|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION
|
Facility
|
IP
|
$7.46
|
|
|
Service Code
|
NDC 63323-506-16
|
| 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: Healthscope Commercial |
$6.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.34
|
| Rate for Payer: PHP Commercial |
$6.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.22
|
| Rate for Payer: Priority Health SBD |
$4.70
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION
|
Facility
|
IP
|
$7.80
|
|
|
Service Code
|
NDC 55150-304-25
|
| 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: Healthscope Commercial |
$7.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.63
|
| Rate for Payer: PHP Commercial |
$6.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.46
|
| Rate for Payer: Priority Health SBD |
$4.91
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION
|
Facility
|
IP
|
$7.80
|
|
|
Service Code
|
NDC 55150-304-01
|
| 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: Healthscope Commercial |
$7.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.63
|
| Rate for Payer: PHP Commercial |
$6.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.46
|
| Rate for Payer: Priority Health SBD |
$4.91
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION
|
Facility
|
IP
|
$9.97
|
|
|
Service Code
|
NDC 70121-1399-1
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$8.97 |
| Rate for Payer: Aetna Commercial |
$8.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.48
|
| Rate for Payer: Cash Price |
$7.98
|
| Rate for Payer: Cofinity Commercial |
$6.98
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Healthscope Commercial |
$8.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.47
|
| Rate for Payer: PHP Commercial |
$8.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.98
|
| Rate for Payer: Priority Health SBD |
$6.28
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION
|
Facility
|
IP
|
$9.97
|
|
|
Service Code
|
NDC 70121-1399-5
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$8.97 |
| Rate for Payer: Aetna Commercial |
$8.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.48
|
| Rate for Payer: Cash Price |
$7.98
|
| Rate for Payer: Cofinity Commercial |
$6.98
|
| Rate for Payer: Cofinity Commercial |
$8.57
|
| Rate for Payer: Healthscope Commercial |
$8.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.47
|
| Rate for Payer: PHP Commercial |
$8.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.98
|
| Rate for Payer: Priority Health SBD |
$6.28
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION
|
Facility
|
IP
|
$6.57
|
|
|
Service Code
|
NDC 63323-506-01
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$5.91 |
| Rate for Payer: Aetna Commercial |
$5.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.27
|
| Rate for Payer: Cash Price |
$5.26
|
| Rate for Payer: Cofinity Commercial |
$4.60
|
| Rate for Payer: Cofinity Commercial |
$5.65
|
| Rate for Payer: Healthscope Commercial |
$5.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5.58
|
| Rate for Payer: PHP Commercial |
$5.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.60
|
| Rate for Payer: Priority Health SBD |
$4.14
|
|
|
DEXAMETHASONE 1 MG/ML DROPS (CONCENTRATE)
|
Facility
|
IP
|
$106.28
|
|
|
Service Code
|
NDC 0054-3176-44
|
| Hospital Charge Code |
108723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.96 |
| Max. Negotiated Rate |
$95.65 |
| Rate for Payer: Aetna Commercial |
$90.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.08
|
| Rate for Payer: Cash Price |
$85.02
|
| Rate for Payer: Cofinity Commercial |
$74.40
|
| Rate for Payer: Cofinity Commercial |
$91.40
|
| Rate for Payer: Healthscope Commercial |
$95.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.34
|
| Rate for Payer: PHP Commercial |
$90.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.40
|
| Rate for Payer: Priority Health SBD |
$66.96
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$447.84
|
|
|
Service Code
|
NDC 0054-8175-25
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.14 |
| Max. Negotiated Rate |
$403.06 |
| Rate for Payer: Aetna Commercial |
$380.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.10
|
| Rate for Payer: BCBS Complete |
$179.14
|
| Rate for Payer: Cash Price |
$358.27
|
| Rate for Payer: Cofinity Commercial |
$313.49
|
| Rate for Payer: Cofinity Commercial |
$385.14
|
| Rate for Payer: Healthscope Commercial |
$403.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$380.66
|
| Rate for Payer: PHP Commercial |
$380.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.49
|
| Rate for Payer: Priority Health SBD |
$282.14
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$447.84
|
|
|
Service Code
|
NDC 0054-8175-25
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$282.14 |
| Max. Negotiated Rate |
$403.06 |
| Rate for Payer: Aetna Commercial |
$380.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.10
|
| Rate for Payer: Cash Price |
$358.27
|
| Rate for Payer: Cofinity Commercial |
$313.49
|
| Rate for Payer: Cofinity Commercial |
$385.14
|
| Rate for Payer: Healthscope Commercial |
$403.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$380.66
|
| Rate for Payer: PHP Commercial |
$380.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.49
|
| Rate for Payer: Priority Health SBD |
$282.14
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$389.50
|
|
|
Service Code
|
NDC 0054-4184-25
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.38 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Aetna Commercial |
$331.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.18
|
| Rate for Payer: Cash Price |
$311.60
|
