|
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) |
$11.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.65
|
| 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 |
$44.86
|
| Rate for Payer: Cofinity Commercial |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.26
|
| 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 |
$13.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.28
|
| Rate for Payer: PHP Commercial |
$54.47
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.65
|
| 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 |
$0.29 |
| Max. Negotiated Rate |
$14.59 |
| Rate for Payer: Cofinity Commercial |
$7.68
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Cofinity Commercial |
$12.59
|
| Rate for Payer: Cofinity Commercial |
$44.86
|
| Rate for Payer: Cofinity Commercial |
$15.84
|
| Rate for Payer: Cofinity Commercial |
$12.89
|
| Rate for Payer: Cofinity Commercial |
$13.94
|
| Rate for Payer: Cofinity Commercial |
$9.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.89
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$12.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.68
|
| Rate for Payer: Aetna American Axle |
$10.54
|
| Rate for Payer: Aetna American Axle |
$11.97
|
| Rate for Payer: Aetna American Axle |
$11.69
|
| 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 |
$15.28
|
| Rate for Payer: Aetna Commercial |
$15.66
|
| Rate for Payer: Aetna Medicare |
$8.99
|
| 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) |
$11.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.65
|
| 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) |
$11.69
|
| Rate for Payer: BCBS Complete |
$6.48
|
| Rate for Payer: BCBS Complete |
$4.39
|
| Rate for Payer: BCBS Complete |
$7.37
|
| Rate for Payer: BCBS Complete |
$25.63
|
| Rate for Payer: BCBS Complete |
$7.19
|
| 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: 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: BCN Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$12.97
|
| Rate for Payer: Cash Price |
$14.38
|
| 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 |
$14.38
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cash Price |
$51.26
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cash Price |
$14.74
|
| Rate for Payer: Cofinity Commercial |
$11.35
|
| Rate for Payer: Cofinity Commercial |
$55.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.74
|
| Rate for Payer: Healthscope Commercial |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$9.87
|
| Rate for Payer: Healthscope Commercial |
$14.59
|
| Rate for Payer: Healthscope Commercial |
$16.18
|
| Rate for Payer: Healthscope Commercial |
$57.67
|
| 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 |
$12.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$48.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.32
|
| Rate for Payer: PHP Commercial |
$54.47
|
| Rate for Payer: PHP Commercial |
$15.66
|
| Rate for Payer: PHP Commercial |
$13.78
|
| Rate for Payer: PHP Commercial |
$9.32
|
| Rate for Payer: PHP Commercial |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.54
|
| Rate for Payer: Priority Health SBD |
$10.21
|
| Rate for Payer: Priority Health SBD |
$40.37
|
| Rate for Payer: Priority Health SBD |
$11.60
|
| Rate for Payer: Priority Health SBD |
$6.91
|
| Rate for Payer: Priority Health SBD |
$11.33
|
| Rate for Payer: UMR Bronson Commercial |
$4.06
|
| Rate for Payer: UMR Bronson Commercial |
$6.65
|
| Rate for Payer: UMR Bronson Commercial |
$6.00
|
| Rate for Payer: UMR Bronson Commercial |
$6.82
|
| Rate for Payer: UMR Bronson Commercial |
$23.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$48.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.23
|
|
|
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 |
$0.29 |
| Max. Negotiated Rate |
$10.58 |
| Rate for Payer: Aetna American Axle |
$7.64
|
| Rate for Payer: Aetna Commercial |
$9.99
|
| Rate for Payer: Aetna Medicare |
$5.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.64
|
| Rate for Payer: BCBS Complete |
$4.70
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| 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: Cofinity Medicare Advantage |
$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 Commercial |
$9.99
|
| Rate for Payer: PHP Commercial |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.64
|
| 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 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: Cofinity Medicare Advantage |
$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 Commercial |
$9.99
|
