|
DESONIDE 0.05 % TOPICAL CREAM
|
Facility
|
OP
|
$27.09
|
|
|
Service Code
|
NDC 62332063215
|
| Hospital Charge Code |
2291
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.02 |
| Max. Negotiated Rate |
$27.09 |
| Rate for Payer: Aetna Commercial |
$24.38
|
| Rate for Payer: Aetna Medicare |
$10.02
|
| Rate for Payer: ASR ASR |
$26.28
|
| Rate for Payer: BCBS Complete |
$10.84
|
| Rate for Payer: BCBS Trust/PPO |
$22.34
|
| Rate for Payer: BCN Commercial |
$22.34
|
| Rate for Payer: Cash Price |
$21.67
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.67
|
| Rate for Payer: Healthscope Commercial |
$26.28
|
| Rate for Payer: Healthscope Whirlpool |
$27.09
|
| Rate for Payer: Mclaren Commercial |
$24.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.03
|
| Rate for Payer: Nomi Health Commercial |
$22.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$23.74
|
| Rate for Payer: Priority Health Narrow Network |
$18.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.84
|
|
|
DESONIDE 0.05 % TOPICAL CREAM
|
Facility
|
IP
|
$27.09
|
|
|
Service Code
|
NDC 62332063215
|
| Hospital Charge Code |
2291
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.32 |
| Max. Negotiated Rate |
$27.09 |
| Rate for Payer: Aetna Commercial |
$24.38
|
| Rate for Payer: ASR ASR |
$26.28
|
| Rate for Payer: BCBS Trust/PPO |
$22.25
|
| Rate for Payer: BCN Commercial |
$22.25
|
| Rate for Payer: Cash Price |
$21.67
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.67
|
| Rate for Payer: Healthscope Commercial |
$26.28
|
| Rate for Payer: Healthscope Whirlpool |
$27.09
|
| Rate for Payer: Mclaren Commercial |
$24.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.03
|
| Rate for Payer: Nomi Health Commercial |
$22.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.84
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
OP
|
$240.62
|
|
|
Service Code
|
NDC 51991031190
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.03 |
| Max. Negotiated Rate |
$240.62 |
| Rate for Payer: Aetna Commercial |
$216.56
|
| Rate for Payer: Aetna Medicare |
$89.03
|
| Rate for Payer: ASR ASR |
$233.41
|
| Rate for Payer: BCBS Complete |
$96.25
|
| Rate for Payer: BCBS Trust/PPO |
$198.39
|
| Rate for Payer: BCN Commercial |
$198.39
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cofinity Commercial |
$226.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.50
|
| Rate for Payer: Healthscope Commercial |
$233.41
|
| Rate for Payer: Healthscope Whirlpool |
$240.62
|
| Rate for Payer: Mclaren Commercial |
$216.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$192.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.53
|
| Rate for Payer: Nomi Health Commercial |
$197.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$210.83
|
| Rate for Payer: Priority Health Narrow Network |
$168.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.75
|
|
|
DESVENLAFAXINE SUCCINATE ER 50 MG TABLET,EXTENDED RELEASE 24 HR
|
Facility
|
IP
|
$240.62
|
|
|
Service Code
|
NDC 51991031190
|
| Hospital Charge Code |
91073
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$180.47 |
| Max. Negotiated Rate |
$240.62 |
| Rate for Payer: Aetna Commercial |
$216.56
|
| Rate for Payer: ASR ASR |
$233.41
|
| Rate for Payer: BCBS Trust/PPO |
$197.60
|
| Rate for Payer: BCN Commercial |
$197.60
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cofinity Commercial |
$226.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$192.50
|
| Rate for Payer: Healthscope Commercial |
$233.41
|
| Rate for Payer: Healthscope Whirlpool |
$240.62
|
| Rate for Payer: Mclaren Commercial |
$216.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.53
|
| Rate for Payer: Nomi Health Commercial |
$197.31
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$211.75
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
IP
|
$4.63
|
|
|
Service Code
|
NDC 70069002125
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Aetna Commercial |
$4.17
|
| Rate for Payer: ASR ASR |
$4.49
|
| Rate for Payer: BCBS Trust/PPO |
$3.80
|
| Rate for Payer: BCN Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cofinity Commercial |
$4.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.71
|
| Rate for Payer: Healthscope Commercial |
$4.49
|
| Rate for Payer: Healthscope Whirlpool |
$4.63
|
| 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: Opus (Opus Packaging Group) HMA |
