|
DEFEROXAMINE 500 MG IM INJECTION
|
Facility
|
IP
|
$143.69
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
200070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.58 |
| Max. Negotiated Rate |
$143.69 |
| Rate for Payer: Aetna Commercial |
$129.32
|
| Rate for Payer: ASR ASR |
$139.38
|
| Rate for Payer: BCBS Trust/PPO |
$111.40
|
| Rate for Payer: BCN Commercial |
$111.40
|
| Rate for Payer: Cash Price |
$114.95
|
| Rate for Payer: Cofinity Commercial |
$135.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$114.95
|
| Rate for Payer: Healthscope Commercial |
$143.69
|
| Rate for Payer: Healthscope Whirlpool |
$139.38
|
| Rate for Payer: Mclaren Commercial |
$129.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$122.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.45
|
|
|
DEFEROXAMINE 500 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$53.53
|
|
|
Service Code
|
HCPCS J0895
|
| Hospital Charge Code |
9723
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.47 |
| Max. Negotiated Rate |
$53.53 |
| Rate for Payer: Aetna Commercial |
$48.18
|
| Rate for Payer: ASR ASR |
$51.92
|
| Rate for Payer: BCBS Trust/PPO |
$41.50
|
| Rate for Payer: BCN Commercial |
$41.50
|
| Rate for Payer: Cash Price |
$42.83
|
| Rate for Payer: Cofinity Commercial |
$50.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.82
|
| Rate for Payer: Healthscope Commercial |
$53.53
|
| Rate for Payer: Healthscope Whirlpool |
$51.92
|
| Rate for Payer: Mclaren Commercial |
$48.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$45.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$47.11
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC
|
Facility
|
IP
|
$30,738.96
|
|
|
Service Code
|
MS-DRG 056
|
| Min. Negotiated Rate |
$20,852.02 |
| Max. Negotiated Rate |
$30,738.96 |
| Rate for Payer: Aetna Medicare |
$21,949.49
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27,436.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27,436.86
|
| Rate for Payer: BCBS MAPPO |
$21,949.49
|
| Rate for Payer: BCN Medicare Advantage |
$21,949.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21,949.49
|
| Rate for Payer: Humana Choice PPO Medicare |
$21,949.49
|
| Rate for Payer: Mclaren Medicare |
$21,949.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$23,046.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25,241.91
|
| Rate for Payer: PACE Medicare |
$20,852.02
|
| Rate for Payer: PACE SWMI |
$21,949.49
|
| Rate for Payer: PHP Commercial |
$24,144.44
|
| Rate for Payer: PHP Medicare Advantage |
$21,949.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$30,738.96
|
| Rate for Payer: Priority Health Medicare |
$21,949.49
|
| Rate for Payer: Priority Health Narrow Network |
$24,591.17
|
| Rate for Payer: Railroad Medicare Medicare |
$21,949.49
|
| Rate for Payer: UHC Medicare Advantage |
$22,607.97
|
| Rate for Payer: VA VA |
$21,949.49
|
|
|
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$17,503.49
|
|
|
Service Code
|
MS-DRG 057
|
| Min. Negotiated Rate |
$12,561.21 |
| Max. Negotiated Rate |
$17,503.49 |
| Rate for Payer: Aetna Medicare |
$13,222.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,527.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,527.91
|
| Rate for Payer: BCBS MAPPO |
$13,222.33
|
| Rate for Payer: BCN Medicare Advantage |
$13,222.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,222.33
|
| Rate for Payer: Humana Choice PPO Medicare |
$13,222.33
|
| Rate for Payer: Mclaren Medicare |
$13,222.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,883.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,205.68
|
| Rate for Payer: PACE Medicare |
$12,561.21
|
| Rate for Payer: PACE SWMI |
$13,222.33
|
| Rate for Payer: PHP Commercial |
$14,544.56
|
| Rate for Payer: PHP Medicare Advantage |
$13,222.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,503.49
|
| Rate for Payer: Priority Health Medicare |
$13,222.33
|
| Rate for Payer: Priority Health Narrow Network |
$14,002.79
|
| Rate for Payer: Railroad Medicare Medicare |
$13,222.33
|
| Rate for Payer: UHC Medicare Advantage |
$13,619.00
|
| Rate for Payer: VA VA |
$13,222.33
|
|
|
DENOSUMAB 120 MG/1.7 ML (70 MG/ML) SUBCUTANEOUS SOLUTION
|
Facility
|
IP
|
$7,723.35
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
106804
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,406.34 |