| Rate for Payer: PHP Commercial |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.64
|
| 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 INJECTION SOLUTION
|
Facility
|
OP
|
$8.45
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Cofinity Medicare Advantage |
$8.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.92
|
| Rate for Payer: Aetna American Axle |
$5.49
|
| Rate for Payer: Aetna American Axle |
$50.43
|
| Rate for Payer: Aetna American Axle |
$12.84
|
| Rate for Payer: Aetna American Axle |
$8.48
|
| Rate for Payer: Aetna American Axle |
$297.45
|
| Rate for Payer: Aetna American Axle |
$7.34
|
| Rate for Payer: Aetna American Axle |
$80.92
|
| Rate for Payer: Aetna American Axle |
$7.64
|
| Rate for Payer: Aetna Commercial |
$105.82
|
| Rate for Payer: Aetna Commercial |
$9.60
|
| Rate for Payer: Aetna Commercial |
$9.99
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Commercial |
$11.09
|
| Rate for Payer: Aetna Commercial |
$388.98
|
| Rate for Payer: Aetna Commercial |
$65.94
|
| Rate for Payer: Aetna Commercial |
$7.18
|
| Rate for Payer: Aetna Medicare |
$6.52
|
| Rate for Payer: Aetna Medicare |
$5.88
|
| Rate for Payer: Aetna Medicare |
$38.79
|
| Rate for Payer: Aetna Medicare |
$62.25
|
| Rate for Payer: Aetna Medicare |
$4.22
|
| Rate for Payer: Aetna Medicare |
$9.88
|
| Rate for Payer: Aetna Medicare |
$5.65
|
| Rate for Payer: Aetna Medicare |
$228.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: BCBS Complete |
$3.38
|
| Rate for Payer: BCBS Complete |
$183.05
|
| Rate for Payer: BCBS Complete |
$5.22
|
| Rate for Payer: BCBS Complete |
$4.70
|
| Rate for Payer: BCBS Complete |
$4.52
|
| Rate for Payer: BCBS Complete |
$49.80
|
| Rate for Payer: BCBS Complete |
$31.03
|
| Rate for Payer: BCBS Complete |
$7.90
|
| 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: 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: 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 |
$99.60
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: Cofinity Commercial |
$11.22
|
| Rate for Payer: Cofinity Commercial |
$393.55
|
| Rate for Payer: Cofinity Commercial |
$320.33
|
| Rate for Payer: Cofinity Commercial |
$7.91
|
| Rate for Payer: Cofinity Commercial |
$8.22
|
| Rate for Payer: Cofinity Commercial |
$5.92
|
| Rate for Payer: Cofinity Commercial |
$9.14
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$107.07
|
| Rate for Payer: Cofinity Commercial |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Cofinity Commercial |
$87.15
|
| Rate for Payer: Cofinity Commercial |
$13.83
|
| Rate for Payer: Cofinity Commercial |
$66.72
|
| Rate for Payer: Cofinity Commercial |
$54.31
|
| Rate for Payer: Cofinity Commercial |
$7.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.04
|
| Rate for Payer: Healthscope Commercial |
$112.05
|
| Rate for Payer: Healthscope Commercial |
$11.74
|
| Rate for Payer: Healthscope Commercial |
$69.82
|
| Rate for Payer: Healthscope Commercial |
$7.60
|
| Rate for Payer: Healthscope Commercial |
$411.86
|
| Rate for Payer: Healthscope Commercial |
$10.17
|
| Rate for Payer: Healthscope Commercial |
$10.58
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.92
|
| 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 |
$13.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$87.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.09
|
| Rate for Payer: PHP Commercial |
$388.98
|
| Rate for Payer: PHP Commercial |
$9.99
|
| Rate for Payer: PHP Commercial |
$7.18
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$9.60
|
| Rate for Payer: PHP Commercial |
$105.82
|
| Rate for Payer: PHP Commercial |
$65.94
|
| Rate for Payer: PHP Commercial |
$11.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.43
|
| Rate for Payer: Priority Health SBD |
$7.12
|
| Rate for Payer: Priority Health SBD |
$5.32
|
| Rate for Payer: Priority Health SBD |
$8.22
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: Priority Health SBD |
$7.40
|
| Rate for Payer: Priority Health SBD |
$78.44
|
| Rate for Payer: Priority Health SBD |
$48.88
|
| Rate for Payer: Priority Health SBD |
$288.30
|
| Rate for Payer: UMR Bronson Commercial |
$28.70
|
| Rate for Payer: UMR Bronson Commercial |
$3.13
|
| Rate for Payer: UMR Bronson Commercial |
$169.32
|
| Rate for Payer: UMR Bronson Commercial |
$7.31
|
| Rate for Payer: UMR Bronson Commercial |
$4.83
|
| Rate for Payer: UMR Bronson Commercial |
$4.35
|
| Rate for Payer: UMR Bronson Commercial |
$4.18
|
| Rate for Payer: UMR Bronson Commercial |
$46.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$93.38
|
| 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 |
