|
DEXAMETHASONE 4 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$8.72
|
|
|
Service Code
|
NDC 55150023701
|
| Hospital Charge Code |
180050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$8.72 |
| Rate for Payer: Aetna Commercial |
$7.85
|
| Rate for Payer: Aetna Medicare |
$4.36
|
| Rate for Payer: ASR ASR |
$8.46
|
| Rate for Payer: ASR Commercial |
$8.46
|
| Rate for Payer: BCBS Complete |
$3.49
|
| Rate for Payer: BCBS Trust/PPO |
$7.14
|
| Rate for Payer: BCN Commercial |
$6.76
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cofinity Commercial |
$8.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.98
|
| Rate for Payer: Healthscope Commercial |
$8.72
|
| Rate for Payer: Healthscope Whirlpool |
$8.46
|
| Rate for Payer: Mclaren Commercial |
$7.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.41
|
| Rate for Payer: Nomi Health Commercial |
$7.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.64
|
| Rate for Payer: Priority Health Narrow Network |
$6.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.67
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$400.90
|
|
|
Service Code
|
NDC 00054418425
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.36 |
| Max. Negotiated Rate |
$400.90 |
| Rate for Payer: Aetna Commercial |
$360.81
|
| Rate for Payer: Aetna Medicare |
$200.45
|
| Rate for Payer: ASR ASR |
$388.87
|
| Rate for Payer: ASR Commercial |
$388.87
|
| Rate for Payer: BCBS Complete |
$160.36
|
| Rate for Payer: BCBS Trust/PPO |
$328.30
|
| Rate for Payer: BCN Commercial |
$310.82
|
| Rate for Payer: Cash Price |
$320.72
|
| Rate for Payer: Cofinity Commercial |
$376.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.72
|
| Rate for Payer: Healthscope Commercial |
$400.90
|
| Rate for Payer: Healthscope Whirlpool |
$388.87
|
| Rate for Payer: Mclaren Commercial |
$360.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.76
|
| Rate for Payer: Nomi Health Commercial |
$328.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$351.27
|
| Rate for Payer: Priority Health Narrow Network |
$281.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.79
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$467.52
|
|
|
Service Code
|
NDC 00054817525
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$187.01 |
| Max. Negotiated Rate |
$467.52 |
| Rate for Payer: Aetna Commercial |
$420.77
|
| Rate for Payer: Aetna Medicare |
$233.76
|
| Rate for Payer: ASR ASR |
$453.49
|
| Rate for Payer: ASR Commercial |
$453.49
|
| Rate for Payer: BCBS Complete |
$187.01
|
| Rate for Payer: BCBS Trust/PPO |
$382.85
|
| Rate for Payer: BCN Commercial |
$362.47
|
| Rate for Payer: Cash Price |
$374.02
|
| Rate for Payer: Cofinity Commercial |
$439.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.02
|
| Rate for Payer: Healthscope Commercial |
$467.52
|
| Rate for Payer: Healthscope Whirlpool |
$453.49
|
| Rate for Payer: Mclaren Commercial |
$420.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.39
|
| Rate for Payer: Nomi Health Commercial |
$383.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$409.64
|
| Rate for Payer: Priority Health Narrow Network |
$327.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$411.42
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$400.90
|
|
|
Service Code
|
NDC 00054418425
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.58 |
| Max. Negotiated Rate |
$400.90 |
| Rate for Payer: Aetna Commercial |
$360.81
|
| Rate for Payer: ASR ASR |
$388.87
|
| Rate for Payer: ASR Commercial |
$388.87
|
| Rate for Payer: BCBS Trust/PPO |
$326.69
|
| Rate for Payer: BCN Commercial |
$310.82
|
| Rate for Payer: Cash Price |
$320.72
|
| Rate for Payer: Cofinity Commercial |
$376.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$320.72
|
| Rate for Payer: Healthscope Commercial |
$400.90
|
| Rate for Payer: Healthscope Whirlpool |
$388.87
|
| Rate for Payer: Mclaren Commercial |
$360.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$340.76
|
| Rate for Payer: Nomi Health Commercial |
$328.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$352.79
