|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$5,827.54
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
173433
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,564.12 |
| Max. Negotiated Rate |
$5,244.79 |
| Rate for Payer: Aetna American Axle |
$3,787.90
|
| Rate for Payer: Aetna Commercial |
$4,953.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,787.90
|
| Rate for Payer: Cash Price |
$4,662.03
|
| Rate for Payer: Cofinity Commercial |
$4,079.28
|
| Rate for Payer: Cofinity Commercial |
$5,011.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,079.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,662.03
|
| Rate for Payer: Healthscope Commercial |
$5,244.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4,079.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4,370.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,953.41
|
| Rate for Payer: PHP Commercial |
$4,953.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,787.90
|
| Rate for Payer: Priority Health SBD |
$3,671.35
|
| Rate for Payer: UMR Bronson Commercial |
$2,564.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,370.65
|
|
|
NORELGESTROMIN 150 MCG-E.ESTRADIOL 35 MCG/24 HR WEEKLY TRANSDERM PATCH
|
Facility
|
OP
|
$143.65
|
|
|
Service Code
|
NDC 00378334016
|
| Hospital Charge Code |
32248
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.15 |
| Max. Negotiated Rate |
$129.28 |
| Rate for Payer: Aetna American Axle |
$93.37
|
| Rate for Payer: Aetna Commercial |
$122.10
|
| Rate for Payer: Aetna Medicare |
$71.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.37
|
| Rate for Payer: BCBS Complete |
$57.46
|
| Rate for Payer: Cash Price |
$114.92
|
| Rate for Payer: Cofinity Commercial |
$100.56
|
| Rate for Payer: Cofinity Commercial |
$123.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.92
|
| Rate for Payer: Healthscope Commercial |
$129.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.10
|
| Rate for Payer: PHP Commercial |
$122.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.37
|
| Rate for Payer: Priority Health SBD |
$90.50
|
| Rate for Payer: UMR Bronson Commercial |
$53.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.74
|
|
|
NORELGESTROMIN 150 MCG-E.ESTRADIOL 35 MCG/24 HR WEEKLY TRANSDERM PATCH
|
Facility
|
IP
|
$143.65
|
|
|
Service Code
|
NDC 00378334016
|
| Hospital Charge Code |
32248
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.21 |
| Max. Negotiated Rate |
$129.28 |
| Rate for Payer: Aetna American Axle |
$93.37
|
| Rate for Payer: Aetna Commercial |
$122.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.37
|
| Rate for Payer: Cash Price |
$114.92
|
| Rate for Payer: Cofinity Commercial |
$100.56
|
| Rate for Payer: Cofinity Commercial |
$123.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.92
|
| Rate for Payer: Healthscope Commercial |
$129.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$107.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.10
|
| Rate for Payer: PHP Commercial |
$122.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.37
|
| Rate for Payer: Priority Health SBD |
$90.50
|
| Rate for Payer: UMR Bronson Commercial |
$63.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$107.74
|
|
|
NORELGESTROMIN 150 MCG-E.ESTRADIOL 35 MCG/24 HR WEEKLY TRANSDERM PATCH
|
Facility
|
OP
|
$430.94
|
|
|
Service Code
|
NDC 00378334053
|
| Hospital Charge Code |
32248
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.45 |
| Max. Negotiated Rate |
$387.85 |
| Rate for Payer: Aetna American Axle |
$280.11
|
| Rate for Payer: Aetna Commercial |
$366.30
|
| Rate for Payer: Aetna Medicare |
$215.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.11
|
| Rate for Payer: BCBS Complete |
$172.38
|
| Rate for Payer: Cash Price |
$344.75
|
| Rate for Payer: Cofinity Commercial |
$301.66
|
| Rate for Payer: Cofinity Commercial |
$370.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.75
|
| Rate for Payer: Healthscope Commercial |
$387.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.30
|
| Rate for Payer: PHP Commercial |
$366.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.11
|
| Rate for Payer: Priority Health SBD |
$271.49
|
| Rate for Payer: UMR Bronson Commercial |
$159.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.20
|
|
|
NORELGESTROMIN 150 MCG-E.ESTRADIOL 35 MCG/24 HR WEEKLY TRANSDERM PATCH
|
Facility
|
IP
|
$430.94
|
|
|
Service Code
|
NDC 00378334053
|
| Hospital Charge Code |
32248
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.61 |
| Max. Negotiated Rate |
$387.85 |
| Rate for Payer: Aetna American Axle |
$280.11
|
| Rate for Payer: Aetna Commercial |
$366.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.11
|
| Rate for Payer: Cash Price |
$344.75
|
| Rate for Payer: Cofinity Commercial |
$301.66
|
| Rate for Payer: Cofinity Commercial |
$370.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$301.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$344.75
|
| Rate for Payer: Healthscope Commercial |
$387.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$301.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$323.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$366.30
|
| Rate for Payer: PHP Commercial |
$366.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.11
|
| Rate for Payer: Priority Health SBD |
$271.49
|
| Rate for Payer: UMR Bronson Commercial |
$189.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$323.20
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.67
|
|
|
Service Code
|
NDC 71839014301
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Aetna American Axle |
$14.09
|
| Rate for Payer: Aetna Commercial |
