|
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 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
|
$113.23
|
|
|
Service Code
|
NDC 00409159610
|
| 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 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 |
$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
|
$124.36
|
|
|
Service Code
|
NDC 00143952510
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.01 |
| Max. Negotiated Rate |
$111.92 |
| Rate for Payer: Aetna American Axle |
$80.83
|
| Rate for Payer: Aetna Commercial |
$105.71
|
| Rate for Payer: Aetna Medicare |
$62.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.83
|
| Rate for Payer: BCBS Complete |
$49.74
|
| 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 |
$46.01
|
| 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
|
$97.64
|
|
|
Service Code
|
NDC 55150029701
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.96 |
| Max. Negotiated Rate |
$87.88 |
| Rate for Payer: Aetna American Axle |
$63.47
|
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.47
|
| 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 |
$42.96
|
| 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
|
$124.36
|
|
|
Service Code
|
NDC 00143952501
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.01 |
| Max. Negotiated Rate |
$111.92 |
| Rate for Payer: Aetna American Axle |
$80.83
|
| Rate for Payer: Aetna Commercial |
$105.71
|
| Rate for Payer: Aetna Medicare |
$62.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.83
|
| Rate for Payer: BCBS Complete |
$49.74
|
| 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 |
$46.01
|
| 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
|
$97.64
|
|
|
Service Code
|
NDC 55150029710
|
| Hospital Charge Code |
166083
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.96 |
| Max. Negotiated Rate |
$87.88 |
| Rate for Payer: Aetna American Axle |
$63.47
|
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.47
|
| 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 |
$42.96
|
| 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
|
$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 Commercial |
$106.21
|
| Rate for Payer: Cofinity Commercial |
$130.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$106.21
|
| 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: PHP Commercial |
$128.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.62
|
| Rate for Payer: Priority Health SBD |
$95.59
|
| 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
|
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 Commercial |
$77.84
|
| Rate for Payer: Cofinity Commercial |
$95.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.84
|
| 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: PHP Commercial |
$94.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.28
|
| 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
|
$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 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 |
$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
|
$113.23
|
|
|
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 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
|
$113.23
|
|
|
Service Code
|
NDC 00409159601
|
| 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 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 |
$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
|
$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 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
|
|
|
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
|
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 Commercial |
$106.21
|
| Rate for Payer: Cofinity Commercial |
$130.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$106.21
|
| 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: PHP Commercial |
$128.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.62
|
| 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
|
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 Commercial |
$77.84
|
| Rate for Payer: Cofinity Commercial |
$95.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.84
|
| 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: PHP Commercial |
$94.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.28
|
| Rate for Payer: Priority Health SBD |
$70.06
|
| 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 00409159601
|
| 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
|
OP
|
$97.64
|
|
|
Service Code
|
NDC 55150029710
|
| 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
|
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 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 |
$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
|
$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 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 |
$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
|
$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 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 |
$44.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$91.18
|
|
|
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 Commercial |
$41.74
|
| Rate for Payer: Cofinity Commercial |
$51.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.74
|
| 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: PHP Commercial |
$50.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.76
|
| 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 Commercial |
$41.74
|
| Rate for Payer: Cofinity Commercial |
$51.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.74
|
| 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: PHP Commercial |
$50.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.76
|
| Rate for Payer: Priority Health SBD |
$37.57
|
| 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 |
$146.48 |
| 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 Commercial |
$113.92
|
| Rate for Payer: Cofinity Commercial |
$139.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.20
|
| Rate for Payer: Healthscope Commercial |
$146.48
|
| 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: PHP Commercial |
$138.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.79
|
| Rate for Payer: Priority Health SBD |
$102.53
|
| 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 |
$146.48 |
| 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 Commercial |
$113.92
|
| Rate for Payer: Cofinity Commercial |
$139.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$130.20
|
| Rate for Payer: Healthscope Commercial |
$146.48
|
| 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: PHP Commercial |
$138.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.79
|
| 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
|
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 |
$275.28
|
| Rate for Payer: Aetna Commercial |
$359.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.28
|
| Rate for Payer: Cash Price |
$338.80
|
| Rate for Payer: Cofinity Commercial |
$296.45
|
| Rate for Payer: Cofinity Commercial |
$364.21
|
| Rate for Payer: Cofinity Medicare Advantage |
$296.45
|
| 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: PHP Commercial |
$359.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$275.28
|
| Rate for Payer: Priority Health SBD |
$266.80
|
| Rate for Payer: UMR Bronson Commercial |
$186.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$317.62
|
|
