|
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 |
$8.38 |
| 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 |
$9.18
|
| Rate for Payer: BCN Commercial |
$9.18
|
| 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: 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: UHC All Payor (Choice/PPO) + Core |
$9.84
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$11.18
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2331
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| 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
|
|
|
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 |
$8.38 |
| 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 |
$9.18
|
| Rate for Payer: BCN Commercial |
$9.18
|
| 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: 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: UHC All Payor (Choice/PPO) + Core |
$9.84
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML FOR IM INJECTION
|
Facility
|
OP
|
$11.43
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
301229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| 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: 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 |
$0.11
|
| Rate for Payer: Priority Health Narrow Network |
$0.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.05
|
|
|
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 |
$8.57 |
| 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 SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$12.88
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$12.88 |
| Rate for Payer: Aetna Commercial |
$11.59
|
| Rate for Payer: Aetna Commercial |
$10.57
|
| Rate for Payer: Aetna Commercial |
$10.28
|
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Commercial |
$69.82
|
| Rate for Payer: Aetna Commercial |
$7.85
|
| Rate for Payer: Aetna Commercial |
$10.24
|
| Rate for Payer: Aetna Medicare |
$4.35
|
| Rate for Payer: Aetna Medicare |
$4.21
|
| Rate for Payer: Aetna Medicare |
$28.70
|
| Rate for Payer: Aetna Medicare |
$7.31
|
| Rate for Payer: Aetna Medicare |
$3.23
|
| Rate for Payer: Aetna Medicare |
$4.76
|
| Rate for Payer: Aetna Medicare |
$4.23
|
| Rate for Payer: ASR ASR |
$12.49
|
| Rate for Payer: ASR ASR |
$11.08
|
| Rate for Payer: ASR ASR |
$11.03
|
| Rate for Payer: ASR ASR |
$11.39
|
| Rate for Payer: ASR ASR |
$75.25
|
| Rate for Payer: ASR ASR |
$8.46
|
| Rate for Payer: ASR ASR |
$19.16
|
| Rate for Payer: BCBS Complete |
$4.55
|
| Rate for Payer: BCBS Complete |
$31.03
|
| Rate for Payer: BCBS Complete |
$3.49
|
| Rate for Payer: BCBS Complete |
$7.90
|
| Rate for Payer: BCBS Complete |
$4.57
|
| Rate for Payer: BCBS Complete |
$4.70
|
| Rate for Payer: BCBS Complete |
$5.15
|
| Rate for Payer: BCBS Trust/PPO |
$16.28
|
| Rate for Payer: BCBS Trust/PPO |
$10.62
|
| Rate for Payer: BCBS Trust/PPO |
$9.68
|
| Rate for Payer: BCBS Trust/PPO |
$9.38
|
| Rate for Payer: BCBS Trust/PPO |
$9.42
|
| Rate for Payer: BCBS Trust/PPO |
$7.19
|
| Rate for Payer: BCBS Trust/PPO |
$63.96
|
| Rate for Payer: BCN Commercial |
$63.96
|
| Rate for Payer: BCN Commercial |
$16.28
|
| Rate for Payer: BCN Commercial |
$9.42
|
| Rate for Payer: BCN Commercial |
$9.38
|
| Rate for Payer: BCN Commercial |
$10.62
|
| Rate for Payer: BCN Commercial |
$9.68
|
| Rate for Payer: BCN Commercial |
$7.19
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$10.74
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$10.69
|
| Rate for Payer: Cofinity Commercial |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$72.92
|
| Rate for Payer: Cofinity Commercial |
$8.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.06
|
| Rate for Payer: Healthscope Commercial |
$75.25
|
| Rate for Payer: Healthscope Commercial |
$11.39
|
| Rate for Payer: Healthscope Commercial |
$11.08
|
| Rate for Payer: Healthscope Commercial |
$11.03
|
| Rate for Payer: Healthscope Commercial |
$8.46
|
| Rate for Payer: Healthscope Commercial |
$19.16
|
| Rate for Payer: Healthscope Commercial |
$12.49
|
| Rate for Payer: Healthscope Whirlpool |
$77.58
|
| Rate for Payer: Healthscope Whirlpool |
$12.88
|
| Rate for Payer: Healthscope Whirlpool |
$11.43
|
| Rate for Payer: Healthscope Whirlpool |
$8.72
|
| Rate for Payer: Healthscope Whirlpool |
$11.38
|
| Rate for Payer: Healthscope Whirlpool |
