|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
OP
|
$5.54
|
|
|
Service Code
|
NDC 63323050601
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.99 |
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Aetna Medicare |
$1.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.73
|
| Rate for Payer: BCBS Complete |
$2.22
|
| Rate for Payer: BCBS MAPPO |
$1.38
|
| Rate for Payer: BCBS Trust/PPO |
$4.55
|
| Rate for Payer: BCN Commercial |
$4.31
|
| Rate for Payer: BCN Medicare Advantage |
$1.38
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.38
|
| Rate for Payer: Healthscope Commercial |
$4.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.71
|
| Rate for Payer: Nomi Health Commercial |
$4.54
|
| Rate for Payer: PACE Senior Care Partners |
$1.32
|
| Rate for Payer: PACE SWMI |
$1.38
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: PHP Medicare Advantage |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.60
|
| Rate for Payer: Priority Health HMO/PPO |
$4.82
|
| Rate for Payer: Priority Health Medicare |
$1.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.71
|
| Rate for Payer: Railroad Medicare Medicare |
$1.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.88
|
| Rate for Payer: UHC Core |
$4.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.38
|
| Rate for Payer: UHC Exchange |
$1.38
|
| Rate for Payer: UHC Medicare Advantage |
$1.38
|
| Rate for Payer: VA VA |
$1.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.16
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
IP
|
$7.13
|
|
|
Service Code
|
NDC 70069002125
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$6.42 |
| Rate for Payer: Aetna Commercial |
$6.06
|
| Rate for Payer: BCBS Trust/PPO |
$5.82
|
| Rate for Payer: BCN Commercial |
$5.51
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cofinity Commercial |
$6.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.70
|
| Rate for Payer: Healthscope Commercial |
$6.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.06
|
| Rate for Payer: Nomi Health Commercial |
$5.85
|
| Rate for Payer: PHP Commercial |
$6.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.63
|
| Rate for Payer: Priority Health HMO/PPO |
$6.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.27
|
| Rate for Payer: UHC Core |
$5.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.35
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
OP
|
$3.74
|
|
|
Service Code
|
NDC 09900000170
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: Aetna Medicare |
$0.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.17
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.17
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: BCBS MAPPO |
$0.94
|
| Rate for Payer: BCBS Trust/PPO |
$3.07
|
| Rate for Payer: BCN Commercial |
$2.91
|
| Rate for Payer: BCN Medicare Advantage |
$0.94
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.94
|
| Rate for Payer: Healthscope Commercial |
$3.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: Nomi Health Commercial |
$3.07
|
| Rate for Payer: PACE Senior Care Partners |
$0.89
|
| Rate for Payer: PACE SWMI |
$0.94
|
| Rate for Payer: PHP Commercial |
$3.18
|
| Rate for Payer: PHP Medicare Advantage |
$0.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.43
|
| Rate for Payer: Priority Health HMO/PPO |
$3.25
|
| Rate for Payer: Priority Health Medicare |
$0.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.51
|
| Rate for Payer: Railroad Medicare Medicare |
$0.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.29
|
| Rate for Payer: UHC Core |
$3.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.94
|
| Rate for Payer: UHC Exchange |
$0.94
|
| Rate for Payer: UHC Medicare Advantage |
$0.94
|
| Rate for Payer: VA VA |
$0.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.80
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
IP
|
$5.54
|
|
|
Service Code
|
NDC 63323050601
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$4.99 |
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: BCBS Trust/PPO |
$4.52
|
| Rate for Payer: BCN Commercial |
$4.28
|
| Rate for Payer: Cash Price |
$4.43
|
| Rate for Payer: Cofinity Commercial |
$4.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.43
|
| Rate for Payer: Healthscope Commercial |
$4.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.71
|
| Rate for Payer: Nomi Health Commercial |
$4.54
|
| Rate for Payer: PHP Commercial |
$4.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.60
|
| Rate for Payer: Priority Health HMO/PPO |
$4.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.88
|
| Rate for Payer: UHC Core |
$4.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.16
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
IP
|
$3.74
|
|
|
Service Code
|
NDC 09900000170
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: BCBS Trust/PPO |
$3.05
|
| Rate for Payer: BCN Commercial |
$2.89
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: Nomi Health Commercial |
$3.07
|
| Rate for Payer: PHP Commercial |
$3.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.43
|
| Rate for Payer: Priority Health HMO/PPO |
$3.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.29
|
| Rate for Payer: UHC Core |
