|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$14,568.75
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
173434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.31 |
| Max. Negotiated Rate |
$13,111.88 |
| Rate for Payer: Aetna American Axle |
$9,469.69
|
| Rate for Payer: Aetna Commercial |
$12,383.44
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,469.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.38
|
| Rate for Payer: BCBS Complete |
$18.18
|
| Rate for Payer: BCBS MAPPO |
$32.30
|
| Rate for Payer: BCBS Trust/PPO |
$87.07
|
| Rate for Payer: BCN Commercial |
$87.07
|
| Rate for Payer: BCN Medicare Advantage |
$32.30
|
| Rate for Payer: Cash Price |
$11,655.00
|
| Rate for Payer: Cash Price |
$11,655.00
|
| Rate for Payer: Cofinity Commercial |
$12,529.12
|
| Rate for Payer: Cofinity Commercial |
$10,198.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,198.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,655.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.30
|
| Rate for Payer: Healthscope Commercial |
$13,111.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,198.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,926.56
|
| Rate for Payer: Mclaren Medicaid |
$17.31
|
| Rate for Payer: Mclaren Medicare |
$32.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.92
|
| Rate for Payer: Meridian Medicaid |
$18.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,383.44
|
| Rate for Payer: Nomi Health Commercial |
$96.90
|
| Rate for Payer: PACE Medicare |
$30.68
|
| Rate for Payer: PACE SWMI |
$32.30
|
| Rate for Payer: PHP Commercial |
$12,383.44
|
| Rate for Payer: PHP Medicare Advantage |
$32.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,469.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.39
|
| Rate for Payer: Priority Health Medicare |
$32.30
|
| Rate for Payer: Priority Health Narrow Network |
$73.11
|
| Rate for Payer: Priority Health SBD |
$9,178.31
|
| Rate for Payer: Railroad Medicare Medicare |
$32.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.30
|
| Rate for Payer: UHC Exchange |
$61.73
|
| Rate for Payer: UHC Medicare Advantage |
$32.30
|
| Rate for Payer: UHCCP Medicaid |
$17.31
|
| Rate for Payer: UMR Bronson Commercial |
$5,390.44
|
| Rate for Payer: VA VA |
$32.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,926.56
|
|
|
NIVOLUMAB 100 MG/10 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$14,568.75
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
173434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,410.25 |
| Max. Negotiated Rate |
$13,111.88 |
| Rate for Payer: Aetna American Axle |
$9,469.69
|
| Rate for Payer: Aetna Commercial |
$12,383.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9,469.69
|
| Rate for Payer: Cash Price |
$11,655.00
|
| Rate for Payer: Cofinity Commercial |
$10,198.12
|
| Rate for Payer: Cofinity Commercial |
$12,529.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$10,198.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11,655.00
|
| Rate for Payer: Healthscope Commercial |
$13,111.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10,198.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10,926.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,383.44
|
| Rate for Payer: PHP Commercial |
$12,383.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9,469.69
|
| Rate for Payer: Priority Health SBD |
$9,178.31
|
| Rate for Payer: UMR Bronson Commercial |
$6,410.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10,926.56
|
|
|
NIVOLUMAB 120 MG/12 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$17,482.56
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
198262
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.31 |
| Max. Negotiated Rate |
$15,734.30 |
| Rate for Payer: Aetna American Axle |
$11,363.66
|
| Rate for Payer: Aetna Commercial |
$14,860.18
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11,363.66
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.38
|
| Rate for Payer: BCBS Complete |
$18.18
|
| Rate for Payer: BCBS MAPPO |
$32.30
|
| Rate for Payer: BCBS Trust/PPO |
$87.07
|
| Rate for Payer: BCN Commercial |
$87.07
|
| Rate for Payer: BCN Medicare Advantage |
$32.30
|
| Rate for Payer: Cash Price |
$13,986.05
|
| Rate for Payer: Cash Price |
$13,986.05
|
| Rate for Payer: Cofinity Commercial |
$15,035.00
|
| Rate for Payer: Cofinity Commercial |
$12,237.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$12,237.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13,986.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.30
|
| Rate for Payer: Healthscope Commercial |
$15,734.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12,237.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13,111.92
|
| Rate for Payer: Mclaren Medicaid |
$17.31
|
| Rate for Payer: Mclaren Medicare |
$32.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.92
|
| Rate for Payer: Meridian Medicaid |
$18.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,860.18
|
| Rate for Payer: Nomi Health Commercial |
$96.90
