|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML FOR IM INJECTION
|
Facility
|
OP
|
$124.50
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$112.05 |
| Rate for Payer: Aetna Commercial |
$105.83
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Commercial |
$65.94
|
| Rate for Payer: Aetna Commercial |
$9.61
|
| Rate for Payer: Aetna Commercial |
$191.89
|
| Rate for Payer: Aetna Commercial |
$388.98
|
| Rate for Payer: Aetna Medicare |
$5.65
|
| Rate for Payer: Aetna Medicare |
$62.25
|
| Rate for Payer: Aetna Medicare |
$9.88
|
| Rate for Payer: Aetna Medicare |
$228.81
|
| Rate for Payer: Aetna Medicare |
$38.79
|
| Rate for Payer: Aetna Medicare |
$112.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: BCBS Complete |
$31.03
|
| Rate for Payer: BCBS Complete |
$183.05
|
| Rate for Payer: BCBS Complete |
$49.80
|
| Rate for Payer: BCBS Complete |
$4.52
|
| Rate for Payer: BCBS Complete |
$90.30
|
| 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: 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: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cofinity Advantage |
$7.91
|
| Rate for Payer: Cofinity Advantage |
$320.33
|
| Rate for Payer: Cofinity Advantage |
$158.03
|
| Rate for Payer: Cofinity Advantage |
$54.31
|
| Rate for Payer: Cofinity Advantage |
$13.83
|
| Rate for Payer: Cofinity Advantage |
$87.15
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$107.07
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Cofinity Commercial |
$66.72
|
| Rate for Payer: Cofinity Commercial |
$194.15
|
| Rate for Payer: Cofinity Commercial |
$393.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.10
|
| Rate for Payer: Healthscope Commercial |
$69.82
|
| Rate for Payer: Healthscope Commercial |
$411.86
|
| Rate for Payer: Healthscope Commercial |
$203.18
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$112.05
|
| Rate for Payer: Healthscope Commercial |
$10.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$180.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$366.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.19
|
| Rate for Payer: PHP Commercial |
$191.89
|
| Rate for Payer: PHP Commercial |
$105.83
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$9.61
|
| Rate for Payer: PHP Commercial |
$65.94
|
| Rate for Payer: PHP Commercial |
$388.98
|
| Rate for Payer: Priority Health SBD |
$288.30
|
| Rate for Payer: Priority Health SBD |
$78.44
|
| Rate for Payer: Priority Health SBD |
$48.88
|
| Rate for Payer: Priority Health SBD |
$142.22
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: Priority Health SBD |
$7.12
|
| 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 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 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
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML FOR IM INJECTION
|
Facility
|
IP
|
$225.75
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.22 |
| Max. Negotiated Rate |
$203.18 |
| Rate for Payer: Aetna Commercial |
$191.89
|
| Rate for Payer: Aetna Commercial |
$388.98
|
| Rate for Payer: Aetna Commercial |
$9.61
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.34
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Cofinity Advantage |
$158.03
|
| Rate for Payer: Cofinity Advantage |
$7.91
|
| Rate for Payer: Cofinity Advantage |
$320.33
|
| Rate for Payer: Cofinity Advantage |
$13.83
|
| Rate for Payer: Cofinity Commercial |
$393.55
|
| Rate for Payer: Cofinity Commercial |
$194.15
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.60
|
| Rate for Payer: Healthscope Commercial |
$203.18
|
| Rate for Payer: Healthscope Commercial |
$411.86
|
| Rate for Payer: Healthscope Commercial |
$10.17
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.82
|
| Rate for Payer: PHP Commercial |
$191.89
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$9.61
|
| Rate for Payer: PHP Commercial |
$388.98
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: Priority Health SBD |
$288.30
|
| Rate for Payer: Priority Health SBD |
$142.22
|
| Rate for Payer: Priority Health SBD |
$7.12
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$19.76
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$17.78 |
