|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$467.52
|
|
|
Service Code
|
NDC 00054817525
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$172.98 |
| Max. Negotiated Rate |
$420.77 |
| Rate for Payer: Aetna American Axle |
$303.89
|
| Rate for Payer: Aetna Commercial |
$397.39
|
| Rate for Payer: Aetna Medicare |
$233.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.89
|
| Rate for Payer: BCBS Complete |
$187.01
|
| Rate for Payer: Cash Price |
$374.02
|
| Rate for Payer: Cofinity Commercial |
$327.26
|
| Rate for Payer: Cofinity Commercial |
$402.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$327.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.02
|
| Rate for Payer: Healthscope Commercial |
$420.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.39
|
| Rate for Payer: PHP Commercial |
$397.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.89
|
| Rate for Payer: Priority Health SBD |
$294.54
|
| Rate for Payer: UMR Bronson Commercial |
$172.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.64
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$400.90
|
|
|
Service Code
|
NDC 00054418425
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.33 |
| Max. Negotiated Rate |
$360.81 |
| Rate for Payer: Aetna American Axle |
$260.58
|
| Rate for Payer: Aetna Commercial |
$340.76
|
| Rate for Payer: Aetna Medicare |
$200.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.58
|
| Rate for Payer: BCBS Complete |
$160.36
|
| Rate for Payer: Cash Price |
$320.72
|
| Rate for Payer: Cofinity Commercial |
$280.63
|
| Rate for Payer: Cofinity Commercial |
$344.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$280.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.72
|
| Rate for Payer: Healthscope Commercial |
$360.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.76
|
| Rate for Payer: PHP Commercial |
$340.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.58
|
| Rate for Payer: Priority Health SBD |
$252.57
|
| Rate for Payer: UMR Bronson Commercial |
$148.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.68
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$4.19
|
|
|
Service Code
|
NDC 48102004711
|
| 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: Cofinity Medicare Advantage |
$2.93
|
| 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 Commercial |
$3.56
|
| Rate for Payer: PHP Commercial |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.72
|
| 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
|
$400.90
|
|
|
Service Code
|
NDC 00054418425
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$360.81 |
| Rate for Payer: Cofinity Commercial |
$280.63
|
| Rate for Payer: Cofinity Commercial |
$344.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$280.63
|
| Rate for Payer: Aetna American Axle |
$260.58
|
| Rate for Payer: Aetna Commercial |
$340.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.58
|
| Rate for Payer: Cash Price |
$320.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.72
|
| Rate for Payer: Healthscope Commercial |
$360.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$280.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$300.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.76
|
| Rate for Payer: PHP Commercial |
$340.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.58
|
| Rate for Payer: Priority Health SBD |
$252.57
|
| Rate for Payer: UMR Bronson Commercial |
$176.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$300.68
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$420.48
|
|
|
Service Code
|
NDC 00904726661
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.58 |
| Max. Negotiated Rate |
$378.43 |
| Rate for Payer: Aetna American Axle |
$273.31
|
| Rate for Payer: Aetna Commercial |
$357.41
|
| Rate for Payer: Aetna Medicare |
$210.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.31
|
| Rate for Payer: BCBS Complete |
$168.19
|
| Rate for Payer: Cash Price |
$336.38
|
| Rate for Payer: Cofinity Commercial |
$294.34
|
| Rate for Payer: Cofinity Commercial |
$361.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.38
|
| Rate for Payer: Healthscope Commercial |
$378.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.41
|
| Rate for Payer: PHP Commercial |
$357.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.31
|
| Rate for Payer: Priority Health SBD |
$264.90
|
| Rate for Payer: UMR Bronson Commercial |
$155.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.36
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$463.68
|
|
|
Service Code
|
NDC 60687071801
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.56 |
| Max. Negotiated Rate |
$417.31 |
| Rate for Payer: Aetna American Axle |
$301.39
|
| Rate for Payer: Aetna Commercial |
$394.13
|
| Rate for Payer: Aetna Medicare |
$231.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.39
|
| Rate for Payer: BCBS Complete |
$185.47
|
