|
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 |
$42.57 |
| 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 Commercial |
$74.49
|
| Rate for Payer: Cofinity Commercial |
$91.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.49
|
| 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: PHP Commercial |
$90.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.17
|
| Rate for Payer: Priority Health SBD |
$67.04
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$467.52
|
|
|
Service Code
|
NDC 00054817525
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.01 |
| Max. Negotiated Rate |
$420.77 |
| Rate for Payer: Aetna Commercial |
$397.39
|
| Rate for Payer: Aetna Medicare |
$233.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.89
|
| Rate for Payer: BCBS Complete |
$187.01
|
| Rate for Payer: Cash Price |
$374.02
|
| Rate for Payer: Cofinity Commercial |
$327.26
|
| Rate for Payer: Cofinity Commercial |
$402.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$327.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.02
|
| Rate for Payer: Healthscope Commercial |
$420.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.39
|
| Rate for Payer: PHP Commercial |
$397.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.89
|
| Rate for Payer: Priority Health SBD |
$294.54
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$400.90
|
|
|
Service Code
|
NDC 00054418425
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$252.57 |
| Max. Negotiated Rate |
$360.81 |
| Rate for Payer: Aetna Commercial |
$340.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.58
|
| Rate for Payer: Cash Price |
$320.72
|
| Rate for Payer: Cofinity Commercial |
$280.63
|
| Rate for Payer: Cofinity Commercial |
$344.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$280.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.72
|
| Rate for Payer: Healthscope Commercial |
$360.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.76
|
| Rate for Payer: PHP Commercial |
$340.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.58
|
| Rate for Payer: Priority Health SBD |
$252.57
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$467.52
|
|
|
Service Code
|
NDC 00054817525
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$294.54 |
| Max. Negotiated Rate |
$420.77 |
| Rate for Payer: Aetna Commercial |
$397.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.89
|
| Rate for Payer: Cash Price |
$374.02
|
| Rate for Payer: Cofinity Commercial |
$327.26
|
| Rate for Payer: Cofinity Commercial |
$402.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$327.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.02
|
| Rate for Payer: Healthscope Commercial |
$420.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.39
|
| Rate for Payer: PHP Commercial |
$397.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.89
|
| Rate for Payer: Priority Health SBD |
$294.54
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$400.90
|
|
|
Service Code
|
NDC 00054418425
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.36 |
| Max. Negotiated Rate |
$360.81 |
| Rate for Payer: Aetna Commercial |
$340.76
|
| Rate for Payer: Aetna Medicare |
$200.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.58
|
| Rate for Payer: BCBS Complete |
$160.36
|
| Rate for Payer: Cash Price |
$320.72
|
| Rate for Payer: Cofinity Commercial |
$280.63
|
| Rate for Payer: Cofinity Commercial |
$344.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$280.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.72
|
| Rate for Payer: Healthscope Commercial |
$360.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.76
|
| Rate for Payer: PHP Commercial |
$340.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.58
|
| Rate for Payer: Priority Health SBD |
$252.57
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
IP
|
$735.84
|
|
|
Service Code
|
NDC 00054818325
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$463.58 |
| Max. Negotiated Rate |
$662.26 |
| Rate for Payer: Aetna Commercial |
$625.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.30
|
| Rate for Payer: Cash Price |
$588.67
|
| Rate for Payer: Cofinity Commercial |
$515.09
|
| Rate for Payer: Cofinity Commercial |
$632.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$515.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.67
|
| Rate for Payer: Healthscope Commercial |
$662.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.46
|
| Rate for Payer: PHP Commercial |
$625.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.30
|
| Rate for Payer: Priority Health SBD |
$463.58
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
OP
|
$735.84
|
|
|
Service Code
|
NDC 00054818325
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$294.34 |
| Max. Negotiated Rate |
$662.26 |
| Rate for Payer: Aetna Commercial |
$625.46
|
| Rate for Payer: Aetna Medicare |
$367.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.30
|
| Rate for Payer: BCBS Complete |
$294.34
|
| Rate for Payer: Cash Price |
$588.67
|
| Rate for Payer: Cofinity Commercial |
$515.09
|
| Rate for Payer: Cofinity Commercial |
$632.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$515.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.67
|
| Rate for Payer: Healthscope Commercial |
$662.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.46
|
| Rate for Payer: PHP Commercial |
$625.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.30
|
| Rate for Payer: Priority Health SBD |
$463.58
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
IP
|
$17.98