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$420.48
|
|
|
Service Code
|
NDC 00904726661
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.31 |
| Max. Negotiated Rate |
$420.48 |
| Rate for Payer: Aetna Commercial |
$378.43
|
| Rate for Payer: ASR ASR |
$407.87
|
| Rate for Payer: ASR Commercial |
$407.87
|
| Rate for Payer: BCBS Trust/PPO |
$342.65
|
| Rate for Payer: BCN Commercial |
$326.00
|
| Rate for Payer: Cash Price |
$336.38
|
| Rate for Payer: Cofinity Commercial |
$395.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.38
|
| Rate for Payer: Healthscope Commercial |
$420.48
|
| Rate for Payer: Healthscope Whirlpool |
$407.87
|
| Rate for Payer: Mclaren Commercial |
$378.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.41
|
| Rate for Payer: Nomi Health Commercial |
$344.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.02
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$420.48
|
|
|
Service Code
|
NDC 00904726661
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.19 |
| Max. Negotiated Rate |
$420.48 |
| Rate for Payer: Aetna Commercial |
$378.43
|
| Rate for Payer: Aetna Medicare |
$210.24
|
| Rate for Payer: ASR ASR |
$407.87
|
| Rate for Payer: ASR Commercial |
$407.87
|
| Rate for Payer: BCBS Complete |
$168.19
|
| Rate for Payer: BCBS Trust/PPO |
$344.33
|
| Rate for Payer: BCN Commercial |
$326.00
|
| Rate for Payer: Cash Price |
$336.38
|
| Rate for Payer: Cofinity Commercial |
$395.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.38
|
| Rate for Payer: Healthscope Commercial |
$420.48
|
| Rate for Payer: Healthscope Whirlpool |
$407.87
|
| Rate for Payer: Mclaren Commercial |
$378.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$357.41
|
| Rate for Payer: Nomi Health Commercial |
$344.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$273.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$368.42
|
| Rate for Payer: Priority Health Narrow Network |
$294.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$370.02
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$467.52
|
|
|
Service Code
|
NDC 00054817525
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$303.89 |
| Max. Negotiated Rate |
$467.52 |
| Rate for Payer: Aetna Commercial |
$420.77
|
| Rate for Payer: ASR ASR |
$453.49
|
| Rate for Payer: ASR Commercial |
$453.49
|
| Rate for Payer: BCBS Trust/PPO |
$380.98
|
| Rate for Payer: BCN Commercial |
$362.47
|
| Rate for Payer: Cash Price |
$374.02
|
| Rate for Payer: Cofinity Commercial |
$439.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$374.02
|
| Rate for Payer: Healthscope Commercial |
$467.52
|
| Rate for Payer: Healthscope Whirlpool |
$453.49
|
| Rate for Payer: Mclaren Commercial |
$420.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.39
|
| Rate for Payer: Nomi Health Commercial |
$383.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$411.42
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$442.56
|
|
|
Service Code
|
NDC 66993073002
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$177.02 |
| Max. Negotiated Rate |
$442.56 |
| Rate for Payer: Aetna Commercial |
$398.30
|
| Rate for Payer: Aetna Medicare |
$221.28
|
| Rate for Payer: ASR ASR |
$429.28
|
| Rate for Payer: ASR Commercial |
$429.28
|
| Rate for Payer: BCBS Complete |
$177.02
|
| Rate for Payer: BCBS Trust/PPO |
$362.41
|
| Rate for Payer: BCN Commercial |
$343.12
|
| Rate for Payer: Cash Price |
$354.05
|
| Rate for Payer: Cofinity Commercial |
$416.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.05
|
| Rate for Payer: Healthscope Commercial |
$442.56
|
| Rate for Payer: Healthscope Whirlpool |
$429.28
|
| Rate for Payer: Mclaren Commercial |
$398.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.18
|
| Rate for Payer: Nomi Health Commercial |
$362.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$387.77
|
| Rate for Payer: Priority Health Narrow Network |
$310.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.45
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$4.63
|
|
|
Service Code
|
NDC 66993073051