| Rate for Payer: Cash Price |
$370.94
|
| Rate for Payer: Cofinity Commercial |
$324.58
|
| Rate for Payer: Cofinity Commercial |
$398.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.94
|
| Rate for Payer: Healthscope Commercial |
$417.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.13
|
| Rate for Payer: PHP Commercial |
$394.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.39
|
| Rate for Payer: Priority Health SBD |
$292.12
|
| Rate for Payer: UMR Bronson Commercial |
$171.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.76
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$418.08
|
|
|
Service Code
|
NDC 48102004720
|
| 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: Cofinity Medicare Advantage |
$292.66
|
| 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 Commercial |
$355.37
|
| Rate for Payer: PHP Commercial |
$355.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.75
|
| 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
|
$463.68
|
|
|
Service Code
|
NDC 60687071801
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.02 |
| Max. Negotiated Rate |
$417.31 |
| Rate for Payer: Aetna American Axle |
$301.39
|
| Rate for Payer: Aetna Commercial |
$394.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.39
|
| Rate for Payer: Cash Price |
$370.94
|
| Rate for Payer: Cofinity Commercial |
$324.58
|
| Rate for Payer: Cofinity Commercial |
$398.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$324.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$370.94
|
| Rate for Payer: Healthscope Commercial |
$417.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$324.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$347.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$394.13
|
| Rate for Payer: PHP Commercial |
$394.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.39
|
| Rate for Payer: Priority Health SBD |
$292.12
|
| Rate for Payer: UMR Bronson Commercial |
$204.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$347.76
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$418.08
|
|
|
Service Code
|
NDC 48102004720
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.69 |
| Max. Negotiated Rate |
$376.27 |
| Rate for Payer: Aetna American Axle |
$271.75
|
| Rate for Payer: Aetna Commercial |
$355.37
|
| Rate for Payer: Aetna Medicare |
$209.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.75
|
| Rate for Payer: BCBS Complete |
$167.23
|
| Rate for Payer: Cash Price |
$334.46
|
| Rate for Payer: Cofinity Commercial |
$292.66
|
| Rate for Payer: Cofinity Commercial |
$359.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$292.66
|
| 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 Commercial |
$355.37
|
| Rate for Payer: PHP Commercial |
$355.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.75
|
| Rate for Payer: Priority Health SBD |
$263.39
|
| Rate for Payer: UMR Bronson Commercial |
$154.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$313.56
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$4.64
|
|
|
Service Code
|
NDC 60687071811
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna American Axle |
$3.02
|
| Rate for Payer: Aetna Commercial |
$3.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.02
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cofinity Commercial |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.71
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.94
|
| Rate for Payer: PHP Commercial |
$3.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.02
|
| Rate for Payer: Priority Health SBD |
$2.92
|
| Rate for Payer: UMR Bronson Commercial |
$2.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.48
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$4.19
|
|
|
Service Code
|
NDC 48102004711
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$3.77 |
| Rate for Payer: Aetna American Axle |
$2.72
|
| Rate for Payer: Aetna Commercial |
$3.56
|
| Rate for Payer: Aetna Medicare |
$2.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.72
|
| Rate for Payer: BCBS Complete |
$1.68
|
| Rate for Payer: Cash Price |
$3.35
|
| Rate for Payer: Cofinity Commercial |
$2.93
|
| Rate for Payer: Cofinity Commercial |
$3.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.93
|
| 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 Commercial |
$3.56
|
| Rate for Payer: PHP Commercial |
$3.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.72
|
| Rate for Payer: Priority Health SBD |
$2.64
|
| Rate for Payer: UMR Bronson Commercial |
$1.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.14
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$467.52
|
|
|
Service Code
|
NDC 00054817525
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.71 |
| Max. Negotiated Rate |
$420.77 |
| Rate for Payer: Aetna American Axle |
$303.89
|
| Rate for Payer: Aetna Commercial |
$397.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$303.89
|