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna Commercial |
$15.28
|
| 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) |
$7.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.69
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cofinity Commercial |
$44.86
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Cofinity Commercial |
$9.43
|
| Rate for Payer: Cofinity Commercial |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$12.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.26
|
| 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 |
$15.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.47
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: PHP Commercial |
$54.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.65
|
| Rate for Payer: Priority Health SBD |
$40.37
|
| Rate for Payer: Priority Health SBD |
$6.91
|
| 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 |
$7.19 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: Aetna Commercial |
$13.78
|
| Rate for Payer: Aetna Commercial |
$54.47
|
| Rate for Payer: Aetna Commercial |
$9.32
|
| Rate for Payer: Aetna Medicare |
$32.04
|
| Rate for Payer: Aetna Medicare |
$8.99
|
| Rate for Payer: Aetna Medicare |
$8.11
|
| Rate for Payer: Aetna Medicare |
$5.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.65
|
| Rate for Payer: BCBS Complete |
$4.39
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: BCBS Complete |
$7.19
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cash Price |
$12.97
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cofinity Commercial |
$13.94
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Cofinity Commercial |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$44.86
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Cofinity Commercial |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$9.43
|
| Rate for Payer: Cofinity Commercial |
$11.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| 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 |
$12.97
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Commercial |
$57.67
|
| Rate for Payer: Healthscope Commercial |
$14.59
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.32
|
| Rate for Payer: PHP Commercial |
$13.78
|
| Rate for Payer: PHP Commercial |
$54.47
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.65
|
| Rate for Payer: Priority Health SBD |
$6.91
|
| Rate for Payer: Priority Health SBD |
$11.33
|
| Rate for Payer: Priority Health SBD |
$10.21
|
| Rate for Payer: Priority Health SBD |
$40.37
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$10.97
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2331
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.39 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Aetna Commercial |
$9.32
|
| Rate for Payer: Aetna Commercial |
$54.47
|
| Rate for Payer: Aetna Commercial |
$13.78
|
| Rate for Payer: Aetna Medicare |
$5.49
|
| Rate for Payer: Aetna Medicare |
$8.11
|
| Rate for Payer: Aetna Medicare |
$32.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.65
|
| Rate for Payer: BCBS Complete |
$4.39
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: Cash Price |
$12.97
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cofinity Commercial |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$11.35
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Cofinity Commercial |
$13.94
|
| Rate for Payer: Cofinity Commercial |
$44.86
|
| Rate for Payer: Cofinity Commercial |
$9.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.26
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Commercial |
$14.59
|
| 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 |
$13.78
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: PHP Commercial |
$54.47
|
| Rate for Payer: PHP Commercial |
$13.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.13
|
| Rate for Payer: Priority Health SBD |
$6.91
|
| Rate for Payer: Priority Health SBD |
$10.21
|
| Rate for Payer: Priority Health SBD |
$40.37
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$64.08
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2331
|
|
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 New Business (MI Preferred) |
$41.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.13
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cofinity Commercial |
$44.86
|
| Rate for Payer: Cofinity Commercial |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$9.43
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.26
|
| Rate for Payer: Healthscope Commercial |
$57.67
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.47
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: PHP Commercial |
$54.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.13
|
| Rate for Payer: Priority Health SBD |
$40.37
|
| Rate for Payer: Priority Health SBD |
$6.91
|
|
|
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 |
$49.80 |
| Max. Negotiated Rate |
$112.05 |
| Rate for Payer: Aetna Commercial |
$105.83
|
| 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 Commercial |
$65.94
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Medicare |
$9.88
|
| Rate for Payer: Aetna Medicare |
$228.81
|
| Rate for Payer: Aetna Medicare |
$112.88
|
| Rate for Payer: Aetna Medicare |
$62.25
|
| Rate for Payer: Aetna Medicare |
$5.65
|
| Rate for Payer: Aetna Medicare |
$38.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.45
|
| 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) |
$146.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.92
|
| Rate for Payer: BCBS Complete |
$4.52
|
