
$45.33
|
| Rate for Payer: UMR Bronson Commercial |
$31.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.96
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$70.27
|
|
|
Service Code
|
NDC 70860060502
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$63.24 |
| Rate for Payer: Aetna American Axle |
$45.68
|
| Rate for Payer: Aetna Commercial |
$59.73
|
| Rate for Payer: Aetna Medicare |
$35.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.68
|
| Rate for Payer: BCBS Complete |
$28.11
|
| Rate for Payer: Cash Price |
$56.22
|
| Rate for Payer: Cofinity Advantage |
$49.19
|
| Rate for Payer: Cofinity Commercial |
$60.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.22
|
| Rate for Payer: Healthscope Commercial |
$63.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$56.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.70
|
| Rate for Payer: PHP Commercial |
$59.73
|
| Rate for Payer: Priority Health SBD |
$44.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.68
|
| Rate for Payer: UHC Core |
$36.61
|
| Rate for Payer: UHC Exchange |
$27.62
|
| Rate for Payer: UMR Bronson Commercial |
$26.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.70
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$67.27
|
|
|
Service Code
|
NDC 16729023930
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$60.54 |
| Rate for Payer: Aetna American Axle |
$43.73
|
| Rate for Payer: Aetna Commercial |
$57.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.73
|
| Rate for Payer: Cash Price |
$53.82
|
| Rate for Payer: Cofinity Advantage |
$47.09
|
| Rate for Payer: Cofinity Commercial |
$57.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.82
|
| Rate for Payer: Healthscope Commercial |
$60.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.45
|
| Rate for Payer: PHP Commercial |
$57.18
|
| Rate for Payer: Priority Health SBD |
$42.38
|
| Rate for Payer: UMR Bronson Commercial |
$29.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50.45
|
|
|
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 |
$26.96 |
| Max. Negotiated Rate |
$65.57 |
| Rate for Payer: Aetna American Axle |
$47.36
|
| Rate for Payer: Aetna Commercial |
$61.93
|
| Rate for Payer: Aetna Medicare |
$36.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.36
|
| Rate for Payer: BCBS Complete |
$29.14
|
| Rate for Payer: Cash Price |
$58.29
|
| Rate for Payer: Cofinity Advantage |
$51.00
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$51.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.65
|
| Rate for Payer: PHP Commercial |
$61.93
|
| Rate for Payer: Priority Health SBD |
$45.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.36
|
| Rate for Payer: UHC Core |
$37.96
|
| Rate for Payer: UHC Exchange |
$28.63
|
| Rate for Payer: UMR Bronson Commercial |
$26.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.65
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$42.40
|
|
|
Service Code
|
NDC 67457025102
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.66 |
| Max. Negotiated Rate |
$38.16 |
| Rate for Payer: Aetna American Axle |
$27.56
|
| Rate for Payer: Aetna Commercial |
$36.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.56
|
| Rate for Payer: Cash Price |
$33.92
|
| Rate for Payer: Cofinity Advantage |
$29.68
|
| Rate for Payer: Cofinity Commercial |
$36.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.92
|
| Rate for Payer: Healthscope Commercial |
$38.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.80
|
| Rate for Payer: PHP Commercial |
$36.04
|
| Rate for Payer: Priority Health SBD |
$26.71
|
| Rate for Payer: UMR Bronson Commercial |
$18.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.80
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$42.40
|
|
|
Service Code
|
NDC 67457025102
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.69 |
| Max. Negotiated Rate |
$38.16 |
| Rate for Payer: Aetna American Axle |
$27.56
|
| Rate for Payer: Aetna Commercial |
$36.04
|
| Rate for Payer: Aetna Medicare |
$21.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.56
|
| Rate for Payer: BCBS Complete |
$16.96
|
| Rate for Payer: Cash Price |
$33.92
|
| Rate for Payer: Cofinity Advantage |
$29.68
|
| Rate for Payer: Cofinity Commercial |
$36.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.92
|
| Rate for Payer: Healthscope Commercial |
$38.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$29.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$31.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$33.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$31.80
|
| Rate for Payer: PHP Commercial |
$36.04
|