$19.75
|
| Rate for Payer: Healthscope Whirlpool |
$11.74
|
| Rate for Payer: Mclaren Commercial |
$10.24
|
| Rate for Payer: Mclaren Commercial |
$10.57
|
| Rate for Payer: Mclaren Commercial |
$10.28
|
| Rate for Payer: Mclaren Commercial |
$17.78
|
| Rate for Payer: Mclaren Commercial |
$11.59
|
| Rate for Payer: Mclaren Commercial |
$69.82
|
| Rate for Payer: Mclaren Commercial |
$7.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$62.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.94
|
| Rate for Payer: Nomi Health Commercial |
$9.37
|
| Rate for Payer: Nomi Health Commercial |
$9.63
|
| Rate for Payer: Nomi Health Commercial |
$7.15
|
| Rate for Payer: Nomi Health Commercial |
$10.56
|
| Rate for Payer: Nomi Health Commercial |
$9.33
|
| Rate for Payer: Nomi Health Commercial |
$63.61
|
| Rate for Payer: Nomi Health Commercial |
$16.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.11
|
| 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: Priority Health Narrow Network |
$0.09
|
| Rate for Payer: Priority Health Narrow Network |
$0.09
|
| Rate for Payer: Priority Health Narrow Network |
$0.09
|
| Rate for Payer: Priority Health Narrow Network |
$0.09
|
| Rate for Payer: Priority Health Narrow Network |
$0.09
|
| Rate for Payer: Priority Health Narrow Network |
$0.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.01
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$11.43
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
2332
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Aetna Commercial |
$10.28
|
| Rate for Payer: Aetna Commercial |
$10.24
|
| Rate for Payer: Aetna Commercial |
$10.57
|
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Commercial |
$7.85
|
| Rate for Payer: Aetna Commercial |
$11.59
|
| Rate for Payer: Aetna Commercial |
$69.82
|
| Rate for Payer: ASR ASR |
$19.16
|
| Rate for Payer: ASR ASR |
$11.39
|
| Rate for Payer: ASR ASR |
$8.46
|
| Rate for Payer: ASR ASR |
$11.03
|
| Rate for Payer: ASR ASR |
$11.08
|
| Rate for Payer: ASR ASR |
$12.49
|
| Rate for Payer: ASR ASR |
$75.25
|
| Rate for Payer: BCBS Trust/PPO |
$7.16
|
| Rate for Payer: BCBS Trust/PPO |
$63.70
|
| Rate for Payer: BCBS Trust/PPO |
$16.22
|
| Rate for Payer: BCBS Trust/PPO |
$9.38
|
| Rate for Payer: BCBS Trust/PPO |
$9.34
|
| Rate for Payer: BCBS Trust/PPO |
$10.57
|
| Rate for Payer: BCBS Trust/PPO |
$9.64
|
| Rate for Payer: BCN Commercial |
$63.70
|
| Rate for Payer: BCN Commercial |
$9.64
|
| Rate for Payer: BCN Commercial |
$9.38
|
| Rate for Payer: BCN Commercial |
$10.57
|
| Rate for Payer: BCN Commercial |
$16.22
|
| Rate for Payer: BCN Commercial |
$9.34
|
| Rate for Payer: BCN Commercial |
$7.16
|
| Rate for Payer: Cash Price |
$9.14
|
| Rate for Payer: Cash Price |
$15.80
|
| Rate for Payer: Cash Price |
$9.40
|
| Rate for Payer: Cash Price |
$9.10
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Cash Price |
$62.06
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cofinity Commercial |
$72.92
|
| Rate for Payer: Cofinity Commercial |
$10.74
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$18.57
|
| Rate for Payer: Cofinity Commercial |
$11.04
|
| Rate for Payer: Cofinity Commercial |
$10.69
|
| Rate for Payer: Cofinity Commercial |
$8.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.10
|
| 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 |
$62.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.98
|
| Rate for Payer: Healthscope Commercial |
$11.08
|
| Rate for Payer: Healthscope Commercial |
$11.39
|
| Rate for Payer: Healthscope Commercial |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$11.03
|
| Rate for Payer: Healthscope Commercial |
$19.16
|
| Rate for Payer: Healthscope Commercial |
$75.25
|
| Rate for Payer: Healthscope Commercial |
$8.46
|
| Rate for Payer: Healthscope Whirlpool |
$19.75
|
| Rate for Payer: Healthscope Whirlpool |
$11.38
|
| Rate for Payer: Healthscope Whirlpool |
$11.43
|
| Rate for Payer: Healthscope Whirlpool |
$77.58
|
| Rate for Payer: Healthscope Whirlpool |
$11.74
|
| Rate for Payer: Healthscope Whirlpool |
$8.72
|
| Rate for Payer: Healthscope Whirlpool |
$12.88
|
| Rate for Payer: Mclaren Commercial |
$10.24
|
| Rate for Payer: Mclaren Commercial |
$11.59
|
| Rate for Payer: Mclaren Commercial |
$10.28
|
