|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$398.43
|
|
|
Service Code
|
NDC 51991-311-90
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.31 |
| Max. Negotiated Rate |
$358.59 |
| Rate for Payer: Aetna American Axle |
$258.98
|
| Rate for Payer: Aetna Commercial |
$338.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.98
|
| Rate for Payer: Cash Price |
$318.74
|
| Rate for Payer: Cofinity Commercial |
$278.90
|
| Rate for Payer: Cofinity Commercial |
$342.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.74
|
| Rate for Payer: Healthscope Commercial |
$358.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$338.67
|
| Rate for Payer: PHP Commercial |
$338.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.90
|
| Rate for Payer: Priority Health SBD |
$251.01
|
| Rate for Payer: UMR Bronson Commercial |
$175.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.82
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$130.61
|
|
|
Service Code
|
NDC 68180-592-06
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.47 |
| Max. Negotiated Rate |
$117.55 |
| Rate for Payer: Aetna American Axle |
$84.90
|
| Rate for Payer: Aetna Commercial |
$111.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.90
|
| Rate for Payer: Cash Price |
$104.49
|
| Rate for Payer: Cofinity Commercial |
$112.32
|
| Rate for Payer: Cofinity Commercial |
$91.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$104.49
|
| Rate for Payer: Healthscope Commercial |
$117.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$91.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$97.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$111.02
|
| Rate for Payer: PHP Commercial |
$111.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.43
|
| Rate for Payer: Priority Health SBD |
$82.28
|
| Rate for Payer: UMR Bronson Commercial |
$57.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$97.96
|
|
|
DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$283.26
|
|
|
Service Code
|
NDC 0078-0925-25
|
| Hospital Charge Code |
19596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.63 |
| Max. Negotiated Rate |
$254.93 |
| Rate for Payer: Aetna American Axle |
$184.12
|
| Rate for Payer: Aetna Commercial |
$240.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.12
|
| Rate for Payer: Cash Price |
$226.61
|
| Rate for Payer: Cofinity Commercial |
$198.28
|
| Rate for Payer: Cofinity Commercial |
$243.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$226.61
|
| Rate for Payer: Healthscope Commercial |
$254.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$198.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$212.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$240.77
|
| Rate for Payer: PHP Commercial |
$240.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.28
|
| Rate for Payer: Priority Health SBD |
$178.45
|
| Rate for Payer: UMR Bronson Commercial |
$124.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$212.44
|
|
|
DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
NDC 0998-0615-05
|
| Hospital Charge Code |
19596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna American Axle |
$159.25
|
| Rate for Payer: Aetna Commercial |
$208.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.25
|
| Rate for Payer: Cash Price |
$196.00
|
| Rate for Payer: Cofinity Commercial |
$171.50
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.00
|
| Rate for Payer: Healthscope Commercial |
$220.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$183.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.25
|
| Rate for Payer: PHP Commercial |
$208.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.50
|
| Rate for Payer: Priority Health SBD |
$154.35
|
| Rate for Payer: UMR Bronson Commercial |
$107.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$183.75
|
|
|
DEXAMETHASONE 0.75 MG TABLET
|
Facility
|
IP
|
$415.95
|
|
|
Service Code
|
NDC 0054-4180-25
|
| Hospital Charge Code |
2323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.02 |
| Max. Negotiated Rate |
$374.36 |
| Rate for Payer: Aetna American Axle |
$270.37
|
| Rate for Payer: Aetna Commercial |
$353.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.37
|
| Rate for Payer: Cash Price |
$332.76
|
| Rate for Payer: Cofinity Commercial |
$291.16
|
| Rate for Payer: Cofinity Commercial |
$357.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.76
|
| Rate for Payer: Healthscope Commercial |
$374.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$311.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$353.56
|
| Rate for Payer: PHP Commercial |
$353.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$291.16
|
| Rate for Payer: Priority Health SBD |
$262.05
|
| Rate for Payer: UMR Bronson Commercial |
$183.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$311.96
|
|
|
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 |
$46.76 |
| Max. Negotiated Rate |
$95.65 |
| Rate for Payer: Aetna American Axle |
$69.08
|
| 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: Encore Health Key Benefits Commercial |
$85.02
|
| Rate for Payer: Healthscope Commercial |