| Rate for Payer: Cofinity Commercial |
$272.65
|
| Rate for Payer: Cofinity Commercial |
$334.97
|
| Rate for Payer: Healthscope Commercial |
$350.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$331.08
|
| Rate for Payer: PHP Commercial |
$331.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.65
|
| Rate for Payer: Priority Health SBD |
$245.38
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
IP
|
$705.12
|
|
|
Service Code
|
NDC 0054-8183-25
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$444.23 |
| Max. Negotiated Rate |
$634.61 |
| Rate for Payer: Aetna Commercial |
$599.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$458.33
|
| Rate for Payer: Cash Price |
$564.10
|
| Rate for Payer: Cofinity Commercial |
$493.58
|
| Rate for Payer: Cofinity Commercial |
$606.40
|
| Rate for Payer: Healthscope Commercial |
$634.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$599.35
|
| Rate for Payer: PHP Commercial |
$599.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$493.58
|
| Rate for Payer: Priority Health SBD |
$444.23
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
IP
|
$10.97
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.91 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Aetna Commercial |
$9.32
|
| Rate for Payer: Aetna Commercial |
$54.47
|
| Rate for Payer: Aetna Commercial |
$15.28
|
| 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) |
$41.65
|
| Rate for Payer: Cash Price |
$14.38
|
| 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 |
$9.43
|
| Rate for Payer: Cofinity Commercial |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Cofinity Commercial |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| 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 Multiplan/Beech St/PHCS |
$9.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.47
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: PHP Commercial |
$54.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.86
|
| Rate for Payer: Priority Health SBD |
$11.33
|
| Rate for Payer: Priority Health SBD |
$40.37
|
| Rate for Payer: Priority Health SBD |
$6.91
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
OP
|
$16.21
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$14.59 |
| 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 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 |
$25.63
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: BCBS Complete |
$4.39
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$12.97
|
| Rate for Payer: Cash Price |
$12.97
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cofinity Commercial |
$13.94
|
| Rate for Payer: Cofinity Commercial |
$44.86
|
| Rate for Payer: Cofinity Commercial |
$11.35
|
| Rate for Payer: Cofinity Commercial |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$9.43
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Commercial |
$57.67
|
| Rate for Payer: Healthscope Commercial |
$14.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.32
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: PHP Commercial |
$13.78
|
| Rate for Payer: PHP Commercial |
$54.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.86
|
| 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
|
OP
|
$16.21
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2331
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$14.59 |
| 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 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: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: Cash Price |
$12.97
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$12.97
|
| 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 |
$11.35
|
| Rate for Payer: Cofinity Commercial |
$13.94
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Healthscope Commercial |
$57.67
|
| Rate for Payer: Healthscope Commercial |
$14.59
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.47
|
| Rate for Payer: PHP Commercial |
$54.47
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: PHP Commercial |
$13.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.35
|
| Rate for Payer: Priority Health SBD |
$6.91
|
| Rate for Payer: Priority Health SBD |
$40.37
|
| Rate for Payer: Priority Health SBD |
$10.21
|
|
|
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) |
$7.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.65
|
| 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 |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$9.43
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Commercial |
$57.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.47
|
| Rate for Payer: PHP Commercial |
$54.47
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.86
|
| Rate for Payer: Priority Health SBD |
$6.91
|
| Rate for Payer: Priority Health SBD |
$40.37
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML FOR IM INJECTION
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna Commercial |
$65.94
|
| Rate for Payer: Aetna Commercial |
$109.01
|
| Rate for Payer: Aetna Commercial |
$9.72
|
| Rate for Payer: Aetna Commercial |
$388.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.45
|
| Rate for Payer: BCBS Complete |
$31.03
|
| Rate for Payer: BCBS Complete |
$50.40
|
| Rate for Payer: BCBS Complete |
$183.05
|
| Rate for Payer: BCBS Complete |
$51.30
|
| Rate for Payer: BCBS Complete |
$4.57
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cofinity Commercial |
$54.31
|
| Rate for Payer: Cofinity Commercial |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$9.83
|
| Rate for Payer: Cofinity Commercial |
$108.36
|
| Rate for Payer: Cofinity Commercial |
$88.20
|
| Rate for Payer: Cofinity Commercial |
$110.30
|