$3.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.80
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
OP
|
$7.13
|
|
|
Service Code
|
NDC 70069002125
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$6.42 |
| Rate for Payer: Aetna Commercial |
$6.06
|
| Rate for Payer: Aetna Medicare |
$1.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.23
|
| Rate for Payer: BCBS Complete |
$2.85
|
| Rate for Payer: BCBS MAPPO |
$1.78
|
| Rate for Payer: BCBS Trust/PPO |
$5.86
|
| Rate for Payer: BCN Commercial |
$5.54
|
| Rate for Payer: BCN Medicare Advantage |
$1.78
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cofinity Commercial |
$6.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.78
|
| Rate for Payer: Healthscope Commercial |
$6.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.06
|
| Rate for Payer: Nomi Health Commercial |
$5.85
|
| Rate for Payer: PACE Senior Care Partners |
$1.69
|
| Rate for Payer: PACE SWMI |
$1.78
|
| Rate for Payer: PHP Commercial |
$6.06
|
| Rate for Payer: PHP Medicare Advantage |
$1.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.63
|
| Rate for Payer: Priority Health HMO/PPO |
$6.20
|
| Rate for Payer: Priority Health Medicare |
$1.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.78
|
| Rate for Payer: Railroad Medicare Medicare |
$1.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.27
|
| Rate for Payer: UHC Core |
$5.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.78
|
| Rate for Payer: UHC Exchange |
$1.78
|
| Rate for Payer: UHC Medicare Advantage |
$1.78
|
| Rate for Payer: VA VA |
$1.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.35
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$467.52
|
|
|
Service Code
|
NDC 00054817525
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$111.04 |
| Max. Negotiated Rate |
$420.77 |
| Rate for Payer: Aetna Commercial |
$397.39
|
| Rate for Payer: Aetna Medicare |
$121.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.10
|
| Rate for Payer: BCBS Complete |
$187.01
|
| Rate for Payer: BCBS MAPPO |
$116.88
|
| Rate for Payer: BCBS Trust/PPO |
$384.35
|
| Rate for Payer: BCN Commercial |
$363.50
|
| Rate for Payer: BCN Medicare Advantage |
$116.88
|
| Rate for Payer: Cash Price |
$374.02
|
| Rate for Payer: Cofinity Commercial |
$402.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.88
|
| Rate for Payer: Healthscope Commercial |
$420.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$134.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.39
|
| Rate for Payer: Nomi Health Commercial |
$383.37
|
| Rate for Payer: PACE Senior Care Partners |
$111.04
|
| Rate for Payer: PACE SWMI |
$116.88
|
| Rate for Payer: PHP Commercial |
$397.39
|
| Rate for Payer: PHP Medicare Advantage |
$116.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.89
|
| Rate for Payer: Priority Health HMO/PPO |
$406.74
|
| Rate for Payer: Priority Health Medicare |
$118.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$313.24
|
| Rate for Payer: Railroad Medicare Medicare |
$116.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.42
|
| Rate for Payer: UHC Core |
$390.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.88
|
| Rate for Payer: UHC Exchange |
$116.88
|
| Rate for Payer: UHC Medicare Advantage |
$116.88
|
| Rate for Payer: VA VA |
$116.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.64
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$467.52
|
|
|
Service Code
|
NDC 00054817525
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$303.89 |
| Max. Negotiated Rate |
$420.77 |
| Rate for Payer: Aetna Commercial |
$397.39
|
| Rate for Payer: BCBS Trust/PPO |
$381.64
|
| Rate for Payer: BCN Commercial |
$361.30
|
| Rate for Payer: Cash Price |
$374.02
|
| Rate for Payer: Cofinity Commercial |
$402.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.02
|
| Rate for Payer: Healthscope Commercial |
$420.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.39
|
| Rate for Payer: Nomi Health Commercial |
$383.37
|
| Rate for Payer: PHP Commercial |
$397.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.89
|
| Rate for Payer: Priority Health HMO/PPO |
$406.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$313.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$411.42
|
| Rate for Payer: UHC Core |
$390.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.64
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
IP
|
$663.84
|
|
|
Service Code
|
NDC 00054418625
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$431.50 |
| Max. Negotiated Rate |
$597.46 |
| Rate for Payer: Aetna Commercial |
$564.26
|
| Rate for Payer: BCBS Trust/PPO |
$541.89
|
| Rate for Payer: BCN Commercial |
$513.02
|
| Rate for Payer: Cash Price |
$531.07
|
| Rate for Payer: Cofinity Commercial |
$570.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$531.07
|
| Rate for Payer: Healthscope Commercial |
$597.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$497.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$564.26
|
| Rate for Payer: Nomi Health Commercial |
$544.35
|
| Rate for Payer: PHP Commercial |
$564.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.50
|
| Rate for Payer: Priority Health HMO/PPO |