$95.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.71
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$46.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.71
|
|
|
DEXAMETHASONE 1 MG TABLET
|
Facility
|
OP
|
$202.35
|
|
|
Service Code
|
NDC 0054-4181-25
|
| Hospital Charge Code |
2324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.87 |
| Max. Negotiated Rate |
$182.12 |
| Rate for Payer: Aetna American Axle |
$131.53
|
| Rate for Payer: Aetna Commercial |
$172.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.53
|
| Rate for Payer: BCBS Complete |
$80.94
|
| Rate for Payer: Cash Price |
$161.88
|
| Rate for Payer: Cofinity Commercial |
$141.64
|
| Rate for Payer: Cofinity Commercial |
$174.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.88
|
| Rate for Payer: Healthscope Commercial |
$182.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.00
|
| Rate for Payer: PHP Commercial |
$172.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.64
|
| Rate for Payer: Priority Health SBD |
$127.48
|
| Rate for Payer: UMR Bronson Commercial |
$74.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.76
|
|
|
DEXAMETHASONE 1 MG TABLET
|
Facility
|
IP
|
$202.35
|
|
|
Service Code
|
NDC 0054-4181-25
|
| Hospital Charge Code |
2324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.03 |
| Max. Negotiated Rate |
$182.12 |
| Rate for Payer: Aetna American Axle |
$131.53
|
| Rate for Payer: Aetna Commercial |
$172.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.53
|
| Rate for Payer: Cash Price |
$161.88
|
| Rate for Payer: Cofinity Commercial |
$141.64
|
| Rate for Payer: Cofinity Commercial |
$174.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$161.88
|
| Rate for Payer: Healthscope Commercial |
$182.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$141.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$151.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.00
|
| Rate for Payer: PHP Commercial |
$172.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.64
|
| Rate for Payer: Priority Health SBD |
$127.48
|
| Rate for Payer: UMR Bronson Commercial |
$89.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$151.76
|
|
|
DEXAMETHASONE 1 MG TABLET
|
Facility
|
OP
|
$272.65
|
|
|
Service Code
|
NDC 0054-8174-25
|
| Hospital Charge Code |
2324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.88 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna American Axle |
$177.22
|
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.22
|
| Rate for Payer: BCBS Complete |
$109.06
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$190.86
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$231.75
|
| Rate for Payer: PHP Commercial |
$231.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.86
|
| Rate for Payer: Priority Health SBD |
$171.77
|
| Rate for Payer: UMR Bronson Commercial |
$100.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.49
|
|
|
DEXAMETHASONE 1 MG TABLET
|
Facility
|
IP
|
$272.65
|
|
|
Service Code
|
NDC 0054-8174-25
|
| Hospital Charge Code |
2324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.97 |
| Max. Negotiated Rate |
$245.38 |
| Rate for Payer: Aetna American Axle |
$177.22
|
| Rate for Payer: Aetna Commercial |
$231.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.22
|
| Rate for Payer: Cash Price |
$218.12
|
| Rate for Payer: Cofinity Commercial |
$190.86
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.12
|
| Rate for Payer: Healthscope Commercial |
$245.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$190.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$204.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$231.75
|
| Rate for Payer: PHP Commercial |
$231.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.86
|
| Rate for Payer: Priority Health SBD |
$171.77
|
| Rate for Payer: UMR Bronson Commercial |
$119.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$204.49
|
|
|
DEXAMETHASONE 4 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$19.76
|
|
|
Service Code
|
NDC 63323-165-01
|
| Hospital Charge Code |
180050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$17.78 |
| Rate for Payer: Aetna American Axle |
$12.84
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cofinity Commercial |
$13.83
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.80
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.83
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: UMR Bronson Commercial |
$8.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.82
|
|
|
DEXAMETHASONE 4 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$16.72
|
|
|
Service Code
|
NDC 9900-0006-47
|
| Hospital Charge Code |
180050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna American Axle |
$10.87
|
| Rate for Payer: Aetna Commercial |
$14.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.87
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cofinity Commercial |
$11.70
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.21
|
| Rate for Payer: PHP Commercial |
$14.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.70
|
| Rate for Payer: Priority Health SBD |
$10.53
|
| Rate for Payer: UMR Bronson Commercial |