| Rate for Payer: Mclaren Commercial |
$17.78
|
| Rate for Payer: Mclaren Commercial |
$69.82
|
| Rate for Payer: Mclaren Commercial |
$10.57
|
| Rate for Payer: Mclaren Commercial |
$7.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.98
|
| Rate for Payer: Nomi Health Commercial |
$9.33
|
| Rate for Payer: Nomi Health Commercial |
$16.20
|
| Rate for Payer: Nomi Health Commercial |
$9.63
|
| Rate for Payer: Nomi Health Commercial |
$63.61
|
| Rate for Payer: Nomi Health Commercial |
$7.15
|
| Rate for Payer: Nomi Health Commercial |
$9.37
|
| Rate for Payer: Nomi Health Commercial |
$10.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.81
|
| 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 |
$7.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.38
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$13.99
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
116809
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$13.99 |
| Rate for Payer: Aetna Commercial |
$12.59
|
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: ASR ASR |
$16.34
|
| Rate for Payer: ASR ASR |
$13.57
|
| Rate for Payer: BCBS Trust/PPO |
$13.84
|
| Rate for Payer: BCBS Trust/PPO |
$11.49
|
| Rate for Payer: BCN Commercial |
$13.84
|
| Rate for Payer: BCN Commercial |
$11.49
|
| Rate for Payer: Cash Price |
$13.48
|
| Rate for Payer: Cash Price |
$11.19
|
| Rate for Payer: Cofinity Commercial |
$13.15
|
| Rate for Payer: Cofinity Commercial |
$15.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.19
|
| Rate for Payer: Healthscope Commercial |
$13.57
|
| Rate for Payer: Healthscope Commercial |
$16.34
|
| Rate for Payer: Healthscope Whirlpool |
$16.85
|
| Rate for Payer: Healthscope Whirlpool |
$13.99
|
| Rate for Payer: Mclaren Commercial |
$15.16
|
| Rate for Payer: Mclaren Commercial |
$12.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.89
|
| Rate for Payer: Nomi Health Commercial |
$13.82
|
| Rate for Payer: Nomi Health Commercial |
$11.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.83
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$16.85
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
116809
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$16.85 |
| Rate for Payer: Aetna Commercial |
$15.16
|
| Rate for Payer: Aetna Commercial |
$12.59
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: Aetna Medicare |
$6.23
|
| Rate for Payer: ASR ASR |
$16.34
|
| Rate for Payer: ASR ASR |
$13.57
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Complete |
$6.74
|
| Rate for Payer: BCBS Trust/PPO |
$13.89
|
| Rate for Payer: BCBS Trust/PPO |
$11.54
|
| Rate for Payer: BCN Commercial |
$11.54
|
| Rate for Payer: BCN Commercial |
$13.89
|
| Rate for Payer: Cash Price |
$13.48
|
| Rate for Payer: Cash Price |
$11.19
|
| Rate for Payer: Cash Price |
$13.48
|
| Rate for Payer: Cash Price |
$11.19
|
| Rate for Payer: Cofinity Commercial |
$13.15
|
| Rate for Payer: Cofinity Commercial |
$15.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.19
|
| Rate for Payer: Healthscope Commercial |
$16.34
|
| Rate for Payer: Healthscope Commercial |
$13.57
|
| Rate for Payer: Healthscope Whirlpool |
$16.85
|
| Rate for Payer: Healthscope Whirlpool |
$13.99
|
| Rate for Payer: Mclaren Commercial |
$15.16
|
| Rate for Payer: Mclaren Commercial |
$12.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.32
|
| Rate for Payer: Nomi Health Commercial |
$11.47
|
| Rate for Payer: Nomi Health Commercial |
$13.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.11
|
| 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: Priority Health Narrow Network |
$0.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.83
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$19.48
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
192063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna Commercial |
$17.53
|
| Rate for Payer: ASR ASR |
$18.89
|
| Rate for Payer: BCBS Trust/PPO |
$15.99
|
| Rate for Payer: BCN Commercial |
$15.99
|
| Rate for Payer: Cash Price |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$18.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.58
|
| Rate for Payer: Healthscope Commercial |
$18.89
|
| Rate for Payer: Healthscope Whirlpool |
$19.48
|
| Rate for Payer: Mclaren Commercial |
$17.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.56
