|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
IP
|
$794.40
|
|
|
Service Code
|
NDC 00009003101
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$500.47 |
| Max. Negotiated Rate |
$714.96 |
| Rate for Payer: Aetna Commercial |
$675.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$516.36
|
| Rate for Payer: Cash Price |
$635.52
|
| Rate for Payer: Cofinity Advantage |
$556.08
|
| Rate for Payer: Cofinity Commercial |
$683.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$635.52
|
| Rate for Payer: Healthscope Commercial |
$714.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$675.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$595.80
|
| Rate for Payer: PHP Commercial |
$675.24
|
| Rate for Payer: Priority Health SBD |
$500.47
|
|
|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
IP
|
$7.81
|
|
|
Service Code
|
NDC 60687058211
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna Commercial |
$6.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.08
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cofinity Advantage |
$5.47
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.25
|
| Rate for Payer: Healthscope Commercial |
$7.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.86
|
| Rate for Payer: PHP Commercial |
$6.64
|
| Rate for Payer: Priority Health SBD |
$4.92
|
|
|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
OP
|
$7.81
|
|
|
Service Code
|
NDC 60687058211
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.07 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna Commercial |
$6.64
|
| Rate for Payer: Aetna Medicare |
$3.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.08
|
| Rate for Payer: BCBS Complete |
$3.12
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cofinity Advantage |
$5.47
|
| Rate for Payer: Cofinity Commercial |
$6.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.25
|
| Rate for Payer: Healthscope Commercial |
$7.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.86
|
| Rate for Payer: PHP Commercial |
$6.64
|
| Rate for Payer: Priority Health SBD |
$4.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.08
|
| Rate for Payer: UHC Core |
$4.07
|
| Rate for Payer: UHC Exchange |
$3.07
|
|
|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
IP
|
$709.92
|
|
|
Service Code
|
NDC 00904718861
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$447.25 |
| Max. Negotiated Rate |
$638.93 |
| Rate for Payer: Aetna Commercial |
$603.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$461.45
|
| Rate for Payer: Cash Price |
$567.94
|
| Rate for Payer: Cofinity Advantage |
$496.94
|
| Rate for Payer: Cofinity Commercial |
$610.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$567.94
|
| Rate for Payer: Healthscope Commercial |
$638.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$603.43
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$532.44
|
| Rate for Payer: PHP Commercial |
$603.43
|
| Rate for Payer: Priority Health SBD |
$447.25
|
|
|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
OP
|
$230.85
|
|
|
Service Code
|
NDC 00115169701
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.72 |
| Max. Negotiated Rate |
$207.76 |
| Rate for Payer: Aetna Commercial |
$196.22
|
| Rate for Payer: Aetna Medicare |
$115.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.05
|
| Rate for Payer: BCBS Complete |
$92.34
|
| Rate for Payer: Cash Price |
$184.68
|
| Rate for Payer: Cofinity Advantage |
$161.59
|
| Rate for Payer: Cofinity Commercial |
$198.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.68
|
| Rate for Payer: Healthscope Commercial |
$207.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$196.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$173.14
|
| Rate for Payer: PHP Commercial |
$196.22
|
| Rate for Payer: Priority Health SBD |
$145.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.05
|
| Rate for Payer: UHC Core |
$120.27
|
| Rate for Payer: UHC Exchange |
$90.72
|
|
|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
OP
|
$252.70
|
|
|
Service Code
|
NDC 59762007401
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.31 |
| Max. Negotiated Rate |
$227.43 |
| Rate for Payer: Aetna Commercial |
$214.79
|
| Rate for Payer: Aetna Medicare |
$126.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.25
|
| Rate for Payer: BCBS Complete |
$101.08
|
| Rate for Payer: Cash Price |
$202.16
|
| Rate for Payer: Cofinity Advantage |
$176.89
|
| Rate for Payer: Cofinity Commercial |
$217.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.16
|
| Rate for Payer: Healthscope Commercial |
$227.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$202.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.53
|
| Rate for Payer: PHP Commercial |
$214.79
|
