|
DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$235.48
|
|
|
Service Code
|
NDC 00078092525
|
| Hospital Charge Code |
19596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.61 |
| Max. Negotiated Rate |
$211.93 |
| Rate for Payer: Aetna American Axle |
$153.06
|
| Rate for Payer: Aetna Commercial |
$200.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.06
|
| Rate for Payer: Cash Price |
$188.38
|
| Rate for Payer: Cofinity Advantage |
$164.84
|
| Rate for Payer: Cofinity Commercial |
$202.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.38
|
| Rate for Payer: Healthscope Commercial |
$211.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.61
|
| Rate for Payer: PHP Commercial |
$200.16
|
| Rate for Payer: Priority Health SBD |
$148.35
|
| Rate for Payer: UMR Bronson Commercial |
$103.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.61
|
|
|
DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
IP
|
$235.48
|
|
|
Service Code
|
NDC 82667060005
|
| Hospital Charge Code |
19596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.61 |
| Max. Negotiated Rate |
$211.93 |
| Rate for Payer: Aetna American Axle |
$153.06
|
| Rate for Payer: Aetna Commercial |
$200.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.06
|
| Rate for Payer: Cash Price |
$188.38
|
| Rate for Payer: Cofinity Advantage |
$164.84
|
| Rate for Payer: Cofinity Commercial |
$202.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.38
|
| Rate for Payer: Healthscope Commercial |
$211.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.61
|
| Rate for Payer: PHP Commercial |
$200.16
|
| Rate for Payer: Priority Health SBD |
$148.35
|
| Rate for Payer: UMR Bronson Commercial |
$103.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.61
|
|
|
DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$235.48
|
|
|
Service Code
|
NDC 00078092525
|
| Hospital Charge Code |
19596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.13 |
| Max. Negotiated Rate |
$211.93 |
| Rate for Payer: Aetna American Axle |
$153.06
|
| Rate for Payer: Aetna Commercial |
$200.16
|
| Rate for Payer: Aetna Medicare |
$117.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.06
|
| Rate for Payer: BCBS Complete |
$94.19
|
| Rate for Payer: Cash Price |
$188.38
|
| Rate for Payer: Cofinity Advantage |
$164.84
|
| Rate for Payer: Cofinity Commercial |
$202.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.38
|
| Rate for Payer: Healthscope Commercial |
$211.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.61
|
| Rate for Payer: PHP Commercial |
$200.16
|
| Rate for Payer: Priority Health SBD |
$148.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.06
|
| Rate for Payer: UHC Core |
$122.69
|
| Rate for Payer: UHC Exchange |
$92.54
|
| Rate for Payer: UMR Bronson Commercial |
$87.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.61
|
|
|
DEXAMETHASONE 0.1 % EYE DROPS,SUSPENSION
|
Facility
|
OP
|
$235.48
|
|
|
Service Code
|
NDC 82667060005
|
| Hospital Charge Code |
19596
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.13 |
| Max. Negotiated Rate |
$211.93 |
| Rate for Payer: Aetna American Axle |
$153.06
|
| Rate for Payer: Aetna Commercial |
$200.16
|
| Rate for Payer: Aetna Medicare |
$117.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.06
|
| Rate for Payer: BCBS Complete |
$94.19
|
| Rate for Payer: Cash Price |
$188.38
|
| Rate for Payer: Cofinity Advantage |
$164.84
|
| Rate for Payer: Cofinity Commercial |
$202.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.38
|
| Rate for Payer: Healthscope Commercial |
$211.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.61
|
| Rate for Payer: PHP Commercial |
$200.16
|
| Rate for Payer: Priority Health SBD |
$148.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.06
|
| Rate for Payer: UHC Core |
$122.69
|
| Rate for Payer: UHC Exchange |
$92.54
|
| Rate for Payer: UMR Bronson Commercial |
$87.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.61
|
|
|
DEXAMETHASONE 0.75 MG TABLET
|
Facility
|
IP
|
$380.70
|
|
|
Service Code
|
NDC 00054418025
|
| Hospital Charge Code |
2323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.51 |
| Max. Negotiated Rate |
$342.63 |
| Rate for Payer: Aetna American Axle |
$247.46
|
| Rate for Payer: Aetna Commercial |
$323.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.46
|
| Rate for Payer: Cash Price |
$304.56
|
| Rate for Payer: Cofinity Advantage |
$266.49
|
| Rate for Payer: Cofinity Commercial |
$327.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.56
|
| Rate for Payer: Healthscope Commercial |
$342.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.52
|
| Rate for Payer: PHP Commercial |
$323.60
|
| Rate for Payer: Priority Health SBD |
$239.84
|
| Rate for Payer: UMR Bronson Commercial |
$167.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.52
|
|
|
DEXAMETHASONE 0.75 MG TABLET
|
Facility
|
OP
|
$380.70
|
|
|
