|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$121.57
|
|
|
Service Code
|
NDC 68094024710
|
| 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
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$113.23
|
|
|
Service Code
|
NDC 00409166035
|
| 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
|
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
|
$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
|
$151.73
|
|
|
Service Code
|
NDC 09900001003
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.14 |
| Max. Negotiated Rate |
$136.56 |
| Rate for Payer: Aetna American Axle |
$98.62
|
| Rate for Payer: Aetna Commercial |
$128.97
|
| Rate for Payer: Aetna Medicare |
$75.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.62
|
| Rate for Payer: BCBS Complete |
$60.69
|
| Rate for Payer: Cash Price |
$121.38
|
| Rate for Payer: Cofinity Advantage |
$106.21
|
| Rate for Payer: Cofinity Commercial |
$130.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.38
|
| Rate for Payer: Healthscope Commercial |
$136.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$121.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.80
|
| Rate for Payer: PHP Commercial |
$128.97
|
| Rate for Payer: Priority Health SBD |
$95.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.62
|
| Rate for Payer: UHC Core |
$79.05
|
| Rate for Payer: UHC Exchange |
$59.63
|
| Rate for Payer: UMR Bronson Commercial |
$56.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.80
|
|
|
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
|
OP
|
$113.23
|
|
|
Service Code
|
NDC 00409166010
|
| 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
|
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
|
IP
|
$151.73
|
|
|
Service Code
|
NDC 09900001003
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$66.76 |
| Max. Negotiated Rate |
$136.56 |
| Rate for Payer: Aetna American Axle |
$98.62
|
| Rate for Payer: Aetna Commercial |
$128.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.62
|
| Rate for Payer: Cash Price |
$121.38
|
| Rate for Payer: Cofinity Advantage |
$106.21
|
| Rate for Payer: Cofinity Commercial |
$130.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.38
|
| Rate for Payer: Healthscope Commercial |
$136.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$106.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$113.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$128.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$113.80
|
| Rate for Payer: PHP Commercial |
$128.97
|
| Rate for Payer: Priority Health SBD |
$95.59
|
| Rate for Payer: UMR Bronson Commercial |
$66.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$113.80
|
|
|
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
|
IP
|
$115.67
|
|
|
Service Code
|
NDC 55150029710
|
| 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 4 MCG/ML IV PUSH SOLUTION
|
Facility
|
IP
|
$59.63
|
|
|
Service Code
|
NDC 09900001085
|
| Hospital Charge Code |
300091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.24 |
| Max. Negotiated Rate |
$53.67 |
| Rate for Payer: Aetna American Axle |
$38.76
|
| Rate for Payer: Aetna Commercial |
$50.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.76
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cofinity Advantage |
$41.74
|
| Rate for Payer: Cofinity Commercial |
$51.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.70
|
| Rate for Payer: Healthscope Commercial |
$53.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.72
|
| Rate for Payer: PHP Commercial |
$50.69
|
| Rate for Payer: Priority Health SBD |
$37.57
|
| Rate for Payer: UMR Bronson Commercial |
$26.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.72
|
|
|
DEXMEDETOMIDINE 4 MCG/ML IV PUSH SOLUTION
|
Facility
|
OP
|
$59.63
|
|
|
Service Code
|
NDC 09900001085
|
| Hospital Charge Code |
300091
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$53.67 |
| Rate for Payer: Aetna American Axle |
$38.76
|
| Rate for Payer: Aetna Commercial |
$50.69
|
| Rate for Payer: Aetna Medicare |
