Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$4.71

Service Code	NDC 50268040011
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$4.24
Rate for Payer: Aetna Commercial	$4.00
Rate for Payer: Aetna Medicare	$2.35
Rate for Payer: Aetna New Business (MI Preferred)	$3.06
Rate for Payer: BCBS Complete	$1.88
Rate for Payer: Cash Price	$3.77
Rate for Payer: Cofinity Commercial	$3.30
Rate for Payer: Cofinity Commercial	$4.05
Rate for Payer: Cofinity Medicare Advantage	$3.30
Rate for Payer: Encore Health Key Benefits Commercial	$3.77
Rate for Payer: Healthscope Commercial	$4.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.00
Rate for Payer: PHP Commercial	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.06
Rate for Payer: Priority Health SBD	$2.97

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$175.00

Service Code	NDC 13107002001
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$110.25
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna Commercial	$148.75
Rate for Payer: Aetna New Business (MI Preferred)	$113.75
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cofinity Commercial	$122.50
Rate for Payer: Cofinity Commercial	$150.50
Rate for Payer: Cofinity Medicare Advantage	$122.50
Rate for Payer: Encore Health Key Benefits Commercial	$140.00
Rate for Payer: Healthscope Commercial	$157.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$148.75
Rate for Payer: PHP Commercial	$148.75
Rate for Payer: Priority Health Cigna Priority Health	$113.75
Rate for Payer: Priority Health SBD	$110.25

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$235.38

Service Code	NDC 50268040015
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$94.15
Max. Negotiated Rate	$211.84
Rate for Payer: Aetna Commercial	$200.07
Rate for Payer: Aetna Medicare	$117.69
Rate for Payer: Aetna New Business (MI Preferred)	$153.00
Rate for Payer: BCBS Complete	$94.15
Rate for Payer: Cash Price	$188.30
Rate for Payer: Cofinity Commercial	$164.77
Rate for Payer: Cofinity Commercial	$202.43
Rate for Payer: Cofinity Medicare Advantage	$164.77
Rate for Payer: Encore Health Key Benefits Commercial	$188.30
Rate for Payer: Healthscope Commercial	$211.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$200.07
Rate for Payer: PHP Commercial	$200.07
Rate for Payer: Priority Health Cigna Priority Health	$153.00
Rate for Payer: Priority Health SBD	$148.29

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$7.58

Service Code	NDC 00406012423
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$3.03
Max. Negotiated Rate	$6.82
Rate for Payer: Aetna Commercial	$6.44
Rate for Payer: Aetna Medicare	$3.79
Rate for Payer: Aetna New Business (MI Preferred)	$4.93
Rate for Payer: BCBS Complete	$3.03
Rate for Payer: Cash Price	$6.06
Rate for Payer: Cofinity Commercial	$5.31
Rate for Payer: Cofinity Commercial	$6.52
Rate for Payer: Cofinity Medicare Advantage	$5.31
Rate for Payer: Encore Health Key Benefits Commercial	$6.06
Rate for Payer: Healthscope Commercial	$6.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.44
Rate for Payer: PHP Commercial	$6.44
Rate for Payer: Priority Health Cigna Priority Health	$4.93
Rate for Payer: Priority Health SBD	$4.78

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$757.75

Service Code	NDC 00406012462
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$477.38
Max. Negotiated Rate	$681.98
Rate for Payer: Aetna Commercial	$644.09
Rate for Payer: Aetna New Business (MI Preferred)	$492.54
Rate for Payer: Cash Price	$606.20
Rate for Payer: Cofinity Commercial	$530.42
Rate for Payer: Cofinity Commercial	$651.66
Rate for Payer: Cofinity Medicare Advantage	$530.42
Rate for Payer: Encore Health Key Benefits Commercial	$606.20
Rate for Payer: Healthscope Commercial	$681.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$644.09
Rate for Payer: PHP Commercial	$644.09
Rate for Payer: Priority Health Cigna Priority Health	$492.54
Rate for Payer: Priority Health SBD	$477.38

