|
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 |
$64.76 |
| 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 Commercial |
$50.36
|
| Rate for Payer: Cofinity Commercial |
$61.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.56
|
| Rate for Payer: Healthscope Commercial |
$64.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.16
|
| Rate for Payer: PHP Commercial |
$61.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.77
|
| Rate for Payer: Priority Health SBD |
$45.33
|
| 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
|
$50.44
|
|
|
Service Code
|
NDC 42023014625
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.19 |
| Max. Negotiated Rate |
$45.40 |
| Rate for Payer: Aetna American Axle |
$32.79
|
| Rate for Payer: Aetna Commercial |
$42.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.79
|
| Rate for Payer: Cash Price |
$40.35
|
| Rate for Payer: Cofinity Commercial |
$35.31
|
| Rate for Payer: Cofinity Commercial |
$43.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.35
|
| Rate for Payer: Healthscope Commercial |
$45.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.87
|
| Rate for Payer: PHP Commercial |
$42.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.79
|
| Rate for Payer: Priority Health SBD |
$31.78
|
| Rate for Payer: UMR Bronson Commercial |
$22.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.83
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$71.95
|
|
|
Service Code
|
NDC 70860060503
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.62 |
| Max. Negotiated Rate |
$64.76 |
| Rate for Payer: Cofinity Commercial |
$61.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.56
|
| Rate for Payer: Healthscope Commercial |
$64.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.16
|
| Rate for Payer: PHP Commercial |
$61.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.77
|
| Rate for Payer: Priority Health SBD |
$45.33
|
| Rate for Payer: UMR Bronson Commercial |
$26.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.96
|
| 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 Commercial |
$50.36
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$84.57
|
|
|
Service Code
|
NDC 00409163802
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.21 |
| Max. Negotiated Rate |
$76.11 |
| Rate for Payer: Aetna American Axle |
$54.97
|
| Rate for Payer: Aetna Commercial |
$71.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.97
|
| Rate for Payer: Cash Price |
$67.66
|
| Rate for Payer: Cofinity Commercial |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$72.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.66
|
| Rate for Payer: Healthscope Commercial |
$76.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.88
|
| Rate for Payer: PHP Commercial |
$71.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.97
|
| Rate for Payer: Priority Health SBD |
$53.28
|
| Rate for Payer: UMR Bronson Commercial |
$37.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.43
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$63.07
|
|
|
Service Code
|
NDC 16729023930
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: PHP Commercial |
$53.61
|
| 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 Commercial |
$44.15
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.15
|
| 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: Priority Health Cigna Priority Health |
$41.00
|
| 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
|
$71.95
|
|
|
Service Code
|
NDC 70860060503
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.66 |
| Max. Negotiated Rate |
$64.76 |
| 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 Commercial |
$50.36
|
| Rate for Payer: Cofinity Commercial |
$61.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.56
|
| Rate for Payer: Healthscope Commercial |
$64.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.16
|
| Rate for Payer: PHP Commercial |
$61.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.77
|
| 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
|
$63.07
|
|
|
Service Code
|
NDC 16729023993
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.34 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna American Axle |
$41.00
|
| Rate for Payer: Aetna Commercial |
$53.61
|
| Rate for Payer: Aetna Medicare |
$31.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.00
|
| Rate for Payer: BCBS Complete |
$25.23
|
| Rate for Payer: Cash Price |
$50.46
|
| Rate for Payer: Cofinity Commercial |
$44.15
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.15
|
| 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: PHP Commercial |
$53.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.00
|
| Rate for Payer: Priority Health SBD |
$39.73
|
| Rate for Payer: UMR Bronson Commercial |
$23.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.30
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$63.07
|
|
|
Service Code
|
NDC 16729023930
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.34 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna American Axle |
$41.00
|
| Rate for Payer: Aetna Commercial |
$53.61
|
| Rate for Payer: Aetna Medicare |
$31.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.00
|
| Rate for Payer: BCBS Complete |
$25.23
|
| Rate for Payer: Cash Price |
$50.46
|
| Rate for Payer: Cofinity Commercial |
$44.15
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.15
|
| 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: PHP Commercial |
$53.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.00
|
| Rate for Payer: Priority Health SBD |
$39.73
|
| Rate for Payer: UMR Bronson Commercial |
$23.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.30
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$99.04
|
|
|
Service Code
|