$29.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.76
|
| Rate for Payer: BCBS Complete |
$23.85
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cofinity Advantage |
$41.74
|
| Rate for Payer: Cofinity Commercial |
$51.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.70
|
| Rate for Payer: Healthscope Commercial |
$53.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.72
|
| Rate for Payer: PHP Commercial |
$50.69
|
| Rate for Payer: Priority Health SBD |
$37.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.76
|
| Rate for Payer: UHC Core |
$31.07
|
| Rate for Payer: UHC Exchange |
$23.43
|
| Rate for Payer: UMR Bronson Commercial |
$22.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.72
|
|
|
DEXMETHYLPHENIDATE 5 MG TABLET
|
Facility
|
OP
|
$162.75
|
|
|
Service Code
|
NDC 67877065601
|
| Hospital Charge Code |
31846
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.22 |
| Max. Negotiated Rate |
$146.47 |
| Rate for Payer: Aetna American Axle |
$105.79
|
| Rate for Payer: Aetna Commercial |
$138.34
|
| Rate for Payer: Aetna Medicare |
$81.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.79
|
| Rate for Payer: BCBS Complete |
$65.10
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cofinity Advantage |
$113.92
|
| Rate for Payer: Cofinity Commercial |
$139.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.20
|
| Rate for Payer: Healthscope Commercial |
$146.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$130.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.06
|
| Rate for Payer: PHP Commercial |
$138.34
|
| Rate for Payer: Priority Health SBD |
$102.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.79
|
| Rate for Payer: UHC Core |
$84.79
|
| Rate for Payer: UHC Exchange |
$63.96
|
| Rate for Payer: UMR Bronson Commercial |
$60.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.06
|
|
|
DEXMETHYLPHENIDATE 5 MG TABLET
|
Facility
|
IP
|
$162.75
|
|
|
Service Code
|
NDC 67877065601
|
| Hospital Charge Code |
31846
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.61 |
| Max. Negotiated Rate |
$146.47 |
| Rate for Payer: Aetna American Axle |
$105.79
|
| Rate for Payer: Aetna Commercial |
$138.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.79
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cofinity Advantage |
$113.92
|
| Rate for Payer: Cofinity Commercial |
$139.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.20
|
| Rate for Payer: Healthscope Commercial |
$146.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$122.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$138.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.06
|
| Rate for Payer: PHP Commercial |
$138.34
|
| Rate for Payer: Priority Health SBD |
$102.53
|
| Rate for Payer: UMR Bronson Commercial |
$71.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$122.06
|
|
|
DEXMETHYLPHENIDATE ER 5 MG CAPSULE,EXTENDED RELEASE BIPHASIC50-50
|
Facility
|
OP
|
$820.95
|
|
|
Service Code
|
NDC 00115991801
|
| Hospital Charge Code |
41545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$303.75 |
| Max. Negotiated Rate |
$738.86 |
| Rate for Payer: Aetna American Axle |
$533.62
|
| Rate for Payer: Aetna Commercial |
$697.81
|
| Rate for Payer: Aetna Medicare |
$410.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$533.62
|
| Rate for Payer: BCBS Complete |
$328.38
|
| Rate for Payer: Cash Price |
$656.76
|
| Rate for Payer: Cofinity Advantage |
$574.66
|
| Rate for Payer: Cofinity Commercial |
$706.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$656.76
|
| Rate for Payer: Healthscope Commercial |
$738.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$574.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$615.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$656.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$697.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$615.71
|
| Rate for Payer: PHP Commercial |
$697.81
|
| Rate for Payer: Priority Health SBD |
$517.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$533.62
|
| Rate for Payer: UHC Core |
