|
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, MICRONIZED (BULK) 100 % POWDER
|
Facility
|
IP
|
$173.25
|
|
|
Service Code
|
NDC 38779-0405-3
|
| Hospital Charge Code |
116458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.23 |
| Max. Negotiated Rate |
$155.92 |
| Rate for Payer: Aetna American Axle |
$112.61
|
| Rate for Payer: Aetna Commercial |
$147.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.61
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cofinity Commercial |
$121.28
|
| Rate for Payer: Cofinity Commercial |
$149.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$138.60
|
| Rate for Payer: Healthscope Commercial |
$155.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$147.26
|
| Rate for Payer: PHP Commercial |
$147.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.28
|
| Rate for Payer: Priority Health SBD |
$109.15
|
| Rate for Payer: UMR Bronson Commercial |
$76.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.94
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
OP
|
$16.21
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$14.59 |
| Rate for Payer: Aetna American Axle |
$10.54
|
| Rate for Payer: Aetna American Axle |
$12.06
|
| Rate for Payer: Aetna American Axle |
$7.13
|
| Rate for Payer: Aetna American Axle |
$41.65
|
| Rate for Payer: Aetna Commercial |
$13.78
|
| Rate for Payer: Aetna Commercial |
$9.32
|
| Rate for Payer: Aetna Commercial |
$54.47
|
| Rate for Payer: Aetna Commercial |
$15.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.13
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS Complete |
$4.39
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS Trust/PPO |
$0.38
|
| Rate for Payer: BCBS Trust/PPO |
$0.38
|
| Rate for Payer: BCBS Trust/PPO |
$0.38
|
| Rate for Payer: BCBS Trust/PPO |
$0.38
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cash Price |
$12.97
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$12.97
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$13.94
|
| Rate for Payer: Cofinity Commercial |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$9.43
|
| Rate for Payer: Cofinity Commercial |
$11.35
|
| Rate for Payer: Cofinity Commercial |
$44.86
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Cofinity Commercial |
$15.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.85
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Commercial |
$14.59
|
| Rate for Payer: Healthscope Commercial |
$16.70
|
| Rate for Payer: Healthscope Commercial |
$57.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.32
|
| Rate for Payer: PHP Commercial |
$54.47
|
| Rate for Payer: PHP Commercial |
$15.78
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: PHP Commercial |
$13.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.68
|
| Rate for Payer: Priority Health SBD |
$10.21
|
| Rate for Payer: Priority Health SBD |
$6.91
|
| Rate for Payer: Priority Health SBD |
$11.69
|
| Rate for Payer: Priority Health SBD |
$40.37
|
| Rate for Payer: UMR Bronson Commercial |
$6.00
|
| Rate for Payer: UMR Bronson Commercial |
$4.06
|
| Rate for Payer: UMR Bronson Commercial |
$23.71
|
| Rate for Payer: UMR Bronson Commercial |
$6.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.16
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$17.98
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2331
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.91 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Aetna American Axle |
$11.69
|
| Rate for Payer: Aetna American Axle |
$41.65
|
| Rate for Payer: Aetna Commercial |
$15.28
|
| Rate for Payer: Aetna Commercial |
$54.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.69
|
| Rate for Payer: Cash Price |
$14.38
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Cofinity Commercial |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Cofinity Commercial |
$44.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Healthscope Commercial |
$57.67
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.47
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: PHP Commercial |
$54.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.59
|
| Rate for Payer: Priority Health SBD |
$11.33
|
| Rate for Payer: Priority Health SBD |
$40.37
|
| Rate for Payer: UMR Bronson Commercial |
$7.91
|
| Rate for Payer: UMR Bronson Commercial |
$28.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.06
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$16.21
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2331
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$14.59 |
| Rate for Payer: Aetna American Axle |
$10.54
|
| Rate for Payer: Aetna American Axle |
$12.06
|
| Rate for Payer: Aetna American Axle |
$7.13
|
| Rate for Payer: Aetna Commercial |
$9.32
|
| Rate for Payer: Aetna Commercial |
$13.78
|
| Rate for Payer: Aetna Commercial |
$15.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.06
|
| Rate for Payer: BCBS Complete |
$7.42
|
| Rate for Payer: BCBS Complete |
$4.39
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.38
|
| Rate for Payer: BCBS Trust/PPO |
$0.38
|
| Rate for Payer: BCBS Trust/PPO |
$0.38
|
| Rate for Payer: Cash Price |
$12.97
|
| Rate for Payer: Cash Price |
$12.97
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$14.85
|
| Rate for Payer: Cofinity Commercial |
$11.35
|
| Rate for Payer: Cofinity Commercial |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$9.43
|
| Rate for Payer: Cofinity Commercial |
$13.94
|
| Rate for Payer: Cofinity Commercial |
$12.99
|