$577.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$444.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$584.18
|
| Rate for Payer: UHC Core |
$554.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$497.88
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
OP
|
$735.84
|
|
|
Service Code
|
NDC 00054818325
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.76 |
| Max. Negotiated Rate |
$662.26 |
| Rate for Payer: Aetna Commercial |
$625.46
|
| Rate for Payer: Aetna Medicare |
$191.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$229.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$229.95
|
| Rate for Payer: BCBS Complete |
$294.34
|
| Rate for Payer: BCBS MAPPO |
$183.96
|
| Rate for Payer: BCBS Trust/PPO |
$604.93
|
| Rate for Payer: BCN Commercial |
$572.12
|
| Rate for Payer: BCN Medicare Advantage |
$183.96
|
| Rate for Payer: Cash Price |
$588.67
|
| Rate for Payer: Cofinity Commercial |
$632.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.96
|
| Rate for Payer: Healthscope Commercial |
$662.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$193.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$211.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.46
|
| Rate for Payer: Nomi Health Commercial |
$603.39
|
| Rate for Payer: PACE Senior Care Partners |
$174.76
|
| Rate for Payer: PACE SWMI |
$183.96
|
| Rate for Payer: PHP Commercial |
$625.46
|
| Rate for Payer: PHP Medicare Advantage |
$183.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.30
|
| Rate for Payer: Priority Health HMO/PPO |
$640.18
|
| Rate for Payer: Priority Health Medicare |
$185.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$493.01
|
| Rate for Payer: Railroad Medicare Medicare |
$183.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.54
|
| Rate for Payer: UHC Core |
$614.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.96
|
| Rate for Payer: UHC Exchange |
$183.96
|
| Rate for Payer: UHC Medicare Advantage |
$183.96
|
| Rate for Payer: VA VA |
$183.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.88
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
OP
|
$663.84
|
|
|
Service Code
|
NDC 00054418625
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.66 |
| Max. Negotiated Rate |
$597.46 |
| Rate for Payer: Aetna Commercial |
$564.26
|
| Rate for Payer: Aetna Medicare |
$172.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$207.45
|
| Rate for Payer: Amish Plain Church Group Commercial |
$207.45
|
| Rate for Payer: BCBS Complete |
$265.54
|
| Rate for Payer: BCBS MAPPO |
$165.96
|
| Rate for Payer: BCBS Trust/PPO |
$545.74
|
| Rate for Payer: BCN Commercial |
$516.14
|
| Rate for Payer: BCN Medicare Advantage |
$165.96
|
| Rate for Payer: Cash Price |
$531.07
|
| Rate for Payer: Cofinity Commercial |
$570.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$531.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.96
|
| Rate for Payer: Healthscope Commercial |
$597.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$497.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$174.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$190.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$564.26
|
| Rate for Payer: Nomi Health Commercial |
$544.35
|
| Rate for Payer: PACE Senior Care Partners |
$157.66
|
| Rate for Payer: PACE SWMI |
$165.96
|
| Rate for Payer: PHP Commercial |
$564.26
|
| Rate for Payer: PHP Medicare Advantage |
$165.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.50
|
| Rate for Payer: Priority Health HMO/PPO |
$577.54
|
| Rate for Payer: Priority Health Medicare |
$167.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$444.77
|
| Rate for Payer: Railroad Medicare Medicare |
$165.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$584.18
|
| Rate for Payer: UHC Core |
$554.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.96
|
| Rate for Payer: UHC Exchange |
$165.96
|
| Rate for Payer: UHC Medicare Advantage |
$165.96
|
| Rate for Payer: VA VA |
$165.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$497.88
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
IP
|
$735.84
|
|
|
Service Code
|
NDC 00054818325
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$478.30 |
| Max. Negotiated Rate |
$662.26 |
| Rate for Payer: Aetna Commercial |
$625.46
|
| Rate for Payer: BCBS Trust/PPO |
$600.67
|
| Rate for Payer: BCN Commercial |
$568.66
|
| Rate for Payer: Cash Price |
$588.67
|
| Rate for Payer: Cofinity Commercial |
$632.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.67
|
| Rate for Payer: Healthscope Commercial |
$662.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.46
|
| Rate for Payer: Nomi Health Commercial |
$603.39
|
| Rate for Payer: PHP Commercial |
$625.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.30
|
| Rate for Payer: Priority Health HMO/PPO |
$640.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$493.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$647.54
|
| Rate for Payer: UHC Core |
$614.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.88
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
OP
|
$10.97
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Aetna Commercial |
$9.32
|
| Rate for Payer: Aetna Commercial |
$54.47
|
| Rate for Payer: Aetna Commercial |