$9.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.48
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$77.58
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$69.82 |
| Rate for Payer: Cofinity Commercial |
$9.14
|
| Rate for Payer: Cofinity Commercial |
$7.91
|
| Rate for Payer: Cofinity Commercial |
$11.22
|
| Rate for Payer: Cofinity Commercial |
$107.07
|
| Rate for Payer: Cofinity Commercial |
$10.10
|
| Rate for Payer: Cofinity Commercial |
$8.22
|
| Rate for Payer: Cofinity Commercial |
$87.15
|
| Rate for Payer: Cofinity Commercial |
$9.72
|
| Rate for Payer: Cofinity Commercial |
$13.83
|
| Rate for Payer: Cofinity Commercial |
$16.99
|
| Rate for Payer: Cofinity Commercial |
$320.33
|
| Rate for Payer: Cofinity Commercial |
$393.55
|
| Rate for Payer: Cofinity Commercial |
$54.31
|
| Rate for Payer: Cofinity Commercial |
$66.72
|
| Rate for Payer: Cofinity Commercial |
$5.92
|
| Rate for Payer: Cofinity Commercial |
$7.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$54.31
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$87.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$320.33
|
| 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 |
$80.92
|
| Rate for Payer: Aetna American Axle |
$7.34
|
| Rate for Payer: Aetna American Axle |
$7.64
|
| Rate for Payer: Aetna American Axle |
$8.48
|
| Rate for Payer: Aetna American Axle |
$5.49
|
| Rate for Payer: Aetna Commercial |
$7.18
|
| Rate for Payer: Aetna Commercial |
$65.94
|
| Rate for Payer: Aetna Commercial |
$105.82
|
| Rate for Payer: Aetna Commercial |
$11.09
|
| Rate for Payer: Aetna Commercial |
$9.99
|
| Rate for Payer: Aetna Commercial |
$9.60
|
| Rate for Payer: Aetna Commercial |
$388.98
|
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.84
|
| Rate for Payer: Cash Price |
$10.44
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cash Price |
$15.81
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$9.04
|
| Rate for Payer: Cash Price |
$366.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.60
|
| Rate for Payer: Healthscope Commercial |
$10.17
|
| Rate for Payer: Healthscope Commercial |
$7.60
|
| Rate for Payer: Healthscope Commercial |
$69.82
|
| Rate for Payer: Healthscope Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$411.86
|
| Rate for Payer: Healthscope Commercial |
$11.74
|
| Rate for Payer: Healthscope Commercial |
$112.05
|
| Rate for Payer: Healthscope Commercial |
$10.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.83
|
| 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 |
$87.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$93.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$343.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$388.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.82
|
| Rate for Payer: PHP Commercial |
$65.94
|
| Rate for Payer: PHP Commercial |
$105.82
|
| Rate for Payer: PHP Commercial |
$388.98
|
| Rate for Payer: PHP Commercial |
$11.09
|
| Rate for Payer: PHP Commercial |
$7.18
|
| Rate for Payer: PHP Commercial |
$9.60
|
| Rate for Payer: PHP Commercial |
$16.80
|
| Rate for Payer: PHP Commercial |
$9.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$297.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.92
|
| Rate for Payer: Priority Health SBD |
$78.44
|
| Rate for Payer: Priority Health SBD |
$7.40
|
| Rate for Payer: Priority Health SBD |
$7.12
|
| Rate for Payer: Priority Health SBD |
$8.22
|
| Rate for Payer: Priority Health SBD |
$288.30
|
| Rate for Payer: Priority Health SBD |
$12.45
|
| Rate for Payer: Priority Health SBD |
$5.32
|
| Rate for Payer: Priority Health SBD |
$48.88
|
| Rate for Payer: UMR Bronson Commercial |
$54.78
|
| Rate for Payer: UMR Bronson Commercial |
$5.74
|
| Rate for Payer: UMR Bronson Commercial |
$201.35
|
| Rate for Payer: UMR Bronson Commercial |
$34.14
|
| Rate for Payer: UMR Bronson Commercial |
$5.17
|
| Rate for Payer: UMR Bronson Commercial |
$3.72
|
| Rate for Payer: UMR Bronson Commercial |
$8.69
|
| Rate for Payer: UMR Bronson Commercial |
$4.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.79
|
| 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 |
$93.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.82
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
IP
|
$16.72
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna American Axle |
$10.87
|
| Rate for Payer: Aetna American Axle |
$13.99
|
| Rate for Payer: Aetna American Axle |
$15.31
|
| Rate for Payer: Aetna Commercial |
$18.29
|
| Rate for Payer: Aetna Commercial |
$14.21
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.99