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Commercial |
$388.98
|
| Rate for Payer: Aetna Commercial |
$65.94
|
| Rate for Payer: Aetna Commercial |
$12.54
|
| Rate for Payer: Aetna Commercial |
$191.89
|
| Rate for Payer: Aetna Commercial |
$105.83
|
| Rate for Payer: Aetna Commercial |
$9.61
|
| Rate for Payer: Aetna Medicare |
$62.25
|
| Rate for Payer: Aetna Medicare |
$228.81
|
| Rate for Payer: Aetna Medicare |
$112.88
|
| Rate for Payer: Aetna Medicare |
$9.88
|
| Rate for Payer: Aetna Medicare |
$38.79
|
| Rate for Payer: Aetna Medicare |
$7.38
|
| Rate for Payer: Aetna Medicare |
$5.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.74
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: BCBS Complete |
$5.90
|
| Rate for Payer: BCBS Complete |
$31.03
|
| Rate for Payer: BCBS Complete |
$90.30
|
| Rate for Payer: BCBS Complete |
$4.52
|
| Rate for Payer: BCBS Complete |
$49.80
|
| Rate for Payer: BCBS Complete |
$183.05
|
| 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: 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: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: BCN Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$11.80
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cofinity Advantage |
$87.15
|
| Rate for Payer: Cofinity Advantage |
$13.83
|
| Rate for Payer: Cofinity Advantage |
$10.32
|
| Rate for Payer: Cofinity Advantage |
$7.91
|
| Rate for Payer: Cofinity Advantage |
$320.33
|
| Rate for Payer: Cofinity Advantage |
$54.31
|
| Rate for Payer: Cofinity Advantage |
$158.03
|
| Rate for Payer: Cofinity Commercial |
$194.15
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$66.72
|
| Rate for Payer: Cofinity Commercial |
$107.07
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Cofinity Commercial |
$12.69
|
| Rate for Payer: Cofinity Commercial |
$393.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.60
|
| Rate for Payer: Healthscope Commercial |
$411.86
|
| Rate for Payer: Healthscope Commercial |
$10.17
|
| Rate for Payer: Healthscope Commercial |
$69.82
|
| Rate for Payer: Healthscope Commercial |
$112.05
|
| Rate for Payer: Healthscope Commercial |
$203.18
|
| Rate for Payer: Healthscope Commercial |
$13.28
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$366.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$180.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.21
|
| Rate for Payer: PHP Commercial |
$9.61
|
| Rate for Payer: PHP Commercial |
$12.54
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$191.89
|
| Rate for Payer: PHP Commercial |
$388.98
|
| Rate for Payer: PHP Commercial |
$65.94
|
| Rate for Payer: PHP Commercial |
$105.83
|
| Rate for Payer: Priority Health SBD |
$288.30
|
| Rate for Payer: Priority Health SBD |
$7.12
|
| Rate for Payer: Priority Health SBD |
$48.88
|
| Rate for Payer: Priority Health SBD |
$142.22
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: Priority Health SBD |
$78.44
|
| Rate for Payer: Priority Health SBD |
$9.29
|
| 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 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 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
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
| Rate for Payer: UHC Exchange |
$0.18
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$225.75
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.22 |
| Max. Negotiated Rate |
$203.18 |
| Rate for Payer: Aetna Commercial |
$191.89
|
| Rate for Payer: Aetna Commercial |
$388.98
|
| Rate for Payer: Aetna Commercial |
$9.61
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.34
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Cofinity Advantage |
$158.03
|
| Rate for Payer: Cofinity Advantage |
$7.91
|
| Rate for Payer: Cofinity Advantage |
$320.33
|
| Rate for Payer: Cofinity Advantage |
$13.83
|
| Rate for Payer: Cofinity Commercial |
$393.55
|
| Rate for Payer: Cofinity Commercial |
$194.15
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.60
|
| Rate for Payer: Healthscope Commercial |
$203.18
|
| Rate for Payer: Healthscope Commercial |
$411.86
|
| Rate for Payer: Healthscope Commercial |
$10.17
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.82
