|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
OP
|
$5.54
|
|
|
Service Code
|
NDC 63323050601
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$4.99 |
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Aetna Medicare |
$2.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.60
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Advantage |
$3.88
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Healthscope Commercial |
$4.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.16
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: Priority Health SBD |
$3.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.60
|
| Rate for Payer: UHC Core |
$2.89
|
| Rate for Payer: UHC Exchange |
$2.18
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
IP
|
$11.81
|
|
|
Service Code
|
NDC 70121139901
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$10.63 |
| Rate for Payer: Aetna Commercial |
$10.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.68
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cofinity Advantage |
$8.27
|
| Rate for Payer: Cofinity Commercial |
$10.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.45
|
| Rate for Payer: Healthscope Commercial |
$10.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.86
|
| Rate for Payer: PHP Commercial |
$10.04
|
| Rate for Payer: Priority Health SBD |
$7.44
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
IP
|
$5.58
|
|
|
Service Code
|
NDC 55150030425
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Aetna Commercial |
$4.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.63
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cofinity Advantage |
$3.91
|
| Rate for Payer: Cofinity Commercial |
$4.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$5.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.18
|
| Rate for Payer: PHP Commercial |
$4.74
|
| Rate for Payer: Priority Health SBD |
$3.52
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
IP
|
$11.81
|
|
|
Service Code
|
NDC 70121139905
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$10.63 |
| Rate for Payer: Aetna Commercial |
$10.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.68
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cofinity Advantage |
$8.27
|
| Rate for Payer: Cofinity Commercial |
$10.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.45
|
| Rate for Payer: Healthscope Commercial |
$10.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.86
|
| Rate for Payer: PHP Commercial |
$10.04
|
| Rate for Payer: Priority Health SBD |
$7.44
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
IP
|
$7.46
|
|
|
Service Code
|
NDC 63323050616
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$6.71 |
| Rate for Payer: Aetna Commercial |
$6.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.85
|
| Rate for Payer: Cash Price |
$5.97
|
| Rate for Payer: Cofinity Advantage |
$5.22
|
| Rate for Payer: Cofinity Commercial |
$6.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.97
|
| Rate for Payer: Healthscope Commercial |
$6.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.59
|
| Rate for Payer: PHP Commercial |
$6.34
|
| Rate for Payer: Priority Health SBD |
$4.70
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
OP
|
$11.81
|
|
|
Service Code
|
NDC 70121139905
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$10.63 |
| Rate for Payer: Aetna Commercial |
$10.04
|
| Rate for Payer: Aetna Medicare |
$5.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.68
|
| Rate for Payer: BCBS Complete |
$4.72
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cofinity Advantage |
$8.27
|
| Rate for Payer: Cofinity Commercial |
$10.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.45
|
| Rate for Payer: Healthscope Commercial |
$10.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.86
|
| Rate for Payer: PHP Commercial |
$10.04
|
| Rate for Payer: Priority Health SBD |
$7.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.68
|
| Rate for Payer: UHC Core |
$6.15
|
| Rate for Payer: UHC Exchange |
$4.64
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
OP
|
$5.58
|
|
|
Service Code
|
NDC 55150030425
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Aetna Commercial |
$4.74
|
| Rate for Payer: Aetna Medicare |
$2.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.63
|
| Rate for Payer: BCBS Complete |
$2.23
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cofinity Advantage |
$3.91
|
| Rate for Payer: Cofinity Commercial |
$4.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$5.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.18
|
| Rate for Payer: PHP Commercial |
$4.74
|
| Rate for Payer: Priority Health SBD |
$3.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.63
|
| Rate for Payer: UHC Core |
$2.91
|
| Rate for Payer: UHC Exchange |
$2.19
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
IP
|
$5.54
|
|
|
Service Code
|
NDC 63323050601
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$4.99 |
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.60
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Advantage |
$3.88
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Healthscope Commercial |
$4.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.16
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: Priority Health SBD |
$3.49
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
OP
|
$11.81
|
|
|
Service Code
|
NDC 70121139901