| Rate for Payer: Priority Health SBD |
$159.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.25
|
| Rate for Payer: UHC Core |
$131.66
|
| Rate for Payer: UHC Exchange |
$99.31
|
|
|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
IP
|
$252.70
|
|
|
Service Code
|
NDC 59762007401
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$227.43 |
| Rate for Payer: Aetna Commercial |
$214.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.25
|
| Rate for Payer: Cash Price |
$202.16
|
| Rate for Payer: Cofinity Advantage |
$176.89
|
| Rate for Payer: Cofinity Commercial |
$217.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$202.16
|
| Rate for Payer: Healthscope Commercial |
$227.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$189.53
|
| Rate for Payer: PHP Commercial |
$214.79
|
| Rate for Payer: Priority Health SBD |
$159.20
|
|
|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
IP
|
$780.96
|
|
|
Service Code
|
NDC 60687058201
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$492.00 |
| Max. Negotiated Rate |
$702.86 |
| Rate for Payer: Aetna Commercial |
$663.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.62
|
| Rate for Payer: Cash Price |
$624.77
|
| Rate for Payer: Cofinity Advantage |
$546.67
|
| Rate for Payer: Cofinity Commercial |
$671.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$624.77
|
| Rate for Payer: Healthscope Commercial |
$702.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$663.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$585.72
|
| Rate for Payer: PHP Commercial |
$663.82
|
| Rate for Payer: Priority Health SBD |
$492.00
|
|
|
HYDROCORTISONE 1 %-PRAMOXINE 1 % RECTAL FOAM
|
Facility
|
IP
|
$594.72
|
|
|
Service Code
|
NDC 00037682210
|
| Hospital Charge Code |
28849
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$374.67 |
| Max. Negotiated Rate |
$535.25 |
| Rate for Payer: Aetna Commercial |
$505.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.57
|
| Rate for Payer: Cash Price |
$475.78
|
| Rate for Payer: Cofinity Advantage |
$416.30
|
| Rate for Payer: Cofinity Commercial |
$511.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.78
|
| Rate for Payer: Healthscope Commercial |
$535.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.04
|
| Rate for Payer: PHP Commercial |
$505.51
|
| Rate for Payer: Priority Health SBD |
$374.67
|
|
|
HYDROCORTISONE 1 %-PRAMOXINE 1 % RECTAL FOAM
|
Facility
|
OP
|
$594.72
|
|
|
Service Code
|
NDC 00037682210
|
| Hospital Charge Code |
28849
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$233.72 |
| Max. Negotiated Rate |
$535.25 |
| Rate for Payer: Aetna Commercial |
$505.51
|
| Rate for Payer: Aetna Medicare |
$297.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.57
|
| Rate for Payer: BCBS Complete |
$237.89
|
| Rate for Payer: Cash Price |
$475.78
|
| Rate for Payer: Cofinity Advantage |
$416.30
|
| Rate for Payer: Cofinity Commercial |
$511.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.78
|
| Rate for Payer: Healthscope Commercial |
$535.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$475.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.04
|
| Rate for Payer: PHP Commercial |
$505.51
|
| Rate for Payer: Priority Health SBD |
$374.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.57
|
| Rate for Payer: UHC Core |
$309.85
|
| Rate for Payer: UHC Exchange |
$233.72
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$10.08
|
|
|
Service Code
|
NDC 61269034356
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$9.07 |
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: Aetna Medicare |
$5.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.55
|
| Rate for Payer: BCBS Complete |
$4.03
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cofinity Advantage |
$7.06
|
| Rate for Payer: Cofinity Commercial |
$8.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.06
|
| Rate for Payer: Healthscope Commercial |
$9.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.56
|
| Rate for Payer: PHP Commercial |
$8.57
|
| Rate for Payer: Priority Health SBD |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.55
|
| Rate for Payer: UHC Core |
$5.25
|
| Rate for Payer: UHC Exchange |
$3.96
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$10.08
|
|
|
Service Code
|
NDC 61269034356
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$9.07 |
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.55
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cofinity Advantage |
$7.06
|
| Rate for Payer: Cofinity Commercial |
$8.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.06
|
| Rate for Payer: Healthscope Commercial |
$9.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.56
|
| Rate for Payer: PHP Commercial |
$8.57
|
| Rate for Payer: Priority Health SBD |
