|
DERMABOND SKIN ADHESIVE
|
Facility
|
OP
|
$86.16
|
|
|
Service Code
|
NDC 09900000199
|
| Hospital Charge Code |
158456
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$86.16 |
| Rate for Payer: Aetna Commercial |
$77.54
|
| Rate for Payer: Aetna Medicare |
$43.08
|
| Rate for Payer: ASR ASR |
$83.58
|
| Rate for Payer: ASR Commercial |
$83.58
|
| Rate for Payer: BCBS Complete |
$34.46
|
| Rate for Payer: BCBS Trust/PPO |
$70.56
|
| Rate for Payer: BCN Commercial |
$66.80
|
| Rate for Payer: Cash Price |
$68.93
|
| Rate for Payer: Cofinity Commercial |
$80.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.93
|
| Rate for Payer: Healthscope Commercial |
$86.16
|
| Rate for Payer: Healthscope Whirlpool |
$83.58
|
| Rate for Payer: Mclaren Commercial |
$77.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.24
|
| Rate for Payer: Nomi Health Commercial |
$70.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.49
|
| Rate for Payer: Priority Health Narrow Network |
$60.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.82
|
|
|
DERMABOND SKIN ADHESIVE
|
Facility
|
IP
|
$86.16
|
|
|
Service Code
|
NDC 09900000199
|
| Hospital Charge Code |
158456
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$86.16 |
| Rate for Payer: Aetna Commercial |
$77.54
|
| Rate for Payer: ASR ASR |
$83.58
|
| Rate for Payer: ASR Commercial |
$83.58
|
| Rate for Payer: BCBS Trust/PPO |
$70.21
|
| Rate for Payer: BCN Commercial |
$66.80
|
| Rate for Payer: Cash Price |
$68.93
|
| Rate for Payer: Cofinity Commercial |
$80.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.93
|
| Rate for Payer: Healthscope Commercial |
$86.16
|
| Rate for Payer: Healthscope Whirlpool |
$83.58
|
| Rate for Payer: Mclaren Commercial |
$77.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.24
|
| Rate for Payer: Nomi Health Commercial |
$70.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.82
|
|
|
DERMAPLANNING
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 00175
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$26.65 |
| Rate for Payer: Aetna Medicare |
$20.50
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$82.77
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
9748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.80 |
| Max. Negotiated Rate |
$82.77 |
| Rate for Payer: Aetna Commercial |
$74.49
|
| Rate for Payer: Aetna Commercial |
$1,768.56
|
| Rate for Payer: Aetna Commercial |
$81.65
|
| Rate for Payer: ASR ASR |
$1,906.12
|
| Rate for Payer: ASR ASR |
$80.29
|
| Rate for Payer: ASR ASR |
$88.00
|
| Rate for Payer: ASR Commercial |
$80.29
|
| Rate for Payer: ASR Commercial |
$1,906.12
|
| Rate for Payer: ASR Commercial |
$88.00
|
| Rate for Payer: BCBS Trust/PPO |
$73.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,601.34
|
| Rate for Payer: BCBS Trust/PPO |
$67.45
|
| Rate for Payer: BCN Commercial |
$1,523.52
|
| Rate for Payer: BCN Commercial |
$70.34
|
| Rate for Payer: BCN Commercial |
$64.17
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cash Price |
$1,572.05
|
| Rate for Payer: Cash Price |
$72.58
|
| Rate for Payer: Cofinity Commercial |
$85.28
|
| Rate for Payer: Cofinity Commercial |
$1,847.17
|
| Rate for Payer: Cofinity Commercial |
$77.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,572.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.58
|
| Rate for Payer: Healthscope Commercial |
$1,965.07
|
| Rate for Payer: Healthscope Commercial |
$82.77
|
| Rate for Payer: Healthscope Commercial |
$90.72
|
| Rate for Payer: Healthscope Whirlpool |
$80.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,906.12
|
| Rate for Payer: Healthscope Whirlpool |
$88.00
|
| Rate for Payer: Mclaren Commercial |
$74.49
|
| Rate for Payer: Mclaren Commercial |
$1,768.56
|