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$10.63 |
| Rate for Payer: Aetna Commercial |
$10.04
|
| Rate for Payer: Aetna Medicare |
$5.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.68
|
| Rate for Payer: BCBS Complete |
$4.72
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cofinity Advantage |
$8.27
|
| Rate for Payer: Cofinity Commercial |
$10.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.45
|
| Rate for Payer: Healthscope Commercial |
$10.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.86
|
| Rate for Payer: PHP Commercial |
$10.04
|
| Rate for Payer: Priority Health SBD |
$7.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.68
|
| Rate for Payer: UHC Core |
$6.15
|
| Rate for Payer: UHC Exchange |
$4.64
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
OP
|
$7.46
|
|
|
Service Code
|
NDC 63323050616
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$6.71 |
| Rate for Payer: Aetna Commercial |
$6.34
|
| Rate for Payer: Aetna Medicare |
$3.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.85
|
| Rate for Payer: BCBS Complete |
$2.98
|
| Rate for Payer: Cash Price |
$5.97
|
| Rate for Payer: Cofinity Advantage |
$5.22
|
| Rate for Payer: Cofinity Commercial |
$6.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.97
|
| Rate for Payer: Healthscope Commercial |
$6.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.59
|
| Rate for Payer: PHP Commercial |
$6.34
|
| Rate for Payer: Priority Health SBD |
$4.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.85
|
| Rate for Payer: UHC Core |
$3.89
|
| Rate for Payer: UHC Exchange |
$2.93
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
IP
|
$5.58
|
|
|
Service Code
|
NDC 55150030401
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Aetna Commercial |
$4.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.63
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cofinity Advantage |
$3.91
|
| Rate for Payer: Cofinity Commercial |
$4.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$5.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.18
|
| Rate for Payer: PHP Commercial |
$4.74
|
| Rate for Payer: Priority Health SBD |
$3.52
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
OP
|
$5.58
|
|
|
Service Code
|
NDC 55150030401
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$5.02 |
| Rate for Payer: Aetna Commercial |
$4.74
|
| Rate for Payer: Aetna Medicare |
$2.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.63
|
| Rate for Payer: BCBS Complete |
$2.23
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Cofinity Advantage |
$3.91
|
| Rate for Payer: Cofinity Commercial |
$4.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.46
|
| Rate for Payer: Healthscope Commercial |
$5.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.18
|
| Rate for Payer: PHP Commercial |
$4.74
|
| Rate for Payer: Priority Health SBD |
$3.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.63
|
| Rate for Payer: UHC Core |
$2.91
|
| Rate for Payer: UHC Exchange |
$2.19
|
|
|
DEXAMETHASONE 1 MG/ML DROPS (CONCENTRATE)
|
Facility
|
IP
|
$106.42
|
|
|
Service Code
|
NDC 00054317644
|
| Hospital Charge Code |
108723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.04 |
| Max. Negotiated Rate |
$95.78 |
| Rate for Payer: Aetna Commercial |
$90.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.17
|
| Rate for Payer: Cash Price |
$85.14
|
| Rate for Payer: Cofinity Advantage |
$74.49
|
| Rate for Payer: Cofinity Commercial |
$91.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.14
|
| Rate for Payer: Healthscope Commercial |
$95.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.81
|
| Rate for Payer: PHP Commercial |
$90.46
|
| Rate for Payer: Priority Health SBD |
$67.04
|
|
|
DEXAMETHASONE 1 MG/ML DROPS (CONCENTRATE)
|
Facility
|
OP
|
$106.42
|
|
|
Service Code
|
NDC 00054317644
|
| Hospital Charge Code |
108723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.82 |
| Max. Negotiated Rate |
$95.78 |
| Rate for Payer: Aetna Commercial |
$90.46
|
| Rate for Payer: Aetna Medicare |
$53.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.17
|
| Rate for Payer: BCBS Complete |
$42.57
|
| Rate for Payer: Cash Price |
$85.14
|
| Rate for Payer: Cofinity Advantage |
$74.49
|
| Rate for Payer: Cofinity Commercial |
$91.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.14
|
| Rate for Payer: Healthscope Commercial |
$95.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.81
|
| Rate for Payer: PHP Commercial |
$90.46
|
| Rate for Payer: Priority Health SBD |
$67.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.17
|
| Rate for Payer: UHC Core |
$55.44
|
| Rate for Payer: UHC Exchange |
$41.82
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$409.45
|
|
|
Service Code
|
NDC 00054418425
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$257.95 |
| Max. Negotiated Rate |
$368.50 |
| Rate for Payer: Aetna Commercial |
$348.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.14
|
| Rate for Payer: Cash Price |
$327.56
|
| Rate for Payer: Cofinity Advantage |
$286.62
|
| Rate for Payer: Cofinity Commercial |
$352.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.56
|
| Rate for Payer: Healthscope Commercial |
$368.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.09
|
| Rate for Payer: PHP Commercial |
$348.03
|
| Rate for Payer: Priority Health SBD |
$257.95
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$470.88