Service Code
|
NDC 00054418025
|
| Hospital Charge Code |
2323
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.86 |
| Max. Negotiated Rate |
$342.63 |
| Rate for Payer: Aetna American Axle |
$247.46
|
| Rate for Payer: Aetna Commercial |
$323.60
|
| Rate for Payer: Aetna Medicare |
$190.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$247.46
|
| Rate for Payer: BCBS Complete |
$152.28
|
| Rate for Payer: Cash Price |
$304.56
|
| Rate for Payer: Cofinity Advantage |
$266.49
|
| Rate for Payer: Cofinity Commercial |
$327.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$304.56
|
| Rate for Payer: Healthscope Commercial |
$342.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$266.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$285.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$304.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$323.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$285.52
|
| Rate for Payer: PHP Commercial |
$323.60
|
| Rate for Payer: Priority Health SBD |
$239.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.46
|
| Rate for Payer: UHC Core |
$198.34
|
| Rate for Payer: UHC Exchange |
$149.62
|
| Rate for Payer: UMR Bronson Commercial |
$140.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$285.52
|
|
|
DEXAMETHASONE 1 MG/ML DROPS (CONCENTRATE)
|
Facility
|
IP
|
$106.42
|
|
|
Service Code
|
NDC 00054317644
|
| Hospital Charge Code |
108723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.82 |
| Max. Negotiated Rate |
$95.78 |
| Rate for Payer: Aetna American Axle |
$69.17
|
| Rate for Payer: Aetna Commercial |
$90.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.17
|
| Rate for Payer: Cash Price |
$85.14
|
| Rate for Payer: Cofinity Advantage |
$74.49
|
| Rate for Payer: Cofinity Commercial |
$91.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.14
|
| Rate for Payer: Healthscope Commercial |
$95.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.81
|
| Rate for Payer: PHP Commercial |
$90.46
|
| Rate for Payer: Priority Health SBD |
$67.04
|
| Rate for Payer: UMR Bronson Commercial |
$46.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.81
|
|
|
DEXAMETHASONE 1 MG/ML DROPS (CONCENTRATE)
|
Facility
|
OP
|
$106.42
|
|
|
Service Code
|
NDC 00054317644
|
| Hospital Charge Code |
108723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.38 |
| Max. Negotiated Rate |
$95.78 |
| Rate for Payer: Aetna American Axle |
$69.17
|
| Rate for Payer: Aetna Commercial |
$90.46
|
| Rate for Payer: Aetna Medicare |
$53.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.17
|
| Rate for Payer: BCBS Complete |
$42.57
|
| Rate for Payer: Cash Price |
$85.14
|
| Rate for Payer: Cofinity Advantage |
$74.49
|
| Rate for Payer: Cofinity Commercial |
$91.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.14
|
| Rate for Payer: Healthscope Commercial |
$95.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$79.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$85.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.81
|
| Rate for Payer: PHP Commercial |
$90.46
|
| Rate for Payer: Priority Health SBD |
$67.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.17
|
| Rate for Payer: UHC Core |
$55.44
|
| Rate for Payer: UHC Exchange |
$41.82
|
| Rate for Payer: UMR Bronson Commercial |
$39.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$79.81
|
|
|
DEXAMETHASONE 1 MG TABLET
|
Facility
|
OP
|
$210.90
|
|
|
Service Code
|
NDC 00054418125
|
| Hospital Charge Code |
2324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.03 |
| Max. Negotiated Rate |
$189.81 |
| Rate for Payer: Aetna American Axle |
$137.09
|
| Rate for Payer: Aetna Commercial |
$179.26
|
| Rate for Payer: Aetna Medicare |
$105.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.09
|
| Rate for Payer: BCBS Complete |
$84.36
|
| Rate for Payer: Cash Price |
$168.72
|
| Rate for Payer: Cofinity Advantage |
$147.63
|
| Rate for Payer: Cofinity Commercial |
$181.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.72
|
| Rate for Payer: Healthscope Commercial |
$189.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.18
|
| Rate for Payer: PHP Commercial |
$179.26
|
| Rate for Payer: Priority Health SBD |
$132.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.09
|
| Rate for Payer: UHC Core |
$109.88
|
| Rate for Payer: UHC Exchange |
$82.88
|
| Rate for Payer: UMR Bronson Commercial |
$78.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.18
|
|
|
DEXAMETHASONE 1 MG TABLET
|
Facility
|
OP
|
$210.90
|
|
|
Service Code
|
NDC 54418125
|
| Hospital Charge Code |
2324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.03 |
| Max. Negotiated Rate |
$189.81 |
| Rate for Payer: Aetna American Axle |
$137.09
|
| Rate for Payer: Aetna Commercial |
$179.26
|
| Rate for Payer: Aetna Medicare |
$105.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.09
|
| Rate for Payer: BCBS Complete |
$84.36