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Aetna Commercial |
$4.17
|
| Rate for Payer: Aetna Medicare |
$2.32
|
| Rate for Payer: ASR ASR |
$4.49
|
| Rate for Payer: ASR Commercial |
$4.49
|
| Rate for Payer: BCBS Complete |
$1.85
|
| Rate for Payer: BCBS Trust/PPO |
$3.79
|
| Rate for Payer: BCN Commercial |
$3.59
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cofinity Commercial |
$4.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.70
|
| Rate for Payer: Healthscope Commercial |
$4.63
|
| Rate for Payer: Healthscope Whirlpool |
$4.49
|
| Rate for Payer: Mclaren Commercial |
$4.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.94
|
| Rate for Payer: Nomi Health Commercial |
$3.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.06
|
| Rate for Payer: Priority Health Narrow Network |
$3.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.07
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$4.63
|
|
|
Service Code
|
NDC 66993073051
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Aetna Commercial |
$4.17
|
| Rate for Payer: ASR ASR |
$4.49
|
| Rate for Payer: ASR Commercial |
$4.49
|
| Rate for Payer: BCBS Trust/PPO |
$3.77
|
| Rate for Payer: BCN Commercial |
$3.59
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Cofinity Commercial |
$4.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.70
|
| Rate for Payer: Healthscope Commercial |
$4.63
|
| Rate for Payer: Healthscope Whirlpool |
$4.49
|
| Rate for Payer: Mclaren Commercial |
$4.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.94
|
| Rate for Payer: Nomi Health Commercial |
$3.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.07
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$442.56
|
|
|
Service Code
|
NDC 66993073002
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$287.66 |
| Max. Negotiated Rate |
$442.56 |
| Rate for Payer: Aetna Commercial |
$398.30
|
| Rate for Payer: ASR ASR |
$429.28
|
| Rate for Payer: ASR Commercial |
$429.28
|
| Rate for Payer: BCBS Trust/PPO |
$360.64
|
| Rate for Payer: BCN Commercial |
$343.12
|
| Rate for Payer: Cash Price |
$354.05
|
| Rate for Payer: Cofinity Commercial |
$416.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$354.05
|
| Rate for Payer: Healthscope Commercial |
$442.56
|
| Rate for Payer: Healthscope Whirlpool |
$429.28
|
| Rate for Payer: Mclaren Commercial |
$398.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.18
|
| Rate for Payer: Nomi Health Commercial |
$362.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$287.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.45
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
OP
|
$11.18
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$11.18 |
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: Aetna Medicare |
$5.59
|
| Rate for Payer: ASR ASR |
$10.84
|
| Rate for Payer: ASR Commercial |
$10.84
|
| Rate for Payer: BCBS Complete |
$4.47
|
| Rate for Payer: BCBS Trust/PPO |
$9.16
|
| Rate for Payer: BCN Commercial |
$8.67
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Cofinity Commercial |
$10.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.94
|
| Rate for Payer: Healthscope Commercial |
$11.18
|
| Rate for Payer: Healthscope Whirlpool |
$10.84
|
| Rate for Payer: Mclaren Commercial |
$10.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.50
|
| Rate for Payer: Nomi Health Commercial |
$9.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.84
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IM INJECTION SOLUTION
|
Facility
|
IP
|
$11.18
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$11.18 |
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: ASR ASR |
$10.84
|
| Rate for Payer: ASR Commercial |
$10.84
|
| Rate for Payer: BCBS Trust/PPO |
$9.11
|
| Rate for Payer: BCN Commercial |
$8.67
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Cofinity Commercial |
$10.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.94
|
| Rate for Payer: Healthscope Commercial |
$11.18
|
| Rate for Payer: Healthscope Whirlpool |
$10.84
|
| Rate for Payer: Mclaren Commercial |