| Rate for Payer: Mclaren Commercial |
$81.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,670.31
|
| Rate for Payer: Nomi Health Commercial |
$67.87
|
| Rate for Payer: Nomi Health Commercial |
$1,611.36
|
| Rate for Payer: Nomi Health Commercial |
$74.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,277.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,729.26
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$90.72
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
9748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$90.72 |
| Rate for Payer: Aetna Commercial |
$81.65
|
| Rate for Payer: Aetna Commercial |
$74.49
|
| Rate for Payer: Aetna Commercial |
$1,768.56
|
| Rate for Payer: Aetna Medicare |
$3.52
|
| Rate for Payer: Aetna Medicare |
$3.52
|
| Rate for Payer: Aetna Medicare |
$3.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.40
|
| Rate for Payer: ASR ASR |
$1,906.12
|
| Rate for Payer: ASR ASR |
$88.00
|
| Rate for Payer: ASR ASR |
$80.29
|
| Rate for Payer: ASR Commercial |
$88.00
|
| Rate for Payer: ASR Commercial |
$1,906.12
|
| Rate for Payer: ASR Commercial |
$80.29
|
| Rate for Payer: BCBS Complete |
$1.98
|
| Rate for Payer: BCBS Complete |
$1.98
|
| Rate for Payer: BCBS Complete |
$1.98
|
| Rate for Payer: BCBS MAPPO |
$3.52
|
| Rate for Payer: BCBS MAPPO |
$3.52
|
| Rate for Payer: BCBS MAPPO |
$3.52
|
| Rate for Payer: BCBS Trust/PPO |
$67.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,609.20
|
| Rate for Payer: BCBS Trust/PPO |
$74.29
|
| Rate for Payer: BCN Commercial |
$70.34
|
| Rate for Payer: BCN Commercial |
$64.17
|
| Rate for Payer: BCN Commercial |
$1,523.52
|
| Rate for Payer: BCN Medicare Advantage |
$3.52
|
| Rate for Payer: BCN Medicare Advantage |
$3.52
|
| Rate for Payer: BCN Medicare Advantage |
$3.52
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cash Price |
$1,572.05
|
| Rate for Payer: Cash Price |
$1,572.05
|
| Rate for Payer: Cash Price |
$72.58
|
| Rate for Payer: Cash Price |
$72.58
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cofinity Commercial |
$1,847.17
|
| Rate for Payer: Cofinity Commercial |
$77.80
|
| Rate for Payer: Cofinity Commercial |
$85.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$72.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,572.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.52
|
| Rate for Payer: Healthscope Commercial |
$82.77
|
| Rate for Payer: Healthscope Commercial |
$1,965.07
|
| Rate for Payer: Healthscope Commercial |
$90.72
|
| Rate for Payer: Healthscope Whirlpool |
$80.29
|
| Rate for Payer: Healthscope Whirlpool |
$88.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,906.12
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$3.52
|
| Rate for Payer: Mclaren Commercial |
$1,768.56
|
| Rate for Payer: Mclaren Commercial |
$81.65
|
| Rate for Payer: Mclaren Commercial |
$74.49
|
| Rate for Payer: Mclaren Medicaid |
$1.89
|
| Rate for Payer: Mclaren Medicaid |
$1.89
|
| Rate for Payer: Mclaren Medicaid |
$1.89
|
| Rate for Payer: Mclaren Medicare |
$3.52
|
| Rate for Payer: Mclaren Medicare |
$3.52
|
| Rate for Payer: Mclaren Medicare |
$3.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.70
|
| Rate for Payer: Meridian Medicaid |
$1.98
|
| Rate for Payer: Meridian Medicaid |
$1.98
|
| Rate for Payer: Meridian Medicaid |
$1.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,670.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.35
|
| Rate for Payer: Nomi Health Commercial |
$67.87
|
| Rate for Payer: Nomi Health Commercial |
$1,611.36
|
| Rate for Payer: Nomi Health Commercial |
$74.39
|
| Rate for Payer: PACE Medicare |
$3.34
|
| Rate for Payer: PACE Medicare |
$3.34
|
| Rate for Payer: PACE Medicare |
$3.34
|
| Rate for Payer: PACE SWMI |
