Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION

Facility

$12.76

Service Code	NDC 60687-417-44
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$7.78
Max. Negotiated Rate	$11.48
Rate for Payer: Aetna Commercial	$10.85
Rate for Payer: BCBS Trust/PPO	$9.86
Rate for Payer: BCN Commercial	$9.86
Rate for Payer: Cash Price	$10.21
Rate for Payer: Cofinity Commercial	$10.97
Rate for Payer: Encore Health Key Benefits Commercial	$10.21
Rate for Payer: Healthscope Commercial	$11.48
Rate for Payer: Lakeland Regional Health Systems Commercial	$9.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.85
Rate for Payer: PHP Commercial	$10.85
Rate for Payer: Priority Health Cigna Priority Health	$8.93
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11.10
Rate for Payer: Priority Health Narrow/Tiered Network	$7.78
Rate for Payer: UHC All Payor (Choice/PPO)	$11.23
Rate for Payer: UHC Core	$10.65
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$9.57

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION

Facility

$20.75

Service Code	NDC 0121-2316-40
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$12.66
Max. Negotiated Rate	$18.68
Rate for Payer: Aetna Commercial	$17.64
Rate for Payer: BCBS Trust/PPO	$16.04
Rate for Payer: BCN Commercial	$16.04
Rate for Payer: Cash Price	$16.60
Rate for Payer: Cofinity Commercial	$17.84
Rate for Payer: Encore Health Key Benefits Commercial	$16.60
Rate for Payer: Healthscope Commercial	$18.68
Rate for Payer: Lakeland Regional Health Systems Commercial	$15.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$17.64
Rate for Payer: PHP Commercial	$17.64
Rate for Payer: Priority Health Cigna Priority Health	$14.52
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$18.05
Rate for Payer: Priority Health Narrow/Tiered Network	$12.66
Rate for Payer: UHC All Payor (Choice/PPO)	$18.26
Rate for Payer: UHC Core	$17.33
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$15.56

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION

Facility

$15.45

Service Code	NDC 66689-023-01
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$9.42
Max. Negotiated Rate	$13.90
Rate for Payer: Aetna Commercial	$13.13
Rate for Payer: BCBS Trust/PPO	$11.94
Rate for Payer: BCN Commercial	$11.94
Rate for Payer: Cash Price	$12.36
Rate for Payer: Cofinity Commercial	$13.29
Rate for Payer: Encore Health Key Benefits Commercial	$12.36
Rate for Payer: Healthscope Commercial	$13.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$11.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.13
Rate for Payer: PHP Commercial	$13.13
Rate for Payer: Priority Health Cigna Priority Health	$10.82
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.44
Rate for Payer: Priority Health Narrow/Tiered Network	$9.42
Rate for Payer: UHC All Payor (Choice/PPO)	$13.60
Rate for Payer: UHC Core	$12.90
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$11.59

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION

Facility

$12.76

Service Code	NDC 60687-417-71
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$7.78
Max. Negotiated Rate	$11.48
Rate for Payer: Aetna Commercial	$10.85
Rate for Payer: BCBS Trust/PPO	$9.86
Rate for Payer: BCN Commercial	$9.86
Rate for Payer: Cash Price	$10.21
Rate for Payer: Cofinity Commercial	$10.97
Rate for Payer: Encore Health Key Benefits Commercial	$10.21
Rate for Payer: Healthscope Commercial	$11.48
Rate for Payer: Lakeland Regional Health Systems Commercial	$9.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.85
Rate for Payer: PHP Commercial	$10.85
Rate for Payer: Priority Health Cigna Priority Health	$8.93
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$11.10
Rate for Payer: Priority Health Narrow/Tiered Network	$7.78
Rate for Payer: UHC All Payor (Choice/PPO)	$11.23
Rate for Payer: UHC Core	$10.65
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$9.57