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$17.22
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$15.06
|
| Rate for Payer: Cofinity Commercial |
$11.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.22
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Healthscope Commercial |
$19.37
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.21
|
| Rate for Payer: PHP Commercial |
$14.21
|
| Rate for Payer: PHP Commercial |
$18.29
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.87
|
| Rate for Payer: Priority Health SBD |
$13.56
|
| Rate for Payer: Priority Health SBD |
$14.84
|
| Rate for Payer: Priority Health SBD |
$10.53
|
| Rate for Payer: UMR Bronson Commercial |
$7.36
|
| Rate for Payer: UMR Bronson Commercial |
$9.47
|
| Rate for Payer: UMR Bronson Commercial |
$10.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.66
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
OP
|
$23.55
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301178
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$21.20 |
| Rate for Payer: Aetna American Axle |
$15.31
|
| Rate for Payer: Aetna American Axle |
$13.99
|
| Rate for Payer: Aetna American Axle |
$10.87
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna Commercial |
$14.21
|
| Rate for Payer: Aetna Commercial |
$18.29
|
| Rate for Payer: Aetna Medicare |
$10.76
|
| Rate for Payer: Aetna Medicare |
$8.36
|
| Rate for Payer: Aetna Medicare |
$11.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.99
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS Complete |
$9.42
|
| Rate for Payer: BCBS Complete |
$6.69
|
| 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: Cash Price |
$17.22
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cash Price |
$17.22
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$11.70
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$15.06
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Healthscope Commercial |
$19.37
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.02
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: PHP Commercial |
$14.21
|
| Rate for Payer: PHP Commercial |
$18.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.31
|
| Rate for Payer: Priority Health SBD |
$13.56
|
| Rate for Payer: Priority Health SBD |
$14.84
|
| Rate for Payer: Priority Health SBD |
$10.53
|
| Rate for Payer: UMR Bronson Commercial |
$8.71
|
| Rate for Payer: UMR Bronson Commercial |
$6.19
|
| Rate for Payer: UMR Bronson Commercial |
$7.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.14
|
| 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 |
$0.29 |
| Max. Negotiated Rate |
$21.20 |
| Rate for Payer: Aetna American Axle |
$15.31
|
| Rate for Payer: Aetna American Axle |
$13.99
|
| Rate for Payer: Aetna American Axle |
$10.87
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna Commercial |
$14.21
|
| Rate for Payer: Aetna Commercial |
$18.29
|
| Rate for Payer: Aetna Medicare |
$10.76
|
| Rate for Payer: Aetna Medicare |
$8.36
|
| Rate for Payer: Aetna Medicare |
$11.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.99
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS Complete |
$9.42
|
| Rate for Payer: BCBS Complete |
$6.69
|
| 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: Cash Price |
$17.22
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cash Price |
$17.22
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cofinity Commercial |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$11.70
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$15.06
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Healthscope Commercial |
$19.37
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.02
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: PHP Commercial |
$14.21
|
| Rate for Payer: PHP Commercial |
$18.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.31
|
| Rate for Payer: Priority Health SBD |
$13.56
|
| Rate for Payer: Priority Health SBD |
$14.84
|
| Rate for Payer: Priority Health SBD |
$10.53
|
| Rate for Payer: UMR Bronson Commercial |
$8.71
|
| Rate for Payer: UMR Bronson Commercial |
$6.19
|
| Rate for Payer: UMR Bronson Commercial |
$7.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.66
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$16.72
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
116809
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna American Axle |
$10.87
|
| Rate for Payer: Aetna American Axle |
$13.99
|
| Rate for Payer: Aetna American Axle |
$15.31
|
| Rate for Payer: Aetna Commercial |
$18.29
|
| Rate for Payer: Aetna Commercial |
$14.21
|