|
| Rate for Payer: PHP Commercial |
$191.89
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$9.61
|
| Rate for Payer: PHP Commercial |
$388.98
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: Priority Health SBD |
$288.30
|
| Rate for Payer: Priority Health SBD |
$142.22
|
| Rate for Payer: Priority Health SBD |
$7.12
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
OP
|
$16.72
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna Commercial |
$14.21
|
| Rate for Payer: Aetna Commercial |
$19.16
|
| Rate for Payer: Aetna Commercial |
$14.32
|
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: Aetna Medicare |
$8.36
|
| Rate for Payer: Aetna Medicare |
$11.27
|
| Rate for Payer: Aetna Medicare |
$8.43
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.87
|
| Rate for Payer: BCBS Complete |
$9.02
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Complete |
$6.74
|
| 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 |
$13.38
|
| Rate for Payer: Cash Price |
$13.48
|
| Rate for Payer: Cash Price |
$18.03
|
| Rate for Payer: Cash Price |
$13.48
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$18.03
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cofinity Advantage |
$15.78
|
| Rate for Payer: Cofinity Advantage |
$9.80
|
| Rate for Payer: Cofinity Advantage |
$11.79
|
| Rate for Payer: Cofinity Advantage |
$11.70
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| Rate for Payer: Cofinity Commercial |
$19.38
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Healthscope Commercial |
$15.16
|
| Rate for Payer: Healthscope Commercial |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$20.29
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.91
|
| Rate for Payer: PHP Commercial |
$14.32
|
| Rate for Payer: PHP Commercial |
$14.21
|
| Rate for Payer: PHP Commercial |
$19.16
|
| Rate for Payer: PHP Commercial |
$11.90
|
| Rate for Payer: Priority Health SBD |
$8.82
|
| Rate for Payer: Priority Health SBD |
$10.62
|
| Rate for Payer: Priority Health SBD |
$14.20
|
| Rate for Payer: Priority Health SBD |
$10.53
|
| 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 (PF) 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
IP
|
$16.85
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.62 |
| Max. Negotiated Rate |
$15.16 |
| Rate for Payer: Aetna Commercial |
$14.32
|
| Rate for Payer: Aetna Commercial |
$19.16
|
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: Aetna Commercial |
$14.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.10
|
| Rate for Payer: Cash Price |
$13.48
|
| Rate for Payer: Cash Price |
$18.03
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Advantage |
$11.79
|
| Rate for Payer: Cofinity Advantage |
$9.80
|
| Rate for Payer: Cofinity Advantage |
$15.78
|
| Rate for Payer: Cofinity Advantage |
$11.70
|
| Rate for Payer: Cofinity Commercial |
$19.38
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.48
|
| Rate for Payer: Healthscope Commercial |
$15.16
|
| Rate for Payer: Healthscope Commercial |
$20.29
|
| Rate for Payer: Healthscope Commercial |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.54
|
| Rate for Payer: PHP Commercial |
$14.32
|
| Rate for Payer: PHP Commercial |
$14.21
|
| Rate for Payer: PHP Commercial |
$11.90
|
| Rate for Payer: PHP Commercial |
$19.16
|
| Rate for Payer: Priority Health SBD |
$10.53
|
| Rate for Payer: Priority Health SBD |
$14.20
|
| Rate for Payer: Priority Health SBD |
$10.62
|
| Rate for Payer: Priority Health SBD |
$8.82
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$16.72
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
116809
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna Commercial |
$14.21
|
| Rate for Payer: Aetna Commercial |
$14.32
|
| Rate for Payer: Aetna Commercial |
$20.08
|
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: Aetna Commercial |
$19.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.65
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cash Price |
$13.48
|
| Rate for Payer: Cash Price |
$18.03
|
| Rate for Payer: Cofinity Advantage |
$9.80
|
| Rate for Payer: Cofinity Advantage |
$11.70
|
| Rate for Payer: Cofinity Advantage |
$15.78
|