| Rate for Payer: Cofinity Commercial |
$15.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.85
|
| Rate for Payer: Healthscope Commercial |
$16.70
|
| Rate for Payer: Healthscope Commercial |
$14.59
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.78
|
| Rate for Payer: PHP Commercial |
$15.78
|
| Rate for Payer: PHP Commercial |
$13.78
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.35
|
| Rate for Payer: Priority Health SBD |
$11.69
|
| Rate for Payer: Priority Health SBD |
$10.21
|
| Rate for Payer: Priority Health SBD |
$6.91
|
| Rate for Payer: UMR Bronson Commercial |
$6.00
|
| Rate for Payer: UMR Bronson Commercial |
$4.06
|
| Rate for Payer: UMR Bronson Commercial |
$6.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.92
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML FOR IM INJECTION
|
Facility
|
IP
|
$11.75
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$10.58 |
| Rate for Payer: Aetna American Axle |
$7.64
|
| Rate for Payer: Aetna Commercial |
$9.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.64
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cofinity Commercial |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.40
|
| Rate for Payer: Healthscope Commercial |
$10.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.99
|
| Rate for Payer: PHP Commercial |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.22
|
| Rate for Payer: Priority Health SBD |
$7.40
|
| Rate for Payer: UMR Bronson Commercial |
$5.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.81
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML FOR IM INJECTION
|
Facility
|
OP
|
$11.75
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$10.58 |
| Rate for Payer: Aetna American Axle |
$7.64
|
| Rate for Payer: Aetna Commercial |
$9.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.64
|
| Rate for Payer: BCBS Complete |
$4.70
|
| Rate for Payer: BCBS Trust/PPO |
$0.38
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cofinity Commercial |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.40
|
| Rate for Payer: Healthscope Commercial |
$10.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.99
|
| Rate for Payer: PHP Commercial |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.22
|
| Rate for Payer: Priority Health SBD |
$7.40
|
| Rate for Payer: UMR Bronson Commercial |
$4.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.81
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$13.05
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$11.74 |
| Rate for Payer: Aetna American Axle |
$8.48
|
| Rate for Payer: Aetna American Axle |
$7.43
|
| Rate for Payer: Aetna American Axle |
$5.49
|
| Rate for Payer: Aetna American Axle |
$50.43
|
| Rate for Payer: Aetna American Axle |
$297.45
|
| Rate for Payer: Aetna American Axle |
$12.84
|
| Rate for Payer: Aetna American Axle |
$7.64
|
| Rate for Payer: Aetna American Axle |
$81.90
|
| Rate for Payer: Aetna Commercial |
$65.94
|
| Rate for Payer: Aetna Commercial |
$388.98
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Commercial |
$9.72
|
| Rate for Payer: Aetna Commercial |
$11.09
|
| Rate for Payer: Aetna Commercial |
$9.99
|
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna Commercial |
$7.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.64
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: Cofinity Commercial |
$393.55
|
| Rate for Payer: Cofinity Commercial |
$8.00
|
| Rate for Payer: Cofinity Commercial |
$5.92
|
| Rate for Payer: Cofinity Commercial |
$88.20
|
| Rate for Payer: Cofinity Commercial |
$320.33
|
| Rate for Payer: Cofinity Commercial |
$108.36
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$13.83
|
| Rate for Payer: Cofinity Commercial |
$8.22
|
| Rate for Payer: Cofinity Commercial |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$7.27
|
| Rate for Payer: Cofinity Commercial |
$11.22
|
| Rate for Payer: Cofinity Commercial |
$9.14
|
| Rate for Payer: Cofinity Commercial |
$9.83
|
| Rate for Payer: Cofinity Commercial |
$54.31
|
| Rate for Payer: Cofinity Commercial |
$66.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$100.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.06
|
| 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 |
$10.44
|
| Rate for Payer: Healthscope Commercial |
$7.60
|
| Rate for Payer: Healthscope Commercial |
$113.40
|
| Rate for Payer: Healthscope Commercial |
$11.74
|
| Rate for Payer: Healthscope Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$69.82
|
| Rate for Payer: Healthscope Commercial |
$10.29
|
| Rate for Payer: Healthscope Commercial |
$411.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$320.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.14
|
| 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 |
$58.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$388.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.99
|
| Rate for Payer: PHP Commercial |
$9.99
|
| Rate for Payer: PHP Commercial |
$107.10
|
| Rate for Payer: PHP Commercial |
$11.09
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$9.72
|
| Rate for Payer: PHP Commercial |
$388.98
|
| Rate for Payer: PHP Commercial |
$65.94
|
| Rate for Payer: PHP Commercial |
$7.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.83
|
| Rate for Payer: Priority Health SBD |
$79.38
|
| Rate for Payer: Priority Health SBD |
$288.30
|
| Rate for Payer: Priority Health SBD |
$5.32
|
| Rate for Payer: Priority Health SBD |
$7.40
|
| Rate for Payer: Priority Health SBD |
$7.20
|
| Rate for Payer: Priority Health SBD |