| Rate for Payer: Cash Price |
$374.02
|
| Rate for Payer: Cofinity Commercial |
$327.26
|
| Rate for Payer: Cofinity Commercial |
$402.07
|
| Rate for Payer: Cofinity Medicare Advantage |
$327.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.02
|
| Rate for Payer: Healthscope Commercial |
$420.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$327.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$350.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.39
|
| Rate for Payer: PHP Commercial |
$397.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.89
|
| Rate for Payer: Priority Health SBD |
$294.54
|
| Rate for Payer: UMR Bronson Commercial |
$205.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$350.64
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$420.48
|
|
|
Service Code
|
NDC 00904726661
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.01 |
| Max. Negotiated Rate |
$378.43 |
| Rate for Payer: Aetna American Axle |
$273.31
|
| Rate for Payer: Aetna Commercial |
$357.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.31
|
| Rate for Payer: Cash Price |
$336.38
|
| Rate for Payer: Cofinity Commercial |
$294.34
|
| Rate for Payer: Cofinity Commercial |
$361.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$294.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.38
|
| Rate for Payer: Healthscope Commercial |
$378.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.41
|
| Rate for Payer: PHP Commercial |
$357.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.31
|
| Rate for Payer: Priority Health SBD |
$264.90
|
| Rate for Payer: UMR Bronson Commercial |
$185.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.36
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$4.64
|
|
|
Service Code
|
NDC 60687071811
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Aetna American Axle |
$3.02
|
| Rate for Payer: Aetna Commercial |
$3.94
|
| Rate for Payer: Aetna Medicare |
$2.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.02
|
| Rate for Payer: BCBS Complete |
$1.86
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cofinity Commercial |
$3.25
|
| Rate for Payer: Cofinity Commercial |
$3.99
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.71
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.94
|
| Rate for Payer: PHP Commercial |
$3.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.02
|
| Rate for Payer: Priority Health SBD |
$2.92
|
| Rate for Payer: UMR Bronson Commercial |
$1.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.48
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
IP
|
$7.04
|
|
|
Service Code
|
NDC 60687072911
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Aetna American Axle |
$4.58
|
| Rate for Payer: Aetna Commercial |
$5.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.58
|
| Rate for Payer: Cash Price |
$5.63
|
| Rate for Payer: Cofinity Commercial |
$4.93
|
| Rate for Payer: Cofinity Commercial |
$6.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.63
|
| Rate for Payer: Healthscope Commercial |
$6.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.98
|
| Rate for Payer: PHP Commercial |
$5.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.58
|
| Rate for Payer: Priority Health SBD |
$4.44
|
| Rate for Payer: UMR Bronson Commercial |
$3.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.28
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
OP
|
$7.04
|
|
|
Service Code
|
NDC 60687072911
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Aetna American Axle |
$4.58
|
| Rate for Payer: Aetna Commercial |
$5.98
|
| Rate for Payer: Aetna Medicare |
$3.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.58
|
| Rate for Payer: BCBS Complete |
$2.82
|
| Rate for Payer: Cash Price |
$5.63
|
| Rate for Payer: Cofinity Commercial |
$4.93
|
| Rate for Payer: Cofinity Commercial |
$6.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.63
|
| Rate for Payer: Healthscope Commercial |
$6.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.98
|
| Rate for Payer: PHP Commercial |
$5.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.58
|
| Rate for Payer: Priority Health SBD |
$4.44
|
| Rate for Payer: UMR Bronson Commercial |
$2.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.28
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
IP
|
$703.68
|
|
|
Service Code
|
NDC 60687072901
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$309.62 |
| Max. Negotiated Rate |
$633.31 |
| Rate for Payer: Aetna American Axle |
$457.39
|
| Rate for Payer: Aetna Commercial |
$598.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.39
|
| Rate for Payer: Cash Price |
$562.94
|
| Rate for Payer: Cofinity Commercial |
$492.58
|
| Rate for Payer: Cofinity Commercial |
$605.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$492.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$562.94
|
| Rate for Payer: Healthscope Commercial |