$3.52
|
| Rate for Payer: PACE SWMI |
$3.52
|
| Rate for Payer: PACE SWMI |
$3.52
|
| Rate for Payer: PHP Commercial |
$3.87
|
| Rate for Payer: PHP Commercial |
$3.87
|
| Rate for Payer: PHP Commercial |
$3.87
|
| Rate for Payer: PHP Medicaid |
$1.89
|
| Rate for Payer: PHP Medicaid |
$1.89
|
| Rate for Payer: PHP Medicaid |
$1.89
|
| Rate for Payer: PHP Medicare Advantage |
$3.52
|
| Rate for Payer: PHP Medicare Advantage |
$3.52
|
| Rate for Payer: PHP Medicare Advantage |
$3.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,277.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,721.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$79.49
|
| Rate for Payer: Priority Health Medicare |
$3.52
|
| Rate for Payer: Priority Health Medicare |
$3.52
|
| Rate for Payer: Priority Health Medicare |
$3.52
|
| Rate for Payer: Priority Health Narrow Network |
$58.02
|
| Rate for Payer: Priority Health Narrow Network |
$1,377.51
|
| Rate for Payer: Priority Health Narrow Network |
$63.59
|
| Rate for Payer: Railroad Medicare Medicare |
$3.52
|
| Rate for Payer: Railroad Medicare Medicare |
$3.52
|
| Rate for Payer: Railroad Medicare Medicare |
$3.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,729.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.52
|
| Rate for Payer: UHC Exchange |
$5.46
|
| Rate for Payer: UHC Exchange |
$5.46
|
| Rate for Payer: UHC Exchange |
$5.46
|
| Rate for Payer: UHC Medicare Advantage |
$3.52
|
| Rate for Payer: UHC Medicare Advantage |
$3.52
|
| Rate for Payer: UHC Medicare Advantage |
$3.52
|
| Rate for Payer: UHCCP DNSP |
$3.52
|
| Rate for Payer: UHCCP DNSP |
$3.52
|
| Rate for Payer: UHCCP DNSP |
$3.52
|
| Rate for Payer: UHCCP Medicaid |
$1.89
|
| Rate for Payer: UHCCP Medicaid |
$1.89
|
| Rate for Payer: UHCCP Medicaid |
$1.89
|
| Rate for Payer: VA VA |
$3.52
|
| Rate for Payer: VA VA |
$3.52
|
| Rate for Payer: VA VA |
$3.52
|
|
|
DESONIDE 0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$26.72
|
|
|
Service Code
|
NDC 62332063215
|
| Hospital Charge Code |
2291
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.37 |
| Max. Negotiated Rate |
$26.72 |
| Rate for Payer: Aetna Commercial |
$24.05
|
| Rate for Payer: ASR ASR |
$25.92
|
| Rate for Payer: ASR Commercial |
$25.92
|
| Rate for Payer: BCBS Trust/PPO |
$21.77
|
| Rate for Payer: BCN Commercial |
$20.72
|
| Rate for Payer: Cash Price |
$21.38
|
| Rate for Payer: Cofinity Commercial |
$25.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.38
|
| Rate for Payer: Healthscope Commercial |
$26.72
|
| Rate for Payer: Healthscope Whirlpool |
$25.92
|
| Rate for Payer: Mclaren Commercial |
$24.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.71
|
| Rate for Payer: Nomi Health Commercial |
$21.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.51
|
|
|
DESONIDE 0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$26.72
|
|
|
Service Code
|
NDC 62332063215
|
| Hospital Charge Code |
2291
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.69 |
| Max. Negotiated Rate |
$26.72 |
| Rate for Payer: Aetna Commercial |
$24.05
|
| Rate for Payer: Aetna Medicare |
$13.36
|
| Rate for Payer: ASR ASR |
$25.92
|
| Rate for Payer: ASR Commercial |
$25.92
|
| Rate for Payer: BCBS Complete |
$10.69
|
| Rate for Payer: BCBS Trust/PPO |
$21.88
|
| Rate for Payer: BCN Commercial |
$20.72
|
| Rate for Payer: Cash Price |
$21.38
|
| Rate for Payer: Cofinity Commercial |
$25.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.38
|
| Rate for Payer: Healthscope Commercial |
$26.72
|
| Rate for Payer: Healthscope Whirlpool |
$25.92
|
| Rate for Payer: Mclaren Commercial |
$24.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.71
|
| Rate for Payer: Nomi Health Commercial |