$15.66
|
| Rate for Payer: Aetna Medicare |
$16.66
|
| Rate for Payer: Aetna Medicare |
$2.85
|
| Rate for Payer: Aetna Medicare |
$4.79
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20.02
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS Complete |
$4.39
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS MAPPO |
$16.02
|
| Rate for Payer: BCBS MAPPO |
$2.74
|
| Rate for Payer: BCBS MAPPO |
$4.60
|
| Rate for Payer: BCBS Trust/PPO |
$15.14
|
| Rate for Payer: BCBS Trust/PPO |
$9.02
|
| Rate for Payer: BCBS Trust/PPO |
$52.68
|
| Rate for Payer: BCN Commercial |
$14.32
|
| Rate for Payer: BCN Commercial |
$49.82
|
| Rate for Payer: BCN Commercial |
$8.53
|
| Rate for Payer: BCN Medicare Advantage |
$2.74
|
| Rate for Payer: BCN Medicare Advantage |
$4.60
|
| Rate for Payer: BCN Medicare Advantage |
$16.02
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Cofinity Commercial |
$9.43
|
| Rate for Payer: Cofinity Commercial |
$15.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.74
|
| Rate for Payer: Healthscope Commercial |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Commercial |
$57.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.32
|
| Rate for Payer: Nomi Health Commercial |
$52.55
|
| Rate for Payer: Nomi Health Commercial |
$9.00
|
| Rate for Payer: Nomi Health Commercial |
$15.10
|
| Rate for Payer: PACE Senior Care Partners |
$15.22
|
| Rate for Payer: PACE Senior Care Partners |
$2.61
|
| Rate for Payer: PACE Senior Care Partners |
$4.37
|
| Rate for Payer: PACE SWMI |
$4.60
|
| Rate for Payer: PACE SWMI |
$2.74
|
| Rate for Payer: PACE SWMI |
$16.02
|
| Rate for Payer: PHP Commercial |
$54.47
|
| Rate for Payer: PHP Commercial |
$15.66
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: PHP Medicare Advantage |
$4.60
|
| Rate for Payer: PHP Medicare Advantage |
$16.02
|
| Rate for Payer: PHP Medicare Advantage |
$2.74
|
| 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 Cigna Priority Health |
$11.97
|
| Rate for Payer: Priority Health HMO/PPO |
$55.75
|
| Rate for Payer: Priority Health HMO/PPO |
$9.54
|
| Rate for Payer: Priority Health HMO/PPO |
$16.03
|
| Rate for Payer: Priority Health Medicare |
$2.77
|
| Rate for Payer: Priority Health Medicare |
$16.18
|
| Rate for Payer: Priority Health Medicare |
$4.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.35
|
| Rate for Payer: Railroad Medicare Medicare |
$4.60
|
| Rate for Payer: Railroad Medicare Medicare |
$16.02
|
| Rate for Payer: Railroad Medicare Medicare |
$2.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.65
|
| Rate for Payer: UHC Core |
$53.51
|
| Rate for Payer: UHC Core |
$15.38
|
| Rate for Payer: UHC Core |
$9.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.60
|
| Rate for Payer: UHC Exchange |
$4.60
|
| Rate for Payer: UHC Exchange |
$2.74
|
| Rate for Payer: UHC Exchange |
$16.02
|
| Rate for Payer: UHC Medicare Advantage |
$2.74
|
| Rate for Payer: UHC Medicare Advantage |
$4.60
|
| Rate for Payer: UHC Medicare Advantage |
$16.02
|
| Rate for Payer: VA VA |
$4.60
|
| Rate for Payer: VA VA |
$16.02
|
| Rate for Payer: VA VA |
$2.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.82
|
|
|
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 |
$7.13 |
| Max. Negotiated Rate |
$9.87 |
| Rate for Payer: Aetna Commercial |
$9.32
|
| Rate for Payer: Aetna Commercial |
$15.66
|
| Rate for Payer: Aetna Commercial |
$54.47
|
| Rate for Payer: BCBS Trust/PPO |
$15.04
|
| Rate for Payer: BCBS Trust/PPO |
$8.95
|
| Rate for Payer: BCBS Trust/PPO |
$52.31
|
| Rate for Payer: BCN Commercial |
$14.23
|
| Rate for Payer: BCN Commercial |
$8.48
|
| Rate for Payer: BCN Commercial |
$49.52
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Cofinity Commercial |
$15.84
|
| Rate for Payer: Cofinity Commercial |
$9.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| 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 |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Commercial |
$57.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.47
|
| Rate for Payer: Nomi Health Commercial |
$9.00
|
| Rate for Payer: Nomi Health Commercial |
$15.10
|
| Rate for Payer: Nomi Health Commercial |
$52.55
|
| Rate for Payer: PHP Commercial |
$15.66
|
| Rate for Payer: PHP Commercial |
$9.32
|
| 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 |
$41.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.97
|
| Rate for Payer: Priority Health HMO/PPO |
$55.75
|
| Rate for Payer: Priority Health HMO/PPO |
$16.03
|
| Rate for Payer: Priority Health HMO/PPO |
$9.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.65
|
| Rate for Payer: UHC Core |
$9.16
|
| Rate for Payer: UHC Core |
$53.51
|
| Rate for Payer: UHC Core |
$15.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.82
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML FOR IM INJECTION
|
Facility
|
OP
|
$11.30
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$10.17 |
| Rate for Payer: Aetna Commercial |
$9.60
|
| Rate for Payer: Aetna Medicare |
$2.94
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.53
|
| Rate for Payer: BCBS Complete |
$4.52
|
| Rate for Payer: BCBS MAPPO |
$2.82
|
| Rate for Payer: BCBS Trust/PPO |
$9.29
|
| Rate for Payer: BCN Commercial |
$8.79
|