$633.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$492.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$527.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.13
|
| Rate for Payer: PHP Commercial |
$598.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$457.39
|
| Rate for Payer: Priority Health SBD |
$443.32
|
| Rate for Payer: UMR Bronson Commercial |
$309.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$527.76
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
IP
|
$735.84
|
|
|
Service Code
|
NDC 00054818325
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$323.77 |
| Max. Negotiated Rate |
$662.26 |
| Rate for Payer: Aetna American Axle |
$478.30
|
| Rate for Payer: Aetna Commercial |
$625.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.30
|
| Rate for Payer: Cash Price |
$588.67
|
| Rate for Payer: Cofinity Commercial |
$515.09
|
| Rate for Payer: Cofinity Commercial |
$632.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$515.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.67
|
| Rate for Payer: Healthscope Commercial |
$662.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$515.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.46
|
| Rate for Payer: PHP Commercial |
$625.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.30
|
| Rate for Payer: Priority Health SBD |
$463.58
|
| Rate for Payer: UMR Bronson Commercial |
$323.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.88
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
OP
|
$735.84
|
|
|
Service Code
|
NDC 00054818325
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$272.26 |
| Max. Negotiated Rate |
$662.26 |
| Rate for Payer: Aetna American Axle |
$478.30
|
| Rate for Payer: Aetna Commercial |
$625.46
|
| Rate for Payer: Aetna Medicare |
$367.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.30
|
| Rate for Payer: BCBS Complete |
$294.34
|
| Rate for Payer: Cash Price |
$588.67
|
| Rate for Payer: Cofinity Commercial |
$515.09
|
| Rate for Payer: Cofinity Commercial |
$632.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$515.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$588.67
|
| Rate for Payer: Healthscope Commercial |
$662.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$515.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$551.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$625.46
|
| Rate for Payer: PHP Commercial |
$625.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$478.30
|
| Rate for Payer: Priority Health SBD |
$463.58
|
| Rate for Payer: UMR Bronson Commercial |
$272.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$551.88
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
OP
|
$703.68
|
|
|
Service Code
|
NDC 60687072901
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.36 |
| Max. Negotiated Rate |
$633.31 |
| Rate for Payer: Aetna American Axle |
$457.39
|
| Rate for Payer: Aetna Commercial |
$598.13
|
| Rate for Payer: Aetna Medicare |
$351.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$457.39
|
| Rate for Payer: BCBS Complete |
$281.47
|
| Rate for Payer: Cash Price |
$562.94
|
| Rate for Payer: Cofinity Commercial |
$492.58
|
| Rate for Payer: Cofinity Commercial |
$605.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$492.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$562.94
|
| Rate for Payer: Healthscope Commercial |
$633.31
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$492.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$527.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$598.13
|
| Rate for Payer: PHP Commercial |
$598.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$457.39
|
| Rate for Payer: Priority Health SBD |
$443.32
|
| Rate for Payer: UMR Bronson Commercial |
$260.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$527.76
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
OP
|
$663.84
|
|
|
Service Code
|
NDC 00054418625
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.62 |
| Max. Negotiated Rate |
$597.46 |
| Rate for Payer: Aetna American Axle |
$431.50
|
| Rate for Payer: Aetna Commercial |
$564.26
|
| Rate for Payer: Aetna Medicare |
$331.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$431.50
|
| Rate for Payer: BCBS Complete |
$265.54
|
| Rate for Payer: Cash Price |
$531.07
|
| Rate for Payer: Cofinity Commercial |
$464.69
|
| Rate for Payer: Cofinity Commercial |
$570.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$464.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$531.07
|
| Rate for Payer: Healthscope Commercial |
$597.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$464.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$497.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$564.26
|
| Rate for Payer: PHP Commercial |
$564.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.50
|
| Rate for Payer: Priority Health SBD |
$418.22
|
| Rate for Payer: UMR Bronson Commercial |