| Max. Negotiated Rate |
$7,723.35 |
| Rate for Payer: Aetna Commercial |
$6,951.02
|
| Rate for Payer: ASR ASR |
$7,491.65
|
| Rate for Payer: BCBS Trust/PPO |
$5,987.91
|
| Rate for Payer: BCN Commercial |
$5,987.91
|
| Rate for Payer: Cash Price |
$6,178.68
|
| Rate for Payer: Cofinity Commercial |
$7,259.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,178.68
|
| Rate for Payer: Healthscope Commercial |
$7,723.35
|
| Rate for Payer: Healthscope Whirlpool |
$7,491.65
|
| Rate for Payer: Mclaren Commercial |
$6,951.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,564.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,406.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6,796.55
|
|
|
DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE
|
Facility
|
IP
|
$5,168.22
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
105502
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,617.75 |
| Max. Negotiated Rate |
$5,168.22 |
| Rate for Payer: Aetna Commercial |
$4,651.40
|
| Rate for Payer: ASR ASR |
$5,013.17
|
| Rate for Payer: BCBS Trust/PPO |
$4,006.92
|
| Rate for Payer: BCN Commercial |
$4,006.92
|
| Rate for Payer: Cash Price |
$4,134.58
|
| Rate for Payer: Cofinity Commercial |
$4,858.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4,134.58
|
| Rate for Payer: Healthscope Commercial |
$5,168.22
|
| Rate for Payer: Healthscope Whirlpool |
$5,013.17
|
| Rate for Payer: Mclaren Commercial |
$4,651.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4,392.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,617.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4,548.03
|
|
|
DENTAL AND ORAL DISEASES WITH CC
|
Facility
|
IP
|
$12,050.34
|
|
|
Service Code
|
MS-DRG 158
|
| Min. Negotiated Rate |
$9,145.32 |
| Max. Negotiated Rate |
$12,050.34 |
| Rate for Payer: Aetna Medicare |
$9,626.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,033.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,033.31
|
| Rate for Payer: BCBS MAPPO |
$9,626.65
|
| Rate for Payer: BCN Medicare Advantage |
$9,626.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,626.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,626.65
|
| Rate for Payer: Mclaren Medicare |
$9,626.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,107.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,070.65
|
| Rate for Payer: PACE Medicare |
$9,145.32
|
| Rate for Payer: PACE SWMI |
$9,626.65
|
| Rate for Payer: PHP Commercial |
$10,589.32
|
| Rate for Payer: PHP Medicare Advantage |
$9,626.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12,050.34
|
| Rate for Payer: Priority Health Medicare |
$9,626.65
|
| Rate for Payer: Priority Health Narrow Network |
$9,640.27
|
| Rate for Payer: Railroad Medicare Medicare |
$9,626.65
|
| Rate for Payer: UHC Medicare Advantage |
$9,915.45
|
| Rate for Payer: VA VA |
$9,626.65
|
|
|
DENTAL AND ORAL DISEASES WITH MCC
|
Facility
|
IP
|
$21,917.88
|
|
|
Service Code
|
MS-DRG 157
|
| Min. Negotiated Rate |
$15,326.43 |
| Max. Negotiated Rate |
$21,917.88 |
| Rate for Payer: Aetna Medicare |
$16,133.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$20,166.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$20,166.35
|
| Rate for Payer: BCBS MAPPO |
$16,133.08
|
| Rate for Payer: BCN Medicare Advantage |
$16,133.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16,133.08
|
| Rate for Payer: Humana Choice PPO Medicare |
$16,133.08
|
| Rate for Payer: Mclaren Medicare |
$16,133.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,939.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18,553.04
|
| Rate for Payer: PACE Medicare |
$15,326.43
|
| Rate for Payer: PACE SWMI |
$16,133.08
|
| Rate for Payer: PHP Commercial |
$17,746.39
|
| Rate for Payer: PHP Medicare Advantage |
$16,133.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21,917.88
|
| Rate for Payer: Priority Health Medicare |
$16,133.08
|
| Rate for Payer: Priority Health Narrow Network |
$17,534.30
|
| Rate for Payer: Railroad Medicare Medicare |
$16,133.08
|
| Rate for Payer: UHC Medicare Advantage |
$16,617.07
|
| Rate for Payer: VA VA |
$16,133.08
|
|
|
DENTAL AND ORAL DISEASES WITHOUT CC/MCC
|
Facility
|
IP
|
$9,246.81
|
|
|
Service Code
|
MS-DRG 159
|
| Min. Negotiated Rate |
$6,935.66 |
| Max. Negotiated Rate |
$9,246.81 |
| Rate for Payer: Aetna Medicare |