$6.35
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$9.45
|
|
|
Service Code
|
NDC 45802043803
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.71 |
| Max. Negotiated Rate |
$8.51 |
| Rate for Payer: Aetna Commercial |
$8.03
|
| Rate for Payer: Aetna Medicare |
$4.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.14
|
| Rate for Payer: BCBS Complete |
$3.78
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Advantage |
$6.62
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Healthscope Commercial |
$8.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.09
|
| Rate for Payer: PHP Commercial |
$8.03
|
| Rate for Payer: Priority Health SBD |
$5.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.14
|
| Rate for Payer: UHC Core |
$4.92
|
| Rate for Payer: UHC Exchange |
$3.71
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$9.45
|
|
|
Service Code
|
NDC 45802043803
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$8.51 |
| Rate for Payer: Aetna Commercial |
$8.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.14
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Advantage |
$6.62
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Healthscope Commercial |
$8.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.09
|
| Rate for Payer: PHP Commercial |
$8.03
|
| Rate for Payer: Priority Health SBD |
$5.95
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$10.91
|
|
|
Service Code
|
NDC 09629513687
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$9.82 |
| Rate for Payer: Aetna Commercial |
$9.27
|
| Rate for Payer: Aetna Medicare |
$5.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.09
|
| Rate for Payer: BCBS Complete |
$4.36
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: Cofinity Advantage |
$7.64
|
| Rate for Payer: Cofinity Commercial |
$9.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.73
|
| Rate for Payer: Healthscope Commercial |
$9.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.18
|
| Rate for Payer: PHP Commercial |
$9.27
|
| Rate for Payer: Priority Health SBD |
$6.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.09
|
| Rate for Payer: UHC Core |
$5.68
|
| Rate for Payer: UHC Exchange |
$4.29
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$10.91
|
|
|
Service Code
|
NDC 09629513687
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$9.82 |
| Rate for Payer: Aetna Commercial |
$9.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.09
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: Cofinity Advantage |
$7.64
|
| Rate for Payer: Cofinity Commercial |
$9.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.73
|
| Rate for Payer: Healthscope Commercial |
$9.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.18
|
| Rate for Payer: PHP Commercial |
$9.27
|
| Rate for Payer: Priority Health SBD |
$6.87
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM
|
Facility
|
OP
|
$10.13
|
|
|
Service Code
|
NDC 00168008031
|
| Hospital Charge Code |
3727
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Aetna Commercial |
$8.61
|
| Rate for Payer: Aetna Medicare |
$5.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.58
|
| Rate for Payer: BCBS Complete |
$4.05
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cofinity Advantage |
$7.09
|
| Rate for Payer: Cofinity Commercial |
$8.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.10
|
| Rate for Payer: Healthscope Commercial |
$9.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.60
|
| Rate for Payer: PHP Commercial |
$8.61
|
| Rate for Payer: Priority Health SBD |
$6.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.58
|
| Rate for Payer: UHC Core |
$5.28
|
| Rate for Payer: UHC Exchange |
$3.98
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM
|
Facility
|
IP
|
$10.13
|
|
|
Service Code
|
NDC 00168008031
|
| Hospital Charge Code |
3727
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$9.12 |
| Rate for Payer: Aetna Commercial |
$8.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.58
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cofinity Advantage |
$7.09
|
| Rate for Payer: Cofinity Commercial |
$8.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.10
|
| Rate for Payer: Healthscope Commercial |
$9.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.60
|
| Rate for Payer: PHP Commercial |
$8.61
|
| Rate for Payer: Priority Health SBD |
$6.38
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$25.97
|
|
|
Service Code
|
NDC 69315031228
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$23.37 |
| Rate for Payer: Aetna Commercial |
$22.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.88
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Cofinity Advantage |
$18.18
|
| Rate for Payer: Cofinity Commercial |