|
| Rate for Payer: Nomi Health Commercial |
$15.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.14
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$19.48
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
192063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: Aetna Commercial |
$17.53
|
| Rate for Payer: Aetna Medicare |
$7.21
|
| Rate for Payer: ASR ASR |
$18.89
|
| Rate for Payer: BCBS Complete |
$7.79
|
| Rate for Payer: BCBS Trust/PPO |
$16.06
|
| Rate for Payer: BCN Commercial |
$16.06
|
| Rate for Payer: Cash Price |
$15.58
|
| Rate for Payer: Cash Price |
$15.58
|
| Rate for Payer: Cofinity Commercial |
$18.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.58
|
| Rate for Payer: Healthscope Commercial |
$18.89
|
| Rate for Payer: Healthscope Whirlpool |
$19.48
|
| Rate for Payer: Mclaren Commercial |
$17.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.56
|
| Rate for Payer: Nomi Health Commercial |
$15.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.61
|
| 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 |
$17.14
|
|
|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$8.40
|
|
|
Service Code
|
NDC 69339015019
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: Aetna Commercial |
$7.56
|
| Rate for Payer: Aetna Medicare |
$3.11
|
| Rate for Payer: ASR ASR |
$8.15
|
| Rate for Payer: BCBS Complete |
$3.36
|
| Rate for Payer: BCBS Trust/PPO |
$6.93
|
| Rate for Payer: BCN Commercial |
$6.93
|
| Rate for Payer: Cash Price |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$7.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.72
|
| Rate for Payer: Healthscope Commercial |
$8.15
|
| Rate for Payer: Healthscope Whirlpool |
$8.40
|
| Rate for Payer: Mclaren Commercial |
$7.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.14
|
| Rate for Payer: Nomi Health Commercial |
$6.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.36
|
| Rate for Payer: Priority Health Narrow Network |
$5.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.39
|
|
|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$8.40
|
|
|
Service Code
|
NDC 69339015019
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: Aetna Commercial |
$7.56
|
| Rate for Payer: ASR ASR |
$8.15
|
| Rate for Payer: BCBS Trust/PPO |
$6.90
|
| Rate for Payer: BCN Commercial |
$6.90
|
| Rate for Payer: Cash Price |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$7.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.72
|
| Rate for Payer: Healthscope Commercial |
$8.15
|
| Rate for Payer: Healthscope Whirlpool |
$8.40
|
| Rate for Payer: Mclaren Commercial |
$7.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.14
|
| Rate for Payer: Nomi Health Commercial |
$6.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.39
|
|
|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$9.31
|
|
|
Service Code
|
NDC 121127610
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$9.31 |
| Rate for Payer: Aetna Commercial |
$8.38
|
| Rate for Payer: Aetna Medicare |
$3.45
|
| Rate for Payer: ASR ASR |
$9.03
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: BCBS Trust/PPO |
$7.68
|
| Rate for Payer: BCN Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Cofinity Commercial |
$8.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.45
|
| Rate for Payer: Healthscope Commercial |
$9.03
|
| Rate for Payer: Healthscope Whirlpool |
$9.31
|
| Rate for Payer: Mclaren Commercial |
$8.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.92
|
| Rate for Payer: Nomi Health Commercial |
$7.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.16
|
| Rate for Payer: Priority Health Narrow Network |
$6.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.19
|
|
|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$9.31
|
|
|
Service Code
|
NDC 121127600
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$9.31 |
| Rate for Payer: Aetna Commercial |
$8.38
|
| Rate for Payer: ASR ASR |
$9.03
|
| Rate for Payer: BCBS Trust/PPO |
$7.65
|
| Rate for Payer: BCN Commercial |
$7.65
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Cofinity Commercial |
$8.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.45
|
| Rate for Payer: Healthscope Commercial |
$9.03
|
| Rate for Payer: Healthscope Whirlpool |
$9.31
|