$48.88
|
| Rate for Payer: Priority Health SBD |
$8.22
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: UMR Bronson Commercial |
$3.72
|
| Rate for Payer: UMR Bronson Commercial |
$8.69
|
| Rate for Payer: UMR Bronson Commercial |
$5.74
|
| Rate for Payer: UMR Bronson Commercial |
$55.44
|
| Rate for Payer: UMR Bronson Commercial |
$201.35
|
| Rate for Payer: UMR Bronson Commercial |
$5.17
|
| Rate for Payer: UMR Bronson Commercial |
$34.14
|
| Rate for Payer: UMR Bronson Commercial |
$5.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$343.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.34
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$11.75
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$10.58 |
| Rate for Payer: Aetna American Axle |
$7.64
|
| Rate for Payer: Aetna Commercial |
$9.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.64
|
| Rate for Payer: BCBS Complete |
$4.70
|
| Rate for Payer: BCBS Trust/PPO |
$0.38
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cofinity Commercial |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$8.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.40
|
| Rate for Payer: Healthscope Commercial |
$10.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.99
|
| Rate for Payer: PHP Commercial |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.22
|
| Rate for Payer: Priority Health SBD |
$7.40
|
| Rate for Payer: UMR Bronson Commercial |
$4.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.81
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
IP
|
$19.83
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Aetna American Axle |
$12.89
|
| Rate for Payer: Aetna American Axle |
$15.31
|
| Rate for Payer: Aetna American Axle |
$17.86
|
| Rate for Payer: Aetna Commercial |
$16.86
|
| Rate for Payer: Aetna Commercial |
$23.35
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.86
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cofinity Commercial |
$19.23
|
| Rate for Payer: Cofinity Commercial |
$23.62
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$13.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Healthscope Commercial |
$24.72
|
| Rate for Payer: Healthscope Commercial |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.35
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: PHP Commercial |
$16.86
|
| Rate for Payer: PHP Commercial |
$23.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.23
|
| Rate for Payer: Priority Health SBD |
$17.31
|
| Rate for Payer: Priority Health SBD |
$14.84
|
| Rate for Payer: Priority Health SBD |
$12.49
|
| Rate for Payer: UMR Bronson Commercial |
$12.09
|
| Rate for Payer: UMR Bronson Commercial |
$10.36
|
| Rate for Payer: UMR Bronson Commercial |
$8.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.60
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$27.47
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
116809
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.09 |
| Max. Negotiated Rate |
$24.72 |
| Rate for Payer: Aetna American Axle |
$17.86
|
| Rate for Payer: Aetna American Axle |
$12.89
|
| Rate for Payer: Aetna American Axle |
$15.31
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna Commercial |
$23.35
|
| Rate for Payer: Aetna Commercial |
$16.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: Cash Price |
$21.98
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Commercial |
$13.88
|
| Rate for Payer: Cofinity Commercial |
$19.23
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$23.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Healthscope Commercial |
$17.85
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Healthscope Commercial |
$24.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.35
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: PHP Commercial |
$16.86
|
| Rate for Payer: PHP Commercial |
$23.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.23
|
| Rate for Payer: Priority Health SBD |
$12.49
|
| Rate for Payer: Priority Health SBD |
$14.84
|
| Rate for Payer: Priority Health SBD |
$17.31
|
| Rate for Payer: UMR Bronson Commercial |
$8.73
|
| Rate for Payer: UMR Bronson Commercial |
$12.09
|
| Rate for Payer: UMR Bronson Commercial |
$10.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.66
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$23.55
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
116809
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$21.20 |
| Rate for Payer: Aetna American Axle |
$15.31
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: BCBS Complete |
$9.42
|
| Rate for Payer: BCBS Trust/PPO |
$0.38
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.02
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.48
|
| Rate for Payer: Priority Health SBD |
$14.84
|
| Rate for Payer: UMR Bronson Commercial |
$8.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.66
|
|
|
DEXLANSOPRAZOLE 60 MG CAPSULE,BIPHASE DELAYED RELEASE
|
Facility
|
IP
|
$1,061.16
|
|
|
Service Code
|
NDC 64764-175-30
|
| Hospital Charge Code |
97009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$466.91 |
| Max. Negotiated Rate |
$955.04 |
| Rate for Payer: Aetna American Axle |
$689.75
|
| Rate for Payer: Aetna Commercial |
$901.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$689.75
|
| Rate for Payer: Cash Price |
$848.93
|
| Rate for Payer: Cofinity Commercial |
$742.81
|
| Rate for Payer: Cofinity Commercial |
$912.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$848.93
|