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.99
|
| Rate for Payer: Cash Price |
$18.84
|
| Rate for Payer: Cash Price |
$17.22
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cofinity Commercial |
$14.38
|
| Rate for Payer: Cofinity Commercial |
$18.51
|
| Rate for Payer: Cofinity Commercial |
$15.06
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$16.48
|
| Rate for Payer: Cofinity Commercial |
$11.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$11.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.22
|
| Rate for Payer: Healthscope Commercial |
$19.37
|
| Rate for Payer: Healthscope Commercial |
$15.05
|
| Rate for Payer: Healthscope Commercial |
$21.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.29
|
| Rate for Payer: PHP Commercial |
$20.02
|
| Rate for Payer: PHP Commercial |
$18.29
|
| Rate for Payer: PHP Commercial |
$14.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.87
|
| Rate for Payer: Priority Health SBD |
$14.84
|
| Rate for Payer: Priority Health SBD |
$13.56
|
| Rate for Payer: Priority Health SBD |
$10.53
|
| Rate for Payer: UMR Bronson Commercial |
$7.36
|
| Rate for Payer: UMR Bronson Commercial |
$10.36
|
| Rate for Payer: UMR Bronson Commercial |
$9.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.14
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$19.42
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
192063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$17.48 |
| Rate for Payer: Aetna American Axle |
$12.62
|
| Rate for Payer: Aetna Commercial |
$16.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.62
|
| Rate for Payer: Cash Price |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Commercial |
$16.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.54
|
| Rate for Payer: Healthscope Commercial |
$17.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.51
|
| Rate for Payer: PHP Commercial |
$16.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.62
|
| Rate for Payer: Priority Health SBD |
$12.23
|
| Rate for Payer: UMR Bronson Commercial |
$8.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.56
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$19.42
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
192063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$17.48 |
| Rate for Payer: Aetna American Axle |
$12.62
|
| Rate for Payer: Aetna Commercial |
$16.51
|
| Rate for Payer: Aetna Medicare |
$9.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.62
|
| Rate for Payer: BCBS Complete |
$7.77
|
| Rate for Payer: BCBS Trust/PPO |
$0.29
|
| Rate for Payer: BCN Commercial |
$0.29
|
| Rate for Payer: Cash Price |
$15.54
|
| Rate for Payer: Cash Price |
$15.54
|
| Rate for Payer: Cofinity Commercial |
$13.59
|
| Rate for Payer: Cofinity Commercial |
$16.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.54
|
| Rate for Payer: Healthscope Commercial |
$17.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.51
|
| Rate for Payer: PHP Commercial |
$16.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.62
|
| Rate for Payer: Priority Health SBD |
$12.23
|
| Rate for Payer: UMR Bronson Commercial |
$7.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.56
|
|
|
DEXLANSOPRAZOLE 60 MG CAPSULE,BIPHASE DELAYED RELEASE
|
Facility
|
OP
|
$1,061.16
|
|
|
Service Code
|
NDC 64764017530
|
| Hospital Charge Code |
97009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$392.63 |
| Max. Negotiated Rate |
$955.04 |
| Rate for Payer: Aetna American Axle |
$689.75
|
| Rate for Payer: Aetna Commercial |
$901.99
|
| Rate for Payer: Aetna Medicare |
$530.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$689.75
|
| Rate for Payer: BCBS Complete |
$424.46
|
| Rate for Payer: Cash Price |
$848.93
|
| Rate for Payer: Cofinity Commercial |
$742.81
|
| Rate for Payer: Cofinity Commercial |
$912.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$742.81
|
| 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 Commercial |
$901.99
|
| Rate for Payer: PHP Commercial |
$901.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$689.75
|
| Rate for Payer: Priority Health SBD |
$668.53
|
| Rate for Payer: UMR Bronson Commercial |
$392.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$795.87
|
|
|
DEXLANSOPRAZOLE 60 MG CAPSULE,BIPHASE DELAYED RELEASE
|
Facility
|
OP
|
$3,183.48
|
|
|
Service Code
|
NDC 64764017590
|
| Hospital Charge Code |
97009
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,177.89 |
| 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 Medicare |
$1,591.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,069.26
|
| Rate for Payer: BCBS Complete |
$1,273.39
|