|
| Rate for Payer: PACE Medicare |
$30.68
|
| Rate for Payer: PACE SWMI |
$32.30
|
| Rate for Payer: PHP Commercial |
$14,860.18
|
| Rate for Payer: PHP Medicare Advantage |
$32.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11,363.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.39
|
| Rate for Payer: Priority Health Medicare |
$32.30
|
| Rate for Payer: Priority Health Narrow Network |
$73.11
|
| Rate for Payer: Priority Health SBD |
$11,014.01
|
| Rate for Payer: Railroad Medicare Medicare |
$32.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.30
|
| Rate for Payer: UHC Exchange |
$61.73
|
| Rate for Payer: UHC Medicare Advantage |
$32.30
|
| Rate for Payer: UHCCP Medicaid |
$17.31
|
| Rate for Payer: UMR Bronson Commercial |
$6,468.55
|
| Rate for Payer: VA VA |
$32.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13,111.92
|
|
|
NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24,919.45
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
185666
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10,964.56 |
| Max. Negotiated Rate |
$22,427.50 |
| Rate for Payer: Aetna American Axle |
$16,197.64
|
| Rate for Payer: Aetna Commercial |
$21,181.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,197.64
|
| Rate for Payer: Cash Price |
$19,935.56
|
| Rate for Payer: Cofinity Commercial |
$17,443.62
|
| Rate for Payer: Cofinity Commercial |
$21,430.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$17,443.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,935.56
|
| Rate for Payer: Healthscope Commercial |
$22,427.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,443.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,689.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,181.53
|
| Rate for Payer: PHP Commercial |
$21,181.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,197.64
|
| Rate for Payer: Priority Health SBD |
$15,699.25
|
| Rate for Payer: UMR Bronson Commercial |
$10,964.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,689.59
|
|
|
NIVOLUMAB 240 MG/24 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24,919.45
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
185666
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.31 |
| Max. Negotiated Rate |
$22,427.50 |
| Rate for Payer: Aetna American Axle |
$16,197.64
|
| Rate for Payer: Aetna Commercial |
$21,181.53
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16,197.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.38
|
| Rate for Payer: BCBS Complete |
$18.18
|
| Rate for Payer: BCBS MAPPO |
$32.30
|
| Rate for Payer: BCBS Trust/PPO |
$87.07
|
| Rate for Payer: BCN Commercial |
$87.07
|
| Rate for Payer: BCN Medicare Advantage |
$32.30
|
| Rate for Payer: Cash Price |
$19,935.56
|
| Rate for Payer: Cash Price |
$19,935.56
|
| Rate for Payer: Cofinity Commercial |
$21,430.73
|
| Rate for Payer: Cofinity Commercial |
$17,443.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$17,443.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19,935.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.30
|
| Rate for Payer: Healthscope Commercial |
$22,427.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17,443.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18,689.59
|
| Rate for Payer: Mclaren Medicaid |
$17.31
|
| Rate for Payer: Mclaren Medicare |
$32.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.92
|
| Rate for Payer: Meridian Medicaid |
$18.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21,181.53
|
| Rate for Payer: Nomi Health Commercial |
$96.90
|
| Rate for Payer: PACE Medicare |
$30.68
|
| Rate for Payer: PACE SWMI |
$32.30
|
| Rate for Payer: PHP Commercial |
$21,181.53
|
| Rate for Payer: PHP Medicare Advantage |
$32.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16,197.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.39
|
| Rate for Payer: Priority Health Medicare |
$32.30
|
| Rate for Payer: Priority Health Narrow Network |
$73.11
|
| Rate for Payer: Priority Health SBD |
$15,699.25
|
| Rate for Payer: Railroad Medicare Medicare |
$32.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.30
|
| Rate for Payer: UHC Exchange |
$61.73
|
| Rate for Payer: UHC Medicare Advantage |
$32.30
|
| Rate for Payer: UHCCP Medicaid |
$17.31
|
| Rate for Payer: UMR Bronson Commercial |
$9,220.20
|
| Rate for Payer: VA VA |
$32.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18,689.59
|
|
|
NIVOLUMAB 240 MG-RELATLIMAB-RMBW 80 MG/20 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$67,886.92
|
|
|
Service Code
|
HCPCS J9298
|
| Hospital Charge Code |
199621
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.91 |
| Max. Negotiated Rate |
$61,098.23 |
| Rate for Payer: PHP Commercial |
$57,703.88
|
| Rate for Payer: PHP Medicare Advantage |
$193.86
|
| Rate for Payer: Aetna American Axle |
$44,126.50
|
| Rate for Payer: Aetna Commercial |
$57,703.88
|
| Rate for Payer: Aetna Medicare |
$201.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44,126.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$242.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$242.32