| Rate for Payer: Healthscope Commercial |
$955.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$742.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$795.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$901.99
|
| Rate for Payer: PHP Commercial |
$901.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$742.81
|
| Rate for Payer: Priority Health SBD |
$668.53
|
| Rate for Payer: UMR Bronson Commercial |
$466.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$795.87
|
|
|
DEXLANSOPRAZOLE 60 MG CAPSULE,BIPHASE DELAYED RELEASE
|
Facility
|
IP
|
$3,183.48
|
|
|
Service Code
|
NDC 64764-175-90
|
| Hospital Charge Code |
97009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,400.73 |
| Max. Negotiated Rate |
$2,865.13 |
| Rate for Payer: Aetna American Axle |
$2,069.26
|
| Rate for Payer: Aetna Commercial |
$2,705.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,069.26
|
| Rate for Payer: Cash Price |
$2,546.78
|
| Rate for Payer: Cofinity Commercial |
$2,228.44
|
| Rate for Payer: Cofinity Commercial |
$2,737.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,546.78
|
| Rate for Payer: Healthscope Commercial |
$2,865.13
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,228.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,387.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,705.96
|
| Rate for Payer: PHP Commercial |
$2,705.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,228.44
|
| Rate for Payer: Priority Health SBD |
$2,005.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,400.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,387.61
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$63.07
|
|
|
Service Code
|
NDC 16729-239-93
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna American Axle |
$41.00
|
| Rate for Payer: Aetna Commercial |
$53.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.00
|
| Rate for Payer: Cash Price |
$50.46
|
| Rate for Payer: Cofinity Commercial |
$44.15
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.46
|
| Rate for Payer: Healthscope Commercial |
$56.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.61
|
| Rate for Payer: PHP Commercial |
$53.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.15
|
| Rate for Payer: Priority Health SBD |
$39.73
|
| Rate for Payer: UMR Bronson Commercial |
$27.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.30
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$70.27
|
|
|
Service Code
|
NDC 70860-605-02
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.92 |
| Max. Negotiated Rate |
$63.24 |
| Rate for Payer: Aetna American Axle |
$45.68
|
| Rate for Payer: Aetna Commercial |
$59.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.68
|
| Rate for Payer: Cash Price |
$56.22
|
| Rate for Payer: Cofinity Commercial |
$49.19
|
| Rate for Payer: Cofinity Commercial |
$60.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$56.22
|
| Rate for Payer: Healthscope Commercial |
$63.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$49.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$59.73
|
| Rate for Payer: PHP Commercial |
$59.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.19
|
| Rate for Payer: Priority Health SBD |
$44.27
|
| Rate for Payer: UMR Bronson Commercial |
$30.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.70
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$63.07
|
|
|
Service Code
|
NDC 16729-239-30
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna American Axle |
$41.00
|
| Rate for Payer: Aetna Commercial |
$53.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.00
|
| Rate for Payer: Cash Price |
$50.46
|
| Rate for Payer: Cofinity Commercial |
$44.15
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.46
|
| Rate for Payer: Healthscope Commercial |
$56.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$53.61
|
| Rate for Payer: PHP Commercial |
$53.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.15
|
| Rate for Payer: Priority Health SBD |
$39.73
|
| Rate for Payer: UMR Bronson Commercial |
$27.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.30
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$84.57
|
|
|
Service Code
|
NDC 0409-1638-02
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.21 |
| Max. Negotiated Rate |
$76.11 |
| Rate for Payer: Aetna American Axle |
$54.97
|
| Rate for Payer: Aetna Commercial |
$71.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.97
|
| Rate for Payer: Cash Price |
$67.66
|
| Rate for Payer: Cofinity Commercial |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$72.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.66
|
| Rate for Payer: Healthscope Commercial |
$76.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.88
|
| Rate for Payer: PHP Commercial |
$71.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.20
|
| Rate for Payer: Priority Health SBD |
$53.28
|
| Rate for Payer: UMR Bronson Commercial |
$37.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.43
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
NDC 0143-9532-25
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna American Axle |
$47.45
|
| Rate for Payer: Aetna Commercial |
$62.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.45
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$51.10
|
| Rate for Payer: Cofinity Commercial |
$62.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.40
|
| Rate for Payer: Healthscope Commercial |
$65.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.05
|
| Rate for Payer: PHP Commercial |