$245.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$497.88
|
|
|
DEXAMETHASONE 6 MG TABLET
|
Facility
|
IP
|
$663.84
|
|
|
Service Code
|
NDC 00054418625
|
| Hospital Charge Code |
2328
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$292.09 |
| Max. Negotiated Rate |
$597.46 |
| Rate for Payer: Cofinity Commercial |
$464.69
|
| Rate for Payer: Cofinity Commercial |
$570.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$464.69
|
| Rate for Payer: Aetna American Axle |
$431.50
|
| Rate for Payer: Aetna Commercial |
$564.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$431.50
|
| Rate for Payer: Cash Price |
$531.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$531.07
|
| Rate for Payer: Healthscope Commercial |
$597.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$464.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$497.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$564.26
|
| Rate for Payer: PHP Commercial |
$564.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$431.50
|
| Rate for Payer: Priority Health SBD |
$418.22
|
| Rate for Payer: UMR Bronson Commercial |
$292.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$497.88
|
|
|
DEXAMETHASONE, MICRONIZED (BULK) 100 % POWDER
|
Facility
|
IP
|
$173.25
|
|
|
Service Code
|
NDC 38779040503
|
| 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: Cofinity Medicare Advantage |
$121.28
|
| 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 Commercial |
$147.26
|
| Rate for Payer: PHP Commercial |
$147.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.61
|
| 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, MICRONIZED (BULK) 100 % POWDER
|
Facility
|
OP
|
$173.25
|
|
|
Service Code
|
NDC 38779040503
|
| Hospital Charge Code |
116458
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.10 |
| Max. Negotiated Rate |
$155.92 |
| Rate for Payer: Aetna American Axle |
$112.61
|
| Rate for Payer: Aetna Commercial |
$147.26
|
| Rate for Payer: Aetna Medicare |
$86.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.61
|
| Rate for Payer: BCBS Complete |
$69.30
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cofinity Commercial |
$121.28
|
| Rate for Payer: Cofinity Commercial |
$149.00
|
| Rate for Payer: Cofinity Medicare Advantage |
$121.28
|
| 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 Commercial |
$147.26
|
| Rate for Payer: PHP Commercial |
$147.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.61
|
| Rate for Payer: Priority Health SBD |
$109.15
|
| Rate for Payer: UMR Bronson Commercial |
$64.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.94
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
OP
|
$64.08
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$57.67 |
| Rate for Payer: Aetna American Axle |
$41.65
|
| Rate for Payer: Aetna American Axle |
$11.97
|
| Rate for Payer: Aetna American Axle |
$7.13
|
| Rate for Payer: Aetna American Axle |
$10.54
|
| Rate for Payer: Aetna Commercial |
$54.47
|
| Rate for Payer: Aetna Commercial |
$13.78
|
| Rate for Payer: Aetna Commercial |
$9.32
|
| Rate for Payer: Aetna Commercial |
$15.66
|
| Rate for Payer: Aetna Medicare |
$9.21
|
| Rate for Payer: Aetna Medicare |
$8.10
|
| Rate for Payer: Aetna Medicare |
$5.48
|
| Rate for Payer: Aetna Medicare |
$32.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.54
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS Complete |
$4.39
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$12.97
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cash Price |
$12.97
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Cofinity Commercial |
$13.94
|
| 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 |
$12.89
|
| Rate for Payer: Cofinity Commercial |
$15.84
|
| Rate for Payer: Cofinity Commercial |
$44.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Commercial |
$57.67
|
| Rate for Payer: Healthscope Commercial |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$14.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.68
|
| 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: Lakeland Regional Health Systems Commercial |
$48.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.32
|
| Rate for Payer: PHP Commercial |
$54.47
|
| Rate for Payer: PHP Commercial |
$13.78
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: PHP Commercial |
$15.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.97
|
| Rate for Payer: Priority Health SBD |
$6.91
|
| Rate for Payer: Priority Health SBD |
$11.60
|
| Rate for Payer: Priority Health SBD |
$10.21
|
| Rate for Payer: Priority Health SBD |
$40.37
|
| Rate for Payer: UMR Bronson Commercial |
$4.06
|
| Rate for Payer: UMR Bronson Commercial |
$6.82
|
| Rate for Payer: UMR Bronson Commercial |
$23.71
|
| Rate for Payer: UMR Bronson Commercial |
$6.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.82
|
| 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 |
$48.06
|
|