$3.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.08
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
IP
|
$4.63
|
|
|
Service Code
|
NDC 70069002101
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Aetna Commercial |
$4.17
|
| Rate for Payer: ASR ASR |
$4.49
|
| Rate for Payer: BCBS Trust/PPO |
$3.80
|
| Rate for Payer: BCN Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cofinity Commercial |
$4.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.71
|
| Rate for Payer: Healthscope Commercial |
$4.49
|
| Rate for Payer: Healthscope Whirlpool |
$4.63
|
| 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: Opus (Opus Packaging Group) HMA |
$3.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.08
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
OP
|
$4.63
|
|
|
Service Code
|
NDC 70069002101
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Aetna Commercial |
$4.17
|
| Rate for Payer: Aetna Medicare |
$1.71
|
| Rate for Payer: ASR ASR |
$4.49
|
| Rate for Payer: BCBS Complete |
$1.85
|
| Rate for Payer: BCBS Trust/PPO |
$3.82
|
| Rate for Payer: BCN Commercial |
$3.82
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cofinity Commercial |
$4.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.71
|
| Rate for Payer: Healthscope Commercial |
$4.49
|
| Rate for Payer: Healthscope Whirlpool |
$4.63
|
| Rate for Payer: Mclaren Commercial |
$4.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.94
|
| Rate for Payer: Nomi Health Commercial |
$3.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.47
|
| Rate for Payer: Priority Health Cigna 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 |
$4.08
|
|
|
DEXAMETHASONE 10 MG/ML PF ORAL SOLUTION (INJECTION FOR ORAL USE CUSTOM)
|
Facility
|
OP
|
$4.63
|
|
|
Service Code
|
NDC 70069002125
|
| Hospital Charge Code |
180638
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Aetna Commercial |
$4.17
|
| Rate for Payer: Aetna Medicare |
$1.71
|
| Rate for Payer: ASR ASR |
$4.49
|
| Rate for Payer: BCBS Complete |
$1.85
|
| Rate for Payer: BCBS Trust/PPO |
$3.82
|
| Rate for Payer: BCN Commercial |
$3.82
|
| Rate for Payer: Cash Price |
$3.71
|
| Rate for Payer: Cofinity Commercial |
$4.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.71
|
| Rate for Payer: Healthscope Commercial |
$4.49
|
| Rate for Payer: Healthscope Whirlpool |
$4.63
|
| Rate for Payer: Mclaren Commercial |
$4.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.94
|
| Rate for Payer: Nomi Health Commercial |
$3.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.47
|
| Rate for Payer: Priority Health Cigna 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 |
$4.08
|
|
|
DEXAMETHASONE 4 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$8.73
|
|
|
Service Code
|
NDC 55150023701
|
| Hospital Charge Code |
180050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.54 |
| 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 |
$7.16
|
| Rate for Payer: BCN Commercial |
$7.16
|
| 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 |
$8.46
|
| Rate for Payer: Healthscope Whirlpool |
$8.72
|
| Rate for Payer: Mclaren Commercial |
$7.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.42
|
| Rate for Payer: Nomi Health Commercial |
$7.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.68
|
|
|
DEXAMETHASONE 4 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$8.73
|
|
|
Service Code
|
NDC 55150023701
|
| Hospital Charge Code |
180050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$8.72 |
| Rate for Payer: Aetna Commercial |
$7.85
|
| Rate for Payer: Aetna Medicare |
$3.23
|
| Rate for Payer: ASR ASR |
$8.46
|
| Rate for Payer: BCBS Complete |
$3.49
|
| Rate for Payer: BCBS Trust/PPO |
$7.19
|
| Rate for Payer: BCN Commercial |
$7.19
|
| 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 |
$8.46
|
| Rate for Payer: Healthscope Whirlpool |
$8.72
|
| Rate for Payer: Mclaren Commercial |
$7.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.42
|
| Rate for Payer: Nomi Health Commercial |
$7.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.64
|
| Rate for Payer: Priority Health Narrow Network |
$6.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.68
|
|
|
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 |
$4.23 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Aetna Commercial |
$10.28
|
| Rate for Payer: Aetna Medicare |
