Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HYDROCORTISONE 1 % TOPICAL CREAM

Facility

$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 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 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR

Facility

$27.25

Service Code	NDC 69315031228
Hospital Charge Code	28824
Hospital Revenue Code	637
Min. Negotiated Rate	$10.90
Max. Negotiated Rate	$24.52
Rate for Payer: Aetna Commercial	$23.16
Rate for Payer: Aetna Medicare	$13.62
Rate for Payer: Aetna New Business (MI Preferred)	$17.71
Rate for Payer: BCBS Complete	$10.90
Rate for Payer: Cash Price	$21.80
Rate for Payer: Cofinity Commercial	$19.07
Rate for Payer: Cofinity Commercial	$23.43
Rate for Payer: Cofinity Medicare Advantage	$19.07
Rate for Payer: Encore Health Key Benefits Commercial	$21.80
Rate for Payer: Healthscope Commercial	$24.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.16
Rate for Payer: PHP Commercial	$23.16
Rate for Payer: Priority Health Cigna Priority Health	$17.71
Rate for Payer: Priority Health SBD	$17.17

HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR

Facility

$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 Commercial	$108.71
Rate for Payer: Cofinity Commercial	$133.56
Rate for Payer: Cofinity Medicare Advantage	$108.71
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: PHP Commercial	$132.00
Rate for Payer: Priority Health Cigna Priority Health	$100.94
Rate for Payer: Priority Health SBD	$97.84

HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR

Facility

$155.30

Service Code	NDC 64980030130
Hospital Charge Code	28824
Hospital Revenue Code	637
Min. Negotiated Rate	$62.12
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 Commercial	$108.71
Rate for Payer: Cofinity Commercial	$133.56
Rate for Payer: Cofinity Medicare Advantage	$108.71
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: PHP Commercial	$132.00
Rate for Payer: Priority Health Cigna Priority Health	$100.94
Rate for Payer: Priority Health SBD	$97.84

HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR

Facility

$27.25

Service Code	NDC 69315031228
Hospital Charge Code	28824
Hospital Revenue Code	637
Min. Negotiated Rate	$17.17
Max. Negotiated Rate	$24.52
Rate for Payer: Aetna Commercial	$23.16
Rate for Payer: Aetna New Business (MI Preferred)	$17.71
Rate for Payer: Cash Price	$21.80
Rate for Payer: Cofinity Commercial	$19.07
Rate for Payer: Cofinity Commercial	$23.43
Rate for Payer: Cofinity Medicare Advantage	$19.07
Rate for Payer: Encore Health Key Benefits Commercial	$21.80
Rate for Payer: Healthscope Commercial	$24.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.16
Rate for Payer: PHP Commercial	$23.16
Rate for Payer: Priority Health Cigna Priority Health	$17.71
Rate for Payer: Priority Health SBD	$17.17

HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR

Facility

$225.54

Service Code	NDC 62559043130
Hospital Charge Code	28824
Hospital Revenue Code	637
Min. Negotiated Rate	$90.22
Max. Negotiated Rate	$202.99
Rate for Payer: Aetna Commercial	$191.71
Rate for Payer: Aetna Medicare	$112.77
Rate for Payer: Aetna New Business (MI Preferred)	$146.60
Rate for Payer: BCBS Complete	$90.22
Rate for Payer: Cash Price	$180.43
Rate for Payer: Cofinity Commercial	$157.88
Rate for Payer: Cofinity Commercial	$193.96
Rate for Payer: Cofinity Medicare Advantage	$157.88
Rate for Payer: Encore Health Key Benefits Commercial	$180.43
Rate for Payer: Healthscope Commercial	$202.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$191.71
Rate for Payer: PHP Commercial	$191.71
Rate for Payer: Priority Health Cigna Priority Health	$146.60
Rate for Payer: Priority Health SBD	$142.09

HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR

Facility

$225.54

Service Code	NDC 62559043130
Hospital Charge Code	28824
Hospital Revenue Code	637
Min. Negotiated Rate	$142.09
Max. Negotiated Rate	$202.99
Rate for Payer: Aetna Commercial	$191.71
Rate for Payer: Aetna New Business (MI Preferred)	$146.60
Rate for Payer: Cash Price	$180.43
Rate for Payer: Cofinity Commercial	$157.88
Rate for Payer: Cofinity Commercial	$193.96
Rate for Payer: Cofinity Medicare Advantage	$157.88
Rate for Payer: Encore Health Key Benefits Commercial	$180.43
Rate for Payer: Healthscope Commercial	$202.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$191.71
Rate for Payer: PHP Commercial	$191.71
Rate for Payer: Priority Health Cigna Priority Health	$146.60
Rate for Payer: Priority Health SBD	$142.09

HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR

Facility

$29.40

Service Code	NDC 64980032430
Hospital Charge Code	28824
Hospital Revenue Code	637
Min. Negotiated Rate	$18.52
Max. Negotiated Rate	$26.46
Rate for Payer: Aetna Commercial	$24.99
Rate for Payer: Aetna New Business (MI Preferred)	$19.11
Rate for Payer: Cash Price	$23.52
Rate for Payer: Cofinity Commercial	$20.58
Rate for Payer: Cofinity Commercial	$25.28
Rate for Payer: Cofinity Medicare Advantage	$20.58
Rate for Payer: Encore Health Key Benefits Commercial	$23.52
Rate for Payer: Healthscope Commercial	$26.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.99
Rate for Payer: PHP Commercial	$24.99
Rate for Payer: Priority Health Cigna Priority Health	$19.11
Rate for Payer: Priority Health SBD	$18.52

HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR

Facility

$29.40

Service Code	NDC 64980032430
Hospital Charge Code	28824
Hospital Revenue Code	637
Min. Negotiated Rate	$11.76
Max. Negotiated Rate	$26.46
Rate for Payer: Aetna Commercial	$24.99
Rate for Payer: Aetna Medicare	$14.70
Rate for Payer: Aetna New Business (MI Preferred)	$19.11
Rate for Payer: BCBS Complete	$11.76
Rate for Payer: Cash Price	$23.52
Rate for Payer: Cofinity Commercial	$20.58
Rate for Payer: Cofinity Commercial	$25.28
Rate for Payer: Cofinity Medicare Advantage	$20.58
Rate for Payer: Encore Health Key Benefits Commercial	$23.52
Rate for Payer: Healthscope Commercial	$26.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.99
Rate for Payer: PHP Commercial	$24.99
Rate for Payer: Priority Health Cigna Priority Health	$19.11
Rate for Payer: Priority Health SBD	$18.52

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY

Facility

$116.73

Service Code	NDC 59741030112
Hospital Charge Code	3738
Hospital Revenue Code	637
Min. Negotiated Rate	$73.54
Max. Negotiated Rate	$105.06
Rate for Payer: Aetna Commercial	$99.22
Rate for Payer: Aetna New Business (MI Preferred)	$75.87
Rate for Payer: Cash Price	$93.38
Rate for Payer: Cofinity Commercial	$100.39
Rate for Payer: Cofinity Commercial	$81.71
Rate for Payer: Cofinity Medicare Advantage	$81.71
Rate for Payer: Encore Health Key Benefits Commercial	$93.38
Rate for Payer: Healthscope Commercial	$105.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$99.22
Rate for Payer: PHP Commercial	$99.22
Rate for Payer: Priority Health Cigna Priority Health	$75.87
Rate for Payer: Priority Health SBD	$73.54

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY

Facility

$39.57

Service Code	NDC 00713050306
Hospital Charge Code	3738
Hospital Revenue Code	637
Min. Negotiated Rate	$15.83
Max. Negotiated Rate	$35.61
Rate for Payer: Aetna Commercial	$33.63
Rate for Payer: Aetna Medicare	$19.79
Rate for Payer: Aetna New Business (MI Preferred)	$25.72
Rate for Payer: BCBS Complete	$15.83
Rate for Payer: Cash Price	$31.66
Rate for Payer: Cofinity Commercial	$27.70
Rate for Payer: Cofinity Commercial	$34.03
Rate for Payer: Cofinity Medicare Advantage	$27.70
Rate for Payer: Encore Health Key Benefits Commercial	$31.66
Rate for Payer: Healthscope Commercial	$35.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.63
Rate for Payer: PHP Commercial	$33.63
Rate for Payer: Priority Health Cigna Priority Health	$25.72
Rate for Payer: Priority Health SBD	$24.93