$427.71
|
| Rate for Payer: UHC Exchange |
$322.63
|
| Rate for Payer: UMR Bronson Commercial |
$303.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$615.71
|
|
|
DEXMETHYLPHENIDATE ER 5 MG CAPSULE,EXTENDED RELEASE BIPHASIC50-50
|
Facility
|
IP
|
$1,783.86
|
|
|
Service Code
|
NDC 00078043005
|
| Hospital Charge Code |
41545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$784.90 |
| Max. Negotiated Rate |
$1,605.47 |
| Rate for Payer: Aetna American Axle |
$1,159.51
|
| Rate for Payer: Aetna Commercial |
$1,516.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,159.51
|
| Rate for Payer: Cash Price |
$1,427.09
|
| Rate for Payer: Cofinity Advantage |
$1,248.70
|
| Rate for Payer: Cofinity Commercial |
$1,534.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,427.09
|
| Rate for Payer: Healthscope Commercial |
$1,605.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,248.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,337.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,516.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,337.89
|
| Rate for Payer: PHP Commercial |
$1,516.28
|
| Rate for Payer: Priority Health SBD |
$1,123.83
|
| Rate for Payer: UMR Bronson Commercial |
$784.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,337.89
|
|
|
DEXMETHYLPHENIDATE ER 5 MG CAPSULE,EXTENDED RELEASE BIPHASIC50-50
|
Facility
|
IP
|
$423.50
|
|
|
Service Code
|
NDC 31722022901
|
| Hospital Charge Code |
41545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$186.34 |
| Max. Negotiated Rate |
$381.15 |
| Rate for Payer: Aetna American Axle |
$275.27
|
| Rate for Payer: Aetna Commercial |
$359.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.27
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Cofinity Advantage |
$296.45
|
| Rate for Payer: Cofinity Commercial |
$364.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.80
|
| Rate for Payer: Healthscope Commercial |
$381.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.62
|
| Rate for Payer: PHP Commercial |
$359.98
|
| Rate for Payer: Priority Health SBD |
$266.81
|
| Rate for Payer: UMR Bronson Commercial |
$186.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.62
|
|
|
DEXMETHYLPHENIDATE ER 5 MG CAPSULE,EXTENDED RELEASE BIPHASIC50-50
|
Facility
|
IP
|
$820.95
|
|
|
Service Code
|
NDC 00115991801
|
| Hospital Charge Code |
41545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$361.22 |
| Max. Negotiated Rate |
$738.86 |
| Rate for Payer: Aetna American Axle |
$533.62
|
| Rate for Payer: Aetna Commercial |
$697.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$533.62
|
| Rate for Payer: Cash Price |
$656.76
|
| Rate for Payer: Cofinity Advantage |
$574.66
|
| Rate for Payer: Cofinity Commercial |
$706.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$656.76
|
| Rate for Payer: Healthscope Commercial |
$738.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$574.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$615.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$697.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$615.71
|
| Rate for Payer: PHP Commercial |
$697.81
|
| Rate for Payer: Priority Health SBD |
$517.20
|
| Rate for Payer: UMR Bronson Commercial |
$361.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$615.71
|
|
|
DEXMETHYLPHENIDATE ER 5 MG CAPSULE,EXTENDED RELEASE BIPHASIC50-50
|
Facility
|
OP
|
$1,783.86
|
|
|
Service Code
|
NDC 00078043005
|
| Hospital Charge Code |
41545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$660.03 |
| Max. Negotiated Rate |
$1,605.47 |
| Rate for Payer: Aetna American Axle |
$1,159.51
|
| Rate for Payer: Aetna Commercial |
$1,516.28
|
| Rate for Payer: Aetna Medicare |
$891.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,159.51
|
| Rate for Payer: BCBS Complete |
$713.54
|
| Rate for Payer: Cash Price |
$1,427.09
|
| Rate for Payer: Cofinity Advantage |
$1,248.70
|
| Rate for Payer: Cofinity Commercial |
$1,534.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,427.09
|
| Rate for Payer: Healthscope Commercial |