$4.23
|
| Rate for Payer: ASR ASR |
$11.08
|
| Rate for Payer: BCBS Complete |
$4.57
|
| Rate for Payer: BCBS Trust/PPO |
$9.42
|
| Rate for Payer: BCN Commercial |
$9.42
|
| 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 |
$11.08
|
| Rate for Payer: Healthscope Whirlpool |
$11.43
|
| Rate for Payer: Mclaren Commercial |
$10.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.71
|
| Rate for Payer: Nomi Health Commercial |
$9.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.57
|
| Rate for Payer: Priority Health Cigna 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 |
$10.05
|
|
|
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 |
$8.57 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Aetna Commercial |
$10.28
|
| Rate for Payer: ASR ASR |
$11.08
|
| Rate for Payer: BCBS Trust/PPO |
$9.38
|
| Rate for Payer: BCN Commercial |
$9.38
|
| 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 |
$11.08
|
| Rate for Payer: Healthscope Whirlpool |
$11.43
|
| Rate for Payer: Mclaren Commercial |
$10.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.71
|
| Rate for Payer: Nomi Health Commercial |
$9.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.05
|
|
|
DEXAMETHASONE 4 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$15.20
|
|
|
Service Code
|
NDC 9900000647
|
| Hospital Charge Code |
180050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.62 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Aetna Commercial |
$13.68
|
| Rate for Payer: Aetna Medicare |
$5.62
|
| Rate for Payer: ASR ASR |
$14.74
|
| Rate for Payer: BCBS Complete |
$6.08
|
| Rate for Payer: BCBS Trust/PPO |
$12.53
|
| Rate for Payer: BCN Commercial |
$12.53
|
| Rate for Payer: Cash Price |
$12.16
|
| Rate for Payer: Cofinity Commercial |
$14.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.16
|
| Rate for Payer: Healthscope Commercial |
$14.74
|
| Rate for Payer: Healthscope Whirlpool |
$15.20
|
| Rate for Payer: Mclaren Commercial |
$13.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.92
|
| Rate for Payer: Nomi Health Commercial |
$12.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$13.32
|
| Rate for Payer: Priority Health Narrow Network |
$10.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.38
|
|
|
DEXAMETHASONE 4 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$15.20
|
|
|
Service Code
|
NDC 9900000647
|
| Hospital Charge Code |
180050
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$15.20 |
| Rate for Payer: Aetna Commercial |
$13.68
|
| Rate for Payer: ASR ASR |
$14.74
|
| Rate for Payer: BCBS Trust/PPO |
$12.48
|
| Rate for Payer: BCN Commercial |
$12.48
|
| Rate for Payer: Cash Price |
$12.16
|
| Rate for Payer: Cofinity Commercial |
$14.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.16
|
| Rate for Payer: Healthscope Commercial |
$14.74
|
| Rate for Payer: Healthscope Whirlpool |
$15.20
|
| Rate for Payer: Mclaren Commercial |
$13.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.92
|
| Rate for Payer: Nomi Health Commercial |
$12.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$11.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.38
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$4.69
|
|
|
Service Code
|
NDC 66993073051
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$4.22
|
| Rate for Payer: ASR ASR |
$4.54
|
| Rate for Payer: BCBS Trust/PPO |
$3.85
|
| Rate for Payer: BCN Commercial |
$3.85
|
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: Cofinity Commercial |
$4.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.75
|
| Rate for Payer: Healthscope Commercial |
$4.54
|
| Rate for Payer: Healthscope Whirlpool |
$4.68
|
| Rate for Payer: Mclaren Commercial |
$4.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: Nomi Health Commercial |
$3.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.12
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$409.45
|
|
|
Service Code
|
NDC 54418425
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.50 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Aetna Commercial |
$368.50
|
| Rate for Payer: Aetna Medicare |
$151.50
|
| Rate for Payer: ASR ASR |
$397.17
|
| Rate for Payer: BCBS Complete |
$163.78
|
| Rate for Payer: BCBS Trust/PPO |
$337.59
|
| Rate for Payer: BCN Commercial |
$337.59
|
| Rate for Payer: Cash Price |
$327.56
|
| Rate for Payer: Cofinity Commercial |