$22.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.78
|
| Rate for Payer: Healthscope Commercial |
$23.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.48
|
| Rate for Payer: PHP Commercial |
$22.07
|
| Rate for Payer: Priority Health SBD |
$16.36
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
OP
|
$28.56
|
|
|
Service Code
|
NDC 62559043130
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$25.70 |
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna Medicare |
$14.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.56
|
| Rate for Payer: BCBS Complete |
$11.42
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Advantage |
$19.99
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.85
|
| Rate for Payer: Healthscope Commercial |
$25.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$22.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.42
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: Priority Health SBD |
$17.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.56
|
| Rate for Payer: UHC Core |
$14.88
|
| Rate for Payer: UHC Exchange |
$11.22
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
OP
|
$155.30
|
|
|
Service Code
|
NDC 64980030130
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.03 |
| Max. Negotiated Rate |
$139.77 |
| Rate for Payer: Aetna Commercial |
$132.00
|
| Rate for Payer: Aetna Medicare |
$77.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.94
|
| Rate for Payer: BCBS Complete |
$62.12
|
| Rate for Payer: Cash Price |
$124.24
|
| Rate for Payer: Cofinity Advantage |
$108.71
|
| Rate for Payer: Cofinity Commercial |
$133.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.24
|
| Rate for Payer: Healthscope Commercial |
$139.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$124.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.47
|
| Rate for Payer: PHP Commercial |
$132.00
|
| Rate for Payer: Priority Health SBD |
$97.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.94
|
| Rate for Payer: UHC Core |
$80.91
|
| Rate for Payer: UHC Exchange |
$61.03
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$155.30
|
|
|
Service Code
|
NDC 64980030130
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.84 |
| Max. Negotiated Rate |
$139.77 |
| Rate for Payer: Aetna Commercial |
$132.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.94
|
| Rate for Payer: Cash Price |
$124.24
|
| Rate for Payer: Cofinity Advantage |
$108.71
|
| Rate for Payer: Cofinity Commercial |
$133.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.24
|
| Rate for Payer: Healthscope Commercial |
$139.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.47
|
| Rate for Payer: PHP Commercial |
$132.00
|
| Rate for Payer: Priority Health SBD |
$97.84
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$28.56
|
|
|
Service Code
|
NDC 62559043130
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.99 |
| Max. Negotiated Rate |
$25.70 |
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.56
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Advantage |
$19.99
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.85
|
| Rate for Payer: Healthscope Commercial |
$25.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.42
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: Priority Health SBD |
$17.99
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$25.94
|
|
|
Service Code
|
NDC 64980032430
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.34 |
| Max. Negotiated Rate |
$23.35 |
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.86
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cofinity Advantage |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.75
|
| Rate for Payer: Healthscope Commercial |
$23.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.45
|
| Rate for Payer: PHP Commercial |
$22.05
|
| Rate for Payer: Priority Health SBD |
$16.34
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
OP
|
$25.97
|
|
|
Service Code
|
NDC 69315031228
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$23.37 |
| Rate for Payer: Aetna Commercial |
$22.07
|
| Rate for Payer: Aetna Medicare |
$12.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.88
|
| Rate for Payer: BCBS Complete |
$10.39
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Cofinity Advantage |
$18.18
|
| Rate for Payer: Cofinity Commercial |
$22.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.78
|
| Rate for Payer: Healthscope Commercial |
$23.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.48
|
| Rate for Payer: PHP Commercial |
$22.07
|
| Rate for Payer: Priority Health SBD |
$16.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.88
|
| Rate for Payer: UHC Core |
$13.53
|
| Rate for Payer: UHC Exchange |
$10.21
|
|