| Rate for Payer: BCN Medicare Advantage |
$2.82
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.82
|
| Rate for Payer: Healthscope Commercial |
$10.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.60
|
| Rate for Payer: Nomi Health Commercial |
$9.27
|
| Rate for Payer: PACE Senior Care Partners |
$2.68
|
| Rate for Payer: PACE SWMI |
$2.82
|
| Rate for Payer: PHP Commercial |
$9.60
|
| Rate for Payer: PHP Medicare Advantage |
$2.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.34
|
| Rate for Payer: Priority Health HMO/PPO |
$9.83
|
| Rate for Payer: Priority Health Medicare |
$2.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.57
|
| Rate for Payer: Railroad Medicare Medicare |
$2.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.94
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.82
|
| Rate for Payer: UHC Exchange |
$2.82
|
| Rate for Payer: UHC Medicare Advantage |
$2.82
|
| Rate for Payer: VA VA |
$2.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.48
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML FOR IM INJECTION
|
Facility
|
IP
|
$11.30
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$10.17 |
| Rate for Payer: Aetna Commercial |
$9.60
|
| Rate for Payer: BCBS Trust/PPO |
$9.22
|
| Rate for Payer: BCN Commercial |
$8.73
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.04
|
| Rate for Payer: Healthscope Commercial |
$10.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.60
|
| Rate for Payer: Nomi Health Commercial |
$9.27
|
| Rate for Payer: PHP Commercial |
$9.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.34
|
| Rate for Payer: Priority Health HMO/PPO |
$9.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.94
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.48
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$19.76
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.84 |
| Max. Negotiated Rate |
$17.78 |
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Commercial |
$9.99
|
| Rate for Payer: Aetna Commercial |
$9.60
|
| Rate for Payer: Aetna Commercial |
$388.98
|
| Rate for Payer: BCBS Trust/PPO |
$16.13
|
| Rate for Payer: BCBS Trust/PPO |
$373.56
|
| Rate for Payer: BCBS Trust/PPO |
$9.59
|
| Rate for Payer: BCBS Trust/PPO |
$9.22
|
| Rate for Payer: BCN Commercial |
$15.27
|
| Rate for Payer: BCN Commercial |
$8.73
|
| Rate for Payer: BCN Commercial |
$353.65
|
| Rate for Payer: BCN Commercial |
$9.08
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Cofinity Commercial |
$393.55
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$10.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.10
|
| Rate for Payer: Healthscope Commercial |
$411.86
|
| Rate for Payer: Healthscope Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$10.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.98
|
| Rate for Payer: Nomi Health Commercial |
$9.27
|
| Rate for Payer: Nomi Health Commercial |
$9.64
|
| Rate for Payer: Nomi Health Commercial |
$375.25
|
| Rate for Payer: Nomi Health Commercial |
$16.20
|
| Rate for Payer: PHP Commercial |
$9.99
|
| Rate for Payer: PHP Commercial |
$9.60
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$388.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.84
|
| Rate for Payer: Priority Health HMO/PPO |
$17.19
|
| Rate for Payer: Priority Health HMO/PPO |
$398.13
|
| Rate for Payer: Priority Health HMO/PPO |
$9.83
|
| Rate for Payer: Priority Health HMO/PPO |
$10.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$306.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$402.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.39
|
| Rate for Payer: UHC Core |
$16.50
|
| Rate for Payer: UHC Core |
$382.11
|
| Rate for Payer: UHC Core |
$9.81
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.82
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$11.30
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$10.17 |
| Rate for Payer: Aetna Commercial |
$9.60
|
| Rate for Payer: Aetna Commercial |
$388.98
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Commercial |
$9.99
|
| Rate for Payer: Aetna Medicare |
$3.06
|
| Rate for Payer: Aetna Medicare |
$2.94
|
| Rate for Payer: Aetna Medicare |
$5.14
|
| Rate for Payer: Aetna Medicare |
$118.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.53
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$143.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$143.01
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.18
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.53
|
| Rate for Payer: BCBS Complete |
$4.52
|
| Rate for Payer: BCBS Complete |
$4.70
|
| Rate for Payer: BCBS Complete |
$183.05
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: BCBS MAPPO |
$2.82
|
| Rate for Payer: BCBS MAPPO |
$2.94
|
| Rate for Payer: BCBS MAPPO |
$114.40
|
| Rate for Payer: BCBS MAPPO |
$4.94
|
| Rate for Payer: BCBS Trust/PPO |
$9.29
|
| Rate for Payer: BCBS Trust/PPO |
$376.21
|
| Rate for Payer: BCBS Trust/PPO |
$9.66
|
| Rate for Payer: BCBS Trust/PPO |
$16.24
|
| Rate for Payer: BCN Commercial |
$8.79
|
| Rate for Payer: BCN Commercial |
$15.36
|
| Rate for Payer: BCN Commercial |
$9.14
|
| Rate for Payer: BCN Commercial |
$355.80
|
| Rate for Payer: BCN Medicare Advantage |
$2.94
|