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$7.58

Service Code	NDC 00406012423
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$4.78
Max. Negotiated Rate	$6.82
Rate for Payer: Aetna Commercial	$6.44
Rate for Payer: Aetna New Business (MI Preferred)	$4.93
Rate for Payer: Cash Price	$6.06
Rate for Payer: Cofinity Commercial	$5.31
Rate for Payer: Cofinity Commercial	$6.52
Rate for Payer: Cofinity Medicare Advantage	$5.31
Rate for Payer: Encore Health Key Benefits Commercial	$6.06
Rate for Payer: Healthscope Commercial	$6.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.44
Rate for Payer: PHP Commercial	$6.44
Rate for Payer: Priority Health Cigna Priority Health	$4.93
Rate for Payer: Priority Health SBD	$4.78

HYDROCOLLOID DRESSING 5 1/2" X 5 1/2"

Facility

$103.38

Service Code	NDC 68455010723
Hospital Charge Code	111353
Hospital Revenue Code	637
Min. Negotiated Rate	$41.35
Max. Negotiated Rate	$93.04
Rate for Payer: Aetna Commercial	$87.87
Rate for Payer: Aetna Medicare	$51.69
Rate for Payer: Aetna New Business (MI Preferred)	$67.20
Rate for Payer: BCBS Complete	$41.35
Rate for Payer: Cash Price	$82.70
Rate for Payer: Cofinity Commercial	$72.37
Rate for Payer: Cofinity Commercial	$88.91
Rate for Payer: Cofinity Medicare Advantage	$72.37
Rate for Payer: Encore Health Key Benefits Commercial	$82.70
Rate for Payer: Healthscope Commercial	$93.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$87.87
Rate for Payer: PHP Commercial	$87.87
Rate for Payer: Priority Health Cigna Priority Health	$67.20
Rate for Payer: Priority Health SBD	$65.13

HYDROCOLLOID DRESSING 5 1/2" X 5 1/2"

Facility

$103.38

Service Code	NDC 68455010723
Hospital Charge Code	111353
Hospital Revenue Code	637
Min. Negotiated Rate	$65.13
Max. Negotiated Rate	$93.04
Rate for Payer: Aetna Commercial	$87.87
Rate for Payer: Aetna New Business (MI Preferred)	$67.20
Rate for Payer: Cash Price	$82.70
Rate for Payer: Cofinity Commercial	$72.37
Rate for Payer: Cofinity Commercial	$88.91
Rate for Payer: Cofinity Medicare Advantage	$72.37
Rate for Payer: Encore Health Key Benefits Commercial	$82.70
Rate for Payer: Healthscope Commercial	$93.04
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$87.87
Rate for Payer: PHP Commercial	$87.87
Rate for Payer: Priority Health Cigna Priority Health	$67.20
Rate for Payer: Priority Health SBD	$65.13

HYDROCOLLOID DRESSING 6" X 6"

Facility

$108.04

Service Code	NDC 68455010692
Hospital Charge Code	111013
Hospital Revenue Code	637
Min. Negotiated Rate	$43.22
Max. Negotiated Rate	$97.24
Rate for Payer: Aetna Commercial	$91.83
Rate for Payer: Aetna Medicare	$54.02
Rate for Payer: Aetna New Business (MI Preferred)	$70.23
Rate for Payer: BCBS Complete	$43.22
Rate for Payer: Cash Price	$86.43
Rate for Payer: Cofinity Commercial	$75.63
Rate for Payer: Cofinity Commercial	$92.91
Rate for Payer: Cofinity Medicare Advantage	$75.63
Rate for Payer: Encore Health Key Benefits Commercial	$86.43
Rate for Payer: Healthscope Commercial	$97.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.83
Rate for Payer: PHP Commercial	$91.83
Rate for Payer: Priority Health Cigna Priority Health	$70.23
Rate for Payer: Priority Health SBD	$68.07

HYDROCOLLOID DRESSING 6" X 6"