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION

Facility

$10.13

Service Code	NDC 9900-0006-53
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$9.12
Rate for Payer: Aetna Commercial	$8.61
Rate for Payer: BCBS Trust/PPO	$7.83
Rate for Payer: BCN Commercial	$7.83
Rate for Payer: Cash Price	$8.10
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: Lakeland Regional Health Systems Commercial	$7.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.61
Rate for Payer: PHP Commercial	$8.61
Rate for Payer: Priority Health Cigna Priority Health	$7.09
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8.81
Rate for Payer: Priority Health Narrow/Tiered Network	$6.18
Rate for Payer: UHC All Payor (Choice/PPO)	$8.91
Rate for Payer: UHC Core	$8.46
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$7.60

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION

Facility

$40.11

Service Code	NDC 0121-0772-04
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$24.46
Max. Negotiated Rate	$36.10
Rate for Payer: Aetna Commercial	$34.09
Rate for Payer: BCBS Trust/PPO	$31.00
Rate for Payer: BCN Commercial	$31.00
Rate for Payer: Cash Price	$32.09
Rate for Payer: Cofinity Commercial	$34.49
Rate for Payer: Encore Health Key Benefits Commercial	$32.09
Rate for Payer: Healthscope Commercial	$36.10
Rate for Payer: Lakeland Regional Health Systems Commercial	$30.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$34.09
Rate for Payer: PHP Commercial	$34.09
Rate for Payer: Priority Health Cigna Priority Health	$28.08
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$34.90
Rate for Payer: Priority Health Narrow/Tiered Network	$24.46
Rate for Payer: UHC All Payor (Choice/PPO)	$35.30
Rate for Payer: UHC Core	$33.49
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$30.08

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION

Facility

$15.45

Service Code	NDC 66689-023-50
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$9.42
Max. Negotiated Rate	$13.90
Rate for Payer: Aetna Commercial	$13.13
Rate for Payer: BCBS Trust/PPO	$11.94
Rate for Payer: BCN Commercial	$11.94
Rate for Payer: Cash Price	$12.36
Rate for Payer: Cofinity Commercial	$13.29
Rate for Payer: Encore Health Key Benefits Commercial	$12.36
Rate for Payer: Healthscope Commercial	$13.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$11.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.13
Rate for Payer: PHP Commercial	$13.13
Rate for Payer: Priority Health Cigna Priority Health	$10.82
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.44
Rate for Payer: Priority Health Narrow/Tiered Network	$9.42
Rate for Payer: UHC All Payor (Choice/PPO)	$13.60
Rate for Payer: UHC Core	$12.90
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$11.59

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION

Facility

$16.91

Service Code	NDC 0121-2316-15
Hospital Charge Code	37848
Hospital Revenue Code	637
Min. Negotiated Rate	$10.31
Max. Negotiated Rate	$15.22
Rate for Payer: Aetna Commercial	$14.37
Rate for Payer: BCBS Trust/PPO	$13.07
Rate for Payer: BCN Commercial	$13.07
Rate for Payer: Cash Price	$13.53
Rate for Payer: Cofinity Commercial	$14.54
Rate for Payer: Encore Health Key Benefits Commercial	$13.53
Rate for Payer: Healthscope Commercial	$15.22
Rate for Payer: Lakeland Regional Health Systems Commercial	$12.68
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.37
Rate for Payer: PHP Commercial	$14.37
Rate for Payer: Priority Health Cigna Priority Health	$11.84
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$14.71
Rate for Payer: Priority Health Narrow/Tiered Network	$10.31
Rate for Payer: UHC All Payor (Choice/PPO)	$14.88
Rate for Payer: UHC Core	$14.12
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$12.68

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$8.23

Service Code	NDC 0406-0124-23
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$7.41
Rate for Payer: Aetna Commercial	$7.00
Rate for Payer: BCBS Trust/PPO	$6.36
Rate for Payer: BCN Commercial	$6.36
Rate for Payer: Cash Price	$6.58
Rate for Payer: Cofinity Commercial	$7.08
Rate for Payer: Encore Health Key Benefits Commercial	$6.58
Rate for Payer: Healthscope Commercial	$7.41
Rate for Payer: Lakeland Regional Health Systems Commercial	$6.17
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.00
Rate for Payer: PHP Commercial	$7.00
Rate for Payer: Priority Health Cigna Priority Health	$5.76
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7.16
Rate for Payer: Priority Health Narrow/Tiered Network	$5.02
Rate for Payer: UHC All Payor (Choice/PPO)	$7.24
Rate for Payer: UHC Core	$6.87
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$6.17