| Rate for Payer: Priority Health SBD |
$26.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.56
|
| Rate for Payer: UHC Core |
$22.09
|
| Rate for Payer: UHC Exchange |
$16.66
|
| Rate for Payer: UMR Bronson Commercial |
$15.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$31.80
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$111.20
|
|
|
Service Code
|
NDC 00338955712
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.93 |
| Max. Negotiated Rate |
$100.08 |
| Rate for Payer: Aetna American Axle |
$72.28
|
| Rate for Payer: Aetna Commercial |
$94.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.28
|
| Rate for Payer: Cash Price |
$88.96
|
| Rate for Payer: Cofinity Advantage |
$77.84
|
| Rate for Payer: Cofinity Commercial |
$95.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.96
|
| Rate for Payer: Healthscope Commercial |
$100.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.40
|
| Rate for Payer: PHP Commercial |
$94.52
|
| Rate for Payer: Priority Health SBD |
$70.06
|
| Rate for Payer: UMR Bronson Commercial |
$48.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.40
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$115.67
|
|
|
Service Code
|
NDC 55150029701
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.89 |
| Max. Negotiated Rate |
$104.10 |
| Rate for Payer: Aetna American Axle |
$75.19
|
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.19
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cofinity Advantage |
$80.97
|
| Rate for Payer: Cofinity Commercial |
$99.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.54
|
| Rate for Payer: Healthscope Commercial |
$104.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.75
|
| Rate for Payer: PHP Commercial |
$98.32
|
| Rate for Payer: Priority Health SBD |
$72.87
|
| Rate for Payer: UMR Bronson Commercial |
$50.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.75
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$121.57
|
|
|
Service Code
|
NDC 68094024710
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$109.41 |
| Rate for Payer: Aetna American Axle |
$79.02
|
| Rate for Payer: Aetna Commercial |
$103.33
|
| Rate for Payer: Aetna Medicare |
$60.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.02
|
| Rate for Payer: BCBS Complete |
$48.63
|
| Rate for Payer: Cash Price |
$97.26
|
| Rate for Payer: Cofinity Advantage |
$85.10
|
| Rate for Payer: Cofinity Commercial |
$104.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.26
|
| Rate for Payer: Healthscope Commercial |
$109.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.18
|
| Rate for Payer: PHP Commercial |
$103.33
|
| Rate for Payer: Priority Health SBD |
$76.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.02
|
| Rate for Payer: UHC Core |
$63.34
|
| Rate for Payer: UHC Exchange |
$47.78
|
| Rate for Payer: UMR Bronson Commercial |
$44.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.18
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$113.84
|
|
|
Service Code
|
NDC 43598097558
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.09 |
| Max. Negotiated Rate |
$102.46 |
| Rate for Payer: Aetna American Axle |
$74.00
|
| Rate for Payer: Aetna Commercial |
$96.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.00
|
| Rate for Payer: Cash Price |
$91.07
|
| Rate for Payer: Cofinity Advantage |
$79.69
|
| Rate for Payer: Cofinity Commercial |
$97.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.07
|
| Rate for Payer: Healthscope Commercial |
$102.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.38
|
| Rate for Payer: PHP Commercial |
$96.76
|
| Rate for Payer: Priority Health SBD |
$71.72
|
| Rate for Payer: UMR Bronson Commercial |
$50.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.38
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$121.57
|
|
|
Service Code
|
NDC 68094024701
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.98 |
| Max. Negotiated Rate |
$109.41 |
| Rate for Payer: Aetna American Axle |
$79.02
|
| Rate for Payer: Aetna Commercial |
$103.33
|
| Rate for Payer: Aetna Medicare |
$60.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.02
|
| Rate for Payer: BCBS Complete |
$48.63
|
| Rate for Payer: Cash Price |
$97.26
|
| Rate for Payer: Cofinity Advantage |
$85.10
|
| Rate for Payer: Cofinity Commercial |
$104.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.26
|
| Rate for Payer: Healthscope Commercial |
$109.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$97.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.18
|
| Rate for Payer: PHP Commercial |
$103.33
|
| Rate for Payer: Priority Health SBD |
$76.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.02