Facility

$108.04

Service Code	NDC 68455010692
Hospital Charge Code	111013
Hospital Revenue Code	637
Min. Negotiated Rate	$68.07
Max. Negotiated Rate	$97.24
Rate for Payer: Aetna Commercial	$91.83
Rate for Payer: Aetna New Business (MI Preferred)	$70.23
Rate for Payer: Cash Price	$86.43
Rate for Payer: Cofinity Commercial	$75.63
Rate for Payer: Cofinity Commercial	$92.91
Rate for Payer: Cofinity Medicare Advantage	$75.63
Rate for Payer: Encore Health Key Benefits Commercial	$86.43
Rate for Payer: Healthscope Commercial	$97.24
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$91.83
Rate for Payer: PHP Commercial	$91.83
Rate for Payer: Priority Health Cigna Priority Health	$70.23
Rate for Payer: Priority Health SBD	$68.07

HYDROCORTISONE 10 MG TABLET

Facility

$794.40

Service Code	NDC 00009003101
Hospital Charge Code	3733
Hospital Revenue Code	637
Min. Negotiated Rate	$317.76
Max. Negotiated Rate	$714.96
Rate for Payer: Aetna Commercial	$675.24
Rate for Payer: Aetna Medicare	$397.20
Rate for Payer: Aetna New Business (MI Preferred)	$516.36
Rate for Payer: BCBS Complete	$317.76
Rate for Payer: Cash Price	$635.52
Rate for Payer: Cofinity Commercial	$556.08
Rate for Payer: Cofinity Commercial	$683.18
Rate for Payer: Cofinity Medicare Advantage	$556.08
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: PHP Commercial	$675.24
Rate for Payer: Priority Health Cigna Priority Health	$516.36
Rate for Payer: Priority Health SBD	$500.47

HYDROCORTISONE 10 MG TABLET

Facility

$252.70

Service Code	NDC 59762007401
Hospital Charge Code	3733
Hospital Revenue Code	637
Min. Negotiated Rate	$101.08
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 Commercial	$176.89
Rate for Payer: Cofinity Commercial	$217.32
Rate for Payer: Cofinity Medicare Advantage	$176.89
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: PHP Commercial	$214.79
Rate for Payer: Priority Health Cigna Priority Health	$164.25
Rate for Payer: Priority Health SBD	$159.20

HYDROCORTISONE 10 MG TABLET

Facility

$716.16

Service Code	NDC 60687058201
Hospital Charge Code	3733
Hospital Revenue Code	637
Min. Negotiated Rate	$286.46
Max. Negotiated Rate	$644.54
Rate for Payer: Aetna Commercial	$608.74
Rate for Payer: Aetna Medicare	$358.08
Rate for Payer: Aetna New Business (MI Preferred)	$465.50
Rate for Payer: BCBS Complete	$286.46
Rate for Payer: Cash Price	$572.93
Rate for Payer: Cofinity Commercial	$501.31
Rate for Payer: Cofinity Commercial	$615.90
Rate for Payer: Cofinity Medicare Advantage	$501.31
Rate for Payer: Encore Health Key Benefits Commercial	$572.93
Rate for Payer: Healthscope Commercial	$644.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$608.74
Rate for Payer: PHP Commercial	$608.74
Rate for Payer: Priority Health Cigna Priority Health	$465.50
Rate for Payer: Priority Health SBD	$451.18

HYDROCORTISONE 10 MG TABLET

Facility

$7.17

Service Code	NDC 60687058211
Hospital Charge Code	3733
Hospital Revenue Code	637
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$6.45
Rate for Payer: Aetna Commercial	$6.09
Rate for Payer: Aetna New Business (MI Preferred)	$4.66
Rate for Payer: Cash Price	$5.74
Rate for Payer: Cofinity Commercial	$5.02
Rate for Payer: Cofinity Commercial	$6.17
Rate for Payer: Cofinity Medicare Advantage	$5.02
Rate for Payer: Encore Health Key Benefits Commercial	$5.74
Rate for Payer: Healthscope Commercial	$6.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.09
Rate for Payer: PHP Commercial	$6.09
Rate for Payer: Priority Health Cigna Priority Health	$4.66
Rate for Payer: Priority Health SBD	$4.52