NDC 67457025100
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.64 |
| Max. Negotiated Rate |
$89.14 |
| Rate for Payer: Aetna American Axle |
$64.38
|
| Rate for Payer: Aetna Commercial |
$84.18
|
| Rate for Payer: Aetna Medicare |
$49.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.38
|
| Rate for Payer: BCBS Complete |
$39.62
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cofinity Commercial |
$69.33
|
| Rate for Payer: Cofinity Commercial |
$85.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.23
|
| Rate for Payer: Healthscope Commercial |
$89.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.18
|
| Rate for Payer: PHP Commercial |
$84.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.38
|
| Rate for Payer: Priority Health SBD |
$62.40
|
| Rate for Payer: UMR Bronson Commercial |
$36.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.28
|
|
|
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 |
$64.76 |
| 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 Commercial |
$50.36
|
| Rate for Payer: Cofinity Commercial |
$61.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$50.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.56
|
| Rate for Payer: Healthscope Commercial |
$64.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.16
|
| Rate for Payer: PHP Commercial |
$61.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.77
|
| 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
|
$63.07
|
|
|
Service Code
|
NDC 55150020902
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.34 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna American Axle |
$41.00
|
| Rate for Payer: Aetna Commercial |
$53.61
|
| Rate for Payer: Aetna Medicare |
$31.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.00
|
| Rate for Payer: BCBS Complete |
$25.23
|
| Rate for Payer: Cash Price |
$50.46
|
| Rate for Payer: Cofinity Commercial |
$44.15
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.15
|
| 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: PHP Commercial |
$53.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.00
|
| Rate for Payer: Priority Health SBD |
$39.73
|
| Rate for Payer: UMR Bronson Commercial |
$23.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.30
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$99.04
|
|
|
Service Code
|
NDC 67457025102
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.64 |
| Max. Negotiated Rate |
$89.14 |
| Rate for Payer: Aetna American Axle |
$64.38
|
| Rate for Payer: Aetna Commercial |
$84.18
|
| Rate for Payer: Aetna Medicare |
$49.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.38
|
| Rate for Payer: BCBS Complete |
$39.62
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cofinity Commercial |
$69.33
|
| Rate for Payer: Cofinity Commercial |
$85.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.23
|
| Rate for Payer: Healthscope Commercial |
$89.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.18
|
| Rate for Payer: PHP Commercial |
$84.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.38
|
| Rate for Payer: Priority Health SBD |
$62.40
|
| Rate for Payer: UMR Bronson Commercial |
$36.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.28
|
|
|
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 Commercial |
$44.15
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.15
|
| 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: PHP Commercial |
$53.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.00
|
| 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
|
$72.86
|
|
|
Service Code
|
NDC 66794023342
|
| 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 Commercial |
$51.00
|
| Rate for Payer: Cofinity Commercial |
$62.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.00
|
| 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 |
$54.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.93
|
| Rate for Payer: PHP Commercial |
$61.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.36
|
| 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 |
$54.64
|
|
|
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 Commercial |
$51.00
|
| Rate for Payer: Cofinity Commercial |
$62.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.00
|
| 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 |
$54.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.93
|
| Rate for Payer: PHP Commercial |
$61.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.36
|
| 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 |
$54.64
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
NDC 00143953201
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna American Axle |
$47.45
|
| Rate for Payer: Aetna Commercial |
$62.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.45
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$51.10
|
| Rate for Payer: Cofinity Commercial |
$62.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.40
|
| Rate for Payer: Healthscope Commercial |
$65.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.05
|
| Rate for Payer: PHP Commercial |
$62.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
| Rate for Payer: Priority Health SBD |
$45.99
|
| Rate for Payer: UMR Bronson Commercial |
$32.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.75
|
|
|
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 Commercial |
$51.00
|
| Rate for Payer: Cofinity Commercial |
$62.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.00
|
| 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 |
$54.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.93
|
| Rate for Payer: PHP Commercial |
$61.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.36
|
| Rate for Payer: Priority Health SBD |
$45.90
|
| Rate for Payer: UMR Bronson Commercial |