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$530.25

Service Code	NDC 0904-6826-61
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$323.40
Max. Negotiated Rate	$477.22
Rate for Payer: Aetna Commercial	$450.71
Rate for Payer: BCBS Trust/PPO	$409.78
Rate for Payer: BCN Commercial	$409.78
Rate for Payer: Cash Price	$424.20
Rate for Payer: Cofinity Commercial	$456.02
Rate for Payer: Encore Health Key Benefits Commercial	$424.20
Rate for Payer: Healthscope Commercial	$477.22
Rate for Payer: Lakeland Regional Health Systems Commercial	$397.69
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$450.71
Rate for Payer: PHP Commercial	$450.71
Rate for Payer: Priority Health Cigna Priority Health	$371.18
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$461.32
Rate for Payer: Priority Health Narrow/Tiered Network	$323.40
Rate for Payer: UHC All Payor (Choice/PPO)	$466.62
Rate for Payer: UHC Core	$442.76
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$397.69

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$204.75

Service Code	NDC 71930-020-12
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$124.88
Max. Negotiated Rate	$184.28
Rate for Payer: Aetna Commercial	$174.04
Rate for Payer: BCBS Trust/PPO	$158.23
Rate for Payer: BCN Commercial	$158.23
Rate for Payer: Cash Price	$163.80
Rate for Payer: Cofinity Commercial	$176.08
Rate for Payer: Encore Health Key Benefits Commercial	$163.80
Rate for Payer: Healthscope Commercial	$184.28
Rate for Payer: Lakeland Regional Health Systems Commercial	$153.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$174.04
Rate for Payer: PHP Commercial	$174.04
Rate for Payer: Priority Health Cigna Priority Health	$143.32
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$178.13
Rate for Payer: Priority Health Narrow/Tiered Network	$124.88
Rate for Payer: UHC All Payor (Choice/PPO)	$180.18
Rate for Payer: UHC Core	$170.97
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$153.56

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$341.25

Service Code	NDC 65162-115-10
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$208.13
Max. Negotiated Rate	$307.12
Rate for Payer: Aetna Commercial	$290.06
Rate for Payer: BCBS Trust/PPO	$263.72
Rate for Payer: BCN Commercial	$263.72
Rate for Payer: Cash Price	$273.00
Rate for Payer: Cofinity Commercial	$293.48
Rate for Payer: Encore Health Key Benefits Commercial	$273.00
Rate for Payer: Healthscope Commercial	$307.12
Rate for Payer: Lakeland Regional Health Systems Commercial	$255.94
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$290.06
Rate for Payer: PHP Commercial	$290.06
Rate for Payer: Priority Health Cigna Priority Health	$238.88
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$296.89
Rate for Payer: Priority Health Narrow/Tiered Network	$208.13
Rate for Payer: UHC All Payor (Choice/PPO)	$300.30
Rate for Payer: UHC Core	$284.94
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$255.94

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$822.50

Service Code	NDC 0406-0124-62
Hospital Charge Code	34544
Hospital Revenue Code	637
Min. Negotiated Rate	$501.64
Max. Negotiated Rate	$740.25
Rate for Payer: Aetna Commercial	$699.12
Rate for Payer: BCBS Trust/PPO	$635.63
Rate for Payer: BCN Commercial	$635.63
Rate for Payer: Cash Price	$658.00
Rate for Payer: Cofinity Commercial	$707.35
Rate for Payer: Encore Health Key Benefits Commercial	$658.00
Rate for Payer: Healthscope Commercial	$740.25
Rate for Payer: Lakeland Regional Health Systems Commercial	$616.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$699.12
Rate for Payer: PHP Commercial	$699.12
Rate for Payer: Priority Health Cigna Priority Health	$575.75
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$715.58
Rate for Payer: Priority Health Narrow/Tiered Network	$501.64
Rate for Payer: UHC All Payor (Choice/PPO)	$723.80
Rate for Payer: UHC Core	$686.79
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$616.88

HYDROCOLLOID DRESSING 4" X 4"