| Rate for Payer: Cofinity Advantage |
$11.79
|
| Rate for Payer: Cofinity Advantage |
$16.53
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$19.38
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$20.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.90
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$21.26
|
| Rate for Payer: Healthscope Commercial |
$20.29
|
| Rate for Payer: Healthscope Commercial |
$15.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.50
|
| Rate for Payer: PHP Commercial |
$20.08
|
| Rate for Payer: PHP Commercial |
$19.16
|
| Rate for Payer: PHP Commercial |
$14.32
|
| Rate for Payer: PHP Commercial |
$14.21
|
| Rate for Payer: PHP Commercial |
$11.90
|
| Rate for Payer: Priority Health SBD |
$10.53
|
| Rate for Payer: Priority Health SBD |
$14.88
|
| Rate for Payer: Priority Health SBD |
$14.20
|
| Rate for Payer: Priority Health SBD |
$8.82
|
| Rate for Payer: Priority Health SBD |
$10.62
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$23.62
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
116809
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$21.26 |
| Rate for Payer: Aetna Commercial |
$20.08
|
| Rate for Payer: Aetna Commercial |
$14.32
|
| Rate for Payer: Aetna Commercial |
$14.21
|
| Rate for Payer: Aetna Commercial |
$19.16
|
| Rate for Payer: Aetna Commercial |
$11.90
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: Aetna Medicare |
$8.36
|
| Rate for Payer: Aetna Medicare |
$8.43
|
| Rate for Payer: Aetna Medicare |
$11.81
|
| Rate for Payer: Aetna Medicare |
$11.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.10
|
| Rate for Payer: BCBS Complete |
$9.45
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS Complete |
$6.74
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Complete |
$9.02
|
| 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: 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: BCN Commercial |
$0.25
|
| Rate for Payer: Cash Price |
$18.03
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$13.48
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cash Price |
$13.48
|
| Rate for Payer: Cash Price |
$18.03
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cofinity Advantage |
$16.53
|
| Rate for Payer: Cofinity Advantage |
$15.78
|
| Rate for Payer: Cofinity Advantage |
$11.70
|
| Rate for Payer: Cofinity Advantage |
$9.80
|
| Rate for Payer: Cofinity Advantage |
$11.79
|
| Rate for Payer: Cofinity Commercial |
$14.49
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$19.38
|
| Rate for Payer: Cofinity Commercial |
$20.31
|
| Rate for Payer: Cofinity Commercial |
$12.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$21.26
|
| Rate for Payer: Healthscope Commercial |
$20.29
|
| Rate for Payer: Healthscope Commercial |
$15.16
|
| Rate for Payer: Healthscope Commercial |
$12.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.91
|
| Rate for Payer: PHP Commercial |
$14.32
|
| Rate for Payer: PHP Commercial |
$14.21
|
| Rate for Payer: PHP Commercial |
$11.90
|
| Rate for Payer: PHP Commercial |
$20.08
|
| Rate for Payer: PHP Commercial |
$19.16
|
| Rate for Payer: Priority Health SBD |
$10.62
|
| Rate for Payer: Priority Health SBD |
$14.20
|
| Rate for Payer: Priority Health SBD |
$14.88
|
| Rate for Payer: Priority Health SBD |
$10.53
|
| Rate for Payer: Priority Health SBD |
$8.82
|
| 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 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 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
|
| Rate for Payer: UHC Exchange |
$0.18
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$67.27
|
|
|
Service Code
|
NDC 16729023930
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$60.54 |
| Rate for Payer: Aetna Commercial |
$57.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.73
|
| Rate for Payer: Cash Price |
$53.82
|
| Rate for Payer: Cofinity Advantage |
$47.09
|
| Rate for Payer: Cofinity Commercial |
$57.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.82
|
| Rate for Payer: Healthscope Commercial |
$60.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.45
|
| Rate for Payer: PHP Commercial |
$57.18
|
| Rate for Payer: Priority Health SBD |
$42.38