$26.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$99.04
|
|
|
Service Code
|
NDC 67457025100
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.58 |
| Max. Negotiated Rate |
$89.14 |
| Rate for Payer: Aetna American Axle |
$64.38
|
| Rate for Payer: Aetna Commercial |
$84.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.38
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cofinity Commercial |
$69.33
|
| Rate for Payer: Cofinity Commercial |
$85.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.23
|
| Rate for Payer: Healthscope Commercial |
$89.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.18
|
| Rate for Payer: PHP Commercial |
$84.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.38
|
| Rate for Payer: Priority Health SBD |
$62.40
|
| Rate for Payer: UMR Bronson Commercial |
$43.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.28
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
NDC 00143953225
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna American Axle |
$47.45
|
| Rate for Payer: Aetna Commercial |
$62.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.45
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$51.10
|
| Rate for Payer: Cofinity Commercial |
$62.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.40
|
| Rate for Payer: Healthscope Commercial |
$65.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.05
|
| Rate for Payer: PHP Commercial |
$62.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
| Rate for Payer: Priority Health SBD |
$45.99
|
| Rate for Payer: UMR Bronson Commercial |
$32.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.75
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$124.36
|
|
|
Service Code
|
NDC 00143952501
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.72 |
| Max. Negotiated Rate |
$111.92 |
| Rate for Payer: Aetna American Axle |
$80.83
|
| Rate for Payer: Aetna Commercial |
$105.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.83
|
| Rate for Payer: Cash Price |
$99.49
|
| Rate for Payer: Cofinity Commercial |
$106.95
|
| Rate for Payer: Cofinity Commercial |
$87.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.49
|
| Rate for Payer: Healthscope Commercial |
$111.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.71
|
| Rate for Payer: PHP Commercial |
$105.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.83
|
| Rate for Payer: Priority Health SBD |
$78.35
|
| Rate for Payer: UMR Bronson Commercial |
$54.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.27
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
IP
|
$124.36
|
|
|
Service Code
|
NDC 00143952510
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.72 |
| Max. Negotiated Rate |
$111.92 |
| Rate for Payer: Aetna American Axle |
$80.83
|
| Rate for Payer: Aetna Commercial |
$105.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.83
|
| Rate for Payer: Cash Price |
$99.49
|
| Rate for Payer: Cofinity Commercial |
$106.95
|
| Rate for Payer: Cofinity Commercial |
$87.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.49
|
| Rate for Payer: Healthscope Commercial |
$111.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.71
|
| Rate for Payer: PHP Commercial |
$105.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.83
|
| Rate for Payer: Priority Health SBD |
$78.35
|
| Rate for Payer: UMR Bronson Commercial |
$54.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.27
|
|
|
DEXMEDETOMIDINE 400 MCG/100 ML (4 MCG/ML) IN 0.9 % SODIUM CHLORIDE IV
|
Facility
|
OP
|
$97.64
|
|
|
Service Code
|
NDC 55150029701
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$87.88 |
| Rate for Payer: Aetna American Axle |
$63.47
|
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna Medicare |
$48.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.47
|
| Rate for Payer: BCBS Complete |
$39.06
|
| Rate for Payer: Cash Price |
$78.11
|
| Rate for Payer: Cofinity Commercial |
$68.35
|
| Rate for Payer: Cofinity Commercial |
$83.97
|
| Rate for Payer: Cofinity Medicare Advantage |
$68.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.11
|
| Rate for Payer: Healthscope Commercial |
$87.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$68.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$73.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.99
|
| Rate for Payer: PHP Commercial |
$82.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.47
|
| Rate for Payer: Priority Health SBD |
$61.51
|
| Rate for Payer: UMR Bronson Commercial |
$36.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$73.23
|
|
|
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 Commercial |
$79.69
|
| Rate for Payer: Cofinity Commercial |
$97.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.69
|
| 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: PHP Commercial |
$96.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.00
|
| Rate for Payer: Priority Health SBD |
$71.72
|
| 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 00409159610
|
| 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 Commercial |
$79.26
|
| Rate for Payer: Cofinity Commercial |
$97.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.26
|
| 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: PHP Commercial |
$96.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.60
|
| Rate for Payer: Priority Health SBD |
$71.33
|
| 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
|
$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 Commercial |
$104.55
|
| Rate for Payer: Cofinity Commercial |
$85.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$85.10
|
| 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: PHP Commercial |
$103.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.02
|
| 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
|
|