|
| Rate for Payer: BCBS Complete |
$109.10
|
| Rate for Payer: BCBS MAPPO |
$193.86
|
| Rate for Payer: BCBS Trust/PPO |
$522.72
|
| Rate for Payer: BCN Commercial |
$522.72
|
| Rate for Payer: BCN Medicare Advantage |
$193.86
|
| Rate for Payer: Cash Price |
$54,309.54
|
| Rate for Payer: Cash Price |
$54,309.54
|
| Rate for Payer: Cofinity Commercial |
$58,382.75
|
| Rate for Payer: Cofinity Commercial |
$47,520.84
|
| Rate for Payer: Cofinity Medicare Advantage |
$47,520.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54,309.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.86
|
| Rate for Payer: Healthscope Commercial |
$61,098.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$47,520.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$50,915.19
|
| Rate for Payer: Mclaren Medicaid |
$103.91
|
| Rate for Payer: Mclaren Medicare |
$193.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$203.55
|
| Rate for Payer: Meridian Medicaid |
$109.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57,703.88
|
| Rate for Payer: Nomi Health Commercial |
$581.58
|
| Rate for Payer: PACE Medicare |
$184.17
|
| Rate for Payer: PACE SWMI |
$193.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44,126.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$548.16
|
| Rate for Payer: Priority Health Medicare |
$193.86
|
| Rate for Payer: Priority Health Narrow Network |
$438.53
|
| Rate for Payer: Priority Health SBD |
$42,768.76
|
| Rate for Payer: Railroad Medicare Medicare |
$193.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.86
|
| Rate for Payer: UHC Exchange |
$370.49
|
| Rate for Payer: UHC Medicare Advantage |
$193.86
|
| Rate for Payer: UHCCP Medicaid |
$103.91
|
| Rate for Payer: UMR Bronson Commercial |
$25,118.16
|
| Rate for Payer: VA VA |
$193.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$50,915.19
|
|
|
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 |
$4,370.66
|
| 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 |
$4,370.66
|
|
|
NIVOLUMAB 40 MG/4 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$5,827.54
|
|
|
Service Code
|
HCPCS J9299
|
| Hospital Charge Code |
173433
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.31 |
| 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 Medicare |
$33.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,787.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.38
|
| Rate for Payer: BCBS Complete |
$18.18
|
| Rate for Payer: BCBS MAPPO |
$32.30
|
| Rate for Payer: BCBS Trust/PPO |
$87.07
|
| Rate for Payer: BCN Commercial |
$87.07
|
| Rate for Payer: BCN Medicare Advantage |
$32.30
|
| Rate for Payer: Cash Price |
$4,662.03
|
| Rate for Payer: Cash Price |
$4,662.03
|
| Rate for Payer: Cofinity Commercial |
$5,011.68
|
| Rate for Payer: Cofinity Commercial |
$4,079.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,079.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,662.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.30
|
| 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 |
$4,370.66
|
| Rate for Payer: Mclaren Medicaid |
$17.31
|
| Rate for Payer: Mclaren Medicare |
$32.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.92
|
| Rate for Payer: Meridian Medicaid |
$18.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$37.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,953.41
|
| Rate for Payer: Nomi Health Commercial |
$96.90
|
| Rate for Payer: PACE Medicare |
$30.68
|
| Rate for Payer: PACE SWMI |
$32.30
|
| Rate for Payer: PHP Commercial |
$4,953.41
|
| Rate for Payer: PHP Medicare Advantage |
$32.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,787.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.39
|
| Rate for Payer: Priority Health Medicare |
$32.30
|
| Rate for Payer: Priority Health Narrow Network |
$73.11
|
| Rate for Payer: Priority Health SBD |
$3,671.35
|
| Rate for Payer: Railroad Medicare Medicare |
$32.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.30
|
| Rate for Payer: UHC Exchange |
$61.73
|
| Rate for Payer: UHC Medicare Advantage |
$32.30
|
| Rate for Payer: UHCCP Medicaid |
$17.31
|
| Rate for Payer: UMR Bronson Commercial |
$2,156.19
|
| Rate for Payer: VA VA |
$32.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4,370.66
|
|
|
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
|
|
|
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
|
$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 |
$71.82
|
| 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
|
|
|
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
|
$23.59
|
|
|
Service Code
|
NDC 00409337514
|
| 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
|
$24.04
|
|
|
Service Code
|
NDC 70121157601
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna American Axle |
$15.63
|
| Rate for Payer: Aetna Commercial |
$20.43
|
| Rate for Payer: Aetna Medicare |
$12.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.63
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Cofinity Commercial |
$16.83
|