$10.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.50
|
| Rate for Payer: Nomi Health Commercial |
$9.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.84
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$11.18
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2331
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$11.18 |
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: Aetna Medicare |
$5.59
|
| Rate for Payer: ASR ASR |
$10.84
|
| Rate for Payer: ASR Commercial |
$10.84
|
| Rate for Payer: BCBS Complete |
$4.47
|
| Rate for Payer: BCBS Trust/PPO |
$9.16
|
| Rate for Payer: BCN Commercial |
$8.67
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Cofinity Commercial |
$10.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.94
|
| Rate for Payer: Healthscope Commercial |
$11.18
|
| Rate for Payer: Healthscope Whirlpool |
$10.84
|
| Rate for Payer: Mclaren Commercial |
$10.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.50
|
| Rate for Payer: Nomi Health Commercial |
$9.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.84
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$11.18
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2331
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$11.18 |
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: ASR ASR |
$10.84
|
| Rate for Payer: ASR Commercial |
$10.84
|
| Rate for Payer: BCBS Trust/PPO |
$9.11
|
| Rate for Payer: BCN Commercial |
$8.67
|
| Rate for Payer: Cash Price |
$8.94
|
| Rate for Payer: Cofinity Commercial |
$10.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.94
|
| Rate for Payer: Healthscope Commercial |
$11.18
|
| Rate for Payer: Healthscope Whirlpool |
$10.84
|
| Rate for Payer: Mclaren Commercial |
$10.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.50
|
| Rate for Payer: Nomi Health Commercial |
$9.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.84
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML FOR IM INJECTION
|
Facility
|
OP
|
$11.43
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: Aetna Medicare |
$5.72
|
| Rate for Payer: ASR ASR |
$11.09
|
| Rate for Payer: ASR Commercial |
$11.09
|
| Rate for Payer: BCBS Complete |
$4.57
|
| Rate for Payer: BCBS Trust/PPO |
$9.36
|
| Rate for Payer: BCN Commercial |
$8.86
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cofinity Commercial |
$10.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.14
|
| Rate for Payer: Healthscope Commercial |
$11.43
|
| Rate for Payer: Healthscope Whirlpool |
$11.09
|
| Rate for Payer: Mclaren Commercial |
$10.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.72
|
| Rate for Payer: Nomi Health Commercial |
$9.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.06
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML FOR IM INJECTION
|
Facility
|
IP
|
$11.43
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: ASR ASR |
$11.09
|
| Rate for Payer: ASR Commercial |
$11.09
|
| Rate for Payer: BCBS Trust/PPO |
$9.31
|
| Rate for Payer: BCN Commercial |
$8.86
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cofinity Commercial |
$10.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.14
|
| Rate for Payer: Healthscope Commercial |
$11.43
|
| Rate for Payer: Healthscope Whirlpool |
$11.09
|
| Rate for Payer: Mclaren Commercial |
$10.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.72
|
| Rate for Payer: Nomi Health Commercial |
$9.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.06
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$11.43
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: Aetna Commercial |
$11.59
|
| Rate for Payer: Aetna Commercial |
$10.57
|
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Commercial |
$7.85
|
| Rate for Payer: Aetna Commercial |
$10.24
|
| Rate for Payer: Aetna Commercial |
$69.82
|
| Rate for Payer: ASR ASR |
$12.49
|
| Rate for Payer: ASR ASR |
$11.39
|
| Rate for Payer: ASR ASR |
$8.46
|
| Rate for Payer: ASR ASR |
$19.16
|
| Rate for Payer: ASR ASR |
$11.09
|
| Rate for Payer: ASR ASR |
$11.04
|
| Rate for Payer: ASR ASR |
$75.25
|