$62.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.10
|
| Rate for Payer: Priority Health SBD |
$45.99
|
| Rate for Payer: UMR Bronson Commercial |
$32.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.75
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$80.39
|
|
|
Service Code
|
NDC 42023-146-25
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.37 |
| Max. Negotiated Rate |
$72.35 |
| Rate for Payer: Aetna American Axle |
$52.25
|
| Rate for Payer: Aetna Commercial |
$68.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.25
|
| Rate for Payer: Cash Price |
$64.31
|
| Rate for Payer: Cofinity Commercial |
$56.27
|
| Rate for Payer: Cofinity Commercial |
$69.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.31
|
| Rate for Payer: Healthscope Commercial |
$72.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$56.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$60.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.33
|
| Rate for Payer: PHP Commercial |
$68.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.27
|
| Rate for Payer: Priority Health SBD |
$50.65
|
| Rate for Payer: UMR Bronson Commercial |
$35.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$60.29
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$71.53
|
|
|
Service Code
|
NDC 70860-605-03
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.47 |
| Max. Negotiated Rate |
$64.38 |
| Rate for Payer: Aetna American Axle |
$46.49
|
| Rate for Payer: Aetna Commercial |
$60.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.49
|
| Rate for Payer: Cash Price |
$57.22
|
| Rate for Payer: Cofinity Commercial |
$50.07
|
| Rate for Payer: Cofinity Commercial |
$61.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.22
|
| Rate for Payer: Healthscope Commercial |
$64.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.80
|
| Rate for Payer: PHP Commercial |
$60.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.07
|
| Rate for Payer: Priority Health SBD |
$45.06
|
| Rate for Payer: UMR Bronson Commercial |
$31.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.65
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$99.04
|
|
|
Service Code
|
NDC 67457-251-00
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.58 |
| Max. Negotiated Rate |
$89.14 |
| Rate for Payer: Aetna American Axle |
$64.38
|
| Rate for Payer: Aetna Commercial |
$84.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.38
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cofinity Commercial |
$69.33
|
| Rate for Payer: Cofinity Commercial |
$85.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.23
|
| Rate for Payer: Healthscope Commercial |
$89.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$84.18
|
| Rate for Payer: PHP Commercial |
$84.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.33
|
| Rate for Payer: Priority Health SBD |
$62.40
|
| Rate for Payer: UMR Bronson Commercial |
$43.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.28
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
NDC 0143-9532-01
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Aetna American Axle |
$47.45
|
| Rate for Payer: Aetna Commercial |
$62.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.45
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$51.10
|
| Rate for Payer: Cofinity Commercial |
$62.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.40
|
| Rate for Payer: Healthscope Commercial |
$65.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.05
|
| Rate for Payer: PHP Commercial |
$62.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.10
|
| Rate for Payer: Priority Health SBD |
$45.99
|
| Rate for Payer: UMR Bronson Commercial |
$32.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.75
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$82.05
|
|
|
Service Code
|
NDC 0781-3297-95
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.10 |
| Max. Negotiated Rate |
$73.84 |
| Rate for Payer: Aetna American Axle |
$53.33
|
| Rate for Payer: Aetna Commercial |
$69.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.33
|
| Rate for Payer: Cash Price |
$65.64
|
| Rate for Payer: Cofinity Commercial |
$57.44
|
| Rate for Payer: Cofinity Commercial |
$70.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.64
|
| Rate for Payer: Healthscope Commercial |
$73.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.74
|
| Rate for Payer: PHP Commercial |
$69.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.44
|
| Rate for Payer: Priority Health SBD |
$51.69
|
| Rate for Payer: UMR Bronson Commercial |
$36.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.54
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$71.53
|
|
|
Service Code
|
NDC 70860-605-41
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.47 |
| Max. Negotiated Rate |
$64.38 |
| Rate for Payer: Aetna American Axle |
$46.49
|
| Rate for Payer: Aetna Commercial |
$60.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.49
|
| Rate for Payer: Cash Price |
$57.22
|
| Rate for Payer: Cofinity Commercial |
$50.07
|
| Rate for Payer: Cofinity Commercial |
$61.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.22
|
| Rate for Payer: Healthscope Commercial |
$64.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$60.80
|
| Rate for Payer: PHP Commercial |
$60.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.07
|
| Rate for Payer: Priority Health SBD |
$45.06
|
| Rate for Payer: UMR Bronson Commercial |
$31.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.65
|
|