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY

Facility

$474.82

Service Code	NDC 00713050312
Hospital Charge Code	3738
Hospital Revenue Code	637
Min. Negotiated Rate	$189.93
Max. Negotiated Rate	$427.34
Rate for Payer: Aetna Commercial	$403.60
Rate for Payer: Aetna Medicare	$237.41
Rate for Payer: Aetna New Business (MI Preferred)	$308.63
Rate for Payer: BCBS Complete	$189.93
Rate for Payer: Cash Price	$379.86
Rate for Payer: Cofinity Commercial	$332.37
Rate for Payer: Cofinity Commercial	$408.35
Rate for Payer: Cofinity Medicare Advantage	$332.37
Rate for Payer: Encore Health Key Benefits Commercial	$379.86
Rate for Payer: Healthscope Commercial	$427.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$403.60
Rate for Payer: PHP Commercial	$403.60
Rate for Payer: Priority Health Cigna Priority Health	$308.63
Rate for Payer: Priority Health SBD	$299.14

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY

Facility

$902.21

Service Code	NDC 00713050324
Hospital Charge Code	3738
Hospital Revenue Code	637
Min. Negotiated Rate	$568.39
Max. Negotiated Rate	$811.99
Rate for Payer: Aetna Commercial	$766.88
Rate for Payer: Aetna New Business (MI Preferred)	$586.44
Rate for Payer: Cash Price	$721.77
Rate for Payer: Cofinity Commercial	$631.55
Rate for Payer: Cofinity Commercial	$775.90
Rate for Payer: Cofinity Medicare Advantage	$631.55
Rate for Payer: Encore Health Key Benefits Commercial	$721.77
Rate for Payer: Healthscope Commercial	$811.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$766.88
Rate for Payer: PHP Commercial	$766.88
Rate for Payer: Priority Health Cigna Priority Health	$586.44
Rate for Payer: Priority Health SBD	$568.39

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY

Facility

$116.73

Service Code	NDC 59741030112
Hospital Charge Code	3738
Hospital Revenue Code	637
Min. Negotiated Rate	$46.69
Max. Negotiated Rate	$105.06
Rate for Payer: Aetna Commercial	$99.22
Rate for Payer: Aetna Medicare	$58.37
Rate for Payer: Aetna New Business (MI Preferred)	$75.87
Rate for Payer: BCBS Complete	$46.69
Rate for Payer: Cash Price	$93.38
Rate for Payer: Cofinity Commercial	$100.39
Rate for Payer: Cofinity Commercial	$81.71
Rate for Payer: Cofinity Medicare Advantage	$81.71
Rate for Payer: Encore Health Key Benefits Commercial	$93.38
Rate for Payer: Healthscope Commercial	$105.06
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$99.22
Rate for Payer: PHP Commercial	$99.22
Rate for Payer: Priority Health Cigna Priority Health	$75.87
Rate for Payer: Priority Health SBD	$73.54

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY

Facility

$39.57

Service Code	NDC 00713050306
Hospital Charge Code	3738
Hospital Revenue Code	637
Min. Negotiated Rate	$24.93
Max. Negotiated Rate	$35.61
Rate for Payer: Aetna Commercial	$33.63
Rate for Payer: Aetna New Business (MI Preferred)	$25.72
Rate for Payer: Cash Price	$31.66
Rate for Payer: Cofinity Commercial	$27.70
Rate for Payer: Cofinity Commercial	$34.03
Rate for Payer: Cofinity Medicare Advantage	$27.70
Rate for Payer: Encore Health Key Benefits Commercial	$31.66
Rate for Payer: Healthscope Commercial	$35.61
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.63
Rate for Payer: PHP Commercial	$33.63
Rate for Payer: Priority Health Cigna Priority Health	$25.72
Rate for Payer: Priority Health SBD	$24.93

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY

Facility

$474.82

Service Code	NDC 00713050312
Hospital Charge Code	3738
Hospital Revenue Code	637
Min. Negotiated Rate	$299.14
Max. Negotiated Rate	$427.34
Rate for Payer: Aetna Commercial	$403.60
Rate for Payer: Aetna New Business (MI Preferred)	$308.63
Rate for Payer: Cash Price	$379.86
Rate for Payer: Cofinity Commercial	$332.37
Rate for Payer: Cofinity Commercial	$408.35
Rate for Payer: Cofinity Medicare Advantage	$332.37
Rate for Payer: Encore Health Key Benefits Commercial	$379.86
Rate for Payer: Healthscope Commercial	$427.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$403.60
Rate for Payer: PHP Commercial	$403.60
Rate for Payer: Priority Health Cigna Priority Health	$308.63
Rate for Payer: Priority Health SBD	$299.14