$7,397.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,246.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,246.81
|
| Rate for Payer: BCBS MAPPO |
$7,397.45
|
| Rate for Payer: BCN Medicare Advantage |
$7,397.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,397.45
|
| Rate for Payer: Humana Choice PPO Medicare |
$7,397.45
|
| Rate for Payer: Mclaren Medicare |
$7,397.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,767.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,507.07
|
| Rate for Payer: PACE Medicare |
$7,027.58
|
| Rate for Payer: PACE SWMI |
$7,397.45
|
| Rate for Payer: PHP Commercial |
$8,137.20
|
| Rate for Payer: PHP Medicare Advantage |
$7,397.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8,669.57
|
| Rate for Payer: Priority Health Medicare |
$7,397.45
|
| Rate for Payer: Priority Health Narrow Network |
$6,935.66
|
| Rate for Payer: Railroad Medicare Medicare |
$7,397.45
|
| Rate for Payer: UHC Medicare Advantage |
$7,619.37
|
| Rate for Payer: VA VA |
$7,397.45
|
|
|
DEPRESSIVE NEUROSES
|
Facility
|
IP
|
$11,694.66
|
|
|
Service Code
|
MS-DRG 881
|
| Min. Negotiated Rate |
$8,887.94 |
| Max. Negotiated Rate |
$11,694.66 |
| Rate for Payer: Aetna Medicare |
$9,355.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,694.66
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,694.66
|
| Rate for Payer: BCBS MAPPO |
$9,355.73
|
| Rate for Payer: BCN Medicare Advantage |
$9,355.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,355.73
|
| Rate for Payer: Humana Choice PPO Medicare |
$9,355.73
|
| Rate for Payer: Mclaren Medicare |
$9,355.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,823.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,759.09
|
| Rate for Payer: PACE Medicare |
$8,887.94
|
| Rate for Payer: PACE SWMI |
$9,355.73
|
| Rate for Payer: PHP Commercial |
$10,291.30
|
| Rate for Payer: PHP Medicare Advantage |
$9,355.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11,639.46
|
| Rate for Payer: Priority Health Medicare |
$9,355.73
|
| Rate for Payer: Priority Health Narrow Network |
$9,311.57
|
| Rate for Payer: Railroad Medicare Medicare |
$9,355.73
|
| Rate for Payer: UHC Medicare Advantage |
$9,636.40
|
| Rate for Payer: VA VA |
$9,355.73
|
|
|
DERMABOND SKIN ADHESIVE
|
Facility
|
IP
|
$86.16
|
|
|
Service Code
|
NDC 9900-0001-99
|
| Hospital Charge Code |
158456
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.31 |
| Max. Negotiated Rate |
$86.16 |
| Rate for Payer: Aetna Commercial |
$77.54
|
| Rate for Payer: ASR ASR |
$83.58
|
| Rate for Payer: BCBS Trust/PPO |
$66.80
|
| 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 Multiplan/Beech St/PHCS |
$73.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.82
|
|
|
DERMAPLANNING
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 00175
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
|
|
DESMOPRESSIN 4 MCG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$1,965.07
|
|
|
Service Code
|
HCPCS J2597
|
| Hospital Charge Code |
9748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,375.55 |
| Max. Negotiated Rate |
$1,965.07 |
| Rate for Payer: Aetna Commercial |
$1,768.56
|
| Rate for Payer: Aetna Commercial |
$81.65
|
| Rate for Payer: ASR ASR |
$88.00
|
| Rate for Payer: ASR ASR |
$1,906.12
|
| Rate for Payer: BCBS Trust/PPO |
$70.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,523.52
|
| Rate for Payer: BCN Commercial |
$1,523.52
|
| Rate for Payer: BCN Commercial |
$70.34
|
| 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: Encore Health Key Benefits Commercial |
$72.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,572.06
|
| Rate for Payer: Healthscope Commercial |
$90.72
|
| Rate for Payer: Healthscope Commercial |
$1,965.07
|
| Rate for Payer: Healthscope Whirlpool |
$88.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,906.12
|
| Rate for Payer: Mclaren Commercial |
$1,768.56
|
| Rate for Payer: Mclaren Commercial |
$81.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,670.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$77.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,375.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,729.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.83
|
|
|
DEXAMETHASONE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$11.18
|
|
|
