Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$1,507.05

Service Code	NDC 00008121130
Hospital Charge Code	91073
Hospital Revenue Code	637
Min. Negotiated Rate	$602.82
Max. Negotiated Rate	$1,356.34
Rate for Payer: Aetna Commercial	$1,280.99
Rate for Payer: Aetna Medicare	$753.52
Rate for Payer: Aetna New Business (MI Preferred)	$979.58
Rate for Payer: BCBS Complete	$602.82
Rate for Payer: Cash Price	$1,205.64
Rate for Payer: Cofinity Commercial	$1,054.94
Rate for Payer: Cofinity Commercial	$1,296.06
Rate for Payer: Cofinity Medicare Advantage	$1,054.94
Rate for Payer: Encore Health Key Benefits Commercial	$1,205.64
Rate for Payer: Healthscope Commercial	$1,356.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,280.99
Rate for Payer: PHP Commercial	$1,280.99
Rate for Payer: Priority Health Cigna Priority Health	$979.58
Rate for Payer: Priority Health SBD	$949.44

DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$287.00

Service Code	NDC 60687060721
Hospital Charge Code	91073
Hospital Revenue Code	637
Min. Negotiated Rate	$114.80
Max. Negotiated Rate	$258.30
Rate for Payer: Aetna Commercial	$243.95
Rate for Payer: Aetna Medicare	$143.50
Rate for Payer: Aetna New Business (MI Preferred)	$186.55
Rate for Payer: BCBS Complete	$114.80
Rate for Payer: Cash Price	$229.60
Rate for Payer: Cofinity Commercial	$200.90
Rate for Payer: Cofinity Commercial	$246.82
Rate for Payer: Cofinity Medicare Advantage	$200.90
Rate for Payer: Encore Health Key Benefits Commercial	$229.60
Rate for Payer: Healthscope Commercial	$258.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$243.95
Rate for Payer: PHP Commercial	$243.95
Rate for Payer: Priority Health Cigna Priority Health	$186.55
Rate for Payer: Priority Health SBD	$180.81

DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$406.98

Service Code	NDC 51991031190
Hospital Charge Code	91073
Hospital Revenue Code	637
Min. Negotiated Rate	$256.40
Max. Negotiated Rate	$366.28
Rate for Payer: Aetna Commercial	$345.93
Rate for Payer: Aetna New Business (MI Preferred)	$264.54
Rate for Payer: Cash Price	$325.58
Rate for Payer: Cofinity Commercial	$284.89
Rate for Payer: Cofinity Commercial	$350.00
Rate for Payer: Cofinity Medicare Advantage	$284.89
Rate for Payer: Encore Health Key Benefits Commercial	$325.58
Rate for Payer: Healthscope Commercial	$366.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$345.93
Rate for Payer: PHP Commercial	$345.93
Rate for Payer: Priority Health Cigna Priority Health	$264.54
Rate for Payer: Priority Health SBD	$256.40

DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$9.57

Service Code	NDC 60687060711
Hospital Charge Code	91073
Hospital Revenue Code	637
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$8.61
Rate for Payer: Aetna Commercial	$8.13
Rate for Payer: Aetna New Business (MI Preferred)	$6.22
Rate for Payer: Cash Price	$7.66
Rate for Payer: Cofinity Commercial	$6.70
Rate for Payer: Cofinity Commercial	$8.23
Rate for Payer: Cofinity Medicare Advantage	$6.70
Rate for Payer: Encore Health Key Benefits Commercial	$7.66
Rate for Payer: Healthscope Commercial	$8.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.13
Rate for Payer: PHP Commercial	$8.13
Rate for Payer: Priority Health Cigna Priority Health	$6.22
Rate for Payer: Priority Health SBD	$6.03

DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$103.25

Service Code	NDC 51991031133
Hospital Charge Code	91073
Hospital Revenue Code	637
Min. Negotiated Rate	$65.05
Max. Negotiated Rate	$92.92
Rate for Payer: Aetna Commercial	$87.76
Rate for Payer: Aetna New Business (MI Preferred)	$67.11
Rate for Payer: Cash Price	$82.60
Rate for Payer: Cofinity Commercial	$72.28
Rate for Payer: Cofinity Commercial	$88.80
Rate for Payer: Cofinity Medicare Advantage	$72.28
Rate for Payer: Encore Health Key Benefits Commercial	$82.60
Rate for Payer: Healthscope Commercial	$92.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$87.76
Rate for Payer: PHP Commercial	$87.76
Rate for Payer: Priority Health Cigna Priority Health	$67.11
Rate for Payer: Priority Health SBD	$65.05

DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$1,507.05

Service Code	NDC 00008121130
Hospital Charge Code	91073
Hospital Revenue Code	637
Min. Negotiated Rate	$949.44
Max. Negotiated Rate	$1,356.34
Rate for Payer: Aetna Commercial	$1,280.99
Rate for Payer: Aetna New Business (MI Preferred)	$979.58
Rate for Payer: Cash Price	$1,205.64
Rate for Payer: Cofinity Commercial	$1,054.94
Rate for Payer: Cofinity Commercial	$1,296.06
Rate for Payer: Cofinity Medicare Advantage	$1,054.94
Rate for Payer: Encore Health Key Benefits Commercial	$1,205.64
Rate for Payer: Healthscope Commercial	$1,356.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,280.99
Rate for Payer: PHP Commercial	$1,280.99
Rate for Payer: Priority Health Cigna Priority Health	$979.58
Rate for Payer: Priority Health SBD	$949.44

DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$287.00

Service Code	NDC 60687060721
Hospital Charge Code	91073
Hospital Revenue Code	637
Min. Negotiated Rate	$180.81
Max. Negotiated Rate	$258.30
Rate for Payer: Aetna Commercial	$243.95
Rate for Payer: Aetna New Business (MI Preferred)	$186.55
Rate for Payer: Cash Price	$229.60
Rate for Payer: Cofinity Commercial	$200.90
Rate for Payer: Cofinity Commercial	$246.82
Rate for Payer: Cofinity Medicare Advantage	$200.90
Rate for Payer: Encore Health Key Benefits Commercial	$229.60
Rate for Payer: Healthscope Commercial	$258.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$243.95
Rate for Payer: PHP Commercial	$243.95
Rate for Payer: Priority Health Cigna Priority Health	$186.55
Rate for Payer: Priority Health SBD	$180.81

DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$9.57

Service Code	NDC 60687060711
Hospital Charge Code	91073
Hospital Revenue Code	637
Min. Negotiated Rate	$3.83
Max. Negotiated Rate	$8.61
Rate for Payer: Aetna Commercial	$8.13
Rate for Payer: Aetna Medicare	$4.78
Rate for Payer: Aetna New Business (MI Preferred)	$6.22
Rate for Payer: BCBS Complete	$3.83
Rate for Payer: Cash Price	$7.66
Rate for Payer: Cofinity Commercial	$6.70
Rate for Payer: Cofinity Commercial	$8.23
Rate for Payer: Cofinity Medicare Advantage	$6.70
Rate for Payer: Encore Health Key Benefits Commercial	$7.66
Rate for Payer: Healthscope Commercial	$8.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.13
Rate for Payer: PHP Commercial	$8.13
Rate for Payer: Priority Health Cigna Priority Health	$6.22
Rate for Payer: Priority Health SBD	$6.03

DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$406.98

Service Code	NDC 51991031190
Hospital Charge Code	91073
Hospital Revenue Code	637
Min. Negotiated Rate	$162.79
Max. Negotiated Rate	$366.28
Rate for Payer: Aetna Commercial	$345.93
Rate for Payer: Aetna Medicare	$203.49
Rate for Payer: Aetna New Business (MI Preferred)	$264.54
Rate for Payer: BCBS Complete	$162.79
Rate for Payer: Cash Price	$325.58
Rate for Payer: Cofinity Commercial	$284.89
Rate for Payer: Cofinity Commercial	$350.00
Rate for Payer: Cofinity Medicare Advantage	$284.89
Rate for Payer: Encore Health Key Benefits Commercial	$325.58
Rate for Payer: Healthscope Commercial	$366.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$345.93
Rate for Payer: PHP Commercial	$345.93
Rate for Payer: Priority Health Cigna Priority Health	$264.54
Rate for Payer: Priority Health SBD	$256.40

DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR

Facility

$103.25

Service Code	NDC 51991031133
Hospital Charge Code	91073
Hospital Revenue Code	637
Min. Negotiated Rate	$41.30
Max. Negotiated Rate	$92.92
Rate for Payer: Aetna Commercial	$87.76
Rate for Payer: Aetna Medicare	$51.62
Rate for Payer: Aetna New Business (MI Preferred)	$67.11
Rate for Payer: BCBS Complete	$41.30
Rate for Payer: Cash Price	$82.60
Rate for Payer: Cofinity Commercial	$72.28
Rate for Payer: Cofinity Commercial	$88.80
Rate for Payer: Cofinity Medicare Advantage	$72.28
Rate for Payer: Encore Health Key Benefits Commercial	$82.60
Rate for Payer: Healthscope Commercial	$92.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$87.76
Rate for Payer: PHP Commercial	$87.76
Rate for Payer: Priority Health Cigna Priority Health	$67.11
Rate for Payer: Priority Health SBD	$65.05

DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION

Facility

$245.00

Service Code	NDC 00998061505
Hospital Charge Code	19596
Hospital Revenue Code	637
Min. Negotiated Rate	$98.00
Max. Negotiated Rate	$220.50
Rate for Payer: Aetna Commercial	$208.25
Rate for Payer: Aetna Medicare	$122.50
Rate for Payer: Aetna New Business (MI Preferred)	$159.25
Rate for Payer: BCBS Complete	$98.00
Rate for Payer: Cash Price	$196.00
Rate for Payer: Cofinity Commercial	$171.50
Rate for Payer: Cofinity Commercial	$210.70
Rate for Payer: Cofinity Medicare Advantage	$171.50
Rate for Payer: Encore Health Key Benefits Commercial	$196.00
Rate for Payer: Healthscope Commercial	$220.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$208.25
Rate for Payer: PHP Commercial	$208.25
Rate for Payer: Priority Health Cigna Priority Health	$159.25
Rate for Payer: Priority Health SBD	$154.35

DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION

Facility

$245.00

Service Code	NDC 00998061505
Hospital Charge Code	19596
Hospital Revenue Code	637
Min. Negotiated Rate	$154.35
Max. Negotiated Rate	$220.50
Rate for Payer: Aetna Commercial	$208.25
Rate for Payer: Aetna New Business (MI Preferred)	$159.25
Rate for Payer: Cash Price	$196.00
Rate for Payer: Cofinity Commercial	$171.50
Rate for Payer: Cofinity Commercial	$210.70
Rate for Payer: Cofinity Medicare Advantage	$171.50
Rate for Payer: Encore Health Key Benefits Commercial	$196.00
Rate for Payer: Healthscope Commercial	$220.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$208.25
Rate for Payer: PHP Commercial	$208.25
Rate for Payer: Priority Health Cigna Priority Health	$159.25
Rate for Payer: Priority Health SBD	$154.35

DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION

Facility

$235.48

Service Code	NDC 00078092525
Hospital Charge Code	19596
Hospital Revenue Code	637
Min. Negotiated Rate	$148.35
Max. Negotiated Rate	$211.93
Rate for Payer: Aetna Commercial	$200.16
Rate for Payer: Aetna New Business (MI Preferred)	$153.06
Rate for Payer: Cash Price	$188.38
Rate for Payer: Cofinity Commercial	$164.84
Rate for Payer: Cofinity Commercial	$202.51
Rate for Payer: Cofinity Medicare Advantage	$164.84
Rate for Payer: Encore Health Key Benefits Commercial	$188.38
Rate for Payer: Healthscope Commercial	$211.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$200.16
Rate for Payer: PHP Commercial	$200.16
Rate for Payer: Priority Health Cigna Priority Health	$153.06
Rate for Payer: Priority Health SBD	$148.35

DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION

Facility

$235.48

Service Code	NDC 00078092525
Hospital Charge Code	19596
Hospital Revenue Code	637
Min. Negotiated Rate	$94.19
Max. Negotiated Rate	$211.93
Rate for Payer: Aetna Commercial	$200.16
Rate for Payer: Aetna Medicare	$117.74
Rate for Payer: Aetna New Business (MI Preferred)	$153.06
Rate for Payer: BCBS Complete	$94.19
Rate for Payer: Cash Price	$188.38
Rate for Payer: Cofinity Commercial	$164.84
Rate for Payer: Cofinity Commercial	$202.51
Rate for Payer: Cofinity Medicare Advantage	$164.84
Rate for Payer: Encore Health Key Benefits Commercial	$188.38
Rate for Payer: Healthscope Commercial	$211.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$200.16
Rate for Payer: PHP Commercial	$200.16
Rate for Payer: Priority Health Cigna Priority Health	$153.06
Rate for Payer: Priority Health SBD	$148.35

DEXAMETHASONE 0.4 % FOR IONTOPHORESIS

Facility

$0.30

Service Code	HCPCS J1100
Hospital Charge Code	163636
Hospital Revenue Code	636
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: BCBS Trust/PPO	$0.30
Rate for Payer: BCN Commercial	$0.30