$1,605.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,248.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,337.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,427.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,516.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,337.89
|
| Rate for Payer: PHP Commercial |
$1,516.28
|
| Rate for Payer: Priority Health SBD |
$1,123.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,159.51
|
| Rate for Payer: UHC Core |
$929.39
|
| Rate for Payer: UHC Exchange |
$701.06
|
| Rate for Payer: UMR Bronson Commercial |
$660.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,337.89
|
|
|
DEXMETHYLPHENIDATE ER 5 MG CAPSULE,EXTENDED RELEASE BIPHASIC50-50
|
Facility
|
OP
|
$423.50
|
|
|
Service Code
|
NDC 31722022901
|
| Hospital Charge Code |
41545
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.69 |
| Max. Negotiated Rate |
$381.15 |
| Rate for Payer: Aetna American Axle |
$275.27
|
| Rate for Payer: Aetna Commercial |
$359.98
|
| Rate for Payer: Aetna Medicare |
$211.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.27
|
| Rate for Payer: BCBS Complete |
$169.40
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Cofinity Advantage |
$296.45
|
| Rate for Payer: Cofinity Commercial |
$364.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$338.80
|
| Rate for Payer: Healthscope Commercial |
$381.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$296.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$317.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$338.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$359.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$317.62
|
| Rate for Payer: PHP Commercial |
$359.98
|
| Rate for Payer: Priority Health SBD |
$266.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$275.27
|
| Rate for Payer: UHC Core |
$220.64
|
| Rate for Payer: UHC Exchange |
$166.44
|
| Rate for Payer: UMR Bronson Commercial |
$156.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.62
|
|
|
DEXRAZOXANE HCL 500 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$317.06
|
|
|
Service Code
|
HCPCS J1190
|
| Hospital Charge Code |
15157
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.01 |
| Max. Negotiated Rate |
$285.35 |
| Rate for Payer: Aetna American Axle |
$206.09
|
| Rate for Payer: Aetna American Axle |
$306.00
|
| Rate for Payer: Aetna American Axle |
$639.32
|
| Rate for Payer: Aetna American Axle |
$517.92
|
| Rate for Payer: Aetna American Axle |
$258.24
|
| Rate for Payer: Aetna Commercial |
$836.03
|
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Aetna Commercial |
$400.15
|
| Rate for Payer: Aetna Commercial |
$337.70
|
| Rate for Payer: Aetna Commercial |
$677.28
|
| Rate for Payer: Aetna Medicare |
$51.73
|
| Rate for Payer: Aetna Medicare |
$51.73
|
| Rate for Payer: Aetna Medicare |
$51.73
|
| Rate for Payer: Aetna Medicare |
$51.73
|
| Rate for Payer: Aetna Medicare |
$51.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$639.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$62.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$62.17
|
| Rate for Payer: BCBS Complete |
$27.32
|
| Rate for Payer: BCBS Complete |
$27.32
|
| Rate for Payer: BCBS Complete |
$27.32
|
| Rate for Payer: BCBS Complete |
$27.32
|
| Rate for Payer: BCBS Complete |
$27.32
|
| Rate for Payer: BCBS MAPPO |
$49.74
|
| Rate for Payer: BCBS MAPPO |
$49.74
|
| Rate for Payer: BCBS MAPPO |
$49.74
|
| Rate for Payer: BCBS MAPPO |
$49.74
|
| Rate for Payer: BCBS MAPPO |
$49.74
|
| Rate for Payer: BCBS Trust/PPO |
$188.09
|
| Rate for Payer: BCBS Trust/PPO |
$188.09
|
| Rate for Payer: BCBS Trust/PPO |
$188.09
|
| Rate for Payer: BCBS Trust/PPO |
$188.09
|
| Rate for Payer: BCBS Trust/PPO |
$188.09
|
| Rate for Payer: BCN Commercial |
$188.09
|
| Rate for Payer: BCN Commercial |
$188.09
|
| Rate for Payer: BCN Commercial |
$188.09
|
| Rate for Payer: BCN Commercial |
$188.09
|
| Rate for Payer: BCN Commercial |
$188.09
|
| Rate for Payer: BCN Medicare Advantage |
$49.74
|
| Rate for Payer: BCN Medicare Advantage |