| Rate for Payer: Mclaren Commercial |
$8.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.92
|
| Rate for Payer: Nomi Health Commercial |
$7.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.19
|
|
|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$8.40
|
|
|
Service Code
|
NDC 69339015001
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: Aetna Commercial |
$7.56
|
| Rate for Payer: Aetna Medicare |
$3.11
|
| Rate for Payer: ASR ASR |
$8.15
|
| Rate for Payer: BCBS Complete |
$3.36
|
| Rate for Payer: BCBS Trust/PPO |
$6.93
|
| Rate for Payer: BCN Commercial |
$6.93
|
| Rate for Payer: Cash Price |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$7.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.72
|
| Rate for Payer: Healthscope Commercial |
$8.15
|
| Rate for Payer: Healthscope Whirlpool |
$8.40
|
| Rate for Payer: Mclaren Commercial |
$7.56
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.14
|
| Rate for Payer: Nomi Health Commercial |
$6.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$7.36
|
| Rate for Payer: Priority Health Narrow Network |
$5.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.39
|
|
|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$8.40
|
|
|
Service Code
|
NDC 69339015001
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$8.40 |
| Rate for Payer: Aetna Commercial |
$7.56
|
| Rate for Payer: ASR ASR |
$8.15
|
| Rate for Payer: BCBS Trust/PPO |
$6.90
|
| Rate for Payer: BCN Commercial |
$6.90
|
| Rate for Payer: Cash Price |
$6.72
|
| Rate for Payer: Cofinity Commercial |
$7.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.72
|
| Rate for Payer: Healthscope Commercial |
$8.15
|
| Rate for Payer: Healthscope Whirlpool |
$8.40
|
| Rate for Payer: Mclaren Commercial |
$7.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.14
|
| Rate for Payer: Nomi Health Commercial |
$6.89
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$7.39
|
|
|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$6.36
|
|
|
Service Code
|
NDC 121063805
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$6.36 |
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: Aetna Medicare |
$2.35
|
| Rate for Payer: ASR ASR |
$6.17
|
| Rate for Payer: BCBS Complete |
$2.54
|
| Rate for Payer: BCBS Trust/PPO |
$5.24
|
| Rate for Payer: BCN Commercial |
$5.24
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Commercial |
$5.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$6.17
|
| Rate for Payer: Healthscope Whirlpool |
$6.36
|
| Rate for Payer: Mclaren Commercial |
$5.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.57
|
| Rate for Payer: Priority Health Narrow Network |
$4.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.60
|
|
|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$6.36
|
|
|
Service Code
|
NDC 121063805
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$6.36 |
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: ASR ASR |
$6.17
|
| Rate for Payer: BCBS Trust/PPO |
$5.22
|
| Rate for Payer: BCN Commercial |
$5.22
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Commercial |
$5.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$6.17
|
| Rate for Payer: Healthscope Whirlpool |
$6.36
|
| Rate for Payer: Mclaren Commercial |
$5.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.60
|
|
|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
OP
|
$9.31
|
|
|
Service Code
|
NDC 121127600
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$9.31 |
| Rate for Payer: Aetna Commercial |
$8.38
|
| Rate for Payer: Aetna Medicare |
$3.45
|
| Rate for Payer: ASR ASR |
$9.03
|
| Rate for Payer: BCBS Complete |
$3.72
|
| Rate for Payer: BCBS Trust/PPO |
$7.68
|
| Rate for Payer: BCN Commercial |
$7.68
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Cofinity Commercial |
$8.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.45
|
| Rate for Payer: Healthscope Commercial |
$9.03
|
| Rate for Payer: Healthscope Whirlpool |
$9.31
|
| Rate for Payer: Mclaren Commercial |
$8.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.92
|
| Rate for Payer: Nomi Health Commercial |
$7.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$8.16
|
| Rate for Payer: Priority Health Narrow Network |
$6.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.19
|
|
|