$18.42
|
| Rate for Payer: Aetna Medicare |
$10.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.09
|
| Rate for Payer: BCBS Complete |
$8.67
|
| Rate for Payer: Cash Price |
$17.34
|
| Rate for Payer: Cofinity Commercial |
$15.17
|
| Rate for Payer: Cofinity Commercial |
$18.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.34
|
| Rate for Payer: Healthscope Commercial |
$19.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.42
|
| Rate for Payer: PHP Commercial |
$18.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.09
|
| Rate for Payer: Priority Health SBD |
$13.65
|
| Rate for Payer: UMR Bronson Commercial |
$8.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.25
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$23.59
|
|
|
Service Code
|
NDC 00409337504
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna American Axle |
$15.33
|
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna Medicare |
$11.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: BCBS Complete |
$9.44
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: UMR Bronson Commercial |
$8.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.78
|
|
|
Service Code
|
NDC 63323094021
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.14 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Aetna American Axle |
$13.51
|
| Rate for Payer: Aetna Commercial |
$17.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.51
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$14.55
|
| Rate for Payer: Cofinity Commercial |
$17.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.62
|
| Rate for Payer: Healthscope Commercial |
$18.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.66
|
| Rate for Payer: PHP Commercial |
$17.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.51
|
| Rate for Payer: Priority Health SBD |
$13.09
|
| Rate for Payer: UMR Bronson Commercial |
$9.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.59
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.25
|
|
|
Service Code
|
NDC 36000016201
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: Aetna American Axle |
$13.16
|
| Rate for Payer: Aetna Commercial |
$17.21
|
| Rate for Payer: Aetna Medicare |
$10.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.16
|
| Rate for Payer: BCBS Complete |
$8.10
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$17.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.20
|
| Rate for Payer: Healthscope Commercial |
$18.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.21
|
| Rate for Payer: PHP Commercial |
$17.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.16
|
| Rate for Payer: Priority Health SBD |
$12.76
|
| Rate for Payer: UMR Bronson Commercial |
$7.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.19
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.59
|
|
|
Service Code
|
NDC 00703115303
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$67.13 |
| Rate for Payer: Aetna American Axle |
$48.48
|
| Rate for Payer: Aetna Commercial |
$63.40
|
| Rate for Payer: Aetna Medicare |
$37.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.48
|
| Rate for Payer: BCBS Complete |
$29.84
|
| Rate for Payer: Cash Price |
$59.67
|
| Rate for Payer: Cofinity Commercial |
$52.21
|
| Rate for Payer: Cofinity Commercial |
$64.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.67
|
| Rate for Payer: Healthscope Commercial |
$67.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.40
|
| Rate for Payer: PHP Commercial |
$63.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.48
|
| Rate for Payer: Priority Health SBD |
$46.99
|
| Rate for Payer: UMR Bronson Commercial |
$27.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.94
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.25
|
|
|
Service Code
|
NDC 36000016210
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: Aetna American Axle |
$13.16
|
| Rate for Payer: Aetna Commercial |
$17.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.16
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$17.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.20
|
| Rate for Payer: Healthscope Commercial |
$18.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.21
|
| Rate for Payer: PHP Commercial |
$17.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.16
|
| Rate for Payer: Priority Health SBD |
$12.76
|
| Rate for Payer: UMR Bronson Commercial |
$8.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.19
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.46
|
|
|
Service Code
|
NDC 00143931810
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$22.91 |
| Rate for Payer: Aetna American Axle |
$16.55
|
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.55
|
| Rate for Payer: Cash Price |
$20.37
|
| Rate for Payer: Cofinity Commercial |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.37
|
| Rate for Payer: Healthscope Commercial |
$22.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.64
|
| Rate for Payer: PHP Commercial |
$21.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.55
|
| Rate for Payer: Priority Health SBD |
$16.04
|
| Rate for Payer: UMR Bronson Commercial |
$11.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.09
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$36.17
|
|
|
Service Code
|
NDC 47335061544
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$32.55 |
| Rate for Payer: Aetna American Axle |
$23.51
|
| Rate for Payer: Aetna Commercial |
$30.74
|
| Rate for Payer: Aetna Medicare |
$18.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.51
|
| Rate for Payer: BCBS Complete |
$14.47
|
| Rate for Payer: Cash Price |
$28.94