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$65.94
|
|
|
Service Code
|
NDC 83634060002
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$59.35 |
| Rate for Payer: Aetna Commercial |
$56.05
|
| Rate for Payer: Aetna Medicare |
$32.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.86
|
| Rate for Payer: BCBS Complete |
$26.38
|
| Rate for Payer: Cash Price |
$52.75
|
| Rate for Payer: Cofinity Advantage |
$46.16
|
| Rate for Payer: Cofinity Commercial |
$56.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.75
|
| Rate for Payer: Healthscope Commercial |
$59.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.45
|
| Rate for Payer: PHP Commercial |
$56.05
|
| Rate for Payer: Priority Health SBD |
$41.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.86
|
| Rate for Payer: UHC Core |
$34.35
|
| Rate for Payer: UHC Exchange |
$25.91
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$65.94
|
|
|
Service Code
|
NDC 83634060041
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$59.35 |
| Rate for Payer: Aetna Commercial |
$56.05
|
| Rate for Payer: Aetna Medicare |
$32.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.86
|
| Rate for Payer: BCBS Complete |
$26.38
|
| Rate for Payer: Cash Price |
$52.75
|
| Rate for Payer: Cofinity Advantage |
$46.16
|
| Rate for Payer: Cofinity Commercial |
$56.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.75
|
| Rate for Payer: Healthscope Commercial |
$59.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.45
|
| Rate for Payer: PHP Commercial |
$56.05
|
| Rate for Payer: Priority Health SBD |
$41.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.86
|
| Rate for Payer: UHC Core |
$34.35
|
| Rate for Payer: UHC Exchange |
$25.91
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$50.73
|
|
|
Service Code
|
NDC 57664059650
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.94 |
| Max. Negotiated Rate |
$45.66 |
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Aetna Medicare |
$25.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.97
|
| Rate for Payer: BCBS Complete |
$20.29
|
| Rate for Payer: Cash Price |
$40.58
|
| Rate for Payer: Cofinity Advantage |
$35.51
|
| Rate for Payer: Cofinity Commercial |
$43.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.58
|
| Rate for Payer: Healthscope Commercial |
$45.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.05
|
| Rate for Payer: PHP Commercial |
$43.12
|
| Rate for Payer: Priority Health SBD |
$31.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$32.97
|
| Rate for Payer: UHC Core |
$26.43
|
| Rate for Payer: UHC Exchange |
$19.94
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$65.94
|
|
|
Service Code
|
NDC 83634060002
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.54 |
| Max. Negotiated Rate |
$59.35 |
| Rate for Payer: Aetna Commercial |
$56.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.86
|
| Rate for Payer: Cash Price |
$52.75
|
| Rate for Payer: Cofinity Advantage |
$46.16
|
| Rate for Payer: Cofinity Commercial |
$56.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.75
|
| Rate for Payer: Healthscope Commercial |
$59.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.45
|
| Rate for Payer: PHP Commercial |
$56.05
|
| Rate for Payer: Priority Health SBD |
$41.54
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$60.77
|
|
|
Service Code
|
NDC 71288050502
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.29 |
| Max. Negotiated Rate |
$54.69 |
| Rate for Payer: Aetna Commercial |
$51.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.50
|
| Rate for Payer: Cash Price |
$48.62
|
| Rate for Payer: Cofinity Advantage |
$42.54
|
| Rate for Payer: Cofinity Commercial |
$52.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.62
|
| Rate for Payer: Healthscope Commercial |
$54.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.58
|
| Rate for Payer: PHP Commercial |
$51.65
|
| Rate for Payer: Priority Health SBD |
$38.29
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$60.77
|
|
|
Service Code
|
NDC 71288050503
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$54.69 |
| Rate for Payer: Aetna Commercial |
$51.65
|
| Rate for Payer: Aetna Medicare |