| Rate for Payer: Cofinity Commercial |
$89.78
|
| Rate for Payer: Cofinity Commercial |
$320.33
|
| Rate for Payer: Cofinity Commercial |
$393.55
|
| Rate for Payer: Cofinity Commercial |
$66.72
|
| Rate for Payer: Healthscope Commercial |
$10.29
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Healthscope Commercial |
$411.86
|
| Rate for Payer: Healthscope Commercial |
$69.82
|
| Rate for Payer: Healthscope Commercial |
$113.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$388.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.94
|
| Rate for Payer: PHP Commercial |
$107.10
|
| Rate for Payer: PHP Commercial |
$388.98
|
| Rate for Payer: PHP Commercial |
$9.72
|
| Rate for Payer: PHP Commercial |
$109.01
|
| Rate for Payer: PHP Commercial |
$65.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.78
|
| Rate for Payer: Priority Health SBD |
$79.38
|
| Rate for Payer: Priority Health SBD |
$288.30
|
| Rate for Payer: Priority Health SBD |
$80.80
|
| Rate for Payer: Priority Health SBD |
$48.88
|
| Rate for Payer: Priority Health SBD |
$7.20
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML FOR IM INJECTION
|
Facility
|
IP
|
$128.25
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna Commercial |
$109.01
|
| Rate for Payer: Aetna Commercial |
$388.98
|
| Rate for Payer: Aetna Commercial |
$9.72
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.45
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cofinity Commercial |
$13.83
|
| Rate for Payer: Cofinity Commercial |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$9.83
|
| Rate for Payer: Cofinity Commercial |
$393.55
|
| Rate for Payer: Cofinity Commercial |
$320.33
|
| Rate for Payer: Cofinity Commercial |
$110.30
|
| Rate for Payer: Cofinity Commercial |
$89.78
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$10.29
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Healthscope Commercial |
$411.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$388.98
|
| Rate for Payer: PHP Commercial |
$9.72
|
| Rate for Payer: PHP Commercial |
$109.01
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$388.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.33
|
| Rate for Payer: Priority Health SBD |
$80.80
|
| Rate for Payer: Priority Health SBD |
$7.20
|
| Rate for Payer: Priority Health SBD |
$288.30
|
| Rate for Payer: Priority Health SBD |
$12.45
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$457.62
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2332
|
|
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 |
$9.72
|
| Rate for Payer: Aetna Commercial |
$109.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.45
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cofinity Commercial |
$13.83
|
| Rate for Payer: Cofinity Commercial |
$110.30
|
| Rate for Payer: Cofinity Commercial |
$89.78
|
| Rate for Payer: Cofinity Commercial |
$393.55
|
| Rate for Payer: Cofinity Commercial |
$9.83
|
| Rate for Payer: Cofinity Commercial |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$320.33
|
| Rate for Payer: Healthscope Commercial |
$411.86
|
| Rate for Payer: Healthscope Commercial |
$10.29
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$388.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.80
|
| Rate for Payer: PHP Commercial |
$109.01
|
| Rate for Payer: PHP Commercial |
$9.72
|
| Rate for Payer: PHP Commercial |
$388.98
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.78
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: Priority Health SBD |
$7.20
|
| Rate for Payer: Priority Health SBD |
$80.80
|
| Rate for Payer: Priority Health SBD |
$288.30
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$11.43
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$10.29 |
| Rate for Payer: Aetna Commercial |
$9.72
|
| Rate for Payer: Aetna Commercial |
$109.01
|
| Rate for Payer: Aetna Commercial |
$388.98
|
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna Commercial |
$65.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.45
|
| Rate for Payer: BCBS Complete |
$183.05
|
| Rate for Payer: BCBS Complete |
$50.40
|
| Rate for Payer: BCBS Complete |
$4.57
|
| Rate for Payer: BCBS Complete |
$31.03
|
| Rate for Payer: BCBS Complete |
$51.30
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cofinity Commercial |
$88.20
|
| Rate for Payer: Cofinity Commercial |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$9.83
|
| Rate for Payer: Cofinity Commercial |
$108.36
|
| Rate for Payer: Cofinity Commercial |
$110.30
|
| Rate for Payer: Cofinity Commercial |
$89.78
|
| Rate for Payer: Cofinity Commercial |
$320.33
|
| Rate for Payer: Cofinity Commercial |
$393.55
|
| Rate for Payer: Cofinity Commercial |
$54.31
|
| Rate for Payer: Cofinity Commercial |
$66.72
|
| Rate for Payer: Healthscope Commercial |
$113.40
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Healthscope Commercial |
$411.86
|
| Rate for Payer: Healthscope Commercial |
$69.82
|
| Rate for Payer: Healthscope Commercial |
$10.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$109.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$388.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.94
|
| Rate for Payer: PHP Commercial |
$65.94
|
| Rate for Payer: PHP Commercial |
$9.72
|
| Rate for Payer: PHP Commercial |
$109.01
|
| Rate for Payer: PHP Commercial |
$107.10
|
| Rate for Payer: PHP Commercial |
$388.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.78
|
| Rate for Payer: Priority Health SBD |
$7.20
|
| Rate for Payer: Priority Health SBD |
$288.30
|
| Rate for Payer: Priority Health SBD |
$79.38
|
| Rate for Payer: Priority Health SBD |
$80.80
|
| Rate for Payer: Priority Health SBD |
$48.88