|
| Rate for Payer: Cofinity Commercial |
$25.32
|
| Rate for Payer: Cofinity Commercial |
$31.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$25.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$28.94
|
| Rate for Payer: Healthscope Commercial |
$32.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$25.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.74
|
| Rate for Payer: PHP Commercial |
$30.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.51
|
| Rate for Payer: Priority Health SBD |
$22.79
|
| Rate for Payer: UMR Bronson Commercial |
$13.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.13
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.78
|
|
|
Service Code
|
NDC 63323094021
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Aetna American Axle |
$13.51
|
| Rate for Payer: Aetna Commercial |
$17.66
|
| Rate for Payer: Aetna Medicare |
$10.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.51
|
| Rate for Payer: BCBS Complete |
$8.31
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$14.55
|
| Rate for Payer: Cofinity Commercial |
$17.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.62
|
| Rate for Payer: Healthscope Commercial |
$18.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.66
|
| Rate for Payer: PHP Commercial |
$17.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.51
|
| Rate for Payer: Priority Health SBD |
$13.09
|
| Rate for Payer: UMR Bronson Commercial |
$7.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.59
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.34
|
|
|
Service Code
|
NDC 67457085204
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$16.51 |
| Rate for Payer: Aetna American Axle |
$11.92
|
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.92
|
| Rate for Payer: Cash Price |
$14.67
|
| Rate for Payer: Cofinity Commercial |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$15.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.67
|
| Rate for Payer: Healthscope Commercial |
$16.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.59
|
| Rate for Payer: PHP Commercial |
$15.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.92
|
| Rate for Payer: Priority Health SBD |
$11.55
|
| Rate for Payer: UMR Bronson Commercial |
$8.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.76
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.78
|
|
|
Service Code
|
NDC 63323094004
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Aetna American Axle |
$13.51
|
| Rate for Payer: Aetna Commercial |
$17.66
|
| Rate for Payer: Aetna Medicare |
$10.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.51
|
| Rate for Payer: BCBS Complete |
$8.31
|
| Rate for Payer: Cash Price |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$14.55
|
| Rate for Payer: Cofinity Commercial |
$17.87
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.62
|
| Rate for Payer: Healthscope Commercial |
$18.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.66
|
| Rate for Payer: PHP Commercial |
$17.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.51
|
| Rate for Payer: Priority Health SBD |
$13.09
|
| Rate for Payer: UMR Bronson Commercial |
$7.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.59
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.59
|
|
|
Service Code
|
NDC 00703115301
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$67.13 |
| Rate for Payer: Aetna American Axle |
$48.48
|
| Rate for Payer: Aetna Commercial |
$63.40
|
| Rate for Payer: Aetna Medicare |
$37.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.48
|
| Rate for Payer: BCBS Complete |
$29.84
|
| Rate for Payer: Cash Price |
$59.67
|
| Rate for Payer: Cofinity Commercial |
$52.21
|
| Rate for Payer: Cofinity Commercial |
$64.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.67
|
| Rate for Payer: Healthscope Commercial |
$67.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.40
|
| Rate for Payer: PHP Commercial |
$63.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.48
|
| Rate for Payer: Priority Health SBD |
$46.99
|
| Rate for Payer: UMR Bronson Commercial |
$27.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.94
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$20.25
|
|
|
Service Code
|
NDC 36000016210
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: Aetna American Axle |
$13.16
|
| Rate for Payer: Aetna Commercial |
$17.21
|
| Rate for Payer: Aetna Medicare |
$10.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.16
|
| Rate for Payer: BCBS Complete |
$8.10
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$17.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.20
|
| Rate for Payer: Healthscope Commercial |
$18.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.21
|
| Rate for Payer: PHP Commercial |
$17.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.16
|
| Rate for Payer: Priority Health SBD |
$12.76
|
| Rate for Payer: UMR Bronson Commercial |
$7.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.19
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$23.59
|
|
|
Service Code
|
NDC 00409337504
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.38 |
| Max. Negotiated Rate |
$21.23 |
| Rate for Payer: Aetna American Axle |
$15.33
|
| Rate for Payer: Aetna Commercial |
$20.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.33
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cofinity Commercial |
$16.51
|
| Rate for Payer: Cofinity Commercial |
$20.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.87
|
| Rate for Payer: Healthscope Commercial |
$21.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.05
|
| Rate for Payer: PHP Commercial |