$30.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.50
|
| Rate for Payer: BCBS Complete |
$24.31
|
| Rate for Payer: Cash Price |
$48.62
|
| Rate for Payer: Cofinity Advantage |
$42.54
|
| Rate for Payer: Cofinity Commercial |
$52.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.62
|
| Rate for Payer: Healthscope Commercial |
$54.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.58
|
| Rate for Payer: PHP Commercial |
$51.65
|
| Rate for Payer: Priority Health SBD |
$38.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.50
|
| Rate for Payer: UHC Core |
$31.66
|
| Rate for Payer: UHC Exchange |
$23.88
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$65.94
|
|
|
Service Code
|
NDC 83634060041
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.54 |
| Max. Negotiated Rate |
$59.35 |
| Rate for Payer: Aetna Commercial |
$56.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.86
|
| Rate for Payer: Cash Price |
$52.75
|
| Rate for Payer: Cofinity Advantage |
$46.16
|
| Rate for Payer: Cofinity Commercial |
$56.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$52.75
|
| Rate for Payer: Healthscope Commercial |
$59.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.45
|
| Rate for Payer: PHP Commercial |
$56.05
|
| Rate for Payer: Priority Health SBD |
$41.54
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$63.07
|
|
|
Service Code
|
NDC 55150020902
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.79 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna Commercial |
$53.61
|
| Rate for Payer: Aetna Medicare |
$31.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.00
|
| Rate for Payer: BCBS Complete |
$25.23
|
| Rate for Payer: Cash Price |
$50.46
|
| Rate for Payer: Cofinity Advantage |
$44.15
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.46
|
| Rate for Payer: Healthscope Commercial |
$56.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.30
|
| Rate for Payer: PHP Commercial |
$53.61
|
| Rate for Payer: Priority Health SBD |
$39.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.00
|
| Rate for Payer: UHC Core |
$32.86
|
| Rate for Payer: UHC Exchange |
$24.79
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$50.73
|
|
|
Service Code
|
NDC 57664059650
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.96 |
| Max. Negotiated Rate |
$45.66 |
| Rate for Payer: Aetna Commercial |
$43.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.97
|
| Rate for Payer: Cash Price |
$40.58
|
| Rate for Payer: Cofinity Advantage |
$35.51
|
| Rate for Payer: Cofinity Commercial |
$43.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.58
|
| Rate for Payer: Healthscope Commercial |
$45.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$38.05
|
| Rate for Payer: PHP Commercial |
$43.12
|
| Rate for Payer: Priority Health SBD |
$31.96
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$84.57
|
|
|
Service Code
|
NDC 00409163802
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.28 |
| Max. Negotiated Rate |
$76.11 |
| Rate for Payer: Aetna Commercial |
$71.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.97
|
| Rate for Payer: Cash Price |
$67.66
|
| Rate for Payer: Cofinity Advantage |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$72.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.66
|
| Rate for Payer: Healthscope Commercial |
$76.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.43
|
| Rate for Payer: PHP Commercial |
$71.88
|
| Rate for Payer: Priority Health SBD |
$53.28
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$84.57
|
|
|
Service Code
|
NDC 00409163802
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.24 |
| Max. Negotiated Rate |
$76.11 |
| Rate for Payer: Aetna Commercial |
$71.88
|
| Rate for Payer: Aetna Medicare |
$42.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.97
|
| Rate for Payer: BCBS Complete |
$33.83
|
| Rate for Payer: Cash Price |
$67.66
|
| Rate for Payer: Cofinity Advantage |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$72.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.66
|
| Rate for Payer: Healthscope Commercial |
$76.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$71.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.43