| Rate for Payer: ASR Commercial |
$8.46
|
| Rate for Payer: ASR Commercial |
$75.25
|
| Rate for Payer: ASR Commercial |
$11.39
|
| Rate for Payer: ASR Commercial |
$19.16
|
| Rate for Payer: ASR Commercial |
$12.49
|
| Rate for Payer: ASR Commercial |
$11.09
|
| Rate for Payer: ASR Commercial |
$11.04
|
| Rate for Payer: BCBS Trust/PPO |
$63.22
|
| Rate for Payer: BCBS Trust/PPO |
$16.09
|
| Rate for Payer: BCBS Trust/PPO |
$9.27
|
| Rate for Payer: BCBS Trust/PPO |
$9.31
|
| Rate for Payer: BCBS Trust/PPO |
$10.50
|
| Rate for Payer: BCBS Trust/PPO |
$9.57
|
| Rate for Payer: BCBS Trust/PPO |
$7.11
|
| Rate for Payer: BCN Commercial |
$9.10
|
| Rate for Payer: BCN Commercial |
$6.76
|
| Rate for Payer: BCN Commercial |
$15.31
|
| Rate for Payer: BCN Commercial |
$8.82
|
| Rate for Payer: BCN Commercial |
$8.86
|
| Rate for Payer: BCN Commercial |
$60.15
|
| Rate for Payer: BCN Commercial |
$9.99
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cofinity Commercial |
$18.56
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$10.70
|
| Rate for Payer: Cofinity Commercial |
$12.11
|
| Rate for Payer: Cofinity Commercial |
$10.74
|
| Rate for Payer: Cofinity Commercial |
$72.93
|
| Rate for Payer: Cofinity Commercial |
$8.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.80
|
| Rate for Payer: Healthscope Commercial |
$19.75
|
| Rate for Payer: Healthscope Commercial |
$8.72
|
| Rate for Payer: Healthscope Commercial |
$11.74
|
| Rate for Payer: Healthscope Commercial |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$77.58
|
| Rate for Payer: Healthscope Commercial |
$11.43
|
| Rate for Payer: Healthscope Commercial |
$11.38
|
| Rate for Payer: Healthscope Whirlpool |
$75.25
|
| Rate for Payer: Healthscope Whirlpool |
$19.16
|
| Rate for Payer: Healthscope Whirlpool |
$12.49
|
| Rate for Payer: Healthscope Whirlpool |
$11.09
|
| Rate for Payer: Healthscope Whirlpool |
$11.39
|
| Rate for Payer: Healthscope Whirlpool |
$11.04
|
| Rate for Payer: Healthscope Whirlpool |
$8.46
|
| Rate for Payer: Mclaren Commercial |
$17.78
|
| Rate for Payer: Mclaren Commercial |
$7.85
|
| Rate for Payer: Mclaren Commercial |
$10.24
|
| Rate for Payer: Mclaren Commercial |
$69.82
|
| Rate for Payer: Mclaren Commercial |
$10.57
|
| Rate for Payer: Mclaren Commercial |
$10.29
|
| Rate for Payer: Mclaren Commercial |
$11.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.94
|
| Rate for Payer: Nomi Health Commercial |
$9.33
|
| Rate for Payer: Nomi Health Commercial |
$63.62
|
| Rate for Payer: Nomi Health Commercial |
$7.15
|
| Rate for Payer: Nomi Health Commercial |
$10.56
|
| Rate for Payer: Nomi Health Commercial |
$9.63
|
| Rate for Payer: Nomi Health Commercial |
$9.37
|
| Rate for Payer: Nomi Health Commercial |
$16.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.33
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$8.72
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$8.72 |
| Rate for Payer: Aetna Commercial |
$7.85
|
| Rate for Payer: Aetna Commercial |
$10.57
|
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: Aetna Commercial |
$11.59
|
| Rate for Payer: Aetna Commercial |
$69.82
|
| Rate for Payer: Aetna Commercial |
$10.24
|
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Medicare |
$5.87
|
| Rate for Payer: Aetna Medicare |
$38.79
|
| Rate for Payer: Aetna Medicare |
$9.88
|
| Rate for Payer: Aetna Medicare |
$4.36
|
| Rate for Payer: Aetna Medicare |
$6.44
|
| Rate for Payer: Aetna Medicare |
$5.72
|
| Rate for Payer: Aetna Medicare |
$5.69
|
| Rate for Payer: ASR ASR |
$75.25
|
| Rate for Payer: ASR ASR |
$12.49
|
| Rate for Payer: ASR ASR |
$11.39
|
| Rate for Payer: ASR ASR |
$11.04
|
| Rate for Payer: ASR ASR |
$11.09
|
| Rate for Payer: ASR ASR |
$8.46
|
| Rate for Payer: ASR ASR |
$19.16
|
| Rate for Payer: ASR Commercial |
$11.04
|
| Rate for Payer: ASR Commercial |
$12.49
|
| Rate for Payer: ASR Commercial |
$11.09
|
| Rate for Payer: ASR Commercial |
$11.39
|
| Rate for Payer: ASR Commercial |
$8.46
|
| Rate for Payer: ASR Commercial |
$75.25
|
| Rate for Payer: ASR Commercial |
$19.16
|
