Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$8,291.41

Service Code	APR-DRG 9522
Min. Negotiated Rate	$7,496.43
Max. Negotiated Rate	$8,291.41
Rate for Payer: BCBS Complete	$8,291.41
Rate for Payer: Mclaren Medicaid	$7,896.59
Rate for Payer: Meridian Medicaid	$8,291.41
Rate for Payer: PHP Medicaid	$7,496.43
Rate for Payer: Priority Health Choice Medicaid	$7,896.59
Rate for Payer: UHC Medicaid	$7,896.59
Rate for Payer: UHCCP Medicaid	$7,896.59

NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$10,819.44

Service Code	APR-DRG 9523
Min. Negotiated Rate	$9,782.07
Max. Negotiated Rate	$10,819.44
Rate for Payer: BCBS Complete	$10,819.44
Rate for Payer: Mclaren Medicaid	$10,304.23
Rate for Payer: Meridian Medicaid	$10,819.44
Rate for Payer: PHP Medicaid	$9,782.07
Rate for Payer: Priority Health Choice Medicaid	$10,304.23
Rate for Payer: UHC Medicaid	$10,304.23
Rate for Payer: UHCCP Medicaid	$10,304.23

NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$6,363.93

Service Code	APR-DRG 9521
Min. Negotiated Rate	$5,753.75
Max. Negotiated Rate	$6,363.93
Rate for Payer: BCBS Complete	$6,363.93
Rate for Payer: Mclaren Medicaid	$6,060.88
Rate for Payer: Meridian Medicaid	$6,363.93
Rate for Payer: PHP Medicaid	$5,753.75
Rate for Payer: Priority Health Choice Medicaid	$6,060.88
Rate for Payer: UHC Medicaid	$6,060.88
Rate for Payer: UHCCP Medicaid	$6,060.88

NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS

Facility

$19,559.89

Service Code	APR-DRG 9524
Min. Negotiated Rate	$17,684.48
Max. Negotiated Rate	$19,559.89
Rate for Payer: BCBS Complete	$19,559.89
Rate for Payer: Mclaren Medicaid	$18,628.47
Rate for Payer: Meridian Medicaid	$19,559.89
Rate for Payer: PHP Medicaid	$17,684.48
Rate for Payer: Priority Health Choice Medicaid	$18,628.47
Rate for Payer: UHC Medicaid	$18,628.47
Rate for Payer: UHCCP Medicaid	$18,628.47

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$2,947.63

Service Code	APR-DRG 4261
Min. Negotiated Rate	$2,665.01
Max. Negotiated Rate	$2,947.63
Rate for Payer: BCBS Complete	$2,947.63
Rate for Payer: Mclaren Medicaid	$2,807.27
Rate for Payer: Meridian Medicaid	$2,947.63
Rate for Payer: PHP Medicaid	$2,665.01
Rate for Payer: Priority Health Choice Medicaid	$2,807.27
Rate for Payer: UHC Medicaid	$2,807.27
Rate for Payer: UHCCP Medicaid	$2,807.27

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$10,900.63

Service Code	APR-DRG 4264
Min. Negotiated Rate	$9,855.48
Max. Negotiated Rate	$10,900.63
Rate for Payer: BCBS Complete	$10,900.63
Rate for Payer: Mclaren Medicaid	$10,381.56
Rate for Payer: Meridian Medicaid	$10,900.63
Rate for Payer: PHP Medicaid	$9,855.48
Rate for Payer: Priority Health Choice Medicaid	$10,381.56
Rate for Payer: UHC Medicaid	$10,381.56
Rate for Payer: UHCCP Medicaid	$10,381.56

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$6,200.99

Service Code	APR-DRG 4263
Min. Negotiated Rate	$5,606.43
Max. Negotiated Rate	$6,200.99
Rate for Payer: BCBS Complete	$6,200.99
Rate for Payer: Mclaren Medicaid	$5,905.70
Rate for Payer: Meridian Medicaid	$6,200.99
Rate for Payer: PHP Medicaid	$5,606.43
Rate for Payer: Priority Health Choice Medicaid	$5,905.70
Rate for Payer: UHC Medicaid	$5,905.70
Rate for Payer: UHCCP Medicaid	$5,905.70