| Rate for Payer: BCBS Complete |
$183.05
|
| Rate for Payer: BCBS Complete |
$31.03
|
| Rate for Payer: BCBS Complete |
$49.80
|
| Rate for Payer: BCBS Complete |
$90.30
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cofinity Commercial |
$13.83
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$158.03
|
| Rate for Payer: Cofinity Commercial |
$320.33
|
| Rate for Payer: Cofinity Commercial |
$393.55
|
| Rate for Payer: Cofinity Commercial |
$107.07
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Cofinity Commercial |
$7.91
|
| Rate for Payer: Cofinity Commercial |
$194.15
|
| Rate for Payer: Cofinity Commercial |
$66.72
|
| Rate for Payer: Cofinity Commercial |
$54.31
|
| Rate for Payer: Cofinity Commercial |
$87.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$158.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.31
|
| 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 |
$180.60
|
| 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 |
$62.06
|
| Rate for Payer: Healthscope Commercial |
$411.86
|
| Rate for Payer: Healthscope Commercial |
$69.82
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$203.18
|
| Rate for Payer: Healthscope Commercial |
$112.05
|
| Rate for Payer: Healthscope Commercial |
$10.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.98
|
| Rate for Payer: PHP Commercial |
$105.83
|
| Rate for Payer: PHP Commercial |
$191.89
|
| Rate for Payer: PHP Commercial |
$9.61
|
| Rate for Payer: PHP Commercial |
$388.98
|
| Rate for Payer: PHP Commercial |
$65.94
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.45
|
| Rate for Payer: Priority Health SBD |
$48.88
|
| Rate for Payer: Priority Health SBD |
$142.22
|
| Rate for Payer: Priority Health SBD |
$78.44
|
| Rate for Payer: Priority Health SBD |
$7.12
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: Priority Health SBD |
$288.30
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML FOR IM INJECTION
|
Facility
|
IP
|
$457.62
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$288.30 |
| Max. Negotiated Rate |
$411.86 |
| Rate for Payer: Aetna Commercial |
$388.98
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Commercial |
$191.89
|
| Rate for Payer: Aetna Commercial |
$9.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cofinity Commercial |
$393.55
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Cofinity Commercial |
$13.83
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$158.03
|
| Rate for Payer: Cofinity Commercial |
$194.15
|
| Rate for Payer: Cofinity Commercial |
$7.91
|
| Rate for Payer: Cofinity Commercial |
$320.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$158.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.83
|
| 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 |
$366.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.04
|
| Rate for Payer: Healthscope Commercial |
$203.18
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$10.17
|
| Rate for Payer: Healthscope Commercial |
$411.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.61
|
| 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 |
$191.89
|
| Rate for Payer: PHP Commercial |
$9.61
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$388.98
|
| Rate for Payer: PHP Commercial |
$191.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.84
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: Priority Health SBD |
$7.12
|
| Rate for Payer: Priority Health SBD |
$142.22
|
| Rate for Payer: Priority Health SBD |
$288.30
|
|
|
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 |
$16.80
|
| Rate for Payer: Aetna Commercial |
$388.98
|
| Rate for Payer: Aetna Commercial |
$9.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.45
|
| 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 |
$366.10
|
| Rate for Payer: Cofinity Commercial |
$7.91
|
| Rate for Payer: Cofinity Commercial |
$393.55
|
| Rate for Payer: Cofinity Commercial |
$320.33
|
| Rate for Payer: Cofinity Commercial |
$13.83
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$194.15
|
| Rate for Payer: Cofinity Commercial |
$158.03
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$158.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.60
|
| 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 |
$366.10
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$10.17
|
| Rate for Payer: Healthscope Commercial |
$411.86
|
| Rate for Payer: Healthscope Commercial |
$203.18
|
| 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 |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.61
|
| Rate for Payer: PHP Commercial |
$9.61
|
| Rate for Payer: PHP Commercial |
$191.89
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$388.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.45
|
| Rate for Payer: Priority Health SBD |
$7.12
|
| Rate for Payer: Priority Health SBD |
$142.22
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: Priority Health SBD |
$288.30
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$124.50
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$112.05 |
| Rate for Payer: Aetna Commercial |
$105.83
|
| 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 Commercial |
$65.94
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Medicare |
$9.88
|
| Rate for Payer: Aetna Medicare |
$228.81
|
| Rate for Payer: Aetna Medicare |
$112.88
|
| Rate for Payer: Aetna Medicare |
$62.25
|
| Rate for Payer: Aetna Medicare |
$5.65
|
| Rate for Payer: Aetna Medicare |
$38.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.45
|
| 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) |