$49.74
|
| Rate for Payer: BCN Medicare Advantage |
$49.74
|
| Rate for Payer: BCN Medicare Advantage |
$49.74
|
| Rate for Payer: BCN Medicare Advantage |
$49.74
|
| Rate for Payer: Cash Price |
$253.65
|
| Rate for Payer: Cash Price |
$253.65
|
| Rate for Payer: Cash Price |
$786.86
|
| Rate for Payer: Cash Price |
$637.44
|
| Rate for Payer: Cash Price |
$317.83
|
| Rate for Payer: Cash Price |
$786.86
|
| Rate for Payer: Cash Price |
$637.44
|
| Rate for Payer: Cash Price |
$376.62
|
| Rate for Payer: Cash Price |
$376.62
|
| Rate for Payer: Cash Price |
$317.83
|
| Rate for Payer: Cofinity Advantage |
$221.94
|
| Rate for Payer: Cofinity Advantage |
$329.54
|
| Rate for Payer: Cofinity Advantage |
$688.50
|
| Rate for Payer: Cofinity Advantage |
$557.76
|
| Rate for Payer: Cofinity Advantage |
$278.10
|
| Rate for Payer: Cofinity Commercial |
$685.25
|
| Rate for Payer: Cofinity Commercial |
$272.67
|
| Rate for Payer: Cofinity Commercial |
$845.87
|
| Rate for Payer: Cofinity Commercial |
$404.86
|
| Rate for Payer: Cofinity Commercial |
$341.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$637.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$786.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.74
|
| Rate for Payer: Healthscope Commercial |
$885.21
|
| Rate for Payer: Healthscope Commercial |
$285.35
|
| Rate for Payer: Healthscope Commercial |
$717.12
|
| Rate for Payer: Healthscope Commercial |
$423.69
|
| Rate for Payer: Healthscope Commercial |
$357.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$557.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$221.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$688.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$353.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$597.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$737.68
|
| Rate for Payer: Mclaren Medicaid |
$49.74
|
| Rate for Payer: Mclaren Medicaid |
$49.74
|
| Rate for Payer: Mclaren Medicaid |
$49.74
|
| Rate for Payer: Mclaren Medicaid |
$49.74
|
| Rate for Payer: Mclaren Medicaid |
$49.74
|
| Rate for Payer: Mclaren Medicare |
$49.74
|
| Rate for Payer: Mclaren Medicare |
$49.74
|
| Rate for Payer: Mclaren Medicare |
$49.74
|
| Rate for Payer: Mclaren Medicare |
$49.74
|
| Rate for Payer: Mclaren Medicare |
$49.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.23
|
| Rate for Payer: Meridian Medicaid |
$52.23
|
| Rate for Payer: Meridian Medicaid |
$52.23
|
| Rate for Payer: Meridian Medicaid |
$52.23
|
| Rate for Payer: Meridian Medicaid |
$52.23
|
| Rate for Payer: Meridian Medicaid |
$52.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$54.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$400.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$677.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$836.03
|
| Rate for Payer: Nomi Health Commercial |
$149.22
|
| Rate for Payer: Nomi Health Commercial |
$149.22
|
| Rate for Payer: Nomi Health Commercial |
$149.22
|
| Rate for Payer: Nomi Health Commercial |
$149.22
|
| Rate for Payer: Nomi Health Commercial |
$149.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$737.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$353.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$597.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.79
|
| Rate for Payer: PACE Medicare |
$47.25
|
| Rate for Payer: PACE Medicare |
$47.25
|
| Rate for Payer: PACE Medicare |
$47.25
|
| Rate for Payer: PACE Medicare |
$47.25
|
| Rate for Payer: PACE Medicare |
$47.25
|
| Rate for Payer: PACE SWMI |
$49.74
|
| Rate for Payer: PACE SWMI |
$49.74
|
| Rate for Payer: PACE SWMI |
$49.74
|
| Rate for Payer: PACE SWMI |
$49.74
|
| Rate for Payer: PACE SWMI |
$49.74
|
| Rate for Payer: PHP Commercial |
$677.28
|
| Rate for Payer: PHP Commercial |
$400.15
|
| Rate for Payer: PHP Commercial |
$269.50
|
| Rate for Payer: PHP Commercial |
$337.70
|
| Rate for Payer: PHP Commercial |
$836.03
|
| Rate for Payer: PHP Medicare Advantage |
$49.74
|
| Rate for Payer: PHP Medicare Advantage |
$49.74