NON-HYPOVOLEMIC SODIUM DISORDERS

Facility

$3,963.97

Service Code	APR-DRG 4262
Min. Negotiated Rate	$3,583.90
Max. Negotiated Rate	$3,963.97
Rate for Payer: BCBS Complete	$3,963.97
Rate for Payer: Mclaren Medicaid	$3,775.21
Rate for Payer: Meridian Medicaid	$3,963.97
Rate for Payer: PHP Medicaid	$3,583.90
Rate for Payer: Priority Health Choice Medicaid	$3,775.21
Rate for Payer: UHC Medicaid	$3,775.21
Rate for Payer: UHCCP Medicaid	$3,775.21

NON-MALIGNANT BREAST DISORDERS WITH CC/MCC

Facility

$14,345.68

Service Code	MSDRG 600
Min. Negotiated Rate	$8,792.52
Max. Negotiated Rate	$14,345.68
Rate for Payer: Aetna Medicare	$9,255.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$11,569.10
Rate for Payer: Amish Plain Church Group Commercial	$11,569.10
Rate for Payer: BCBS MAPPO	$9,255.28
Rate for Payer: BCN Medicare Advantage	$9,255.28
Rate for Payer: Health Alliance Plan Medicare Advantage	$9,255.28
Rate for Payer: Humana Choice PPO Medicare	$9,255.28
Rate for Payer: Mclaren Medicare	$9,255.28
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9,718.04
Rate for Payer: MI Amish Medical Board Commercial	$10,643.57
Rate for Payer: Molina Medicare/Medicaid	$10,180.81
Rate for Payer: PACE Medicare	$8,792.52
Rate for Payer: PACE SWMI	$9,255.28
Rate for Payer: PHP Commercial	$10,180.81
Rate for Payer: PHP Medicare Advantage	$9,255.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$14,310.33
Rate for Payer: Priority Health Medicare	$9,255.28
Rate for Payer: Priority Health Narrow Network	$11,448.27
Rate for Payer: Railroad Medicare Medicare	$9,255.28
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$9,255.28
Rate for Payer: UHC Exchange	$14,345.68
Rate for Payer: UHCCP DNSP	$9,255.28
Rate for Payer: VA VA	$9,255.28

NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC

Facility

$9,472.38

Service Code	MSDRG 601
Min. Negotiated Rate	$5,805.65
Max. Negotiated Rate	$9,472.38
Rate for Payer: Aetna Medicare	$6,111.21
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,639.01
Rate for Payer: Amish Plain Church Group Commercial	$7,639.01
Rate for Payer: BCBS MAPPO	$6,111.21
Rate for Payer: BCN Medicare Advantage	$6,111.21
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,111.21
Rate for Payer: Humana Choice PPO Medicare	$6,111.21
Rate for Payer: Mclaren Medicare	$6,111.21
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$6,416.77
Rate for Payer: MI Amish Medical Board Commercial	$7,027.89
Rate for Payer: Molina Medicare/Medicaid	$6,722.33
Rate for Payer: PACE Medicare	$5,805.65
Rate for Payer: PACE SWMI	$6,111.21
Rate for Payer: PHP Commercial	$6,722.33
Rate for Payer: PHP Medicare Advantage	$6,111.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$8,311.97
Rate for Payer: Priority Health Medicare	$6,111.21
Rate for Payer: Priority Health Narrow Network	$6,649.58
Rate for Payer: Railroad Medicare Medicare	$6,111.21
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$6,111.21
Rate for Payer: UHC Exchange	$9,472.38
Rate for Payer: UHCCP DNSP	$6,111.21
Rate for Payer: VA VA	$6,111.21

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility

$5,324.16

Service Code	APR-DRG 0461
Min. Negotiated Rate	$4,813.68
Max. Negotiated Rate	$5,324.16
Rate for Payer: BCBS Complete	$5,324.16
Rate for Payer: Mclaren Medicaid	$5,070.63
Rate for Payer: Meridian Medicaid	$5,324.16
Rate for Payer: PHP Medicaid	$4,813.68
Rate for Payer: Priority Health Choice Medicaid	$5,070.63
Rate for Payer: UHC Medicaid	$5,070.63
Rate for Payer: UHCCP Medicaid	$5,070.63

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility

$6,569.92

Service Code	APR-DRG 0462
Min. Negotiated Rate	$5,939.99
Max. Negotiated Rate	$6,569.92
Rate for Payer: BCBS Complete	$6,569.92
Rate for Payer: Mclaren Medicaid	$6,257.06
Rate for Payer: Meridian Medicaid	$6,569.92
Rate for Payer: PHP Medicaid	$5,939.99
Rate for Payer: Priority Health Choice Medicaid	$6,257.06
Rate for Payer: UHC Medicaid	$6,257.06
Rate for Payer: UHCCP Medicaid	$6,257.06