| 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: Cofinity Medicare Advantage |
$2,228.44
|
| 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 Commercial |
$2,705.96
|
| Rate for Payer: PHP Commercial |
$2,705.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,069.26
|
| Rate for Payer: Priority Health SBD |
$2,005.59
|
| Rate for Payer: UMR Bronson Commercial |
$1,177.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,387.61
|
|
|
DEXLANSOPRAZOLE 60 MG CAPSULE,BIPHASE DELAYED RELEASE
|
Facility
|
IP
|
$3,183.48
|
|
|
Service Code
|
NDC 64764017590
|
| 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: Cofinity Medicare Advantage |
$2,228.44
|
| 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 Commercial |
$2,705.96
|
| Rate for Payer: PHP Commercial |
$2,705.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,069.26
|
| 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
|
|
|
DEXLANSOPRAZOLE 60 MG CAPSULE,BIPHASE DELAYED RELEASE
|
Facility
|
IP
|
$1,061.16
|
|
|
Service Code
|
NDC 64764017530
|
| 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: Cofinity Medicare Advantage |
$742.81
|
| 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 Commercial |
$901.99
|
| Rate for Payer: PHP Commercial |
$901.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$689.75
|
| 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
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$63.07
|
|
|
Service Code
|
NDC 16729023993
|
| 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: Cofinity Medicare Advantage |
$44.15
|
| 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 Commercial |
$53.61
|
| Rate for Payer: PHP Commercial |
$53.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.00
|
| 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
|
OP
|
$50.44
|
|
|
Service Code
|
NDC 42023014625
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.66 |
| Max. Negotiated Rate |
$45.40 |
| Rate for Payer: Cofinity Commercial |
$43.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.31
|
| Rate for Payer: Aetna American Axle |
$32.79
|
| Rate for Payer: Aetna Commercial |
$42.87
|
| Rate for Payer: Aetna Medicare |
$25.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.79
|
| Rate for Payer: BCBS Complete |
$20.18
|
| Rate for Payer: Cash Price |
$40.35
|
| Rate for Payer: Cofinity Commercial |
$35.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.35
|
| Rate for Payer: Healthscope Commercial |
$45.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.87
|
| Rate for Payer: PHP Commercial |
$42.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.79
|
| Rate for Payer: Priority Health SBD |
$31.78
|
| Rate for Payer: UMR Bronson Commercial |
$18.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.83
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$70.27
|
|
|
Service Code
|
NDC 70860060502
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$63.24 |
| Rate for Payer: Aetna American Axle |
$45.68
|
| Rate for Payer: Aetna Commercial |
$59.73
|
| Rate for Payer: Aetna Medicare |
$35.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.68
|
| Rate for Payer: BCBS Complete |
$28.11
|
| Rate for Payer: Cash Price |
$56.22
|
| Rate for Payer: Cofinity Commercial |
$49.19
|
| Rate for Payer: Cofinity Commercial |
$60.43
|
| Rate for Payer: Cofinity Medicare Advantage |
$49.19
|
| 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 Commercial |
$59.73
|
| Rate for Payer: PHP Commercial |
$59.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.68
|
| Rate for Payer: Priority Health SBD |
$44.27
|
| Rate for Payer: UMR Bronson Commercial |
$26.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.70
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$63.07
|
|
|
Service Code
|
NDC 55150020902
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.34 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna American Axle |
$41.00
|
| Rate for Payer: Aetna Commercial |
$53.61
|
| Rate for Payer: Aetna Medicare |
$31.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.00
|
| Rate for Payer: BCBS Complete |
$25.23
|
| Rate for Payer: Cash Price |
$50.46
|
| Rate for Payer: Cofinity Commercial |
$44.15
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.15
|
| 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 Commercial |
$53.61
|
| Rate for Payer: PHP Commercial |
$53.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.00
|
| Rate for Payer: Priority Health SBD |
$39.73
|
| Rate for Payer: UMR Bronson Commercial |
$23.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.30
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$63.07