| Rate for Payer: BCN Medicare Advantage |
$114.40
|
| Rate for Payer: BCN Medicare Advantage |
$2.82
|
| Rate for Payer: BCN Medicare Advantage |
$4.94
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cofinity Commercial |
$393.55
|
| Rate for Payer: Cofinity Commercial |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.94
|
| Rate for Payer: Healthscope Commercial |
$10.17
|
| Rate for Payer: Healthscope Commercial |
$411.86
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$10.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Nomi Health Commercial |
$16.20
|
| Rate for Payer: Nomi Health Commercial |
$375.25
|
| Rate for Payer: Nomi Health Commercial |
$9.27
|
| Rate for Payer: Nomi Health Commercial |
$9.64
|
| Rate for Payer: PACE Senior Care Partners |
$2.68
|
| Rate for Payer: PACE Senior Care Partners |
$4.69
|
| Rate for Payer: PACE Senior Care Partners |
$108.68
|
| Rate for Payer: PACE Senior Care Partners |
$2.79
|
| Rate for Payer: PACE SWMI |
$2.94
|
| Rate for Payer: PACE SWMI |
$2.82
|
| Rate for Payer: PACE SWMI |
$4.94
|
| Rate for Payer: PACE SWMI |
$114.40
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$388.98
|
| Rate for Payer: PHP Commercial |
$9.99
|
| Rate for Payer: PHP Commercial |
$9.60
|
| Rate for Payer: PHP Medicare Advantage |
$2.94
|
| Rate for Payer: PHP Medicare Advantage |
$2.82
|
| Rate for Payer: PHP Medicare Advantage |
$114.40
|
| Rate for Payer: PHP Medicare Advantage |
$4.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.34
|
| Rate for Payer: Priority Health HMO/PPO |
$10.22
|
| Rate for Payer: Priority Health HMO/PPO |
$398.13
|
| Rate for Payer: Priority Health HMO/PPO |
$17.19
|
| Rate for Payer: Priority Health HMO/PPO |
$9.83
|
| Rate for Payer: Priority Health Medicare |
$4.99
|
| Rate for Payer: Priority Health Medicare |
$2.85
|
| Rate for Payer: Priority Health Medicare |
$2.97
|
| Rate for Payer: Priority Health Medicare |
$115.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$306.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.57
|
| Rate for Payer: Railroad Medicare Medicare |
$2.94
|
| Rate for Payer: Railroad Medicare Medicare |
$4.94
|
| Rate for Payer: Railroad Medicare Medicare |
$2.82
|
| Rate for Payer: Railroad Medicare Medicare |
$114.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$402.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.34
|
| Rate for Payer: UHC Core |
$9.44
|
| Rate for Payer: UHC Core |
$382.11
|
| Rate for Payer: UHC Core |
$9.81
|
| Rate for Payer: UHC Core |
$16.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$114.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.94
|
| Rate for Payer: UHC Exchange |
$114.40
|
| Rate for Payer: UHC Exchange |
$2.94
|
| Rate for Payer: UHC Exchange |
$2.82
|
| Rate for Payer: UHC Exchange |
$4.94
|
| Rate for Payer: UHC Medicare Advantage |
$114.40
|
| Rate for Payer: UHC Medicare Advantage |
$2.82
|
| Rate for Payer: UHC Medicare Advantage |
$4.94
|
| Rate for Payer: UHC Medicare Advantage |
$2.94
|
| Rate for Payer: VA VA |
$2.94
|
| Rate for Payer: VA VA |
$114.40
|
| Rate for Payer: VA VA |
$4.94
|
| Rate for Payer: VA VA |
$2.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.82
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
OP
|
$21.52
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$19.37 |
| Rate for Payer: Aetna Commercial |
$18.29
|
| Rate for Payer: Aetna Commercial |
$14.21
|
| Rate for Payer: Aetna Medicare |
$5.60
|
| Rate for Payer: Aetna Medicare |
$4.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.22
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS MAPPO |
$4.18
|
| Rate for Payer: BCBS MAPPO |
$5.38
|
| Rate for Payer: BCBS Trust/PPO |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$13.75
|
| Rate for Payer: BCN Commercial |
$16.73
|
| Rate for Payer: BCN Commercial |
$13.00
|
| Rate for Payer: BCN Medicare Advantage |
$5.38
|
| Rate for Payer: BCN Medicare Advantage |
$4.18
|
| Rate for Payer: Cash Price |
$17.22
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$18.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.38
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$19.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.21
|
| Rate for Payer: Nomi Health Commercial |
$17.65
|
| Rate for Payer: Nomi Health Commercial |
$13.71
|
| Rate for Payer: PACE Senior Care Partners |
$5.11
|
| Rate for Payer: PACE Senior Care Partners |
$3.97
|
| Rate for Payer: PACE SWMI |
$5.38
|
| Rate for Payer: PACE SWMI |
$4.18
|
| Rate for Payer: PHP Commercial |
$18.29
|
| Rate for Payer: PHP Commercial |
$14.21
|
| Rate for Payer: PHP Medicare Advantage |
$4.18
|
| Rate for Payer: PHP Medicare Advantage |
$5.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.87
|
| Rate for Payer: Priority Health HMO/PPO |
$14.55
|
| Rate for Payer: Priority Health HMO/PPO |
$18.72
|
| Rate for Payer: Priority Health Medicare |
$5.43
|
| Rate for Payer: Priority Health Medicare |
$4.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.20
|
| Rate for Payer: Railroad Medicare Medicare |
$4.18
|
| Rate for Payer: Railroad Medicare Medicare |
$5.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.94
|
| Rate for Payer: UHC Core |
$17.97
|
| Rate for Payer: UHC Core |