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility

$8,514.30

Service Code	APR-DRG 0463
Min. Negotiated Rate	$7,697.94
Max. Negotiated Rate	$8,514.30
Rate for Payer: BCBS Complete	$8,514.30
Rate for Payer: Mclaren Medicaid	$8,108.86
Rate for Payer: Meridian Medicaid	$8,514.30
Rate for Payer: PHP Medicaid	$7,697.94
Rate for Payer: Priority Health Choice Medicaid	$8,108.86
Rate for Payer: UHC Medicaid	$8,108.86
Rate for Payer: UHCCP Medicaid	$8,108.86

NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION

Facility

$14,662.97

Service Code	APR-DRG 0464
Min. Negotiated Rate	$13,257.08
Max. Negotiated Rate	$14,662.97
Rate for Payer: BCBS Complete	$14,662.97
Rate for Payer: Mclaren Medicaid	$13,964.73
Rate for Payer: Meridian Medicaid	$14,662.97
Rate for Payer: PHP Medicaid	$13,257.08
Rate for Payer: Priority Health Choice Medicaid	$13,964.73
Rate for Payer: UHC Medicaid	$13,964.73
Rate for Payer: UHCCP Medicaid	$13,964.73

NONTRAUMATIC STUPOR AND COMA WITH MCC

Facility

$24,867.23

Service Code	MSDRG 080
Min. Negotiated Rate	$14,049.27
Max. Negotiated Rate	$24,867.23
Rate for Payer: Aetna Medicare	$14,788.71
Rate for Payer: Allen County Amish Medical Aid Commercial	$18,485.89
Rate for Payer: Amish Plain Church Group Commercial	$18,485.89
Rate for Payer: BCBS MAPPO	$14,788.71
Rate for Payer: BCN Medicare Advantage	$14,788.71
Rate for Payer: Health Alliance Plan Medicare Advantage	$14,788.71
Rate for Payer: Humana Choice PPO Medicare	$14,788.71
Rate for Payer: Mclaren Medicare	$14,788.71
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$15,528.15
Rate for Payer: MI Amish Medical Board Commercial	$17,007.02
Rate for Payer: Molina Medicare/Medicaid	$16,267.58
Rate for Payer: PACE Medicare	$14,049.27
Rate for Payer: PACE SWMI	$14,788.71
Rate for Payer: PHP Commercial	$16,267.58
Rate for Payer: PHP Medicare Advantage	$14,788.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$24,867.23
Rate for Payer: Priority Health Medicare	$14,788.71
Rate for Payer: Priority Health Narrow Network	$19,893.78
Rate for Payer: Railroad Medicare Medicare	$14,788.71
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$14,788.71
Rate for Payer: UHC Exchange	$22,922.50
Rate for Payer: UHCCP DNSP	$14,788.71
Rate for Payer: VA VA	$14,788.71

NONTRAUMATIC STUPOR AND COMA WITHOUT MCC

Facility

$12,716.03

Service Code	MSDRG 081
Min. Negotiated Rate	$7,793.70
Max. Negotiated Rate	$12,716.03
Rate for Payer: Aetna Medicare	$8,203.89
Rate for Payer: Allen County Amish Medical Aid Commercial	$10,254.86
Rate for Payer: Amish Plain Church Group Commercial	$10,254.86
Rate for Payer: BCBS MAPPO	$8,203.89
Rate for Payer: BCN Medicare Advantage	$8,203.89
Rate for Payer: Health Alliance Plan Medicare Advantage	$8,203.89
Rate for Payer: Humana Choice PPO Medicare	$8,203.89
Rate for Payer: Mclaren Medicare	$8,203.89
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$8,614.08
Rate for Payer: MI Amish Medical Board Commercial	$9,434.47
Rate for Payer: Molina Medicare/Medicaid	$9,024.28
Rate for Payer: PACE Medicare	$7,793.70
Rate for Payer: PACE SWMI	$8,203.89
Rate for Payer: PHP Commercial	$9,024.28
Rate for Payer: PHP Medicare Advantage	$8,203.89
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$12,304.47
Rate for Payer: Priority Health Medicare	$8,203.89
Rate for Payer: Priority Health Narrow Network	$9,843.58
Rate for Payer: Railroad Medicare Medicare	$8,203.89
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$8,203.89
Rate for Payer: UHC Exchange	$12,716.03
Rate for Payer: UHCCP DNSP	$8,203.89
Rate for Payer: VA VA	$8,203.89