| Rate for Payer: BCBS Complete |
$4.70
|
| Rate for Payer: BCBS Complete |
$4.57
|
| Rate for Payer: BCBS Complete |
$4.55
|
| Rate for Payer: BCBS Complete |
$3.49
|
| Rate for Payer: BCBS Complete |
$31.03
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: BCBS Complete |
$5.15
|
| Rate for Payer: BCBS Trust/PPO |
$9.61
|
| Rate for Payer: BCBS Trust/PPO |
$9.32
|
| Rate for Payer: BCBS Trust/PPO |
$7.14
|
| Rate for Payer: BCBS Trust/PPO |
$9.36
|
| Rate for Payer: BCBS Trust/PPO |
$63.53
|
| Rate for Payer: BCBS Trust/PPO |
$10.55
|
| Rate for Payer: BCBS Trust/PPO |
$16.17
|
| Rate for Payer: BCN Commercial |
$6.76
|
| Rate for Payer: BCN Commercial |
$8.86
|
| Rate for Payer: BCN Commercial |
$15.31
|
| Rate for Payer: BCN Commercial |
$8.82
|
| Rate for Payer: BCN Commercial |
$9.10
|
| Rate for Payer: BCN Commercial |
$9.99
|
| Rate for Payer: BCN Commercial |
$60.15
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cofinity Commercial |
$10.74
|
| Rate for Payer: Cofinity Commercial |
$8.20
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$72.93
|
| Rate for Payer: Cofinity Commercial |
$10.70
|
| Rate for Payer: Cofinity Commercial |
$12.11
|
| Rate for Payer: Cofinity Commercial |
$18.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.80
|
| Rate for Payer: Healthscope Commercial |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$11.38
|
| Rate for Payer: Healthscope Commercial |
$11.43
|
| Rate for Payer: Healthscope Commercial |
$77.58
|
| Rate for Payer: Healthscope Commercial |
$19.75
|
| Rate for Payer: Healthscope Commercial |
$11.74
|
| Rate for Payer: Healthscope Commercial |
$8.72
|
| Rate for Payer: Healthscope Whirlpool |
$12.49
|
| Rate for Payer: Healthscope Whirlpool |
$11.39
|
| Rate for Payer: Healthscope Whirlpool |
$11.09
|
| Rate for Payer: Healthscope Whirlpool |
$19.16
|
| Rate for Payer: Healthscope Whirlpool |
$75.25
|
| Rate for Payer: Healthscope Whirlpool |
$8.46
|
| Rate for Payer: Healthscope Whirlpool |
$11.04
|
| Rate for Payer: Mclaren Commercial |
$69.82
|
| Rate for Payer: Mclaren Commercial |
$11.59
|
| Rate for Payer: Mclaren Commercial |
$10.57
|
| Rate for Payer: Mclaren Commercial |
$7.85
|
| Rate for Payer: Mclaren Commercial |
$17.78
|
| Rate for Payer: Mclaren Commercial |
$10.29
|
| Rate for Payer: Mclaren Commercial |
$10.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.94
|
| Rate for Payer: Nomi Health Commercial |
$9.33
|
| Rate for Payer: Nomi Health Commercial |
$10.56
|
| Rate for Payer: Nomi Health Commercial |
$9.63
|
| Rate for Payer: Nomi Health Commercial |
$9.37
|
| Rate for Payer: Nomi Health Commercial |
$16.20
|
| Rate for Payer: Nomi Health Commercial |
$7.15
|
| Rate for Payer: Nomi Health Commercial |
$63.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.06
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$21.52
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
116809
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$21.52 |
| Rate for Payer: Aetna Commercial |
$19.37
|
| Rate for Payer: ASR ASR |
$20.87
|
| Rate for Payer: ASR Commercial |
$20.87
|
| Rate for Payer: BCBS Trust/PPO |
$17.54
|
| Rate for Payer: BCN Commercial |
$16.68
|
| Rate for Payer: Cash Price |
$17.21
|
| Rate for Payer: Cofinity Commercial |
$20.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.22
|
| Rate for Payer: Healthscope Commercial |
$21.52
|
| Rate for Payer: Healthscope Whirlpool |
$20.87
|
| Rate for Payer: Mclaren Commercial |
$19.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.29
|
| Rate for Payer: Nomi Health Commercial |
$17.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.94
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$21.52
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
116809
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$21.52 |
| Rate for Payer: Aetna Commercial |
$19.37
|
| Rate for Payer: Aetna Medicare |
$10.76
|
| Rate for Payer: ASR ASR |
$20.87
|
| Rate for Payer: ASR Commercial |
$20.87
|
| Rate for Payer: BCBS Complete |
$8.61
|
| Rate for Payer: BCBS Trust/PPO |
$17.62
|