$21.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.41
|
| Rate for Payer: Priority Health Narrow Network |
$18.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.51
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
OP
|
$7.12
|
|
|
Service Code
|
NDC 70069002101
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$7.12 |
| Rate for Payer: Aetna Commercial |
$6.41
|
| Rate for Payer: Aetna Medicare |
$3.56
|
| Rate for Payer: ASR ASR |
$6.91
|
| Rate for Payer: ASR Commercial |
$6.91
|
| Rate for Payer: BCBS Complete |
$2.85
|
| Rate for Payer: BCBS Trust/PPO |
$5.83
|
| Rate for Payer: BCN Commercial |
$5.52
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cofinity Commercial |
$6.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.70
|
| Rate for Payer: Healthscope Commercial |
$7.12
|
| Rate for Payer: Healthscope Whirlpool |
$6.91
|
| Rate for Payer: Mclaren Commercial |
$6.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.05
|
| Rate for Payer: Nomi Health Commercial |
$5.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.24
|
| Rate for Payer: Priority Health Narrow Network |
$4.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.27
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
IP
|
$7.12
|
|
|
Service Code
|
NDC 70069002101
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$7.12 |
| Rate for Payer: Aetna Commercial |
$6.41
|
| Rate for Payer: ASR ASR |
$6.91
|
| Rate for Payer: ASR Commercial |
$6.91
|
| Rate for Payer: BCBS Trust/PPO |
$5.80
|
| Rate for Payer: BCN Commercial |
$5.52
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cofinity Commercial |
$6.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.70
|
| Rate for Payer: Healthscope Commercial |
$7.12
|
| Rate for Payer: Healthscope Whirlpool |
$6.91
|
| Rate for Payer: Mclaren Commercial |
$6.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.05
|
| Rate for Payer: Nomi Health Commercial |
$5.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.27
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
OP
|
$7.12
|
|
|
Service Code
|
NDC 70069002125
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$7.12 |
| Rate for Payer: Aetna Commercial |
$6.41
|
| Rate for Payer: Aetna Medicare |
$3.56
|
| Rate for Payer: ASR ASR |
$6.91
|
| Rate for Payer: ASR Commercial |
$6.91
|
| Rate for Payer: BCBS Complete |
$2.85
|
| Rate for Payer: BCBS Trust/PPO |
$5.83
|
| Rate for Payer: BCN Commercial |
$5.52
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cofinity Commercial |
$6.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.70
|
| Rate for Payer: Healthscope Commercial |
$7.12
|
| Rate for Payer: Healthscope Whirlpool |
$6.91
|
| Rate for Payer: Mclaren Commercial |
$6.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.05
|
| Rate for Payer: Nomi Health Commercial |
$5.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.24
|
| Rate for Payer: Priority Health Narrow Network |
$4.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.27
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
IP
|
$7.12
|
|
|
Service Code
|
NDC 70069002125
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.63 |
| Max. Negotiated Rate |
$7.12 |
| Rate for Payer: Aetna Commercial |
$6.41
|
| Rate for Payer: ASR ASR |
$6.91
|
| Rate for Payer: ASR Commercial |
$6.91
|
| Rate for Payer: BCBS Trust/PPO |
$5.80
|
| Rate for Payer: BCN Commercial |
$5.52
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cofinity Commercial |
$6.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.70
|
| Rate for Payer: Healthscope Commercial |
$7.12
|
| Rate for Payer: Healthscope Whirlpool |
$6.91
|
| Rate for Payer: Mclaren Commercial |
$6.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.05
|
| Rate for Payer: Nomi Health Commercial |