Service Code
|
NDC 0641-0367-25
|
| Hospital Charge Code |
154971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$11.18 |
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: ASR ASR |
$10.84
|
| Rate for Payer: BCBS Trust/PPO |
$8.67
|
| 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 Multiplan/Beech St/PHCS |
$9.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.84
|
|
|
DEXAMETHASONE 10 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$11.18
|
|
|
Service Code
|
NDC 0641-0367-21
|
| Hospital Charge Code |
154971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$11.18 |
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: ASR ASR |
$10.84
|
| Rate for Payer: BCBS Trust/PPO |
$8.67
|
| 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 Multiplan/Beech St/PHCS |
$9.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.84
|
|
|
DEXAMETHASONE 4 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$11.43
|
|
|
Service Code
|
NDC 67457-423-12
|
| Hospital Charge Code |
180050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: ASR ASR |
$11.09
|
| Rate for Payer: BCBS Trust/PPO |
$8.86
|
| 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 Multiplan/Beech St/PHCS |
$9.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.06
|
|
|
DEXAMETHASONE 4 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$16.72
|
|
|
Service Code
|
NDC 9900-0006-47
|
| Hospital Charge Code |
180050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.70 |
| Max. Negotiated Rate |
$16.72 |
| Rate for Payer: Aetna Commercial |
$15.05
|
| Rate for Payer: ASR ASR |
$16.22
|
| Rate for Payer: BCBS Trust/PPO |
$12.96
|
| 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 Multiplan/Beech St/PHCS |
$14.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.71
|
|
|
DEXAMETHASONE 4 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$8.72
|
|
|
Service Code
|
NDC 55150-237-01
|
| Hospital Charge Code |
180050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$8.72 |
| Rate for Payer: Aetna Commercial |
$7.85
|
| Rate for Payer: ASR ASR |
$8.46
|
| Rate for Payer: BCBS Trust/PPO |
$6.76
|
| 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 Multiplan/Beech St/PHCS |
$7.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.67
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$447.84
|
|
|
Service Code
|
NDC 0054-8175-25
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$313.49 |
| Max. Negotiated Rate |
$447.84 |
| Rate for Payer: Aetna Commercial |
$403.06
|
| Rate for Payer: ASR ASR |
$434.40
|
| Rate for Payer: BCBS Trust/PPO |
$347.21
|
| Rate for Payer: BCN Commercial |
$347.21
|
| Rate for Payer: Cash Price |
$358.27
|
| Rate for Payer: Cofinity Commercial |
$420.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.27
|
| Rate for Payer: Healthscope Commercial |
$447.84
|
| Rate for Payer: Healthscope Whirlpool |
$434.40
|
| Rate for Payer: Mclaren Commercial |
$403.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$380.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$394.10
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$369.60
|
|
|
Service Code
|
NDC 0904-7266-61
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$258.72 |
| Max. Negotiated Rate |
$369.60 |
| Rate for Payer: Aetna Commercial |
$332.64
|
| Rate for Payer: ASR ASR |
$358.51
|
| Rate for Payer: BCBS Trust/PPO |
$286.55
|
| Rate for Payer: BCN Commercial |
$286.55
|
| Rate for Payer: Cash Price |
$295.68
|
| Rate for Payer: Cofinity Commercial |
$347.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.68
|
| Rate for Payer: Healthscope Commercial |
$369.60
|
| Rate for Payer: Healthscope Whirlpool |
$358.51
|
| Rate for Payer: Mclaren Commercial |
$332.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$314.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$325.25
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$389.50
|
|
|
Service Code
|
NDC 0054-4184-25
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$272.65 |
| Max. Negotiated Rate |
$389.50 |
| Rate for Payer: Aetna Commercial |
$350.55
|
| Rate for Payer: ASR ASR |
$377.82
|
| Rate for Payer: BCBS Trust/PPO |
$301.98
|
| Rate for Payer: BCN Commercial |
$301.98
|
| Rate for Payer: Cash Price |
$311.60
|
| Rate for Payer: Cofinity Commercial |
$366.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$311.60
|