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
IP
|
$19.83
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Aetna Commercial |
$16.86
|
| Rate for Payer: Aetna Commercial |
$23.35
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna Commercial |
$19.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.86
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cash Price |
$18.03
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$19.38
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$23.62
|
| Rate for Payer: Cofinity Commercial |
$19.23
|
| Rate for Payer: Cofinity Commercial |
$13.88
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Healthscope Commercial |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$20.29
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Healthscope Commercial |
$24.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.86
|
| Rate for Payer: PHP Commercial |
$23.35
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: PHP Commercial |
$16.86
|
| Rate for Payer: PHP Commercial |
$19.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.23
|
| Rate for Payer: Priority Health SBD |
$14.20
|
| Rate for Payer: Priority Health SBD |
$17.31
|
| Rate for Payer: Priority Health SBD |
$12.49
|
| Rate for Payer: Priority Health SBD |
$14.84
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
OP
|
$19.83
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Aetna Commercial |
$16.86
|
| Rate for Payer: Aetna Commercial |
$23.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.89
|
| Rate for Payer: BCBS Complete |
$10.99
|
| Rate for Payer: BCBS Complete |
$7.93
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cofinity Commercial |
$19.23
|
| Rate for Payer: Cofinity Commercial |
$13.88
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$23.62
|
| Rate for Payer: Healthscope Commercial |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$24.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.86
|
| Rate for Payer: PHP Commercial |
$23.35
|
| Rate for Payer: PHP Commercial |
$16.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.23
|
| Rate for Payer: Priority Health SBD |
$12.49
|
| Rate for Payer: Priority Health SBD |
$17.31
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$22.54
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
116809
|
|
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 |
$23.35
|
| Rate for Payer: Aetna Commercial |
$16.86
|
| Rate for Payer: Aetna Commercial |
$16.94
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.86
|
| Rate for Payer: Cash Price |
$15.94
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cash Price |
$18.03
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cofinity Commercial |
$19.38
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$13.95
|
| Rate for Payer: Cofinity Commercial |
$17.14
|
| Rate for Payer: Cofinity Commercial |
$23.62
|
| Rate for Payer: Cofinity Commercial |
$19.23
|
| Rate for Payer: Cofinity Commercial |
$13.88
|
| Rate for Payer: Cofinity Commercial |
$15.78
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Healthscope Commercial |
$24.72
|
| Rate for Payer: Healthscope Commercial |
$17.94
|
| Rate for Payer: Healthscope Commercial |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$20.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.86
|
| Rate for Payer: PHP Commercial |
$16.94
|
| Rate for Payer: PHP Commercial |
$16.86
|
| Rate for Payer: PHP Commercial |
$19.16
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: PHP Commercial |
$23.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.95
|
| Rate for Payer: Priority Health SBD |
$14.84
|
| Rate for Payer: Priority Health SBD |
$14.20
|
| Rate for Payer: Priority Health SBD |
$12.56
|
| Rate for Payer: Priority Health SBD |
$12.49
|
| Rate for Payer: Priority Health SBD |
$17.31
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$19.83
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
116809
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Aetna Commercial |
$16.86
|
| Rate for Payer: Aetna Commercial |
$23.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.89
|
| Rate for Payer: BCBS Complete |
$10.99
|
| Rate for Payer: BCBS Complete |
$7.93
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: BCBS Trust/PPO |
$0.35
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cofinity Commercial |
$19.23
|
| Rate for Payer: Cofinity Commercial |
$13.88
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$23.62
|
| Rate for Payer: Healthscope Commercial |
$24.72
|
| Rate for Payer: Healthscope Commercial |
$17.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.86
|
| Rate for Payer: PHP Commercial |
$16.86
|
| Rate for Payer: PHP Commercial |
$23.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.23
|
| Rate for Payer: Priority Health SBD |
$17.31
|
| Rate for Payer: Priority Health SBD |
$12.49
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$63.07
|
|
|
Service Code
|
NDC 16729-239-30
|
| 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: Healthscope Commercial |
$56.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.61
|
| Rate for Payer: PHP Commercial |
$53.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.15
|
| Rate for Payer: Priority Health SBD |
$39.73
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$63.07
|
|
|
Service Code
|
NDC 55150-209-02
|
| 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: Healthscope Commercial |
$56.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.61
|
| Rate for Payer: PHP Commercial |
$53.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.15
|
| Rate for Payer: Priority Health SBD |
$39.73
|
|