$7.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.54
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$418.08
|
|
|
Service Code
|
NDC 48102-047-20
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.96 |
| Max. Negotiated Rate |
$376.27 |
| Rate for Payer: Aetna American Axle |
$271.75
|
| Rate for Payer: Aetna Commercial |
$355.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.75
|
| Rate for Payer: Cash Price |
$334.46
|
| Rate for Payer: Cofinity Commercial |
$292.66
|
| Rate for Payer: Cofinity Commercial |
$359.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$334.46
|
| Rate for Payer: Healthscope Commercial |
$376.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$292.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$313.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$355.37
|
| Rate for Payer: PHP Commercial |
$355.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.66
|
| Rate for Payer: Priority Health SBD |
$263.39
|
| Rate for Payer: UMR Bronson Commercial |
$183.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.56
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$4.10
|
|
|
Service Code
|
NDC 60687-718-11
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$3.69 |
| Rate for Payer: Aetna American Axle |
$2.66
|
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.66
|
| Rate for Payer: Cash Price |
$3.28
|
| Rate for Payer: Cofinity Commercial |
$2.87
|
| Rate for Payer: Cofinity Commercial |
$3.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.28
|
| Rate for Payer: Healthscope Commercial |
$3.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.48
|
| Rate for Payer: PHP Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.87
|
| Rate for Payer: Priority Health SBD |
$2.58
|
| Rate for Payer: UMR Bronson Commercial |
$1.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.08
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$369.60
|
|
|
Service Code
|
NDC 0904-7266-61
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.62 |
| Max. Negotiated Rate |
$332.64 |
| Rate for Payer: Aetna American Axle |
$240.24
|
| Rate for Payer: Aetna Commercial |
$314.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.24
|
| Rate for Payer: Cash Price |
$295.68
|
| Rate for Payer: Cofinity Commercial |
$258.72
|
| Rate for Payer: Cofinity Commercial |
$317.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.68
|
| Rate for Payer: Healthscope Commercial |
$332.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$258.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$277.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$314.16
|
| Rate for Payer: PHP Commercial |
$314.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.72
|
| Rate for Payer: Priority Health SBD |
$232.85
|
| Rate for Payer: UMR Bronson Commercial |
$162.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$277.20
|
|
|
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 |
$165.70 |
| Max. Negotiated Rate |
$403.06 |
| Rate for Payer: Aetna American Axle |
$291.10
|
| 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: Encore Health Key Benefits Commercial |
$358.27
|
| Rate for Payer: Healthscope Commercial |
$403.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.88
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$165.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.88
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$389.50
|
|
|
Service Code
|
NDC 0054-4184-25
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.12 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Aetna American Axle |
$253.18
|
| Rate for Payer: Aetna Commercial |
$331.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.18
|
| Rate for Payer: BCBS Complete |
$155.80
|
| Rate for Payer: Cash Price |
$311.60
|
| Rate for Payer: Cofinity Commercial |
$272.65
|
| Rate for Payer: Cofinity Commercial |
$334.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.60
|
| Rate for Payer: Healthscope Commercial |
$350.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$272.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.12
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$144.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.12
|
|
|
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 |
$171.38 |
| Max. Negotiated Rate |
$350.55 |
| Rate for Payer: Aetna American Axle |
$253.18
|
| 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: Encore Health Key Benefits Commercial |
$311.60
|
| Rate for Payer: Healthscope Commercial |
$350.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$272.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$292.12
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$171.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$292.12
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$4.19
|
|
|
Service Code
|
NDC 48102-047-11
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Aetna American Axle |
$2.72
|
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.72
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.35
|
| Rate for Payer: Healthscope Commercial |
$3.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.56