|
| Rate for Payer: PHP Medicare Advantage |
$49.74
|
| Rate for Payer: PHP Medicare Advantage |
$49.74
|
| Rate for Payer: PHP Medicare Advantage |
$49.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$198.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$198.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$198.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$198.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$198.88
|
| Rate for Payer: Priority Health Medicare |
$49.74
|
| Rate for Payer: Priority Health Medicare |
$49.74
|
| Rate for Payer: Priority Health Medicare |
$49.74
|
| Rate for Payer: Priority Health Medicare |
$49.74
|
| Rate for Payer: Priority Health Medicare |
$49.74
|
| Rate for Payer: Priority Health SBD |
$501.98
|
| Rate for Payer: Priority Health SBD |
$296.59
|
| Rate for Payer: Priority Health SBD |
$250.29
|
| Rate for Payer: Priority Health SBD |
$619.65
|
| Rate for Payer: Priority Health SBD |
$199.75
|
| Rate for Payer: Priority Health Tiered Network |
$159.10
|
| Rate for Payer: Priority Health Tiered Network |
$159.10
|
| Rate for Payer: Priority Health Tiered Network |
$159.10
|
| Rate for Payer: Priority Health Tiered Network |
$159.10
|
| Rate for Payer: Priority Health Tiered Network |
$159.10
|
| Rate for Payer: Railroad Medicare Medicare |
$49.74
|
| Rate for Payer: Railroad Medicare Medicare |
$49.74
|
| Rate for Payer: Railroad Medicare Medicare |
$49.74
|
| Rate for Payer: Railroad Medicare Medicare |
$49.74
|
| Rate for Payer: Railroad Medicare Medicare |
$49.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.72
|
| Rate for Payer: UHC Core |
$95.72
|
| Rate for Payer: UHC Core |
$95.72
|
| Rate for Payer: UHC Core |
$95.72
|
| Rate for Payer: UHC Core |
$95.72
|
| Rate for Payer: UHC Core |
$95.72
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.74
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$49.74
|
| Rate for Payer: UHC Exchange |
$95.72
|
| Rate for Payer: UHC Exchange |
$95.72
|
| Rate for Payer: UHC Exchange |
$95.72
|
| Rate for Payer: UHC Exchange |
$95.72
|
| Rate for Payer: UHC Exchange |
$95.72
|
| Rate for Payer: UHC Medicaid |
$26.01
|
| Rate for Payer: UHC Medicaid |
$26.01
|
| Rate for Payer: UHC Medicaid |
$26.01
|
| Rate for Payer: UHC Medicaid |
$26.01
|
| Rate for Payer: UHC Medicaid |
$26.01
|
| Rate for Payer: UHCCP Medicaid |
$26.01
|
| Rate for Payer: UHCCP Medicaid |
$26.01
|
| Rate for Payer: UHCCP Medicaid |
$26.01
|
| Rate for Payer: UHCCP Medicaid |
$26.01
|
| Rate for Payer: UHCCP Medicaid |
$26.01
|
| Rate for Payer: UMR Bronson Commercial |
$174.18
|
| Rate for Payer: UMR Bronson Commercial |
$363.92
|
| Rate for Payer: UMR Bronson Commercial |
$294.82
|
| Rate for Payer: UMR Bronson Commercial |
$117.31
|
| Rate for Payer: UMR Bronson Commercial |
$147.00
|
| Rate for Payer: VA VA |
$49.74
|
| Rate for Payer: VA VA |
$49.74
|
| Rate for Payer: VA VA |
$49.74
|
| Rate for Payer: VA VA |
$49.74
|
| Rate for Payer: VA VA |
$49.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$597.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$353.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$737.68
|
|
|
DEXRAZOXANE HCL 500 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$796.80
|
|
|
Service Code
|
HCPCS J1190
|
| Hospital Charge Code |
15157
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$350.59 |
| Max. Negotiated Rate |
$717.12 |
| Rate for Payer: Aetna American Axle |
$517.92
|
| Rate for Payer: Aetna American Axle |
$306.00
|
| Rate for Payer: Aetna American Axle |
$639.32
|
| Rate for Payer: Aetna American Axle |
$258.24
|
| Rate for Payer: Aetna American Axle |
$206.09
|
| Rate for Payer: Aetna Commercial |
$269.50
|
| Rate for Payer: Aetna Commercial |
$400.15
|
| Rate for Payer: Aetna Commercial |
$677.28
|
| Rate for Payer: Aetna Commercial |
$836.03
|
| Rate for Payer: Aetna Commercial |
$337.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$517.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$206.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$639.32
|