|
|
|
Service Code
|
NDC 16729023930
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.34 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna American Axle |
$41.00
|
| Rate for Payer: Aetna Commercial |
$53.61
|
| Rate for Payer: Aetna Medicare |
$31.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.00
|
| Rate for Payer: BCBS Complete |
$25.23
|
| Rate for Payer: Cash Price |
$50.46
|
| Rate for Payer: Cofinity Commercial |
$44.15
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.15
|
| 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 Commercial |
$53.61
|
| Rate for Payer: PHP Commercial |
$53.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.00
|
| Rate for Payer: Priority Health SBD |
$39.73
|
| Rate for Payer: UMR Bronson Commercial |
$23.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.30
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$99.04
|
|
|
Service Code
|
NDC 67457025100
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.64 |
| Max. Negotiated Rate |
$89.14 |
| Rate for Payer: Aetna American Axle |
$64.38
|
| Rate for Payer: Aetna Commercial |
$84.18
|
| Rate for Payer: Aetna Medicare |
$49.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.38
|
| Rate for Payer: BCBS Complete |
$39.62
|
| Rate for Payer: Cash Price |
$79.23
|
| Rate for Payer: Cofinity Commercial |
$69.33
|
| Rate for Payer: Cofinity Commercial |
$85.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$69.33
|
| 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 Commercial |
$84.18
|
| Rate for Payer: PHP Commercial |
$84.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.38
|
| Rate for Payer: Priority Health SBD |
$62.40
|
| Rate for Payer: UMR Bronson Commercial |
$36.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.28
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$63.07
|
|
|
Service Code
|
NDC 16729023993
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.34 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna American Axle |
$41.00
|
| Rate for Payer: Aetna Commercial |
$53.61
|
| Rate for Payer: Aetna Medicare |
$31.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.00
|
| Rate for Payer: BCBS Complete |
$25.23
|
| Rate for Payer: Cash Price |
$50.46
|
| Rate for Payer: Cofinity Commercial |
$44.15
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.15
|
| 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 Commercial |
$53.61
|
| Rate for Payer: PHP Commercial |
$53.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.00
|
| Rate for Payer: Priority Health SBD |
$39.73
|
| Rate for Payer: UMR Bronson Commercial |
$23.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.30
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$50.44
|
|
|
Service Code
|
NDC 42023014625
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.19 |
| Max. Negotiated Rate |
$45.40 |
| Rate for Payer: Aetna American Axle |
$32.79
|
| Rate for Payer: Aetna Commercial |
$42.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.79
|
| Rate for Payer: Cash Price |
$40.35
|
| Rate for Payer: Cofinity Commercial |
$35.31
|
| Rate for Payer: Cofinity Commercial |
$43.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$35.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.35
|
| Rate for Payer: Healthscope Commercial |
$45.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.87
|
| Rate for Payer: PHP Commercial |
$42.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.79
|
| Rate for Payer: Priority Health SBD |
$31.78
|
| Rate for Payer: UMR Bronson Commercial |
$22.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.83
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$84.57
|
|
|
Service Code
|
NDC 00409163802
|
| Hospital Charge Code |
27103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.29 |
| Max. Negotiated Rate |
$76.11 |
| Rate for Payer: Aetna American Axle |
$54.97
|
| Rate for Payer: Aetna Commercial |
$71.88
|
| Rate for Payer: Aetna Medicare |
$42.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.97
|
| Rate for Payer: BCBS Complete |
$33.83
|
| Rate for Payer: Cash Price |
$67.66
|
| Rate for Payer: Cofinity Commercial |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$72.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$59.20
|
| 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 Commercial |
$71.88
|
| Rate for Payer: PHP Commercial |
$71.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.97
|
| Rate for Payer: Priority Health SBD |
$53.28
|
| Rate for Payer: UMR Bronson Commercial |
$31.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.43
|
|