|
| Rate for Payer: PHP Commercial |
$71.88
|
| Rate for Payer: Priority Health SBD |
$53.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.97
|
| Rate for Payer: UHC Core |
$44.06
|
| Rate for Payer: UHC Exchange |
$33.24
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$67.27
|
|
|
Service Code
|
NDC 16729023930
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.44 |
| Max. Negotiated Rate |
$60.54 |
| Rate for Payer: Aetna Commercial |
$57.18
|
| Rate for Payer: Aetna Medicare |
$33.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.73
|
| Rate for Payer: BCBS Complete |
$26.91
|
| Rate for Payer: Cash Price |
$53.82
|
| Rate for Payer: Cofinity Advantage |
$47.09
|
| Rate for Payer: Cofinity Commercial |
$57.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.82
|
| Rate for Payer: Healthscope Commercial |
$60.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.45
|
| Rate for Payer: PHP Commercial |
$57.18
|
| Rate for Payer: Priority Health SBD |
$42.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.73
|
| Rate for Payer: UHC Core |
$35.05
|
| Rate for Payer: UHC Exchange |
$26.44
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$63.07
|
|
|
Service Code
|
NDC 55150020902
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.73 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna Commercial |
$53.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.00
|
| Rate for Payer: Cash Price |
$50.46
|
| Rate for Payer: Cofinity Advantage |
$44.15
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.46
|
| Rate for Payer: Healthscope Commercial |
$56.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.30
|
| Rate for Payer: PHP Commercial |
$53.61
|
| Rate for Payer: Priority Health SBD |
$39.73
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$67.27
|
|
|
Service Code
|
NDC 16729023993
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$60.54 |
| Rate for Payer: Aetna Commercial |
$57.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.73
|
| Rate for Payer: Cash Price |
$53.82
|
| Rate for Payer: Cofinity Advantage |
$47.09
|
| Rate for Payer: Cofinity Commercial |
$57.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.82
|
| Rate for Payer: Healthscope Commercial |
$60.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.45
|
| Rate for Payer: PHP Commercial |
$57.18
|
| Rate for Payer: Priority Health SBD |
$42.38
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$67.27
|
|
|
Service Code
|
NDC 16729023993
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.44 |
| Max. Negotiated Rate |
$60.54 |
| Rate for Payer: Aetna Commercial |
$57.18
|
| Rate for Payer: Aetna Medicare |
$33.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.73
|
| Rate for Payer: BCBS Complete |
$26.91
|
| Rate for Payer: Cash Price |
$53.82
|
| Rate for Payer: Cofinity Advantage |
$47.09
|
| Rate for Payer: Cofinity Commercial |
$57.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.82
|
| Rate for Payer: Healthscope Commercial |
$60.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$50.45
|
| Rate for Payer: PHP Commercial |
$57.18
|
| Rate for Payer: Priority Health SBD |
$42.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.73
|
| Rate for Payer: UHC Core |
$35.05
|
| Rate for Payer: UHC Exchange |
$26.44
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$60.77
|
|
|
Service Code
|
NDC 71288050502
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$54.69 |
| Rate for Payer: Aetna Commercial |
$51.65
|
| Rate for Payer: Aetna Medicare |
$30.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.50
|
| Rate for Payer: BCBS Complete |
$24.31
|
| Rate for Payer: Cash Price |
$48.62
|
| Rate for Payer: Cofinity Advantage |
$42.54
|
| Rate for Payer: Cofinity Commercial |
$52.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.62
|
| Rate for Payer: Healthscope Commercial |
$54.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.58
|
| Rate for Payer: PHP Commercial |
$51.65
|
| Rate for Payer: Priority Health SBD |
$38.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$39.50
|
| Rate for Payer: UHC Core |
$31.66
|
| Rate for Payer: UHC Exchange |
$23.88
|
|