| Rate for Payer: Cofinity Commercial |
$20.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.23
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: PHP Commercial |
$20.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.63
|
| Rate for Payer: Priority Health SBD |
$15.15
|
| Rate for Payer: UMR Bronson Commercial |
$8.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.03
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.34
|
|
|
Service Code
|
NDC 67457085200
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$16.51 |
| Rate for Payer: Aetna American Axle |
$11.92
|
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: Aetna Medicare |
$9.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.92
|
| Rate for Payer: BCBS Complete |
$7.34
|
| 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 |
$6.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.76
|
|
|
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 |
$18.22 |
| 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 |
$17.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.20
|
| Rate for Payer: Healthscope Commercial |
$18.22
|
| 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
|
$21.67
|
|
|
Service Code
|
NDC 71839014301
|
| 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
|
IP
|
$24.04
|
|
|
Service Code
|
NDC 70121157601
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna American Axle |
$15.63
|
| Rate for Payer: Aetna Commercial |
$20.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.63
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Cofinity Commercial |
$16.83
|
| Rate for Payer: Cofinity Commercial |
$20.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.23
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: PHP Commercial |
$20.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.63
|
| Rate for Payer: Priority Health SBD |
$15.15
|
| Rate for Payer: UMR Bronson Commercial |
$10.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.03
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$24.04
|
|
|
Service Code
|
NDC 70121157607
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna American Axle |
$15.63
|
| Rate for Payer: Aetna Commercial |
$20.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.63
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Cofinity Commercial |
$16.83
|
| Rate for Payer: Cofinity Commercial |
$20.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.23
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: PHP Commercial |
$20.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.63
|
| Rate for Payer: Priority Health SBD |
$15.15
|
| Rate for Payer: UMR Bronson Commercial |
$10.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.03
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$18.34
|
|
|
Service Code
|
NDC 67457085204
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$16.51 |
| Rate for Payer: Aetna American Axle |
$11.92
|
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: Aetna Medicare |
$9.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.92
|
| Rate for Payer: BCBS Complete |
$7.34
|
| 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 |
$6.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.76
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$36.17
|
|
|
Service Code
|
NDC 47335061540
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$32.55 |
| Rate for Payer: Aetna American Axle |
$23.51
|
| Rate for Payer: Aetna Commercial |
$30.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.51
|
| 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 |
$15.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.13
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$25.46
|
|
|
Service Code
|
NDC 00143931801
|
| 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 |
$19.10
|
| 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 |
$19.10
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.46
|
|
|
Service Code
|
NDC 00143931801
|
| 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 |
$19.10
|
| 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 |
$19.10
|
|
|
NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$24.04
|
|
|
Service Code
|
NDC 70121157607
|
| Hospital Charge Code |
10734
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna American Axle |
$15.63
|
| Rate for Payer: Aetna Commercial |
$20.43
|
| Rate for Payer: Aetna Medicare |
$12.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.63
|
| Rate for Payer: BCBS Complete |
$9.62
|
| Rate for Payer: Cash Price |
$19.23
|
| Rate for Payer: Cofinity Commercial |
$16.83
|
| Rate for Payer: Cofinity Commercial |
$20.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.23
|
| Rate for Payer: Healthscope Commercial |
$21.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.43
|
| Rate for Payer: PHP Commercial |
$20.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.63
|
| Rate for Payer: Priority Health SBD |
$15.15
|
| Rate for Payer: UMR Bronson Commercial |
$8.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.03
|
|