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION

Facility

$36.17

Service Code	NDC 47335061540
Hospital Charge Code	10734
Hospital Revenue Code	250
Min. Negotiated Rate	$27.13
Max. Negotiated Rate	$36.17
Rate for Payer: Aetna Commercial	$32.55
Rate for Payer: ASR ASR	$35.08
Rate for Payer: BCBS Trust/PPO	$29.70
Rate for Payer: BCN Commercial	$29.70
Rate for Payer: Cash Price	$28.94
Rate for Payer: Cofinity Commercial	$34.00
Rate for Payer: Encore Health Key Benefits Commercial	$28.94
Rate for Payer: Healthscope Commercial	$35.08
Rate for Payer: Healthscope Whirlpool	$36.17
Rate for Payer: Mclaren Commercial	$32.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$30.74
Rate for Payer: Nomi Health Commercial	$29.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$27.13
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$31.83

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION

Facility

$22.64

Service Code	NDC 51991098399
Hospital Charge Code	10734
Hospital Revenue Code	250
Min. Negotiated Rate	$16.98
Max. Negotiated Rate	$22.64
Rate for Payer: Aetna Commercial	$20.38
Rate for Payer: ASR ASR	$21.96
Rate for Payer: BCBS Trust/PPO	$18.60
Rate for Payer: BCN Commercial	$18.60
Rate for Payer: Cash Price	$18.12
Rate for Payer: Cofinity Commercial	$21.29
Rate for Payer: Encore Health Key Benefits Commercial	$18.12
Rate for Payer: Healthscope Commercial	$21.96
Rate for Payer: Healthscope Whirlpool	$22.64
Rate for Payer: Mclaren Commercial	$20.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.25
Rate for Payer: Nomi Health Commercial	$18.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$16.98
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$19.93

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION

Facility

$20.70

Service Code	NDC 43066099701
Hospital Charge Code	10734
Hospital Revenue Code	250
Min. Negotiated Rate	$7.66
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna Commercial	$18.63
Rate for Payer: Aetna Medicare	$7.66
Rate for Payer: ASR ASR	$20.08
Rate for Payer: BCBS Complete	$8.28
Rate for Payer: BCBS Trust/PPO	$17.07
Rate for Payer: BCN Commercial	$17.07
Rate for Payer: Cash Price	$16.56
Rate for Payer: Cofinity Commercial	$19.46
Rate for Payer: Encore Health Key Benefits Commercial	$16.56
Rate for Payer: Healthscope Commercial	$20.08
Rate for Payer: Healthscope Whirlpool	$20.70
Rate for Payer: Mclaren Commercial	$18.63
Rate for Payer: MI Amish Medical Board Commercial	$16.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.60
Rate for Payer: Nomi Health Commercial	$16.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.53
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$18.14
Rate for Payer: Priority Health Narrow Network	$14.51
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$18.22

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION

Facility

$22.64

Service Code	NDC 51991098399
Hospital Charge Code	10734
Hospital Revenue Code	250
Min. Negotiated Rate	$8.38
Max. Negotiated Rate	$22.64
Rate for Payer: Aetna Commercial	$20.38
Rate for Payer: Aetna Medicare	$8.38
Rate for Payer: ASR ASR	$21.96
Rate for Payer: BCBS Complete	$9.06
Rate for Payer: BCBS Trust/PPO	$18.67
Rate for Payer: BCN Commercial	$18.67
Rate for Payer: Cash Price	$18.12
Rate for Payer: Cofinity Commercial	$21.29
Rate for Payer: Encore Health Key Benefits Commercial	$18.12
Rate for Payer: Healthscope Commercial	$21.96
Rate for Payer: Healthscope Whirlpool	$22.64
Rate for Payer: Mclaren Commercial	$20.38
Rate for Payer: MI Amish Medical Board Commercial	$18.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$19.25
Rate for Payer: Nomi Health Commercial	$18.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$16.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$19.84
Rate for Payer: Priority Health Narrow Network	$15.87
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$19.93