$5.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.27
|
|
|
DEXAMETHASONE 4 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$16.72
|
|
|
Service Code
|
NDC 09900000647
|
| Hospital Charge Code |
180050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.69 |
| Max. Negotiated Rate |
$16.72 |
| Rate for Payer: Aetna Commercial |
$15.05
|
| Rate for Payer: Aetna Medicare |
$8.36
|
| Rate for Payer: ASR ASR |
$16.22
|
| Rate for Payer: ASR Commercial |
$16.22
|
| Rate for Payer: BCBS Complete |
$6.69
|
| Rate for Payer: BCBS Trust/PPO |
$13.69
|
| Rate for Payer: BCN Commercial |
$12.96
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cofinity Commercial |
$15.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Healthscope Commercial |
$16.72
|
| Rate for Payer: Healthscope Whirlpool |
$16.22
|
| Rate for Payer: Mclaren Commercial |
$15.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.21
|
| Rate for Payer: Nomi Health Commercial |
$13.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.65
|
| Rate for Payer: Priority Health Narrow Network |
$11.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.71
|
|
|
DEXAMETHASONE 4 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$8.72
|
|
|
Service Code
|
NDC 55150023701
|
| Hospital Charge Code |
180050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$8.72 |
| Rate for Payer: Aetna Commercial |
$7.85
|
| Rate for Payer: ASR ASR |
$8.46
|
| Rate for Payer: ASR Commercial |
$8.46
|
| Rate for Payer: BCBS Trust/PPO |
$7.11
|
| 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: UHC All Payor (Choice/PPO) + Core |
$7.67
|
|
|
DEXAMETHASONE 4 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$11.43
|
|
|
Service Code
|
NDC 67457042312
|
| Hospital Charge Code |
180050
|
|
Hospital Revenue Code
|
250
|
| 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 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/ML ORAL SOLUTION
|
Facility
|
OP
|
$11.43
|
|
|
Service Code
|
NDC 67457042312
|
| Hospital Charge Code |
180050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: Aetna Medicare |
$5.71
|
| 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: 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 |
$10.01
|
| Rate for Payer: Priority Health Narrow Network |
$8.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.06
|
|
|
DEXAMETHASONE 4 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$16.72
|
|
|
Service Code
|
NDC 09900000647
|
| Hospital Charge Code |
180050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.87 |
| Max. Negotiated Rate |
$16.72 |
| Rate for Payer: Aetna Commercial |
$15.05
|
| Rate for Payer: ASR ASR |
$16.22
|
| Rate for Payer: ASR Commercial |
$16.22
|
| Rate for Payer: BCBS Trust/PPO |
$13.63
|
| Rate for Payer: BCN Commercial |
$12.96
|
| Rate for Payer: Cash Price |
$13.38
|
| Rate for Payer: Cofinity Commercial |
$15.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.38
|
| Rate for Payer: Healthscope Commercial |
$16.72
|
| Rate for Payer: Healthscope Whirlpool |
$16.22
|
| Rate for Payer: Mclaren Commercial |
$15.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.21
|
| Rate for Payer: Nomi Health Commercial |
$13.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.71
|
|
|
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
|
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 |
$2.31
|
| 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
|
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
|
$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
|
$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
|
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
|
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 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
|
|