|
|
|
Service Code
|
NDC 54817525
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.06 |
| Max. Negotiated Rate |
$423.79 |
| Rate for Payer: Aetna Commercial |
$400.25
|
| Rate for Payer: Aetna Medicare |
$235.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.07
|
| Rate for Payer: BCBS Complete |
$188.35
|
| Rate for Payer: Cash Price |
$376.70
|
| Rate for Payer: Cofinity Advantage |
$329.62
|
| Rate for Payer: Cofinity Commercial |
$404.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.70
|
| Rate for Payer: Healthscope Commercial |
$423.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$400.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$353.16
|
| Rate for Payer: PHP Commercial |
$400.25
|
| Rate for Payer: Priority Health SBD |
$296.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.07
|
| Rate for Payer: UHC Core |
$245.33
|
| Rate for Payer: UHC Exchange |
$185.06
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$470.88
|
|
|
Service Code
|
NDC 00054817525
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$296.65 |
| Max. Negotiated Rate |
$423.79 |
| Rate for Payer: Aetna Commercial |
$400.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.07
|
| Rate for Payer: Cash Price |
$376.70
|
| Rate for Payer: Cofinity Advantage |
$329.62
|
| Rate for Payer: Cofinity Commercial |
$404.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.70
|
| Rate for Payer: Healthscope Commercial |
$423.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$400.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$353.16
|
| Rate for Payer: PHP Commercial |
$400.25
|
| Rate for Payer: Priority Health SBD |
$296.65
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$470.88
|
|
|
Service Code
|
NDC 00054817525
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.06 |
| Max. Negotiated Rate |
$423.79 |
| Rate for Payer: Aetna Commercial |
$400.25
|
| Rate for Payer: Aetna Medicare |
$235.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.07
|
| Rate for Payer: BCBS Complete |
$188.35
|
| Rate for Payer: Cash Price |
$376.70
|
| Rate for Payer: Cofinity Advantage |
$329.62
|
| Rate for Payer: Cofinity Commercial |
$404.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.70
|
| Rate for Payer: Healthscope Commercial |
$423.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$400.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$353.16
|
| Rate for Payer: PHP Commercial |
$400.25
|
| Rate for Payer: Priority Health SBD |
$296.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.07
|
| Rate for Payer: UHC Core |
$245.33
|
| Rate for Payer: UHC Exchange |
$185.06
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$409.45
|
|
|
Service Code
|
NDC 00054418425
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.91 |
| Max. Negotiated Rate |
$368.50 |
| Rate for Payer: Aetna Commercial |
$348.03
|
| Rate for Payer: Aetna Medicare |
$204.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.14
|
| Rate for Payer: BCBS Complete |
$163.78
|
| Rate for Payer: Cash Price |
$327.56
|
| Rate for Payer: Cofinity Advantage |
$286.62
|
| Rate for Payer: Cofinity Commercial |
$352.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.56
|
| Rate for Payer: Healthscope Commercial |
$368.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$327.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.09
|
| Rate for Payer: PHP Commercial |
$348.03
|
| Rate for Payer: Priority Health SBD |
$257.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$266.14
|
| Rate for Payer: UHC Core |
$213.32
|
| Rate for Payer: UHC Exchange |
$160.91
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
IP
|
$813.60
|
|
|
Service Code
|
NDC 00054818325
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$512.57 |
| Max. Negotiated Rate |
$732.24 |
| Rate for Payer: Aetna Commercial |
$691.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$528.84
|
| Rate for Payer: Cash Price |
$650.88
|
| Rate for Payer: Cofinity Advantage |
$569.52
|
| Rate for Payer: Cofinity Commercial |
$699.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$650.88
|
| Rate for Payer: Healthscope Commercial |
$732.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$691.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$610.20
|
| Rate for Payer: PHP Commercial |
$691.56
|
| Rate for Payer: Priority Health SBD |
$512.57
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
OP
|
$813.60
|
|
|
Service Code
|
NDC 00054818325
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$319.74 |
| Max. Negotiated Rate |
$732.24 |
| Rate for Payer: Aetna Commercial |
$691.56
|
| Rate for Payer: Aetna Medicare |
$406.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$528.84
|
| Rate for Payer: BCBS Complete |
$325.44
|
| Rate for Payer: Cash Price |
$650.88
|
| Rate for Payer: Cofinity Advantage |
$569.52
|
| Rate for Payer: Cofinity Commercial |
$699.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$650.88
|
| Rate for Payer: Healthscope Commercial |
$732.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$650.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$691.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$610.20
|
| Rate for Payer: PHP Commercial |
$691.56
|
| Rate for Payer: Priority Health SBD |
$512.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$528.84
|
| Rate for Payer: UHC Core |
$423.89
|
| Rate for Payer: UHC Exchange |
$319.74