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION

Facility

$74.58

Service Code	NDC 703115303
Hospital Charge Code	10734
Hospital Revenue Code	250
Min. Negotiated Rate	$55.94
Max. Negotiated Rate	$74.58
Rate for Payer: Aetna Commercial	$67.12
Rate for Payer: ASR ASR	$72.34
Rate for Payer: BCBS Trust/PPO	$61.25
Rate for Payer: BCN Commercial	$61.25
Rate for Payer: Cash Price	$59.67
Rate for Payer: Cofinity Commercial	$70.11
Rate for Payer: Encore Health Key Benefits Commercial	$59.67
Rate for Payer: Healthscope Commercial	$72.34
Rate for Payer: Healthscope Whirlpool	$74.58
Rate for Payer: Mclaren Commercial	$67.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$63.39
Rate for Payer: Nomi Health Commercial	$61.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$55.94
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$65.63

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION

Facility

$20.70

Service Code	NDC 43066099710
Hospital Charge Code	10734
Hospital Revenue Code	250
Min. Negotiated Rate	$15.53
Max. Negotiated Rate	$20.70
Rate for Payer: Aetna Commercial	$18.63
Rate for Payer: ASR ASR	$20.08
Rate for Payer: BCBS Trust/PPO	$17.00
Rate for Payer: BCN Commercial	$17.00
Rate for Payer: Cash Price	$16.56
Rate for Payer: Cofinity Commercial	$19.46
Rate for Payer: Encore Health Key Benefits Commercial	$16.56
Rate for Payer: Healthscope Commercial	$20.08
Rate for Payer: Healthscope Whirlpool	$20.70
Rate for Payer: Mclaren Commercial	$18.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.60
Rate for Payer: Nomi Health Commercial	$16.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.53
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$18.22

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION

Facility

$24.10

Service Code	NDC 781375595
Hospital Charge Code	10734
Hospital Revenue Code	250
Min. Negotiated Rate	$18.07
Max. Negotiated Rate	$24.09
Rate for Payer: Aetna Commercial	$21.69
Rate for Payer: ASR ASR	$23.37
Rate for Payer: BCBS Trust/PPO	$19.79
Rate for Payer: BCN Commercial	$19.79
Rate for Payer: Cash Price	$19.28
Rate for Payer: Cofinity Commercial	$22.65
Rate for Payer: Encore Health Key Benefits Commercial	$19.28
Rate for Payer: Healthscope Commercial	$23.37
Rate for Payer: Healthscope Whirlpool	$24.09
Rate for Payer: Mclaren Commercial	$21.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$20.48
Rate for Payer: Nomi Health Commercial	$19.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$18.07
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$21.20

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION

Facility

$14.98

Service Code	NDC 67457085204
Hospital Charge Code	10734
Hospital Revenue Code	250
Min. Negotiated Rate	$11.23
Max. Negotiated Rate	$14.98
Rate for Payer: Aetna Commercial	$13.48
Rate for Payer: ASR ASR	$14.53
Rate for Payer: BCBS Trust/PPO	$12.30
Rate for Payer: BCN Commercial	$12.30
Rate for Payer: Cash Price	$11.98
Rate for Payer: Cofinity Commercial	$14.08
Rate for Payer: Encore Health Key Benefits Commercial	$11.98
Rate for Payer: Healthscope Commercial	$14.53
Rate for Payer: Healthscope Whirlpool	$14.98
Rate for Payer: Mclaren Commercial	$13.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.73
Rate for Payer: Nomi Health Commercial	$12.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$13.18

NOREPINEPHRINE BITARTRATE 1 MG/ML INTRAVENOUS SOLUTION

Facility

$20.24

Service Code	NDC 36000016210
Hospital Charge Code	10734
Hospital Revenue Code	250
Min. Negotiated Rate	$7.49
Max. Negotiated Rate	$20.24
Rate for Payer: Aetna Commercial	$18.22
Rate for Payer: Aetna Medicare	$7.49
Rate for Payer: ASR ASR	$19.63
Rate for Payer: BCBS Complete	$8.10
Rate for Payer: BCBS Trust/PPO	$16.69
Rate for Payer: BCN Commercial	$16.69
Rate for Payer: Cash Price	$16.19
Rate for Payer: Cofinity Commercial	$19.03
Rate for Payer: Encore Health Key Benefits Commercial	$16.19
Rate for Payer: Healthscope Commercial	$19.63
Rate for Payer: Healthscope Whirlpool	$20.24
Rate for Payer: Mclaren Commercial	$18.22
Rate for Payer: MI Amish Medical Board Commercial	$16.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$17.21
Rate for Payer: Nomi Health Commercial	$16.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network	$17.74
Rate for Payer: Priority Health Narrow Network	$14.19
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$17.81

Know your out-of-pocket cost for care.

All Charges