$13.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.18
|
| Rate for Payer: UHC Exchange |
$4.18
|
| Rate for Payer: UHC Exchange |
$5.38
|
| Rate for Payer: UHC Medicare Advantage |
$4.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: VA VA |
$4.18
|
| Rate for Payer: VA VA |
$5.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.54
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
IP
|
$16.72
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna Commercial |
$14.21
|
| Rate for Payer: Aetna Commercial |
$18.29
|
| Rate for Payer: BCBS Trust/PPO |
$13.65
|
| Rate for Payer: BCBS Trust/PPO |
$17.57
|
| Rate for Payer: BCN Commercial |
$12.92
|
| Rate for Payer: BCN Commercial |
$16.63
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cash Price |
$17.22
|
| Rate for Payer: Cofinity Commercial |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$19.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.29
|
| Rate for Payer: Nomi Health Commercial |
$13.71
|
| Rate for Payer: Nomi Health Commercial |
$17.65
|
| Rate for Payer: PHP Commercial |
$14.21
|
| Rate for Payer: PHP Commercial |
$18.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.87
|
| Rate for Payer: Priority Health HMO/PPO |
$18.72
|
| Rate for Payer: Priority Health HMO/PPO |
$14.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.94
|
| Rate for Payer: UHC Core |
$13.96
|
| Rate for Payer: UHC Core |
$17.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.14
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$16.72
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
116809
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna Commercial |
$14.21
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna Commercial |
$18.29
|
| Rate for Payer: Aetna Medicare |
$6.12
|
| Rate for Payer: Aetna Medicare |
$4.35
|
| Rate for Payer: Aetna Medicare |
$5.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.36
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$5.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$5.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.36
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS Complete |
$9.42
|
| Rate for Payer: BCBS MAPPO |
$5.89
|
| Rate for Payer: BCBS MAPPO |
$4.18
|
| Rate for Payer: BCBS MAPPO |
$5.38
|
| Rate for Payer: BCBS Trust/PPO |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$13.75
|
| Rate for Payer: BCBS Trust/PPO |
$19.36
|
| Rate for Payer: BCN Commercial |
$16.73
|
| Rate for Payer: BCN Commercial |
$18.31
|
| Rate for Payer: BCN Commercial |
$13.00
|
| Rate for Payer: BCN Medicare Advantage |
$4.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.38
|
| Rate for Payer: BCN Medicare Advantage |
$5.89
|
| Rate for Payer: Cash Price |
$17.22
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$18.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.18
|
| Rate for Payer: Healthscope Commercial |
$19.37
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.77
|
| 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: Nomi Health Commercial |
$19.31
|
| Rate for Payer: Nomi Health Commercial |
$13.71
|
| Rate for Payer: Nomi Health Commercial |
$17.65
|
| Rate for Payer: PACE Senior Care Partners |
$5.59
|
| Rate for Payer: PACE Senior Care Partners |
$3.97
|
| Rate for Payer: PACE Senior Care Partners |
$5.11
|
| Rate for Payer: PACE SWMI |
$5.38
|
| Rate for Payer: PACE SWMI |
$4.18
|
| Rate for Payer: PACE SWMI |
$5.89
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: PHP Commercial |
$18.29
|
| Rate for Payer: PHP Commercial |
$14.21
|
| Rate for Payer: PHP Medicare Advantage |
$5.38
|
| Rate for Payer: PHP Medicare Advantage |
$5.89
|
| Rate for Payer: PHP Medicare Advantage |
$4.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.99
|
| Rate for Payer: Priority Health HMO/PPO |
$20.49
|
| Rate for Payer: Priority Health HMO/PPO |
$14.55
|
| Rate for Payer: Priority Health HMO/PPO |
$18.72
|
| Rate for Payer: Priority Health Medicare |
$4.22
|
| Rate for Payer: Priority Health Medicare |
$5.95
|
| Rate for Payer: Priority Health Medicare |
$5.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.20
|
| Rate for Payer: Railroad Medicare Medicare |
$5.38
|
| Rate for Payer: Railroad Medicare Medicare |
$5.89
|
| Rate for Payer: Railroad Medicare Medicare |
$4.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.71
|
| Rate for Payer: UHC Core |
$19.66
|
| Rate for Payer: UHC Core |
$17.97
|
| Rate for Payer: UHC Core |
$13.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.38
|
| Rate for Payer: UHC Exchange |
$5.38
|
| Rate for Payer: UHC Exchange |
$4.18
|
| Rate for Payer: UHC Exchange |
$5.89
|
| Rate for Payer: UHC Medicare Advantage |
$4.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.38
|
| Rate for Payer: UHC Medicare Advantage |
$5.89
|
| Rate for Payer: VA VA |
$5.38
|
| Rate for Payer: VA VA |
$5.89
|
| Rate for Payer: VA VA |
$4.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.14
|
|
|
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 |
$10.87 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna Commercial |
$14.21
|
| Rate for Payer: Aetna Commercial |
$18.29
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: BCBS Trust/PPO |
$17.57
|
| Rate for Payer: BCBS Trust/PPO |