DEXAMETHASONE 0.5 MG TABLET

Facility

$251.45

Service Code	HCPCS J8540
Hospital Charge Code	2322
Hospital Revenue Code	636
Min. Negotiated Rate	$158.41
Max. Negotiated Rate	$226.30
Rate for Payer: Aetna Commercial	$213.73
Rate for Payer: Aetna Commercial	$31.96
Rate for Payer: Aetna New Business (MI Preferred)	$163.44
Rate for Payer: Aetna New Business (MI Preferred)	$24.44
Rate for Payer: Cash Price	$201.16
Rate for Payer: Cash Price	$30.08
Rate for Payer: Cofinity Commercial	$176.02
Rate for Payer: Cofinity Commercial	$26.32
Rate for Payer: Cofinity Commercial	$32.34
Rate for Payer: Cofinity Commercial	$216.25
Rate for Payer: Cofinity Medicare Advantage	$26.32
Rate for Payer: Cofinity Medicare Advantage	$176.02
Rate for Payer: Encore Health Key Benefits Commercial	$201.16
Rate for Payer: Encore Health Key Benefits Commercial	$30.08
Rate for Payer: Healthscope Commercial	$226.30
Rate for Payer: Healthscope Commercial	$33.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$213.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.96
Rate for Payer: PHP Commercial	$213.73
Rate for Payer: PHP Commercial	$31.96
Rate for Payer: Priority Health Cigna Priority Health	$24.44
Rate for Payer: Priority Health Cigna Priority Health	$163.44
Rate for Payer: Priority Health SBD	$23.69
Rate for Payer: Priority Health SBD	$158.41

DEXAMETHASONE 0.5 MG TABLET

Facility

$251.45

Service Code	HCPCS J8540
Hospital Charge Code	2322
Hospital Revenue Code	636
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$226.30
Rate for Payer: Aetna Commercial	$213.73
Rate for Payer: Aetna Commercial	$31.96
Rate for Payer: Aetna Medicare	$18.80
Rate for Payer: Aetna Medicare	$125.72
Rate for Payer: Aetna New Business (MI Preferred)	$163.44
Rate for Payer: Aetna New Business (MI Preferred)	$24.44
Rate for Payer: BCBS Complete	$15.04
Rate for Payer: BCBS Complete	$100.58
Rate for Payer: BCBS Trust/PPO	$0.11
Rate for Payer: BCBS Trust/PPO	$0.11
Rate for Payer: BCN Commercial	$0.11
Rate for Payer: BCN Commercial	$0.11
Rate for Payer: Cash Price	$30.08
Rate for Payer: Cash Price	$30.08
Rate for Payer: Cash Price	$201.16
Rate for Payer: Cash Price	$201.16
Rate for Payer: Cofinity Commercial	$176.02
Rate for Payer: Cofinity Commercial	$32.34
Rate for Payer: Cofinity Commercial	$26.32
Rate for Payer: Cofinity Commercial	$216.25
Rate for Payer: Cofinity Medicare Advantage	$26.32
Rate for Payer: Cofinity Medicare Advantage	$176.02
Rate for Payer: Encore Health Key Benefits Commercial	$201.16
Rate for Payer: Encore Health Key Benefits Commercial	$30.08
Rate for Payer: Healthscope Commercial	$226.30
Rate for Payer: Healthscope Commercial	$33.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$213.73
Rate for Payer: PHP Commercial	$31.96
Rate for Payer: PHP Commercial	$213.73
Rate for Payer: Priority Health Cigna Priority Health	$163.44
Rate for Payer: Priority Health Cigna Priority Health	$24.44
Rate for Payer: Priority Health SBD	$23.69
Rate for Payer: Priority Health SBD	$158.41

DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)

Facility

$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 Commercial	$3.88
Rate for Payer: Cofinity Commercial	$4.76
Rate for Payer: Cofinity Medicare Advantage	$3.88
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: PHP Commercial	$4.71
Rate for Payer: Priority Health Cigna Priority Health	$3.60
Rate for Payer: Priority Health SBD	$3.49

DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)

Facility

$5.54

Service Code	NDC 63323050601
Hospital Charge Code	180638
Hospital Revenue Code	250
Min. Negotiated Rate	$2.22
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 Commercial	$3.88
Rate for Payer: Cofinity Commercial	$4.76
Rate for Payer: Cofinity Medicare Advantage	$3.88
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: PHP Commercial	$4.71
Rate for Payer: Priority Health Cigna Priority Health	$3.60
Rate for Payer: Priority Health SBD	$3.49

DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)