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
IP
|
$64.08
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.37 |
| Max. Negotiated Rate |
$57.67 |
| Rate for Payer: Aetna Commercial |
$54.47
|
| Rate for Payer: Aetna Commercial |
$9.32
|
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.65
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cofinity Advantage |
$44.86
|
| Rate for Payer: Cofinity Advantage |
$7.68
|
| Rate for Payer: Cofinity Advantage |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$9.43
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Healthscope Commercial |
$57.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.06
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: PHP Commercial |
$54.47
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: Priority Health SBD |
$6.91
|
| Rate for Payer: Priority Health SBD |
$40.37
|
| Rate for Payer: Priority Health SBD |
$11.33
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
OP
|
$17.98
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: Aetna Commercial |
$54.47
|
| Rate for Payer: Aetna Commercial |
$33.44
|
| Rate for Payer: Aetna Commercial |
$9.32
|
| Rate for Payer: Aetna Medicare |
$8.99
|
| Rate for Payer: Aetna Medicare |
$32.04
|
| Rate for Payer: Aetna Medicare |
$19.67
|
| Rate for Payer: Aetna Medicare |
$5.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.69
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS Complete |
$7.19
|
| Rate for Payer: BCBS Complete |
$4.39
|
| Rate for Payer: BCBS Complete |
$15.74
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cofinity Advantage |
$44.86
|
| Rate for Payer: Cofinity Advantage |
$7.68
|
| Rate for Payer: Cofinity Advantage |
$27.54
|
| Rate for Payer: Cofinity Advantage |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$9.43
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Cofinity Commercial |
$33.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| Rate for Payer: Healthscope Commercial |
$35.41
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Commercial |
$57.67
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.06
|
| Rate for Payer: PHP Commercial |
$33.44
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: PHP Commercial |
$54.47
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: Priority Health SBD |
$6.91
|
| Rate for Payer: Priority Health SBD |
$24.78
|
| Rate for Payer: Priority Health SBD |
$40.37
|
| Rate for Payer: Priority Health SBD |
$11.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$18.42
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2331
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$16.58 |
| Rate for Payer: Aetna Commercial |
$15.66
|
| Rate for Payer: Aetna Commercial |
$54.47
|
| Rate for Payer: Aetna Commercial |
$33.44
|
| Rate for Payer: Aetna Commercial |
$9.32
|
| Rate for Payer: Aetna Medicare |
$9.21
|
| Rate for Payer: Aetna Medicare |
$32.04
|
| Rate for Payer: Aetna Medicare |
$19.67
|
| Rate for Payer: Aetna Medicare |
$5.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.97
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS Complete |
$4.39
|
| Rate for Payer: BCBS Complete |
$15.74
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCBS Trust/PPO |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cash Price |
$31.47
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Advantage |
$44.86
|
| Rate for Payer: Cofinity Advantage |
$7.68
|
| Rate for Payer: Cofinity Advantage |
$27.54
|
| Rate for Payer: Cofinity Advantage |
$12.89
|
| Rate for Payer: Cofinity Commercial |
$9.43
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Cofinity Commercial |
$15.84
|
| Rate for Payer: Cofinity Commercial |
$33.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$35.41
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Commercial |
$57.67
|
| Rate for Payer: Healthscope Commercial |
$16.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.06
|
| Rate for Payer: PHP Commercial |
$33.44
|
| Rate for Payer: PHP Commercial |
$15.66
|
| Rate for Payer: PHP Commercial |
$54.47
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: Priority Health SBD |
$6.91
|
| Rate for Payer: Priority Health SBD |
$24.78
|
| Rate for Payer: Priority Health SBD |
$40.37
|
| Rate for Payer: Priority Health SBD |
$11.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Core |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$18.42
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2331
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$16.58 |
| Rate for Payer: Aetna Commercial |
$15.66
|
| Rate for Payer: Aetna Commercial |
$9.32
|
| Rate for Payer: Aetna Commercial |
$54.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.13
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cofinity Advantage |
$44.86
|
| Rate for Payer: Cofinity Advantage |
$7.68
|
| Rate for Payer: Cofinity Advantage |
$12.89
|
| Rate for Payer: Cofinity Commercial |
$15.84
|
| Rate for Payer: Cofinity Commercial |
$9.43
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$57.67
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Commercial |
$16.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.81
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: PHP Commercial |
$54.47
|
| Rate for Payer: PHP Commercial |
$15.66
|
| Rate for Payer: Priority Health SBD |
$40.37
|
| Rate for Payer: Priority Health SBD |
$11.60
|
| Rate for Payer: Priority Health SBD |
$6.91
|
|