Facility

$149.85

Service Code	NDC 6845510270
Hospital Charge Code	110996
Hospital Revenue Code	637
Min. Negotiated Rate	$91.39
Max. Negotiated Rate	$134.86
Rate for Payer: Aetna Commercial	$127.37
Rate for Payer: BCBS Trust/PPO	$115.80
Rate for Payer: BCN Commercial	$115.80
Rate for Payer: Cash Price	$119.88
Rate for Payer: Cofinity Commercial	$128.87
Rate for Payer: Encore Health Key Benefits Commercial	$119.88
Rate for Payer: Healthscope Commercial	$134.86
Rate for Payer: Lakeland Regional Health Systems Commercial	$112.39
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$127.37
Rate for Payer: PHP Commercial	$127.37
Rate for Payer: Priority Health Cigna Priority Health	$104.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$130.37
Rate for Payer: Priority Health Narrow/Tiered Network	$91.39
Rate for Payer: UHC All Payor (Choice/PPO)	$131.87
Rate for Payer: UHC Core	$125.12
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$112.39

HYDROCOLLOID DRESSING 6" X 6"

Facility

$68.55

Service Code	NDC 6845510271
Hospital Charge Code	111013
Hospital Revenue Code	637
Min. Negotiated Rate	$41.81
Max. Negotiated Rate	$61.70
Rate for Payer: Aetna Commercial	$58.27
Rate for Payer: BCBS Trust/PPO	$52.98
Rate for Payer: BCN Commercial	$52.98
Rate for Payer: Cash Price	$54.84
Rate for Payer: Cofinity Commercial	$58.95
Rate for Payer: Encore Health Key Benefits Commercial	$54.84
Rate for Payer: Healthscope Commercial	$61.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$51.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$58.27
Rate for Payer: PHP Commercial	$58.27
Rate for Payer: Priority Health Cigna Priority Health	$47.98
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$59.64
Rate for Payer: Priority Health Narrow/Tiered Network	$41.81
Rate for Payer: UHC All Payor (Choice/PPO)	$60.32
Rate for Payer: UHC Core	$57.24
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$51.41

HYDROCORTISONE 10 MG TABLET

Facility

$639.84

Service Code	NDC 0904-7188-61
Hospital Charge Code	3733
Hospital Revenue Code	637
Min. Negotiated Rate	$390.24
Max. Negotiated Rate	$575.86
Rate for Payer: Aetna Commercial	$543.86
Rate for Payer: BCBS Trust/PPO	$494.47
Rate for Payer: BCN Commercial	$494.47
Rate for Payer: Cash Price	$511.87
Rate for Payer: Cofinity Commercial	$550.26
Rate for Payer: Encore Health Key Benefits Commercial	$511.87
Rate for Payer: Healthscope Commercial	$575.86
Rate for Payer: Lakeland Regional Health Systems Commercial	$479.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$543.86
Rate for Payer: PHP Commercial	$543.86
Rate for Payer: Priority Health Cigna Priority Health	$447.89
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$556.66
Rate for Payer: Priority Health Narrow/Tiered Network	$390.24
Rate for Payer: UHC All Payor (Choice/PPO)	$563.06
Rate for Payer: UHC Core	$534.27
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$479.88

HYDROCORTISONE 1 % TOPICAL CREAM

Facility

$7.73

Service Code	NDC 0904-7623-31
Hospital Charge Code	3726
Hospital Revenue Code	637
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$6.96
Rate for Payer: Aetna Commercial	$6.57
Rate for Payer: BCBS Trust/PPO	$5.97
Rate for Payer: BCN Commercial	$5.97
Rate for Payer: Cash Price	$6.18
Rate for Payer: Cofinity Commercial	$6.65
Rate for Payer: Encore Health Key Benefits Commercial	$6.18
Rate for Payer: Healthscope Commercial	$6.96
Rate for Payer: Lakeland Regional Health Systems Commercial	$5.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6.57
Rate for Payer: PHP Commercial	$6.57
Rate for Payer: Priority Health Cigna Priority Health	$5.41
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$6.73
Rate for Payer: Priority Health Narrow/Tiered Network	$4.71
Rate for Payer: UHC All Payor (Choice/PPO)	$6.80
Rate for Payer: UHC Core	$6.45
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$5.80