$20.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.33
|
| Rate for Payer: Priority Health SBD |
$14.86
|
| Rate for Payer: UMR Bronson Commercial |
$10.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.69
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21.67
|
|
|
Service Code
|
NDC 71839014325
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Aetna American Axle |
$14.09
|
| Rate for Payer: Aetna Commercial |
$18.42
|
| Rate for Payer: Aetna Medicare |
$10.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.09
|
| Rate for Payer: BCBS Complete |
$8.67
|
| Rate for Payer: Cash Price |
$17.34
|
| Rate for Payer: Cofinity Commercial |
$15.17
|
| Rate for Payer: Cofinity Commercial |
$18.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.34
|
| Rate for Payer: Healthscope Commercial |
$19.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.42
|
| Rate for Payer: PHP Commercial |
$18.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.09
|
| Rate for Payer: Priority Health SBD |
$13.65
|
| Rate for Payer: UMR Bronson Commercial |
$8.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.25
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21.67
|
|
|
Service Code
|
NDC 71839014325
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$19.50 |
| Rate for Payer: Aetna American Axle |
$14.09
|
| Rate for Payer: Aetna Commercial |
$18.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.09
|
| Rate for Payer: Cash Price |
$17.34
|
| Rate for Payer: Cofinity Commercial |
$15.17
|
| Rate for Payer: Cofinity Commercial |
$18.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.34
|
| Rate for Payer: Healthscope Commercial |
$19.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.42
|
| Rate for Payer: PHP Commercial |
$18.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.09
|
| Rate for Payer: Priority Health SBD |
$13.65
|
| Rate for Payer: UMR Bronson Commercial |
$9.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.25
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.46
|
|
|
Service Code
|
NDC 00143931810
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.42 |
| Max. Negotiated Rate |
$22.91 |
| Rate for Payer: Aetna American Axle |
$16.55
|
| Rate for Payer: Aetna Commercial |
$21.64
|
| Rate for Payer: Aetna Medicare |
$12.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.55
|
| Rate for Payer: BCBS Complete |
$10.18
|
| Rate for Payer: Cash Price |
$20.37
|
| Rate for Payer: Cofinity Commercial |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$21.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$17.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.37
|
| Rate for Payer: Healthscope Commercial |
$22.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.64
|
| Rate for Payer: PHP Commercial |
$21.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.55
|
| Rate for Payer: Priority Health SBD |
$16.04
|
| Rate for Payer: UMR Bronson Commercial |
$9.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.09
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$18.34
|
|
|
Service Code
|
NDC 67457085200
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$16.51 |
| Rate for Payer: Aetna American Axle |
$11.92
|
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.92
|
| Rate for Payer: Cash Price |
$14.67
|
| Rate for Payer: Cofinity Commercial |
$12.84
|
| Rate for Payer: Cofinity Commercial |
$15.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.67
|
| Rate for Payer: Healthscope Commercial |
$16.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.59
|
| Rate for Payer: PHP Commercial |
$15.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.92
|
| Rate for Payer: Priority Health SBD |
$11.55
|
| Rate for Payer: UMR Bronson Commercial |
$8.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.76
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$74.59
|
|
|
Service Code
|
NDC 00703115303
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.82 |
| Max. Negotiated Rate |
$67.13 |
| Rate for Payer: Aetna American Axle |
$48.48
|
| Rate for Payer: Aetna Commercial |
$63.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.48
|
| Rate for Payer: Cash Price |
$59.67
|
| Rate for Payer: Cofinity Commercial |
$52.21
|
| Rate for Payer: Cofinity Commercial |
$64.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$52.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.67
|
| Rate for Payer: Healthscope Commercial |
$67.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.40
|
| Rate for Payer: PHP Commercial |
$63.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.48
|
| Rate for Payer: Priority Health SBD |
$46.99
|
| Rate for Payer: UMR Bronson Commercial |
$32.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.94
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$20.25
|
|
|
Service Code
|
NDC 36000016201
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.91 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: Aetna American Axle |
$13.16
|
| Rate for Payer: Aetna Commercial |
$17.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.16
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cofinity Commercial |
$14.18
|
| Rate for Payer: Cofinity Commercial |
$17.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.20
|
| Rate for Payer: Healthscope Commercial |
$18.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.21
|
| Rate for Payer: PHP Commercial |
$17.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.16
|
| Rate for Payer: Priority Health SBD |
$12.76
|
| Rate for Payer: UMR Bronson Commercial |
$8.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.19
|
|