|
| Rate for Payer: Cash Price |
$168.72
|
| Rate for Payer: Cofinity Advantage |
$147.63
|
| Rate for Payer: Cofinity Commercial |
$181.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.72
|
| Rate for Payer: Healthscope Commercial |
$189.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.18
|
| Rate for Payer: PHP Commercial |
$179.26
|
| Rate for Payer: Priority Health SBD |
$132.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.09
|
| Rate for Payer: UHC Core |
$109.88
|
| Rate for Payer: UHC Exchange |
$82.88
|
| Rate for Payer: UMR Bronson Commercial |
$78.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.18
|
|
|
DEXAMETHASONE 1 MG TABLET
|
Facility
|
IP
|
$273.60
|
|
|
Service Code
|
NDC 00054817425
|
| Hospital Charge Code |
2324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.38 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna American Axle |
$177.84
|
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.84
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Advantage |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.20
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health SBD |
$172.37
|
| Rate for Payer: UMR Bronson Commercial |
$120.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
|
|
DEXAMETHASONE 1 MG TABLET
|
Facility
|
OP
|
$273.60
|
|
|
Service Code
|
NDC 54817425
|
| Hospital Charge Code |
2324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.23 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna American Axle |
$177.84
|
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna Medicare |
$136.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.84
|
| Rate for Payer: BCBS Complete |
$109.44
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Advantage |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.20
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health SBD |
$172.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.84
|
| Rate for Payer: UHC Core |
$142.55
|
| Rate for Payer: UHC Exchange |
$107.52
|
| Rate for Payer: UMR Bronson Commercial |
$101.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
|
|
DEXAMETHASONE 1 MG TABLET
|
Facility
|
OP
|
$273.60
|
|
|
Service Code
|
NDC 00054817425
|
| Hospital Charge Code |
2324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.23 |
| Max. Negotiated Rate |
$246.24 |
| Rate for Payer: Aetna American Axle |
$177.84
|
| Rate for Payer: Aetna Commercial |
$232.56
|
| Rate for Payer: Aetna Medicare |
$136.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.84
|
| Rate for Payer: BCBS Complete |
$109.44
|
| Rate for Payer: Cash Price |
$218.88
|
| Rate for Payer: Cofinity Advantage |
$191.52
|
| Rate for Payer: Cofinity Commercial |
$235.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$218.88
|
| Rate for Payer: Healthscope Commercial |
$246.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$191.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$205.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$218.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$205.20
|
| Rate for Payer: PHP Commercial |
$232.56
|
| Rate for Payer: Priority Health SBD |
$172.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$177.84
|
| Rate for Payer: UHC Core |
$142.55
|
| Rate for Payer: UHC Exchange |
$107.52
|
| Rate for Payer: UMR Bronson Commercial |
$101.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$205.20
|
|
|
DEXAMETHASONE 1 MG TABLET
|
Facility
|
IP
|
$210.90
|
|
|
Service Code
|
NDC 00054418125
|
| Hospital Charge Code |
2324
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.80 |
| Max. Negotiated Rate |
$189.81 |
| Rate for Payer: Aetna American Axle |
$137.09
|
| Rate for Payer: Aetna Commercial |
$179.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.09
|
| Rate for Payer: Cash Price |
$168.72
|
| Rate for Payer: Cofinity Advantage |
$147.63
|
| Rate for Payer: Cofinity Commercial |
$181.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$168.72
|
| Rate for Payer: Healthscope Commercial |
$189.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$147.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$158.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$179.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$158.18
|
| Rate for Payer: PHP Commercial |
$179.26
|
| Rate for Payer: Priority Health SBD |
$132.87
|
| Rate for Payer: UMR Bronson Commercial |
$92.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$158.18
|
|
|
DEXAMETHASONE 4 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$19.76
|
|
|
Service Code
|
NDC 63323016501
|
| Hospital Charge Code |
180050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$17.78 |
| Rate for Payer: Aetna American Axle |
$12.84
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Medicare |
$9.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$15.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.82