HYDROCORTISONE 2.5 % TOPICAL CREAM

Facility

$10.08

Service Code	NDC 45802-004-02
Hospital Charge Code	3727
Hospital Revenue Code	637
Min. Negotiated Rate	$6.15
Max. Negotiated Rate	$9.07
Rate for Payer: Aetna Commercial	$8.57
Rate for Payer: BCBS Trust/PPO	$7.79
Rate for Payer: BCN Commercial	$7.79
Rate for Payer: Cash Price	$8.06
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: Lakeland Regional Health Systems Commercial	$7.56
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.57
Rate for Payer: PHP Commercial	$8.57
Rate for Payer: Priority Health Cigna Priority Health	$7.06
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8.77
Rate for Payer: Priority Health Narrow/Tiered Network	$6.15
Rate for Payer: UHC All Payor (Choice/PPO)	$8.87
Rate for Payer: UHC Core	$8.42
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$7.56

HYDROCORTISONE 2.5 % TOPICAL CREAM

Facility

$15.82

Service Code	NDC 45802-004-03
Hospital Charge Code	3727
Hospital Revenue Code	637
Min. Negotiated Rate	$9.65
Max. Negotiated Rate	$14.24
Rate for Payer: Aetna Commercial	$13.45
Rate for Payer: BCBS Trust/PPO	$12.23
Rate for Payer: BCN Commercial	$12.23
Rate for Payer: Cash Price	$12.66
Rate for Payer: Cofinity Commercial	$13.61
Rate for Payer: Encore Health Key Benefits Commercial	$12.66
Rate for Payer: Healthscope Commercial	$14.24
Rate for Payer: Lakeland Regional Health Systems Commercial	$11.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.45
Rate for Payer: PHP Commercial	$13.45
Rate for Payer: Priority Health Cigna Priority Health	$11.07
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$13.76
Rate for Payer: Priority Health Narrow/Tiered Network	$9.65
Rate for Payer: UHC All Payor (Choice/PPO)	$13.92
Rate for Payer: UHC Core	$13.21
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$11.86

HYDROCORTISONE 2.5 % TOPICAL CREAM

Facility

$9.18

Service Code	NDC 0168-0080-31
Hospital Charge Code	3727
Hospital Revenue Code	637
Min. Negotiated Rate	$5.60
Max. Negotiated Rate	$8.26
Rate for Payer: Aetna Commercial	$7.80
Rate for Payer: BCBS Trust/PPO	$7.09
Rate for Payer: BCN Commercial	$7.09
Rate for Payer: Cash Price	$7.34
Rate for Payer: Cofinity Commercial	$7.89
Rate for Payer: Encore Health Key Benefits Commercial	$7.34
Rate for Payer: Healthscope Commercial	$8.26
Rate for Payer: Lakeland Regional Health Systems Commercial	$6.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.80
Rate for Payer: PHP Commercial	$7.80
Rate for Payer: Priority Health Cigna Priority Health	$6.43
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7.99
Rate for Payer: Priority Health Narrow/Tiered Network	$5.60
Rate for Payer: UHC All Payor (Choice/PPO)	$8.08
Rate for Payer: UHC Core	$7.67
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$6.88

HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR

Facility

$28.88

Service Code	NDC 64980-324-30
Hospital Charge Code	28824
Hospital Revenue Code	637
Min. Negotiated Rate	$17.61
Max. Negotiated Rate	$25.99
Rate for Payer: Aetna Commercial	$24.55
Rate for Payer: BCBS Trust/PPO	$22.32
Rate for Payer: BCN Commercial	$22.32
Rate for Payer: Cash Price	$23.10
Rate for Payer: Cofinity Commercial	$24.84
Rate for Payer: Encore Health Key Benefits Commercial	$23.10
Rate for Payer: Healthscope Commercial	$25.99
Rate for Payer: Lakeland Regional Health Systems Commercial	$21.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$24.55
Rate for Payer: PHP Commercial	$24.55
Rate for Payer: Priority Health Cigna Priority Health	$20.22
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$25.13
Rate for Payer: Priority Health Narrow/Tiered Network	$17.61
Rate for Payer: UHC All Payor (Choice/PPO)	$25.41
Rate for Payer: UHC Core	$24.11
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$21.66

HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR

Facility

$26.76

Service Code	NDC 69315-312-28
Hospital Charge Code	28824
Hospital Revenue Code	637
Min. Negotiated Rate	$16.32
Max. Negotiated Rate	$24.08
Rate for Payer: Aetna Commercial	$22.75
Rate for Payer: BCBS Trust/PPO	$20.68
Rate for Payer: BCN Commercial	$20.68
Rate for Payer: Cash Price	$21.41
Rate for Payer: Cofinity Commercial	$23.01
Rate for Payer: Encore Health Key Benefits Commercial	$21.41
Rate for Payer: Healthscope Commercial	$24.08
Rate for Payer: Lakeland Regional Health Systems Commercial	$20.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$22.75
Rate for Payer: PHP Commercial	$22.75
Rate for Payer: Priority Health Cigna Priority Health	$18.73
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$23.28
Rate for Payer: Priority Health Narrow/Tiered Network	$16.32
Rate for Payer: UHC All Payor (Choice/PPO)	$23.55
Rate for Payer: UHC Core	$22.34
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$20.07

HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR

Facility

$155.30

Service Code	NDC 64980-301-30
Hospital Charge Code	28824
Hospital Revenue Code	637
Min. Negotiated Rate	$94.72
Max. Negotiated Rate	$139.77
Rate for Payer: Aetna Commercial	$132.00
Rate for Payer: BCBS Trust/PPO	$120.02
Rate for Payer: BCN Commercial	$120.02
Rate for Payer: Cash Price	$124.24
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: Lakeland Regional Health Systems Commercial	$116.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$132.00
Rate for Payer: PHP Commercial	$132.00
Rate for Payer: Priority Health Cigna Priority Health	$108.71
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$135.11
Rate for Payer: Priority Health Narrow/Tiered Network	$94.72
Rate for Payer: UHC All Payor (Choice/PPO)	$136.66
Rate for Payer: UHC Core	$129.68
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$116.48

HYDROCORTISONE 5 MG TABLET

Facility

$223.25

Service Code	NDC 0115-1696-06
Hospital Charge Code	10209
Hospital Revenue Code	637
Min. Negotiated Rate	$136.16
Max. Negotiated Rate	$200.92
Rate for Payer: Aetna Commercial	$189.76
Rate for Payer: BCBS Trust/PPO	$172.53
Rate for Payer: BCN Commercial	$172.53
Rate for Payer: Cash Price	$178.60
Rate for Payer: Cofinity Commercial	$192.00
Rate for Payer: Encore Health Key Benefits Commercial	$178.60
Rate for Payer: Healthscope Commercial	$200.92
Rate for Payer: Lakeland Regional Health Systems Commercial	$167.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$189.76
Rate for Payer: PHP Commercial	$189.76
Rate for Payer: Priority Health Cigna Priority Health	$156.28
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$194.23
Rate for Payer: Priority Health Narrow/Tiered Network	$136.16
Rate for Payer: UHC All Payor (Choice/PPO)	$196.46
Rate for Payer: UHC Core	$186.41
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$167.44

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY

Facility

$512.34

Service Code	NDC 0574-7090-12
Hospital Charge Code	3738
Hospital Revenue Code	637
Min. Negotiated Rate	$312.48
Max. Negotiated Rate	$461.11
Rate for Payer: Aetna Commercial	$435.49
Rate for Payer: BCBS Trust/PPO	$395.94
Rate for Payer: BCN Commercial	$395.94
Rate for Payer: Cash Price	$409.87
Rate for Payer: Cofinity Commercial	$440.61
Rate for Payer: Encore Health Key Benefits Commercial	$409.87
Rate for Payer: Healthscope Commercial	$461.11
Rate for Payer: Lakeland Regional Health Systems Commercial	$384.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$435.49
Rate for Payer: PHP Commercial	$435.49
Rate for Payer: Priority Health Cigna Priority Health	$358.64
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$445.74
Rate for Payer: Priority Health Narrow/Tiered Network	$312.48
Rate for Payer: UHC All Payor (Choice/PPO)	$450.86
Rate for Payer: UHC Core	$427.80
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$384.26

Know your out-of-pocket cost for care.

All Charges