| Rate for Payer: Cash Price |
$376.62
|
| Rate for Payer: Cash Price |
$317.83
|
| Rate for Payer: Cash Price |
$786.86
|
| Rate for Payer: Cash Price |
$637.44
|
| Rate for Payer: Cash Price |
$253.65
|
| Rate for Payer: Cofinity Advantage |
$221.94
|
| Rate for Payer: Cofinity Advantage |
$688.50
|
| Rate for Payer: Cofinity Advantage |
$278.10
|
| Rate for Payer: Cofinity Advantage |
$557.76
|
| Rate for Payer: Cofinity Advantage |
$329.54
|
| Rate for Payer: Cofinity Commercial |
$845.87
|
| Rate for Payer: Cofinity Commercial |
$272.67
|
| Rate for Payer: Cofinity Commercial |
$341.67
|
| Rate for Payer: Cofinity Commercial |
$404.86
|
| Rate for Payer: Cofinity Commercial |
$685.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$637.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$317.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$786.86
|
| Rate for Payer: Healthscope Commercial |
$285.35
|
| Rate for Payer: Healthscope Commercial |
$357.56
|
| Rate for Payer: Healthscope Commercial |
$423.69
|
| Rate for Payer: Healthscope Commercial |
$717.12
|
| Rate for Payer: Healthscope Commercial |
$885.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$688.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$221.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$557.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$297.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$353.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$597.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$737.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$677.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$400.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$337.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$836.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$353.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$297.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$737.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$597.60
|
| Rate for Payer: PHP Commercial |
$400.15
|
| Rate for Payer: PHP Commercial |
$269.50
|
| Rate for Payer: PHP Commercial |
$677.28
|
| Rate for Payer: PHP Commercial |
$836.03
|
| Rate for Payer: PHP Commercial |
$337.70
|
| Rate for Payer: Priority Health SBD |
$501.98
|
| Rate for Payer: Priority Health SBD |
$619.65
|
| Rate for Payer: Priority Health SBD |
$250.29
|
| Rate for Payer: Priority Health SBD |
$199.75
|
| Rate for Payer: Priority Health SBD |
$296.59
|
| Rate for Payer: UMR Bronson Commercial |
$174.81
|
| Rate for Payer: UMR Bronson Commercial |
$432.77
|
| Rate for Payer: UMR Bronson Commercial |
$207.14
|
| Rate for Payer: UMR Bronson Commercial |
$139.51
|
| Rate for Payer: UMR Bronson Commercial |
$350.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$597.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$353.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$737.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$297.97
|
|
|
DEXTRAN 40 10 % IN 5 % DEXTROSE INTRAVENOUS
|
Facility
|
IP
|
$1,216.03
|
|
|
Service Code
|
HCPCS J7100
|
| Hospital Charge Code |
9759
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$535.05 |
| Max. Negotiated Rate |
$1,094.43 |
| Rate for Payer: Aetna American Axle |
$790.42
|
| Rate for Payer: Aetna Commercial |
$1,033.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$790.42
|
| Rate for Payer: Cash Price |
$972.82
|
| Rate for Payer: Cofinity Advantage |
$851.22
|
| Rate for Payer: Cofinity Commercial |
$1,045.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$972.82
|
| Rate for Payer: Healthscope Commercial |
$1,094.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$851.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$912.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,033.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$912.02
|
| Rate for Payer: PHP Commercial |
$1,033.63
|
| Rate for Payer: Priority Health SBD |
$766.10
|
| Rate for Payer: UMR Bronson Commercial |
$535.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$912.02
|
|