$384.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.56
|
| Rate for Payer: Healthscope Commercial |
$397.17
|
| Rate for Payer: Healthscope Whirlpool |
$409.45
|
| Rate for Payer: Mclaren Commercial |
$368.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$327.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.03
|
| Rate for Payer: Nomi Health Commercial |
$335.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.09
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$358.76
|
| Rate for Payer: Priority Health Narrow Network |
$287.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$360.32
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$442.56
|
|
|
Service Code
|
NDC 66993073002
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.75 |
| Max. Negotiated Rate |
$442.56 |
| Rate for Payer: Aetna Commercial |
$398.30
|
| Rate for Payer: Aetna Medicare |
$163.75
|
| Rate for Payer: ASR ASR |
$429.28
|
| Rate for Payer: BCBS Complete |
$177.02
|
| Rate for Payer: BCBS Trust/PPO |
$364.89
|
| Rate for Payer: BCN Commercial |
$364.89
|
| 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 |
$429.28
|
| Rate for Payer: Healthscope Whirlpool |
$442.56
|
| Rate for Payer: Mclaren Commercial |
$398.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$354.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$376.18
|
| Rate for Payer: Nomi Health Commercial |
$362.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.92
|
| Rate for Payer: Priority Health Cigna 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
|
IP
|
$409.45
|
|
|
Service Code
|
NDC 54418425
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$307.09 |
| Max. Negotiated Rate |
$409.45 |
| Rate for Payer: Aetna Commercial |
$368.50
|
| Rate for Payer: ASR ASR |
$397.17
|
| Rate for Payer: BCBS Trust/PPO |
$336.24
|
| Rate for Payer: BCN Commercial |
$336.24
|
| Rate for Payer: Cash Price |
$327.56
|
| Rate for Payer: Cofinity Commercial |
$384.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$327.56
|
| Rate for Payer: Healthscope Commercial |
$397.17
|
| Rate for Payer: Healthscope Whirlpool |
$409.45
|
| Rate for Payer: Mclaren Commercial |
$368.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$348.03
|
| Rate for Payer: Nomi Health Commercial |
$335.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$307.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$360.32
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$426.24
|
|
|
Service Code
|
NDC 904726661
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.71 |
| Max. Negotiated Rate |
$426.24 |
| Rate for Payer: Aetna Commercial |
$383.62
|
| Rate for Payer: Aetna Medicare |
$157.71
|
| Rate for Payer: ASR ASR |
$413.45
|
| Rate for Payer: BCBS Complete |
$170.50
|
| Rate for Payer: BCBS Trust/PPO |
$351.43
|
| Rate for Payer: BCN Commercial |
$351.43
|
| Rate for Payer: Cash Price |
$340.99
|
| Rate for Payer: Cofinity Commercial |
$400.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.99
|
| Rate for Payer: Healthscope Commercial |
$413.45
|
| Rate for Payer: Healthscope Whirlpool |
$426.24
|
| Rate for Payer: Mclaren Commercial |
$383.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$340.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.30
|
| Rate for Payer: Nomi Health Commercial |
$349.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$373.47
|
| Rate for Payer: Priority Health Narrow Network |
$298.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$375.09
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$470.88
|
|
|
Service Code
|
NDC 54817525
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$353.16 |
| Max. Negotiated Rate |
$470.88 |
| Rate for Payer: Aetna Commercial |
$423.79
|
| Rate for Payer: ASR ASR |
$456.75
|
| Rate for Payer: BCBS Trust/PPO |
$386.69
|
| Rate for Payer: BCN Commercial |
$386.69
|
| Rate for Payer: Cash Price |
$376.70
|
| Rate for Payer: Cofinity Commercial |
$442.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.70
|
| Rate for Payer: Healthscope Commercial |
$456.75
|
| Rate for Payer: Healthscope Whirlpool |
$470.88
|
| Rate for Payer: Mclaren Commercial |
$423.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$400.25
|
| Rate for Payer: Nomi Health Commercial |
$386.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$353.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$414.37