$13.65
|
| Rate for Payer: BCBS Trust/PPO |
$19.22
|
| Rate for Payer: BCN Commercial |
$16.63
|
| Rate for Payer: BCN Commercial |
$12.92
|
| Rate for Payer: BCN Commercial |
$18.20
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$17.22
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| 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: Healthscope Commercial |
$19.37
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.02
|
| Rate for Payer: Nomi Health Commercial |
$13.71
|
| Rate for Payer: Nomi Health Commercial |
$17.65
|
| Rate for Payer: Nomi Health Commercial |
$19.31
|
| Rate for Payer: PHP Commercial |
$18.29
|
| Rate for Payer: PHP Commercial |
$14.21
|
| Rate for Payer: PHP Commercial |
$20.02
|
| 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 HMO/PPO |
$20.49
|
| Rate for Payer: Priority Health HMO/PPO |
$18.72
|
| Rate for Payer: Priority Health HMO/PPO |
$14.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$11.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.71
|
| Rate for Payer: UHC Core |
$13.96
|
| Rate for Payer: UHC Core |
$19.66
|
| Rate for Payer: UHC Core |
$17.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.14
|
|
|
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 |
$14.98 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna Commercial |
$53.61
|
| Rate for Payer: Aetna Medicare |
$16.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.71
|
| Rate for Payer: BCBS Complete |
$25.23
|
| Rate for Payer: BCBS MAPPO |
$15.77
|
| Rate for Payer: BCBS Trust/PPO |
$51.85
|
| Rate for Payer: BCN Commercial |
$49.04
|
| Rate for Payer: BCN Medicare Advantage |
$15.77
|
| Rate for Payer: Cash Price |
$50.46
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.77
|
| Rate for Payer: Healthscope Commercial |
$56.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.61
|
| Rate for Payer: Nomi Health Commercial |
$51.72
|
| Rate for Payer: PACE Senior Care Partners |
$14.98
|
| Rate for Payer: PACE SWMI |
$15.77
|
| Rate for Payer: PHP Commercial |
$53.61
|
| Rate for Payer: PHP Medicare Advantage |
$15.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.00
|
| Rate for Payer: Priority Health HMO/PPO |
$54.87
|
| Rate for Payer: Priority Health Medicare |
$15.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.26
|
| Rate for Payer: Railroad Medicare Medicare |
$15.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.50
|
| Rate for Payer: UHC Core |
$52.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.77
|
| Rate for Payer: UHC Exchange |
$15.77
|
| Rate for Payer: UHC Medicare Advantage |
$15.77
|
| Rate for Payer: VA VA |
$15.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.30
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$72.86
|
|
|
Service Code
|
NDC 66794023042
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.36 |
| Max. Negotiated Rate |
$65.57 |
| Rate for Payer: Aetna Commercial |
$61.93
|
| Rate for Payer: BCBS Trust/PPO |
$59.48
|
| Rate for Payer: BCN Commercial |
$56.31
|
| Rate for Payer: Cash Price |
$58.29
|
| Rate for Payer: Cofinity Commercial |
$62.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.29
|
| Rate for Payer: Healthscope Commercial |
$65.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.93
|
| Rate for Payer: Nomi Health Commercial |
$59.75
|
| Rate for Payer: PHP Commercial |
$61.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.36
|
| Rate for Payer: Priority Health HMO/PPO |
$63.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.12
|
| Rate for Payer: UHC Core |
$60.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.64
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$80.11
|
|
|
Service Code
|
NDC 71288050502
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.03 |
| Max. Negotiated Rate |
$72.10 |
| Rate for Payer: Aetna Commercial |
$68.09
|
| Rate for Payer: Aetna Medicare |
$20.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.03
|
| Rate for Payer: BCBS Complete |
$32.04
|
| Rate for Payer: BCBS MAPPO |
$20.03
|
| Rate for Payer: BCBS Trust/PPO |
$65.86
|
| Rate for Payer: BCN Commercial |
$62.29
|
| Rate for Payer: BCN Medicare Advantage |
$20.03
|
| Rate for Payer: Cash Price |
$64.09
|
| Rate for Payer: Cofinity Commercial |
$68.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.03
|
| Rate for Payer: Healthscope Commercial |
$72.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.09
|
| Rate for Payer: Nomi Health Commercial |
$65.69
|
| Rate for Payer: PACE Senior Care Partners |
$19.03
|
| Rate for Payer: PACE SWMI |
$20.03
|
| Rate for Payer: PHP Commercial |
$68.09
|
| Rate for Payer: PHP Medicare Advantage |
$20.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.07
|
| Rate for Payer: Priority Health HMO/PPO |
$69.70
|
| Rate for Payer: Priority Health Medicare |
$20.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.67
|
| Rate for Payer: Railroad Medicare Medicare |
$20.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.50
|
| Rate for Payer: UHC Core |
$66.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.03
|
| Rate for Payer: UHC Exchange |
$20.03
|
| Rate for Payer: UHC Medicare Advantage |
$20.03
|
| Rate for Payer: VA VA |
$20.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.08
|
|