$146.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.92
|
| Rate for Payer: BCBS Complete |
$4.52
|
| Rate for Payer: BCBS Complete |
$183.05
|
| Rate for Payer: BCBS Complete |
$31.03
|
| Rate for Payer: BCBS Complete |
$49.80
|
| Rate for Payer: BCBS Complete |
$90.30
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cofinity Commercial |
$13.83
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$158.03
|
| Rate for Payer: Cofinity Commercial |
$320.33
|
| Rate for Payer: Cofinity Commercial |
$393.55
|
| Rate for Payer: Cofinity Commercial |
$107.07
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Cofinity Commercial |
$7.91
|
| Rate for Payer: Cofinity Commercial |
$194.15
|
| Rate for Payer: Cofinity Commercial |
$66.72
|
| Rate for Payer: Cofinity Commercial |
$54.31
|
| Rate for Payer: Cofinity Commercial |
$87.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$158.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.31
|
| 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 |
$180.60
|
| 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 |
$62.06
|
| Rate for Payer: Healthscope Commercial |
$411.86
|
| Rate for Payer: Healthscope Commercial |
$69.82
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$203.18
|
| Rate for Payer: Healthscope Commercial |
$112.05
|
| Rate for Payer: Healthscope Commercial |
$10.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.98
|
| Rate for Payer: PHP Commercial |
$105.83
|
| Rate for Payer: PHP Commercial |
$191.89
|
| Rate for Payer: PHP Commercial |
$9.61
|
| Rate for Payer: PHP Commercial |
$388.98
|
| Rate for Payer: PHP Commercial |
$65.94
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.45
|
| Rate for Payer: Priority Health SBD |
$48.88
|
| Rate for Payer: Priority Health SBD |
$142.22
|
| Rate for Payer: Priority Health SBD |
$78.44
|
| Rate for Payer: Priority Health SBD |
$7.12
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: Priority Health SBD |
$288.30
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
OP
|
$22.54
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$20.29 |
| Rate for Payer: Aetna Commercial |
$19.16
|
| Rate for Payer: Aetna Commercial |
$18.29
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna Commercial |
$14.21
|
| Rate for Payer: Aetna Medicare |
$11.78
|
| Rate for Payer: Aetna Medicare |
$11.27
|
| Rate for Payer: Aetna Medicare |
$10.76
|
| Rate for Payer: Aetna Medicare |
$8.36
|
| 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) |
$13.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS Complete |
$9.42
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS Complete |
$9.02
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$17.22
|
| Rate for Payer: Cash Price |
$18.03
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cofinity Commercial |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$19.38
|
| Rate for Payer: Cofinity Commercial |
$11.70
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$15.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.22
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Healthscope Commercial |
$19.37
|
| Rate for Payer: Healthscope Commercial |
$20.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.21
|
| Rate for Payer: PHP Commercial |
$18.29
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: PHP Commercial |
$19.16
|
| Rate for Payer: PHP Commercial |
$14.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.31
|
| Rate for Payer: Priority Health SBD |
$10.53
|
| Rate for Payer: Priority Health SBD |
$14.20
|
| Rate for Payer: Priority Health SBD |
$13.56
|
| Rate for Payer: Priority Health SBD |
$14.84
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
IP
|
$22.54
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.20 |
| Max. Negotiated Rate |
$20.29 |
| Rate for Payer: Aetna Commercial |
$19.16
|
| Rate for Payer: Aetna Commercial |
$18.29
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna Commercial |
$14.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: Cash Price |
$18.03
|
| Rate for Payer: Cash Price |
$17.22
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$11.70
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$15.06
|
| Rate for Payer: Cofinity Commercial |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$19.38
|
| Rate for Payer: Cofinity Commercial |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Healthscope Commercial |
$19.37
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Healthscope Commercial |
$20.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.21
|
| Rate for Payer: PHP Commercial |
$14.21
|
| Rate for Payer: PHP Commercial |
$19.16
|
| Rate for Payer: PHP Commercial |
$18.29
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.31
|
| Rate for Payer: Priority Health SBD |
$10.53
|
| Rate for Payer: Priority Health SBD |
$14.20
|
| Rate for Payer: Priority Health SBD |
$13.56
|
| Rate for Payer: Priority Health SBD |
$14.84
|
|
|
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 |
$16.75
|
| Rate for Payer: Aetna Commercial |
$19.16
|
| Rate for Payer: Aetna Commercial |
$18.29
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.65
|
| Rate for Payer: Cash Price |
$18.03
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cash Price |
$17.22
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$11.70
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$16.95
|
| Rate for Payer: Cofinity Commercial |
$15.06
|
| Rate for Payer: Cofinity Commercial |
$19.38
|
| Rate for Payer: Cofinity Commercial |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.03