|
| Rate for Payer: PHP Commercial |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.93
|
| Rate for Payer: Priority Health SBD |
$2.64
|
| Rate for Payer: UMR Bronson Commercial |
$1.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.14
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$409.44
|
|
|
Service Code
|
NDC 60687-718-01
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.15 |
| Max. Negotiated Rate |
$368.50 |
| Rate for Payer: Aetna American Axle |
$266.14
|
| Rate for Payer: Aetna Commercial |
$348.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$266.14
|
| Rate for Payer: Cash Price |
$327.55
|
| Rate for Payer: Cofinity Commercial |
$286.61
|
| Rate for Payer: Cofinity Commercial |
$352.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.55
|
| Rate for Payer: Healthscope Commercial |
$368.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$286.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$307.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$348.02
|
| Rate for Payer: PHP Commercial |
$348.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$286.61
|
| Rate for Payer: Priority Health SBD |
$257.95
|
| Rate for Payer: UMR Bronson Commercial |
$180.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$307.08
|
|
|
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 |
$197.05 |
| Max. Negotiated Rate |
$403.06 |
| Rate for Payer: Aetna American Axle |
$291.10
|
| 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: Encore Health Key Benefits Commercial |
$358.27
|
| Rate for Payer: Healthscope Commercial |
$403.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$313.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$335.88
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$197.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$335.88
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
IP
|
$708.00
|
|
|
Service Code
|
NDC 60687-729-01
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$311.52 |
| Max. Negotiated Rate |
$637.20 |
| Rate for Payer: Aetna American Axle |
$460.20
|
| Rate for Payer: Aetna Commercial |
$601.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.20
|
| Rate for Payer: Cash Price |
$566.40
|
| Rate for Payer: Cofinity Commercial |
$495.60
|
| Rate for Payer: Cofinity Commercial |
$608.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$566.40
|
| Rate for Payer: Healthscope Commercial |
$637.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$495.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$531.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$601.80
|
| Rate for Payer: PHP Commercial |
$601.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$495.60
|
| Rate for Payer: Priority Health SBD |
$446.04
|
| Rate for Payer: UMR Bronson Commercial |
$311.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$531.00
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
NDC 0054-4186-25
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$269.28 |
| Max. Negotiated Rate |
$550.80 |
| Rate for Payer: Aetna American Axle |
$397.80
|
| Rate for Payer: Aetna Commercial |
$520.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.80
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$428.40
|
| Rate for Payer: Cofinity Commercial |
$526.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Healthscope Commercial |
$550.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$428.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$520.20
|
| Rate for Payer: PHP Commercial |
$520.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$428.40
|
| Rate for Payer: Priority Health SBD |
$385.56
|
| Rate for Payer: UMR Bronson Commercial |
$269.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.00
|
|
|
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 |
$310.25 |
| Max. Negotiated Rate |
$634.61 |
| Rate for Payer: Aetna American Axle |
$458.33
|
| 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: Encore Health Key Benefits Commercial |
$564.10
|
| Rate for Payer: Healthscope Commercial |
$634.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$493.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$528.84
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$310.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$528.84
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
IP
|
$7.08
|
|
|
Service Code
|
NDC 60687-729-11
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$6.37 |
| Rate for Payer: Aetna American Axle |
$4.60
|
| Rate for Payer: Aetna Commercial |
$6.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.60
|
| Rate for Payer: Cash Price |
$5.66
|
| Rate for Payer: Cofinity Commercial |
$4.96
|
| Rate for Payer: Cofinity Commercial |
$6.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.66
|
| Rate for Payer: Healthscope Commercial |
$6.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.02
|
| Rate for Payer: PHP Commercial |
$6.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.96
|
| Rate for Payer: Priority Health SBD |
$4.46
|
| Rate for Payer: UMR Bronson Commercial |
$3.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.31
|
|