|
| Rate for Payer: UHC Core |
$63.34
|
| Rate for Payer: UHC Exchange |
$47.78
|
| Rate for Payer: UMR Bronson Commercial |
$44.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.18
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$106.49
|
|
|
Service Code
|
NDC 00143952501
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$95.84 |
| Rate for Payer: Aetna American Axle |
$69.22
|
| Rate for Payer: Aetna Commercial |
$90.52
|
| Rate for Payer: Aetna Medicare |
$53.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.22
|
| Rate for Payer: BCBS Complete |
$42.60
|
| Rate for Payer: Cash Price |
$85.19
|
| Rate for Payer: Cofinity Advantage |
$74.54
|
| Rate for Payer: Cofinity Commercial |
$91.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.19
|
| Rate for Payer: Healthscope Commercial |
$95.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.87
|
| Rate for Payer: PHP Commercial |
$90.52
|
| Rate for Payer: Priority Health SBD |
$67.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.22
|
| Rate for Payer: UHC Core |
$55.48
|
| Rate for Payer: UHC Exchange |
$41.85
|
| Rate for Payer: UMR Bronson Commercial |
$39.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.87
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$106.49
|
|
|
Service Code
|
NDC 00143952501
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.86 |
| Max. Negotiated Rate |
$95.84 |
| Rate for Payer: Aetna American Axle |
$69.22
|
| Rate for Payer: Aetna Commercial |
$90.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.22
|
| Rate for Payer: Cash Price |
$85.19
|
| Rate for Payer: Cofinity Advantage |
$74.54
|
| Rate for Payer: Cofinity Commercial |
$91.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.19
|
| Rate for Payer: Healthscope Commercial |
$95.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.87
|
| Rate for Payer: PHP Commercial |
$90.52
|
| Rate for Payer: Priority Health SBD |
$67.09
|
| Rate for Payer: UMR Bronson Commercial |
$46.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.87
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$106.49
|
|
|
Service Code
|
NDC 00143952510
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$95.84 |
| Rate for Payer: Aetna American Axle |
$69.22
|
| Rate for Payer: Aetna Commercial |
$90.52
|
| Rate for Payer: Aetna Medicare |
$53.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.22
|
| Rate for Payer: BCBS Complete |
$42.60
|
| Rate for Payer: Cash Price |
$85.19
|
| Rate for Payer: Cofinity Advantage |
$74.54
|
| Rate for Payer: Cofinity Commercial |
$91.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.19
|
| Rate for Payer: Healthscope Commercial |
$95.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.87
|
| Rate for Payer: PHP Commercial |
$90.52
|
| Rate for Payer: Priority Health SBD |
$67.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.22
|
| Rate for Payer: UHC Core |
$55.48
|
| Rate for Payer: UHC Exchange |
$41.85
|
| Rate for Payer: UMR Bronson Commercial |
$39.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.87
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$113.84
|
|
|
Service Code
|
NDC 43598097558
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.12 |
| Max. Negotiated Rate |
$102.46 |
| Rate for Payer: Aetna American Axle |
$74.00
|
| Rate for Payer: Aetna Commercial |
$96.76
|
| Rate for Payer: Aetna Medicare |
$56.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.00
|
| Rate for Payer: BCBS Complete |
$45.54
|
| Rate for Payer: Cash Price |
$91.07
|
| Rate for Payer: Cofinity Advantage |
$79.69
|
| Rate for Payer: Cofinity Commercial |
$97.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.07
|
| Rate for Payer: Healthscope Commercial |
$102.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.38
|
| Rate for Payer: PHP Commercial |
$96.76
|
| Rate for Payer: Priority Health SBD |
$71.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.00
|
| Rate for Payer: UHC Core |
$59.31
|
| Rate for Payer: UHC Exchange |
$44.74
|
| Rate for Payer: UMR Bronson Commercial |
$42.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.38
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$113.23
|
|
|
Service Code
|
NDC 00409166035
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.90 |
| Max. Negotiated Rate |
$101.91 |
| Rate for Payer: Aetna American Axle |
$73.60
|
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Aetna Medicare |
$56.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.60
|
| Rate for Payer: BCBS Complete |
$45.29
|
| Rate for Payer: Cash Price |
$90.58
|
| Rate for Payer: Cofinity Advantage |
$79.26
|