HYDROCORTISONE 10 MG TABLET

Facility

$7.17

Service Code	NDC 60687058211
Hospital Charge Code	3733
Hospital Revenue Code	637
Min. Negotiated Rate	$2.87
Max. Negotiated Rate	$6.45
Rate for Payer: Aetna Commercial	$6.09
Rate for Payer: Aetna Medicare	$3.58
Rate for Payer: Aetna New Business (MI Preferred)	$4.66
Rate for Payer: BCBS Complete	$2.87
Rate for Payer: Cash Price	$5.74
Rate for Payer: Cofinity Commercial	$5.02
Rate for Payer: Cofinity Commercial	$6.17
Rate for Payer: Cofinity Medicare Advantage	$5.02
Rate for Payer: Encore Health Key Benefits Commercial	$5.74
Rate for Payer: Healthscope Commercial	$6.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.09
Rate for Payer: PHP Commercial	$6.09
Rate for Payer: Priority Health Cigna Priority Health	$4.66
Rate for Payer: Priority Health SBD	$4.52

HYDROCORTISONE 10 MG TABLET

Facility

$716.16

Service Code	NDC 60687058201
Hospital Charge Code	3733
Hospital Revenue Code	637
Min. Negotiated Rate	$451.18
Max. Negotiated Rate	$644.54
Rate for Payer: Aetna Commercial	$608.74
Rate for Payer: Aetna New Business (MI Preferred)	$465.50
Rate for Payer: Cash Price	$572.93
Rate for Payer: Cofinity Commercial	$501.31
Rate for Payer: Cofinity Commercial	$615.90
Rate for Payer: Cofinity Medicare Advantage	$501.31
Rate for Payer: Encore Health Key Benefits Commercial	$572.93
Rate for Payer: Healthscope Commercial	$644.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$608.74
Rate for Payer: PHP Commercial	$608.74
Rate for Payer: Priority Health Cigna Priority Health	$465.50
Rate for Payer: Priority Health SBD	$451.18

HYDROCORTISONE 10 MG TABLET

Facility

$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 Commercial	$176.89
Rate for Payer: Cofinity Commercial	$217.32
Rate for Payer: Cofinity Medicare Advantage	$176.89
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: PHP Commercial	$214.79
Rate for Payer: Priority Health Cigna Priority Health	$164.25
Rate for Payer: Priority Health SBD	$159.20

HYDROCORTISONE 10 MG TABLET

Facility

$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 Commercial	$556.08
Rate for Payer: Cofinity Commercial	$683.18
Rate for Payer: Cofinity Medicare Advantage	$556.08
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: PHP Commercial	$675.24
Rate for Payer: Priority Health Cigna Priority Health	$516.36
Rate for Payer: Priority Health SBD	$500.47

HYDROCORTISONE 1 %-PRAMOXINE 1 % RECTAL FOAM

Facility

$566.41

Service Code	NDC 00037682210
Hospital Charge Code	28849
Hospital Revenue Code	637
Min. Negotiated Rate	$356.84
Max. Negotiated Rate	$509.77
Rate for Payer: Aetna Commercial	$481.45
Rate for Payer: Aetna New Business (MI Preferred)	$368.17
Rate for Payer: Cash Price	$453.13
Rate for Payer: Cofinity Commercial	$396.49
Rate for Payer: Cofinity Commercial	$487.11
Rate for Payer: Cofinity Medicare Advantage	$396.49
Rate for Payer: Encore Health Key Benefits Commercial	$453.13
Rate for Payer: Healthscope Commercial	$509.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$481.45
Rate for Payer: PHP Commercial	$481.45
Rate for Payer: Priority Health Cigna Priority Health	$368.17
Rate for Payer: Priority Health SBD	$356.84