Facility

$9.86

Service Code	NDC 70121139905
Hospital Charge Code	180638
Hospital Revenue Code	250
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$8.87
Rate for Payer: Aetna Commercial	$8.38
Rate for Payer: Aetna Medicare	$4.93
Rate for Payer: Aetna New Business (MI Preferred)	$6.41
Rate for Payer: BCBS Complete	$3.94
Rate for Payer: Cash Price	$7.89
Rate for Payer: Cofinity Commercial	$6.90
Rate for Payer: Cofinity Commercial	$8.48
Rate for Payer: Cofinity Medicare Advantage	$6.90
Rate for Payer: Encore Health Key Benefits Commercial	$7.89
Rate for Payer: Healthscope Commercial	$8.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.38
Rate for Payer: PHP Commercial	$8.38
Rate for Payer: Priority Health Cigna Priority Health	$6.41
Rate for Payer: Priority Health SBD	$6.21

DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)

Facility

$7.46

Service Code	NDC 63323050616
Hospital Charge Code	180638
Hospital Revenue Code	250
Min. Negotiated Rate	$2.98
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 Commercial	$5.22
Rate for Payer: Cofinity Commercial	$6.42
Rate for Payer: Cofinity Medicare Advantage	$5.22
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: PHP Commercial	$6.34
Rate for Payer: Priority Health Cigna Priority Health	$4.85
Rate for Payer: Priority Health SBD	$4.70

DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)

Facility

$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 Commercial	$5.22
Rate for Payer: Cofinity Commercial	$6.42
Rate for Payer: Cofinity Medicare Advantage	$5.22
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: PHP Commercial	$6.34
Rate for Payer: Priority Health Cigna Priority Health	$4.85
Rate for Payer: Priority Health SBD	$4.70

DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)

Facility

$7.80

Service Code	NDC 55150030425
Hospital Charge Code	180638
Hospital Revenue Code	250
Min. Negotiated Rate	$3.12
Max. Negotiated Rate	$7.02
Rate for Payer: Aetna Commercial	$6.63
Rate for Payer: Aetna Medicare	$3.90
Rate for Payer: Aetna New Business (MI Preferred)	$5.07
Rate for Payer: BCBS Complete	$3.12
Rate for Payer: Cash Price	$6.24
Rate for Payer: Cofinity Commercial	$5.46
Rate for Payer: Cofinity Commercial	$6.71
Rate for Payer: Cofinity Medicare Advantage	$5.46
Rate for Payer: Encore Health Key Benefits Commercial	$6.24
Rate for Payer: Healthscope Commercial	$7.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.63
Rate for Payer: PHP Commercial	$6.63
Rate for Payer: Priority Health Cigna Priority Health	$5.07
Rate for Payer: Priority Health SBD	$4.91

DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)

Facility

$9.86

Service Code	NDC 70121139901
Hospital Charge Code	180638
Hospital Revenue Code	250
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$8.87
Rate for Payer: Aetna Commercial	$8.38
Rate for Payer: Aetna Medicare	$4.93
Rate for Payer: Aetna New Business (MI Preferred)	$6.41
Rate for Payer: BCBS Complete	$3.94
Rate for Payer: Cash Price	$7.89
Rate for Payer: Cofinity Commercial	$6.90
Rate for Payer: Cofinity Commercial	$8.48
Rate for Payer: Cofinity Medicare Advantage	$6.90
Rate for Payer: Encore Health Key Benefits Commercial	$7.89
Rate for Payer: Healthscope Commercial	$8.87
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.38
Rate for Payer: PHP Commercial	$8.38
Rate for Payer: Priority Health Cigna Priority Health	$6.41
Rate for Payer: Priority Health SBD	$6.21

DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)

Facility

$7.80

Service Code	NDC 55150030401
Hospital Charge Code	180638
Hospital Revenue Code	250
Min. Negotiated Rate	$4.91
Max. Negotiated Rate	$7.02
Rate for Payer: Aetna Commercial	$6.63
Rate for Payer: Aetna New Business (MI Preferred)	$5.07
Rate for Payer: Cash Price	$6.24
Rate for Payer: Cofinity Commercial	$5.46
Rate for Payer: Cofinity Commercial	$6.71
Rate for Payer: Cofinity Medicare Advantage	$5.46
Rate for Payer: Encore Health Key Benefits Commercial	$6.24
Rate for Payer: Healthscope Commercial	$7.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.63
Rate for Payer: PHP Commercial	$6.63
Rate for Payer: Priority Health Cigna Priority Health	$5.07
Rate for Payer: Priority Health SBD	$4.91

Know your out-of-pocket cost for care.

All Charges