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY

Facility

$902.21

Service Code	NDC 00713050324
Hospital Charge Code	3738
Hospital Revenue Code	637
Min. Negotiated Rate	$360.88
Max. Negotiated Rate	$811.99
Rate for Payer: Aetna Commercial	$766.88
Rate for Payer: Aetna Medicare	$451.11
Rate for Payer: Aetna New Business (MI Preferred)	$586.44
Rate for Payer: BCBS Complete	$360.88
Rate for Payer: Cash Price	$721.77
Rate for Payer: Cofinity Commercial	$631.55
Rate for Payer: Cofinity Commercial	$775.90
Rate for Payer: Cofinity Medicare Advantage	$631.55
Rate for Payer: Encore Health Key Benefits Commercial	$721.77
Rate for Payer: Healthscope Commercial	$811.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$766.88
Rate for Payer: PHP Commercial	$766.88
Rate for Payer: Priority Health Cigna Priority Health	$586.44
Rate for Payer: Priority Health SBD	$568.39

HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION

Facility

$78.06

Service Code	HCPCS J1720
Hospital Charge Code	108970
Hospital Revenue Code	636
Min. Negotiated Rate	$49.18
Max. Negotiated Rate	$70.25
Rate for Payer: Aetna Commercial	$66.35
Rate for Payer: Aetna New Business (MI Preferred)	$50.74
Rate for Payer: Cash Price	$62.45
Rate for Payer: Cofinity Commercial	$54.64
Rate for Payer: Cofinity Commercial	$67.13
Rate for Payer: Cofinity Medicare Advantage	$54.64
Rate for Payer: Encore Health Key Benefits Commercial	$62.45
Rate for Payer: Healthscope Commercial	$70.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$66.35
Rate for Payer: PHP Commercial	$66.35
Rate for Payer: Priority Health Cigna Priority Health	$50.74
Rate for Payer: Priority Health SBD	$49.18

HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION

Facility

$78.06

Service Code	HCPCS J1720
Hospital Charge Code	108970
Hospital Revenue Code	636
Min. Negotiated Rate	$31.22
Max. Negotiated Rate	$70.25
Rate for Payer: Aetna Commercial	$66.35
Rate for Payer: Aetna Medicare	$39.03
Rate for Payer: Aetna New Business (MI Preferred)	$50.74
Rate for Payer: BCBS Complete	$31.22
Rate for Payer: Cash Price	$62.45
Rate for Payer: Cofinity Commercial	$54.64
Rate for Payer: Cofinity Commercial	$67.13
Rate for Payer: Cofinity Medicare Advantage	$54.64
Rate for Payer: Encore Health Key Benefits Commercial	$62.45
Rate for Payer: Healthscope Commercial	$70.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$66.35
Rate for Payer: PHP Commercial	$66.35
Rate for Payer: Priority Health Cigna Priority Health	$50.74
Rate for Payer: Priority Health SBD	$49.18

HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION

Facility

$98.35

Service Code	HCPCS J1720
Hospital Charge Code	119665
Hospital Revenue Code	636
Min. Negotiated Rate	$39.34
Max. Negotiated Rate	$88.52
Rate for Payer: Aetna Commercial	$83.60
Rate for Payer: Aetna Commercial	$82.94
Rate for Payer: Aetna Medicare	$48.79
Rate for Payer: Aetna Medicare	$49.17
Rate for Payer: Aetna New Business (MI Preferred)	$63.43
Rate for Payer: Aetna New Business (MI Preferred)	$63.93
Rate for Payer: BCBS Complete	$39.03
Rate for Payer: BCBS Complete	$39.34
Rate for Payer: Cash Price	$78.06
Rate for Payer: Cash Price	$78.68
Rate for Payer: Cofinity Commercial	$68.84
Rate for Payer: Cofinity Commercial	$68.31
Rate for Payer: Cofinity Commercial	$84.58
Rate for Payer: Cofinity Commercial	$83.92
Rate for Payer: Cofinity Medicare Advantage	$68.84
Rate for Payer: Cofinity Medicare Advantage	$68.31
Rate for Payer: Encore Health Key Benefits Commercial	$78.06
Rate for Payer: Encore Health Key Benefits Commercial	$78.68
Rate for Payer: Healthscope Commercial	$87.82
Rate for Payer: Healthscope Commercial	$88.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$82.94
Rate for Payer: PHP Commercial	$82.94
Rate for Payer: PHP Commercial	$83.60
Rate for Payer: Priority Health Cigna Priority Health	$63.43
Rate for Payer: Priority Health Cigna Priority Health	$63.93
Rate for Payer: Priority Health SBD	$61.48
Rate for Payer: Priority Health SBD	$61.96

HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION

Facility

$98.35

Service Code	HCPCS J1720
Hospital Charge Code	119665
Hospital Revenue Code	636
Min. Negotiated Rate	$61.96
Max. Negotiated Rate	$88.52
Rate for Payer: Aetna Commercial	$83.60
Rate for Payer: Aetna New Business (MI Preferred)	$63.93
Rate for Payer: Cash Price	$78.68
Rate for Payer: Cofinity Commercial	$68.84
Rate for Payer: Cofinity Commercial	$84.58
Rate for Payer: Cofinity Medicare Advantage	$68.84
Rate for Payer: Encore Health Key Benefits Commercial	$78.68
Rate for Payer: Healthscope Commercial	$88.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.60
Rate for Payer: PHP Commercial	$83.60
Rate for Payer: Priority Health Cigna Priority Health	$63.93
Rate for Payer: Priority Health SBD	$61.96

HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION

Facility

$182.94

Service Code	HCPCS J1720
Hospital Charge Code	119664
Hospital Revenue Code	636
Min. Negotiated Rate	$73.18
Max. Negotiated Rate	$164.65
Rate for Payer: Aetna Commercial	$155.50
Rate for Payer: Aetna Commercial	$153.45
Rate for Payer: Aetna Medicare	$90.27
Rate for Payer: Aetna Medicare	$91.47
Rate for Payer: Aetna New Business (MI Preferred)	$117.34
Rate for Payer: Aetna New Business (MI Preferred)	$118.91
Rate for Payer: BCBS Complete	$73.18
Rate for Payer: BCBS Complete	$72.21
Rate for Payer: Cash Price	$144.42
Rate for Payer: Cash Price	$146.35
Rate for Payer: Cofinity Commercial	$126.37
Rate for Payer: Cofinity Commercial	$128.06
Rate for Payer: Cofinity Commercial	$157.33
Rate for Payer: Cofinity Commercial	$155.26
Rate for Payer: Cofinity Medicare Advantage	$128.06
Rate for Payer: Cofinity Medicare Advantage	$126.37
Rate for Payer: Encore Health Key Benefits Commercial	$144.42
Rate for Payer: Encore Health Key Benefits Commercial	$146.35
Rate for Payer: Healthscope Commercial	$162.48
Rate for Payer: Healthscope Commercial	$164.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$155.50
Rate for Payer: PHP Commercial	$155.50
Rate for Payer: PHP Commercial	$153.45
Rate for Payer: Priority Health Cigna Priority Health	$117.34
Rate for Payer: Priority Health Cigna Priority Health	$118.91
Rate for Payer: Priority Health SBD	$115.25
Rate for Payer: Priority Health SBD	$113.73

HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION

Facility

$182.94

Service Code	HCPCS J1720
Hospital Charge Code	119664
Hospital Revenue Code	636
Min. Negotiated Rate	$115.25
Max. Negotiated Rate	$164.65
Rate for Payer: Aetna Commercial	$155.50
Rate for Payer: Aetna Commercial	$153.45
Rate for Payer: Aetna New Business (MI Preferred)	$117.34
Rate for Payer: Aetna New Business (MI Preferred)	$118.91
Rate for Payer: Cash Price	$144.42
Rate for Payer: Cash Price	$146.35
Rate for Payer: Cofinity Commercial	$126.37
Rate for Payer: Cofinity Commercial	$128.06
Rate for Payer: Cofinity Commercial	$157.33
Rate for Payer: Cofinity Commercial	$155.26
Rate for Payer: Cofinity Medicare Advantage	$128.06
Rate for Payer: Cofinity Medicare Advantage	$126.37
Rate for Payer: Encore Health Key Benefits Commercial	$144.42
Rate for Payer: Encore Health Key Benefits Commercial	$146.35
Rate for Payer: Healthscope Commercial	$162.48
Rate for Payer: Healthscope Commercial	$164.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$155.50
Rate for Payer: PHP Commercial	$153.45
Rate for Payer: PHP Commercial	$155.50
Rate for Payer: Priority Health Cigna Priority Health	$118.91
Rate for Payer: Priority Health Cigna Priority Health	$117.34
Rate for Payer: Priority Health SBD	$115.25
Rate for Payer: Priority Health SBD	$113.73

HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE

Facility

$14.07

Service Code	HCPCS J1171
Hospital Charge Code	166819
Hospital Revenue Code	636
Min. Negotiated Rate	$5.63
Max. Negotiated Rate	$12.66
Rate for Payer: Aetna Commercial	$11.96
Rate for Payer: Aetna Commercial	$18.20
Rate for Payer: Aetna Commercial	$14.01
Rate for Payer: Aetna Medicare	$10.71
Rate for Payer: Aetna Medicare	$7.04
Rate for Payer: Aetna Medicare	$8.24
Rate for Payer: Aetna New Business (MI Preferred)	$13.92
Rate for Payer: Aetna New Business (MI Preferred)	$9.15
Rate for Payer: Aetna New Business (MI Preferred)	$10.71
Rate for Payer: BCBS Complete	$6.59
Rate for Payer: BCBS Complete	$5.63
Rate for Payer: BCBS Complete	$8.56
Rate for Payer: Cash Price	$17.13
Rate for Payer: Cash Price	$11.26
Rate for Payer: Cash Price	$13.18
Rate for Payer: Cofinity Commercial	$18.41
Rate for Payer: Cofinity Commercial	$9.85
Rate for Payer: Cofinity Commercial	$12.10
Rate for Payer: Cofinity Commercial	$14.17
Rate for Payer: Cofinity Commercial	$11.54
Rate for Payer: Cofinity Commercial	$14.99
Rate for Payer: Cofinity Medicare Advantage	$11.54
Rate for Payer: Cofinity Medicare Advantage	$9.85
Rate for Payer: Cofinity Medicare Advantage	$14.99
Rate for Payer: Encore Health Key Benefits Commercial	$13.18
Rate for Payer: Encore Health Key Benefits Commercial	$17.13
Rate for Payer: Encore Health Key Benefits Commercial	$11.26
Rate for Payer: Healthscope Commercial	$14.83
Rate for Payer: Healthscope Commercial	$12.66
Rate for Payer: Healthscope Commercial	$19.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11.96
Rate for Payer: PHP Commercial	$14.01
Rate for Payer: PHP Commercial	$11.96
Rate for Payer: PHP Commercial	$18.20
Rate for Payer: Priority Health Cigna Priority Health	$9.15
Rate for Payer: Priority Health Cigna Priority Health	$13.92
Rate for Payer: Priority Health Cigna Priority Health	$10.71
Rate for Payer: Priority Health SBD	$13.49
Rate for Payer: Priority Health SBD	$10.38
Rate for Payer: Priority Health SBD	$8.86

HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE

Facility

$16.48

Service Code	HCPCS J1171
Hospital Charge Code	166819
Hospital Revenue Code	636
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$14.83
Rate for Payer: Aetna Commercial	$14.01
Rate for Payer: Aetna Commercial	$11.96
Rate for Payer: Aetna Commercial	$18.20
Rate for Payer: Aetna New Business (MI Preferred)	$10.71
Rate for Payer: Aetna New Business (MI Preferred)	$9.15
Rate for Payer: Aetna New Business (MI Preferred)	$13.92
Rate for Payer: Cash Price	$11.26
Rate for Payer: Cash Price	$17.13
Rate for Payer: Cash Price	$13.18
Rate for Payer: Cofinity Commercial	$12.10
Rate for Payer: Cofinity Commercial	$9.85
Rate for Payer: Cofinity Commercial	$11.54
Rate for Payer: Cofinity Commercial	$14.17
Rate for Payer: Cofinity Commercial	$14.99
Rate for Payer: Cofinity Commercial	$18.41
Rate for Payer: Cofinity Medicare Advantage	$9.85
Rate for Payer: Cofinity Medicare Advantage	$14.99
Rate for Payer: Cofinity Medicare Advantage	$11.54
Rate for Payer: Encore Health Key Benefits Commercial	$11.26
Rate for Payer: Encore Health Key Benefits Commercial	$13.18
Rate for Payer: Encore Health Key Benefits Commercial	$17.13
Rate for Payer: Healthscope Commercial	$12.66
Rate for Payer: Healthscope Commercial	$14.83
Rate for Payer: Healthscope Commercial	$19.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$11.96
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$14.01
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$18.20
Rate for Payer: PHP Commercial	$14.01
Rate for Payer: PHP Commercial	$18.20
Rate for Payer: PHP Commercial	$11.96
Rate for Payer: Priority Health Cigna Priority Health	$13.92
Rate for Payer: Priority Health Cigna Priority Health	$10.71
Rate for Payer: Priority Health Cigna Priority Health	$9.15
Rate for Payer: Priority Health SBD	$13.49
Rate for Payer: Priority Health SBD	$10.38
Rate for Payer: Priority Health SBD	$8.86

Know your out-of-pocket cost for care.

All Charges