| Rate for Payer: BCN Commercial |
$16.68
|
| Rate for Payer: Cash Price |
$17.21
|
| Rate for Payer: Cash Price |
$17.21
|
| Rate for Payer: Cofinity Commercial |
$20.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.22
|
| Rate for Payer: Healthscope Commercial |
$21.52
|
| Rate for Payer: Healthscope Whirlpool |
$20.87
|
| Rate for Payer: Mclaren Commercial |
$19.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.29
|
| Rate for Payer: Nomi Health Commercial |
$17.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.94
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$19.48
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
192063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.66 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna Commercial |
$17.53
|
| Rate for Payer: ASR ASR |
$18.90
|
| Rate for Payer: ASR Commercial |
$18.90
|
| Rate for Payer: BCBS Trust/PPO |
$15.87
|
| Rate for Payer: BCN Commercial |
$15.10
|
| Rate for Payer: Cash Price |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$18.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.58
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Healthscope Whirlpool |
$18.90
|
| Rate for Payer: Mclaren Commercial |
$17.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.56
|
| Rate for Payer: Nomi Health Commercial |
$15.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.14
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$19.48
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
192063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna Commercial |
$17.53
|
| Rate for Payer: Aetna Medicare |
$9.74
|
| Rate for Payer: ASR ASR |
$18.90
|
| Rate for Payer: ASR Commercial |
$18.90
|
| Rate for Payer: BCBS Complete |
$7.79
|
| Rate for Payer: BCBS Trust/PPO |
$15.95
|
| Rate for Payer: BCN Commercial |
$15.10
|
| Rate for Payer: Cash Price |
$15.58
|
| Rate for Payer: Cash Price |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$18.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.58
|
| Rate for Payer: Healthscope Commercial |
$19.48
|
| Rate for Payer: Healthscope Whirlpool |
$18.90
|
| Rate for Payer: Mclaren Commercial |
$17.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.56
|
| Rate for Payer: Nomi Health Commercial |
$15.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$0.10
|
| Rate for Payer: Priority Health Narrow Network |
$0.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.14
|
|
|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$7.54
|
|
|
Service Code
|
NDC 00121127610
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$7.54 |
| Rate for Payer: Aetna Commercial |
$6.79
|
| Rate for Payer: ASR ASR |
$7.31
|
| Rate for Payer: ASR Commercial |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$6.14
|
| Rate for Payer: BCN Commercial |
$5.85
|
| Rate for Payer: Cash Price |
$6.03
|
| Rate for Payer: Cofinity Commercial |
$7.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.03
|
| Rate for Payer: Healthscope Commercial |
$7.54
|
| Rate for Payer: Healthscope Whirlpool |
$7.31
|
| Rate for Payer: Mclaren Commercial |
$6.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.41
|
| Rate for Payer: Nomi Health Commercial |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.64
|
|
|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$7.54
|
|
|
Service Code
|
NDC 00121127600
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$7.54 |
| Rate for Payer: Aetna Commercial |
$6.79
|
| Rate for Payer: ASR ASR |
$7.31
|
| Rate for Payer: ASR Commercial |
$7.31
|
| Rate for Payer: BCBS Trust/PPO |
$6.14
|
| Rate for Payer: BCN Commercial |
$5.85
|
| Rate for Payer: Cash Price |
$6.03
|
| Rate for Payer: Cofinity Commercial |
$7.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.03
|
| Rate for Payer: Healthscope Commercial |
$7.54
|
| Rate for Payer: Healthscope Whirlpool |
$7.31
|
| Rate for Payer: Mclaren Commercial |
$6.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.41
|
| Rate for Payer: Nomi Health Commercial |
$6.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.64
|
|