DEXTROMETHORPHAN-GUAIFENESIN 10 MG-100 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$9.31
|
|
|
Service Code
|
NDC 121127610
|
| Hospital Charge Code |
9774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$9.31 |
| Rate for Payer: Aetna Commercial |
$8.38
|
| Rate for Payer: ASR ASR |
$9.03
|
| Rate for Payer: BCBS Trust/PPO |
$7.65
|
| Rate for Payer: BCN Commercial |
$7.65
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Cofinity Commercial |
$8.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.45
|
| Rate for Payer: Healthscope Commercial |
$9.03
|
| Rate for Payer: Healthscope Whirlpool |
$9.31
|
| Rate for Payer: Mclaren Commercial |
$8.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.92
|
| Rate for Payer: Nomi Health Commercial |
$7.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.19
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
NDC 338002304
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.87 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Medicare |
$25.87
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$57.65
|
| Rate for Payer: BCN Commercial |
$57.65
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$69.92
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$52.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$61.26
|
| Rate for Payer: Priority Health Narrow Network |
$49.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$63.80
|
|
|
Service Code
|
NDC 264752020
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.61 |
| Max. Negotiated Rate |
$63.80 |
| Rate for Payer: Aetna Commercial |
$57.42
|
| Rate for Payer: Aetna Medicare |
$23.61
|
| Rate for Payer: ASR ASR |
$61.89
|
| Rate for Payer: BCBS Complete |
$25.52
|
| Rate for Payer: BCBS Trust/PPO |
$52.60
|
| Rate for Payer: BCN Commercial |
$52.60
|
| Rate for Payer: Cash Price |
$51.04
|
| Rate for Payer: Cofinity Commercial |
$59.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$51.04
|
| Rate for Payer: Healthscope Commercial |
$61.89
|
| Rate for Payer: Healthscope Whirlpool |
$63.80
|
| Rate for Payer: Mclaren Commercial |
$57.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.23
|
| Rate for Payer: Nomi Health Commercial |
$52.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$55.90
|
| Rate for Payer: Priority Health Narrow Network |
$44.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$56.14
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$79.75
|
|
|
Service Code
|
NDC 990793002
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.81 |
| Max. Negotiated Rate |
$79.75 |
| Rate for Payer: Aetna Commercial |
$71.78
|
| Rate for Payer: ASR ASR |
$77.36
|
| Rate for Payer: BCBS Trust/PPO |
$65.49
|
| Rate for Payer: BCN Commercial |
$65.49
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cofinity Commercial |
$74.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.80
|
| Rate for Payer: Healthscope Commercial |
$77.36
|
| Rate for Payer: Healthscope Whirlpool |
$79.75
|
| Rate for Payer: Mclaren Commercial |
$71.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.79
|
| Rate for Payer: Nomi Health Commercial |
$65.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.18
|
|
|
DEXTROSE 10 % IN WATER (D10W) INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$79.75
|
|
|
Service Code
|
NDC 990793002
|
| Hospital Charge Code |
2357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.51 |
| Max. Negotiated Rate |
$79.75 |
| Rate for Payer: Aetna Commercial |
$71.78
|
| Rate for Payer: Aetna Medicare |
$29.51
|
| Rate for Payer: ASR ASR |
$77.36
|
| Rate for Payer: BCBS Complete |
$31.90
|
| Rate for Payer: BCBS Trust/PPO |
$65.75
|
| Rate for Payer: BCN Commercial |
$65.75
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cofinity Commercial |
$74.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.80
|
| Rate for Payer: Healthscope Commercial |
$77.36
|
| Rate for Payer: Healthscope Whirlpool |
$79.75
|
| Rate for Payer: Mclaren Commercial |
$71.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.79
|
| Rate for Payer: Nomi Health Commercial |
$65.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$59.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$69.88
|
| Rate for Payer: Priority Health Narrow Network |
$55.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.18
|
|