| Rate for Payer: Cofinity Commercial |
$97.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.58
|
| Rate for Payer: Healthscope Commercial |
$101.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.92
|
| Rate for Payer: PHP Commercial |
$96.25
|
| Rate for Payer: Priority Health SBD |
$71.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.60
|
| Rate for Payer: UHC Core |
$58.99
|
| Rate for Payer: UHC Exchange |
$44.50
|
| Rate for Payer: UMR Bronson Commercial |
$41.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.92
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$111.20
|
|
|
Service Code
|
NDC 00338955712
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.14 |
| Max. Negotiated Rate |
$100.08 |
| Rate for Payer: Aetna American Axle |
$72.28
|
| Rate for Payer: Aetna Commercial |
$94.52
|
| Rate for Payer: Aetna Medicare |
$55.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.28
|
| Rate for Payer: BCBS Complete |
$44.48
|
| Rate for Payer: Cash Price |
$88.96
|
| Rate for Payer: Cofinity Advantage |
$77.84
|
| Rate for Payer: Cofinity Commercial |
$95.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.96
|
| Rate for Payer: Healthscope Commercial |
$100.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.40
|
| Rate for Payer: PHP Commercial |
$94.52
|
| Rate for Payer: Priority Health SBD |
$70.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.28
|
| Rate for Payer: UHC Core |
$57.94
|
| Rate for Payer: UHC Exchange |
$43.70
|
| Rate for Payer: UMR Bronson Commercial |
$41.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.40
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$113.23
|
|
|
Service Code
|
NDC 00409166010
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.82 |
| Max. Negotiated Rate |
$101.91 |
| Rate for Payer: Aetna American Axle |
$73.60
|
| Rate for Payer: Aetna Commercial |
$96.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.60
|
| Rate for Payer: Cash Price |
$90.58
|
| Rate for Payer: Cofinity Advantage |
$79.26
|
| Rate for Payer: Cofinity Commercial |
$97.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$90.58
|
| Rate for Payer: Healthscope Commercial |
$101.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$84.92
|
| Rate for Payer: PHP Commercial |
$96.25
|
| Rate for Payer: Priority Health SBD |
$71.33
|
| Rate for Payer: UMR Bronson Commercial |
$49.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.92
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$115.67
|
|
|
Service Code
|
NDC 55150029701
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$104.10 |
| Rate for Payer: Aetna American Axle |
$75.19
|
| Rate for Payer: Aetna Commercial |
$98.32
|
| Rate for Payer: Aetna Medicare |
$57.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.19
|
| Rate for Payer: BCBS Complete |
$46.27
|
| Rate for Payer: Cash Price |
$92.54
|
| Rate for Payer: Cofinity Advantage |
$80.97
|
| Rate for Payer: Cofinity Commercial |
$99.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$92.54
|
| Rate for Payer: Healthscope Commercial |
$104.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$80.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$86.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$92.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$86.75
|
| Rate for Payer: PHP Commercial |
$98.32
|
| Rate for Payer: Priority Health SBD |
$72.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.19
|
| Rate for Payer: UHC Core |
$60.26
|
| Rate for Payer: UHC Exchange |
$45.46
|
| Rate for Payer: UMR Bronson Commercial |
$42.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$86.75
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$121.57
|
|
|
Service Code
|
NDC 68094024701
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.49 |
| Max. Negotiated Rate |
$109.41 |
| Rate for Payer: Aetna American Axle |
$79.02
|
| Rate for Payer: Aetna Commercial |
$103.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.02
|
| Rate for Payer: Cash Price |
$97.26
|
| Rate for Payer: Cofinity Advantage |
$85.10
|
| Rate for Payer: Cofinity Commercial |
$104.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$97.26
|
| Rate for Payer: Healthscope Commercial |
$109.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$85.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$91.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$103.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$91.18
|
| Rate for Payer: PHP Commercial |
$103.33
|
| Rate for Payer: Priority Health SBD |
$76.59
|
| Rate for Payer: UMR Bronson Commercial |
$53.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.18
|
|