HYDROCORTISONE 1 %-PRAMOXINE 1 % RECTAL FOAM

Facility

$566.41

Service Code	NDC 00037682210
Hospital Charge Code	28849
Hospital Revenue Code	637
Min. Negotiated Rate	$226.56
Max. Negotiated Rate	$509.77
Rate for Payer: Aetna Commercial	$481.45
Rate for Payer: Aetna Medicare	$283.20
Rate for Payer: Aetna New Business (MI Preferred)	$368.17
Rate for Payer: BCBS Complete	$226.56
Rate for Payer: Cash Price	$453.13
Rate for Payer: Cofinity Commercial	$396.49
Rate for Payer: Cofinity Commercial	$487.11
Rate for Payer: Cofinity Medicare Advantage	$396.49
Rate for Payer: Encore Health Key Benefits Commercial	$453.13
Rate for Payer: Healthscope Commercial	$509.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$481.45
Rate for Payer: PHP Commercial	$481.45
Rate for Payer: Priority Health Cigna Priority Health	$368.17
Rate for Payer: Priority Health SBD	$356.84

HYDROCORTISONE 1 % TOPICAL CREAM

Facility

$10.74

Service Code	NDC 09629513687
Hospital Charge Code	3726
Hospital Revenue Code	637
Min. Negotiated Rate	$6.77
Max. Negotiated Rate	$9.67
Rate for Payer: Aetna Commercial	$9.13
Rate for Payer: Aetna New Business (MI Preferred)	$6.98
Rate for Payer: Cash Price	$8.59
Rate for Payer: Cofinity Commercial	$7.52
Rate for Payer: Cofinity Commercial	$9.24
Rate for Payer: Cofinity Medicare Advantage	$7.52
Rate for Payer: Encore Health Key Benefits Commercial	$8.59
Rate for Payer: Healthscope Commercial	$9.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.13
Rate for Payer: PHP Commercial	$9.13
Rate for Payer: Priority Health Cigna Priority Health	$6.98
Rate for Payer: Priority Health SBD	$6.77

HYDROCORTISONE 1 % TOPICAL CREAM

Facility

$10.08

Service Code	NDC 61269034356
Hospital Charge Code	3726
Hospital Revenue Code	637
Min. Negotiated Rate	$4.03
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 Commercial	$7.06
Rate for Payer: Cofinity Commercial	$8.67
Rate for Payer: Cofinity Medicare Advantage	$7.06
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: PHP Commercial	$8.57
Rate for Payer: Priority Health Cigna Priority Health	$6.55
Rate for Payer: Priority Health SBD	$6.35

HYDROCORTISONE 1 % TOPICAL CREAM

Facility

$10.74

Service Code	NDC 09629513687
Hospital Charge Code	3726
Hospital Revenue Code	637
Min. Negotiated Rate	$4.30
Max. Negotiated Rate	$9.67
Rate for Payer: Aetna Commercial	$9.13
Rate for Payer: Aetna Medicare	$5.37
Rate for Payer: Aetna New Business (MI Preferred)	$6.98
Rate for Payer: BCBS Complete	$4.30
Rate for Payer: Cash Price	$8.59
Rate for Payer: Cofinity Commercial	$7.52
Rate for Payer: Cofinity Commercial	$9.24
Rate for Payer: Cofinity Medicare Advantage	$7.52
Rate for Payer: Encore Health Key Benefits Commercial	$8.59
Rate for Payer: Healthscope Commercial	$9.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$9.13
Rate for Payer: PHP Commercial	$9.13
Rate for Payer: Priority Health Cigna Priority Health	$6.98
Rate for Payer: Priority Health SBD	$6.77

HYDROCORTISONE 1 % TOPICAL CREAM

Facility

$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 Commercial	$6.62
Rate for Payer: Cofinity Commercial	$8.13
Rate for Payer: Cofinity Medicare Advantage	$6.62
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: PHP Commercial	$8.03
Rate for Payer: Priority Health Cigna Priority Health	$6.14
Rate for Payer: Priority Health SBD	$5.95

HYDROCORTISONE 1 % TOPICAL CREAM

Facility

$9.45

Service Code	NDC 45802043803
Hospital Charge Code	3726
Hospital Revenue Code	637
Min. Negotiated Rate	$3.78
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 Commercial	$6.62
Rate for Payer: Cofinity Commercial	$8.13
Rate for Payer: Cofinity Medicare Advantage	$6.62
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: PHP Commercial	$8.03
Rate for Payer: Priority Health Cigna Priority Health	$6.14
Rate for Payer: Priority Health SBD	$5.95

Know your out-of-pocket cost for care.

All Charges