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.84
|
| Rate for Payer: UHC Core |
$10.29
|
| Rate for Payer: UHC Exchange |
$7.77
|
| Rate for Payer: UMR Bronson Commercial |
$7.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.82
|
|
|
DEXAMETHASONE 4 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$19.76
|
|
|
Service Code
|
NDC 63323016501
|
| 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 Advantage |
$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 Commercial |
$16.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.82
|
| Rate for Payer: PHP Commercial |
$16.80
|
| 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
|
$15.20
|
|
|
Service Code
|
NDC 09900000647
|
| Hospital Charge Code |
180050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$13.68 |
| Rate for Payer: Aetna American Axle |
$9.88
|
| Rate for Payer: Aetna Commercial |
$12.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.88
|
| Rate for Payer: Cash Price |
$12.16
|
| Rate for Payer: Cofinity Advantage |
$10.64
|
| Rate for Payer: Cofinity Commercial |
$13.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.16
|
| Rate for Payer: Healthscope Commercial |
$13.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.40
|
| Rate for Payer: PHP Commercial |
$12.92
|
| Rate for Payer: Priority Health SBD |
$9.58
|
| Rate for Payer: UMR Bronson Commercial |
$6.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.40
|
|
|
DEXAMETHASONE 4 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$15.20
|
|
|
Service Code
|
NDC 09900000647
|
| Hospital Charge Code |
180050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$13.68 |
| Rate for Payer: Aetna American Axle |
$9.88
|
| Rate for Payer: Aetna Commercial |
$12.92
|
| Rate for Payer: Aetna Medicare |
$7.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.88
|
| Rate for Payer: BCBS Complete |
$6.08
|
| Rate for Payer: Cash Price |
$12.16
|
| Rate for Payer: Cofinity Advantage |
$10.64
|
| Rate for Payer: Cofinity Commercial |
$13.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.16
|
| Rate for Payer: Healthscope Commercial |
$13.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.40
|
| Rate for Payer: PHP Commercial |
$12.92
|
| Rate for Payer: Priority Health SBD |
$9.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.88
|
| Rate for Payer: UHC Core |
$7.92
|
| Rate for Payer: UHC Exchange |
$5.97
|
| Rate for Payer: UMR Bronson Commercial |
$5.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.40
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$469.92
|
|
|
Service Code
|
NDC 60687071801
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.87 |
| Max. Negotiated Rate |
$422.93 |
| Rate for Payer: Aetna American Axle |
$305.45
|
| Rate for Payer: Aetna Commercial |
$399.43
|
| Rate for Payer: Aetna Medicare |
$234.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.45
|
| Rate for Payer: BCBS Complete |
$187.97
|
| Rate for Payer: Cash Price |
$375.94
|
| Rate for Payer: Cofinity Advantage |
$328.94
|
| Rate for Payer: Cofinity Commercial |
$404.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$375.94
|
| Rate for Payer: Healthscope Commercial |
$422.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$328.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$352.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$375.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$399.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$352.44
|
| Rate for Payer: PHP Commercial |
$399.43
|
| Rate for Payer: Priority Health SBD |
$296.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$305.45
|
| Rate for Payer: UHC Core |
$244.83
|
| Rate for Payer: UHC Exchange |
$184.68
|
| Rate for Payer: UMR Bronson Commercial |
$173.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$352.44
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$4.70
|
|
|
Service Code
|
NDC 60687071811
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna American Axle |
$3.06
|
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: Aetna Medicare |
$2.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.06
|
| Rate for Payer: BCBS Complete |
$1.88
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cofinity Advantage |
$3.29
|
| Rate for Payer: Cofinity Commercial |
$4.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$4.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.52
|
| Rate for Payer: PHP Commercial |
$4.00
|
| Rate for Payer: Priority Health SBD |
$2.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.06
|
| Rate for Payer: UHC Core |
$2.45
|
| Rate for Payer: UHC Exchange |
$1.85
|
| Rate for Payer: UMR Bronson Commercial |
$1.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.52
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$4.70
|
|
|
Service Code
|
NDC 60687071811
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna American Axle |
$3.06
|