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$4.69
|
|
|
Service Code
|
NDC 66993073051
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$4.68 |
| Rate for Payer: Aetna Commercial |
$4.22
|
| Rate for Payer: Aetna Medicare |
$1.73
|
| Rate for Payer: ASR ASR |
$4.54
|
| Rate for Payer: BCBS Complete |
$1.87
|
| Rate for Payer: BCBS Trust/PPO |
$3.86
|
| Rate for Payer: BCN Commercial |
$3.86
|
| Rate for Payer: Cash Price |
$3.75
|
| Rate for Payer: Cofinity Commercial |
$4.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.75
|
| Rate for Payer: Healthscope Commercial |
$4.54
|
| Rate for Payer: Healthscope Whirlpool |
$4.68
|
| Rate for Payer: Mclaren Commercial |
$4.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.98
|
| Rate for Payer: Nomi Health Commercial |
$3.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.10
|
| Rate for Payer: Priority Health Narrow Network |
$3.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.12
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
OP
|
$470.88
|
|
|
Service Code
|
NDC 54817525
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.23 |
| Max. Negotiated Rate |
$470.88 |
| Rate for Payer: Aetna Commercial |
$423.79
|
| Rate for Payer: Aetna Medicare |
$174.23
|
| Rate for Payer: ASR ASR |
$456.75
|
| Rate for Payer: BCBS Complete |
$188.35
|
| Rate for Payer: BCBS Trust/PPO |
$388.24
|
| Rate for Payer: BCN Commercial |
$388.24
|
| Rate for Payer: Cash Price |
$376.70
|
| Rate for Payer: Cofinity Commercial |
$442.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$376.70
|
| Rate for Payer: Healthscope Commercial |
$456.75
|
| Rate for Payer: Healthscope Whirlpool |
$470.88
|
| Rate for Payer: Mclaren Commercial |
$423.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$376.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$400.25
|
| Rate for Payer: Nomi Health Commercial |
$386.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$353.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$412.59
|
| Rate for Payer: Priority Health Narrow Network |
$330.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$414.37
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$426.24
|
|
|
Service Code
|
NDC 904726661
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$319.68 |
| Max. Negotiated Rate |
$426.24 |
| Rate for Payer: Aetna Commercial |
$383.62
|
| Rate for Payer: ASR ASR |
$413.45
|
| Rate for Payer: BCBS Trust/PPO |
$350.03
|
| Rate for Payer: BCN Commercial |
$350.03
|
| Rate for Payer: Cash Price |
$340.99
|
| Rate for Payer: Cofinity Commercial |
$400.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.99
|
| Rate for Payer: Healthscope Commercial |
$413.45
|
| Rate for Payer: Healthscope Whirlpool |
$426.24
|
| Rate for Payer: Mclaren Commercial |
$383.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$362.30
|
| Rate for Payer: Nomi Health Commercial |
$349.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$375.09
|
|
|
DEXAMETHASONE 4 MG TABLET
|
Facility
|
IP
|
$442.56
|
|
|
Service Code
|
NDC 66993073002
|
| Hospital Charge Code |
2327
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$331.92 |
| Max. Negotiated Rate |
$442.56 |
| Rate for Payer: Aetna Commercial |
$398.30
|
| Rate for Payer: ASR ASR |
$429.28
|
| Rate for Payer: BCBS Trust/PPO |
$363.43
|
| Rate for Payer: BCN Commercial |
$363.43
|
| 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 |
$429.28
|
| Rate for Payer: Healthscope Whirlpool |
$442.56
|
| 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: Opus (Opus Packaging Group) HMA |
$331.92
|
| 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 |
$0.09 |
| Max. Negotiated Rate |
$11.18 |
| Rate for Payer: Aetna Commercial |
$10.06
|
| Rate for Payer: Aetna Medicare |
$4.14
|
| Rate for Payer: ASR ASR |
$10.84
|
| Rate for Payer: BCBS Complete |
$4.47
|
| Rate for Payer: BCBS Trust/PPO |
$9.22
|
| Rate for Payer: BCN Commercial |
$9.22
|
| 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 |
$10.84
|
| Rate for Payer: Healthscope Whirlpool |
$11.18
|
| Rate for Payer: Mclaren Commercial |
$10.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.50
|
| Rate for Payer: Nomi Health Commercial |
$9.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.11
|
| Rate for Payer: Priority Health Narrow Network |
$0.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.84
|
|