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$17.74
|
| Rate for Payer: Healthscope Commercial |
$19.37
|
| Rate for Payer: Healthscope Commercial |
$20.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.02
|
| Rate for Payer: PHP Commercial |
$19.16
|
| Rate for Payer: PHP Commercial |
$14.21
|
| Rate for Payer: PHP Commercial |
$16.75
|
| Rate for Payer: PHP Commercial |
$18.29
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.31
|
| Rate for Payer: Priority Health SBD |
$14.84
|
| Rate for Payer: Priority Health SBD |
$12.42
|
| Rate for Payer: Priority Health SBD |
$13.56
|
| Rate for Payer: Priority Health SBD |
$10.53
|
| Rate for Payer: Priority Health SBD |
$14.20
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$22.54
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
116809
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$20.29 |
| Rate for Payer: Aetna Commercial |
$19.16
|
| Rate for Payer: Aetna Commercial |
$18.29
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna Commercial |
$14.21
|
| Rate for Payer: Aetna Commercial |
$16.75
|
| Rate for Payer: Aetna Medicare |
$10.76
|
| Rate for Payer: Aetna Medicare |
$11.78
|
| Rate for Payer: Aetna Medicare |
$11.27
|
| Rate for Payer: Aetna Medicare |
$9.86
|
| Rate for Payer: Aetna Medicare |
$8.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.87
|
| Rate for Payer: BCBS Complete |
$7.88
|
| Rate for Payer: BCBS Complete |
$9.02
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS Complete |
$9.42
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cash Price |
$17.22
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$15.77
|
| Rate for Payer: Cash Price |
$18.03
|
| Rate for Payer: Cofinity Commercial |
$19.38
|
| Rate for Payer: Cofinity Commercial |
$11.70
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$13.80
|
| Rate for Payer: Cofinity Commercial |
$16.95
|
| Rate for Payer: Cofinity Commercial |
$15.06
|
| Rate for Payer: Cofinity Commercial |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.77
|
| Rate for Payer: Healthscope Commercial |
$17.74
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$20.29
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Healthscope Commercial |
$19.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.02
|
| Rate for Payer: PHP Commercial |
$19.16
|
| Rate for Payer: PHP Commercial |
$18.29
|
| Rate for Payer: PHP Commercial |
$16.75
|
| Rate for Payer: PHP Commercial |
$14.21
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.99
|
| Rate for Payer: Priority Health SBD |
$14.84
|
| Rate for Payer: Priority Health SBD |
$10.53
|
| Rate for Payer: Priority Health SBD |
$12.42
|
| Rate for Payer: Priority Health SBD |
$14.20
|
| Rate for Payer: Priority Health SBD |
$13.56
|
|
|
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 |
$25.23 |
| 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 Commercial |
$44.15
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.15
|
| 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: PHP Commercial |
$53.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.00
|
| Rate for Payer: Priority Health SBD |
$39.73
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$63.07
|
|
|
Service Code
|
NDC 16729023930
|
| 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 Commercial |
$44.15
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.15
|
| 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: PHP Commercial |
$53.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.00
|
| Rate for Payer: Priority Health SBD |
$39.73
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$68.32
|
|
|
Service Code
|
NDC 83634060002
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.04 |
| Max. Negotiated Rate |
$61.49 |
| Rate for Payer: Aetna Commercial |
$58.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.41
|
| Rate for Payer: Cash Price |
$54.66
|
| Rate for Payer: Cofinity Commercial |
$47.82
|
| Rate for Payer: Cofinity Commercial |
$58.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$47.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$54.66
|
| Rate for Payer: Healthscope Commercial |
$61.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.07
|
| Rate for Payer: PHP Commercial |
$58.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.41
|
| Rate for Payer: Priority Health SBD |
$43.04
|
|
|
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 |
$33.83 |
| 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 Commercial |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$72.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.20
|
| 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: PHP Commercial |
$71.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.97
|
| Rate for Payer: Priority Health SBD |
$53.28
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$63.07
|
|
|
Service Code
|
NDC 16729023993
|
| 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 Commercial |
$44.15
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.15
|
| 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: PHP Commercial |
$53.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.00
|
| Rate for Payer: Priority Health SBD |
$39.73
|
|
|
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 Commercial |
$35.51
|
| Rate for Payer: Cofinity Commercial |
$43.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.51
|
| 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: PHP Commercial |
$43.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.97
|
| Rate for Payer: Priority Health SBD |
$31.96
|
|