| Rate for Payer: Aetna Commercial |
$4.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.06
|
| Rate for Payer: Cash Price |
$3.76
|
| Rate for Payer: Cofinity Advantage |
$3.29
|
| Rate for Payer: Cofinity Commercial |
$4.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.76
|
| Rate for Payer: Healthscope Commercial |
$4.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.52
|
| Rate for Payer: PHP Commercial |
$4.00
|
| Rate for Payer: Priority Health SBD |
$2.96
|
| Rate for Payer: UMR Bronson Commercial |
$2.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.52
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$470.88
|
|
|
Service Code
|
NDC 00054817525
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$207.19 |
| Max. Negotiated Rate |
$423.79 |
| Rate for Payer: Aetna American Axle |
$306.07
|
| Rate for Payer: Aetna Commercial |
$400.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.07
|
| Rate for Payer: Cash Price |
$376.70
|
| Rate for Payer: Cofinity Advantage |
$329.62
|
| Rate for Payer: Cofinity Commercial |
$404.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.70
|
| Rate for Payer: Healthscope Commercial |
$423.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$353.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$400.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$353.16
|
| Rate for Payer: PHP Commercial |
$400.25
|
| Rate for Payer: Priority Health SBD |
$296.65
|
| Rate for Payer: UMR Bronson Commercial |
$207.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$353.16
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$470.88
|
|
|
Service Code
|
NDC 00054817525
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.23 |
| Max. Negotiated Rate |
$423.79 |
| Rate for Payer: Aetna American Axle |
$306.07
|
| Rate for Payer: Aetna Commercial |
$400.25
|
| Rate for Payer: Aetna Medicare |
$235.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.07
|
| Rate for Payer: BCBS Complete |
$188.35
|
| Rate for Payer: Cash Price |
$376.70
|
| Rate for Payer: Cofinity Advantage |
$329.62
|
| Rate for Payer: Cofinity Commercial |
$404.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.70
|
| Rate for Payer: Healthscope Commercial |
$423.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$353.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$400.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$353.16
|
| Rate for Payer: PHP Commercial |
$400.25
|
| Rate for Payer: Priority Health SBD |
$296.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.07
|
| Rate for Payer: UHC Core |
$245.33
|
| Rate for Payer: UHC Exchange |
$185.06
|
| Rate for Payer: UMR Bronson Commercial |
$174.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$353.16
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$470.88
|
|
|
Service Code
|
NDC 54817525
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.23 |
| Max. Negotiated Rate |
$423.79 |
| Rate for Payer: Aetna American Axle |
$306.07
|
| Rate for Payer: Aetna Commercial |
$400.25
|
| Rate for Payer: Aetna Medicare |
$235.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.07
|
| Rate for Payer: BCBS Complete |
$188.35
|
| Rate for Payer: Cash Price |
$376.70
|
| Rate for Payer: Cofinity Advantage |
$329.62
|
| Rate for Payer: Cofinity Commercial |
$404.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.70
|
| Rate for Payer: Healthscope Commercial |
$423.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$329.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$353.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$400.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$353.16
|
| Rate for Payer: PHP Commercial |
$400.25
|
| Rate for Payer: Priority Health SBD |
$296.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$306.07
|
| Rate for Payer: UHC Core |
$245.33
|
| Rate for Payer: UHC Exchange |
$185.06
|
| Rate for Payer: UMR Bronson Commercial |
$174.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$353.16
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$426.24
|
|
|
Service Code
|
NDC 00904726661
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$383.62 |
| Rate for Payer: Aetna American Axle |
$277.06
|
| Rate for Payer: Aetna Commercial |
$362.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.06
|
| Rate for Payer: Cash Price |
$340.99
|
| Rate for Payer: Cofinity Advantage |
$298.37
|
| Rate for Payer: Cofinity Commercial |
$366.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.99
|
| Rate for Payer: Healthscope Commercial |
$383.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$298.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$319.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.68
|
| Rate for Payer: PHP Commercial |
$362.30
|
| Rate for Payer: Priority Health SBD |
$268.53
|
| Rate for Payer: UMR Bronson Commercial |
$187.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$319.68
|
|