| Rate for Payer: Healthscope Commercial |
$389.50
|
| Rate for Payer: Healthscope Whirlpool |
$377.82
|
| Rate for Payer: Mclaren Commercial |
$350.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$331.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$272.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$342.76
|
|
|
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 |
$7.83 |
| Max. Negotiated Rate |
$11.18 |
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: ASR ASR |
$10.84
|
| Rate for Payer: BCBS Trust/PPO |
$8.67
|
| 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 Multiplan/Beech St/PHCS |
$9.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.83
|
| 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 |
$7.83 |
| Max. Negotiated Rate |
$11.18 |
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: ASR ASR |
$10.84
|
| Rate for Payer: BCBS Trust/PPO |
$8.67
|
| 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 Multiplan/Beech St/PHCS |
$9.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.84
|
|
|
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 |
$8.00 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: ASR ASR |
$11.09
|
| Rate for Payer: BCBS Trust/PPO |
$8.86
|
| 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 Multiplan/Beech St/PHCS |
$9.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.06
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$19.75
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.82 |
| Max. Negotiated Rate |
$19.75 |
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Commercial |
$10.29
|
| Rate for Payer: Aetna Commercial |
$7.85
|
| Rate for Payer: Aetna Commercial |
$69.82
|
| Rate for Payer: Aetna Commercial |
$11.59
|
| Rate for Payer: Aetna Commercial |
$10.24
|
| Rate for Payer: Aetna Commercial |
$10.57
|
| Rate for Payer: ASR ASR |
$11.39
|
| Rate for Payer: ASR ASR |
$11.04
|
| Rate for Payer: ASR ASR |
$8.46
|
| Rate for Payer: ASR ASR |
$75.25
|
| Rate for Payer: ASR ASR |
$11.09
|
| Rate for Payer: ASR ASR |
$19.16
|
| Rate for Payer: ASR ASR |
$12.49
|
| Rate for Payer: BCBS Trust/PPO |
$9.10
|
| Rate for Payer: BCBS Trust/PPO |
$8.86
|
| Rate for Payer: BCBS Trust/PPO |
$15.31
|
| Rate for Payer: BCBS Trust/PPO |
$8.82
|
| Rate for Payer: BCBS Trust/PPO |
$60.15
|
| Rate for Payer: BCBS Trust/PPO |
$9.99
|
| Rate for Payer: BCBS Trust/PPO |
$6.76
|
| Rate for Payer: BCN Commercial |
$8.82
|
| Rate for Payer: BCN Commercial |
$60.15
|
| Rate for Payer: BCN Commercial |
$8.86
|
| Rate for Payer: BCN Commercial |
$6.76
|
| Rate for Payer: BCN Commercial |
$15.31
|
| Rate for Payer: BCN Commercial |
$9.99
|
| Rate for Payer: BCN Commercial |
$9.10
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cofinity Commercial |
$10.70
|
| Rate for Payer: Cofinity Commercial |
$10.74
|
| Rate for Payer: Cofinity Commercial |
$12.11
|
| Rate for Payer: Cofinity Commercial |
$72.93
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$18.56
|
| Rate for Payer: Cofinity Commercial |
$8.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.80
|
| 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 |
$62.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.14
|
| Rate for Payer: Healthscope Commercial |
$77.58
|
| Rate for Payer: Healthscope Commercial |
$11.43
|
| Rate for Payer: Healthscope Commercial |
$19.75
|
| Rate for Payer: Healthscope Commercial |
$8.72
|
| Rate for Payer: Healthscope Commercial |
$12.88
|
| Rate for Payer: Healthscope Commercial |
$11.74
|
| Rate for Payer: Healthscope Commercial |
$11.38
|
| Rate for Payer: Healthscope Whirlpool |
$11.39
|
| Rate for Payer: Healthscope Whirlpool |
$12.49
|
| 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 |
$11.04
|
| Rate for Payer: Healthscope Whirlpool |
$8.46
|
| Rate for Payer: Mclaren Commercial |
$11.59
|
| Rate for Payer: Mclaren Commercial |
$69.82
|
| Rate for Payer: Mclaren Commercial |
$7.85
|
| Rate for Payer: Mclaren Commercial |
$10.57
|
| Rate for Payer: Mclaren Commercial |
$17.78
|
| Rate for Payer: Mclaren Commercial |
$10.24
|
| Rate for Payer: Mclaren Commercial |
$10.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.00
|
| 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 |
$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 |
$10.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.67
|
|
