|
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 |
$27.38 |
| Max. Negotiated Rate |
$139.77 |
| Rate for Payer: Aetna Commercial |
$132.00
|
| Rate for Payer: Aetna Medicare |
$40.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$48.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$48.53
|
| Rate for Payer: BCBS Complete |
$28.75
|
| Rate for Payer: BCBS MAPPO |
$38.83
|
| Rate for Payer: BCBS Trust/PPO |
$127.67
|
| Rate for Payer: BCN Commercial |
$127.67
|
| Rate for Payer: BCN Medicare Advantage |
$38.83
|
| 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: Health Alliance Plan Medicare Advantage |
$38.83
|
| Rate for Payer: Healthscope Commercial |
$139.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.47
|
| Rate for Payer: Mclaren Medicaid |
$27.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.77
|
| Rate for Payer: Meridian Medicaid |
$28.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.00
|
| Rate for Payer: Nomi Health Commercial |
$127.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.47
|
| Rate for Payer: PACE Senior Care Partners |
$36.88
|
| Rate for Payer: PACE SWMI |
$38.83
|
| Rate for Payer: PHP Commercial |
$132.00
|
| Rate for Payer: PHP Medicare Advantage |
$38.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$135.11
|
| Rate for Payer: Priority Health Medicare |
$39.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.09
|
| Rate for Payer: Railroad Medicare Medicare |
$38.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.66
|
| Rate for Payer: UHC Core |
$129.68
|
| Rate for Payer: UHC Exchange |
$38.83
|
| Rate for Payer: UHC Medicaid |
$27.38
|
| Rate for Payer: UHC Medicare Advantage |
$38.83
|
| Rate for Payer: UHCCP Medicaid |
$27.38
|
| Rate for Payer: VA VA |
$38.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.47
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
OP
|
$25.94
|
|
|
Service Code
|
NDC 64980032430
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$23.35 |
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: Aetna Medicare |
$6.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.11
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS MAPPO |
$6.49
|
| Rate for Payer: BCBS Trust/PPO |
$21.33
|
| Rate for Payer: BCN Commercial |
$21.33
|
| Rate for Payer: BCN Medicare Advantage |
$6.49
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.49
|
| Rate for Payer: Healthscope Commercial |
$23.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.45
|
| Rate for Payer: Mclaren Medicaid |
$4.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.81
|
| Rate for Payer: Meridian Medicaid |
$4.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: Nomi Health Commercial |
$21.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.45
|
| Rate for Payer: PACE Senior Care Partners |
$6.16
|
| Rate for Payer: PACE SWMI |
$6.49
|
| Rate for Payer: PHP Commercial |
$22.05
|
| Rate for Payer: PHP Medicare Advantage |
$6.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.57
|
| Rate for Payer: Priority Health Medicare |
$6.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.05
|
| Rate for Payer: Railroad Medicare Medicare |
$6.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.83
|
| Rate for Payer: UHC Core |
$21.66
|
| Rate for Payer: UHC Exchange |
$6.49
|
| Rate for Payer: UHC Medicaid |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$6.49
|
| Rate for Payer: UHCCP Medicaid |
$4.57
|
| Rate for Payer: VA VA |
$6.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.45
|
|
|
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 |
$4.58 |
| Max. Negotiated Rate |
$23.37 |
| Rate for Payer: Aetna Commercial |
$22.07
|
| Rate for Payer: Aetna Medicare |
$6.75
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.12
|
| Rate for Payer: BCBS Complete |
$4.81
|
| Rate for Payer: BCBS MAPPO |
$6.49
|
| Rate for Payer: BCBS Trust/PPO |
$21.35
|
| Rate for Payer: BCN Commercial |
$21.35
|
| Rate for Payer: BCN Medicare Advantage |
$6.49
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Cofinity Commercial |
$22.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.49
|
| Rate for Payer: Healthscope Commercial |
$23.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.48
|
| Rate for Payer: Mclaren Medicaid |
$4.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.82
|
| Rate for Payer: Meridian Medicaid |
$4.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.07
|
| Rate for Payer: Nomi Health Commercial |
$21.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.48
|
| Rate for Payer: PACE Senior Care Partners |
$6.17
|
| Rate for Payer: PACE SWMI |
$6.49
|
| Rate for Payer: PHP Commercial |
$22.07
|
| Rate for Payer: PHP Medicare Advantage |
$6.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.59
|
| Rate for Payer: Priority Health Medicare |
$6.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.08
|
| Rate for Payer: Railroad Medicare Medicare |
$6.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.85
|
| Rate for Payer: UHC Core |
$21.68
|
| Rate for Payer: UHC Exchange |
$6.49
|
| Rate for Payer: UHC Medicaid |
$4.58
|
| Rate for Payer: UHC Medicare Advantage |
$6.49
|
| Rate for Payer: UHCCP Medicaid |
$4.58
|
| Rate for Payer: VA VA |
$6.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.48
|
|
|
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 |
$5.04 |
| Max. Negotiated Rate |
$25.70 |
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna Medicare |
$7.43
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.93
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.93
|
| Rate for Payer: BCBS Complete |
$5.29
|
| Rate for Payer: BCBS MAPPO |
$7.14
|
| Rate for Payer: BCBS Trust/PPO |
$23.48
|
| Rate for Payer: BCN Commercial |
$23.48
|
| Rate for Payer: BCN Medicare Advantage |
$7.14
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.14
|
| Rate for Payer: Healthscope Commercial |
$25.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.42
|
| Rate for Payer: Mclaren Medicaid |
$5.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.50
|
| Rate for Payer: Meridian Medicaid |
$5.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.28
|
| Rate for Payer: Nomi Health Commercial |
$23.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.42
|
| Rate for Payer: PACE Senior Care Partners |
$6.78
|
| Rate for Payer: PACE SWMI |
$7.14
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: PHP Medicare Advantage |
$7.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.85
|
| Rate for Payer: Priority Health Medicare |
$7.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.88
|
| Rate for Payer: Railroad Medicare Medicare |
$7.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.13
|
| Rate for Payer: UHC Core |
$23.85
|
| Rate for Payer: UHC Exchange |
$7.14
|
| Rate for Payer: UHC Medicaid |
$5.04
|
| Rate for Payer: UHC Medicare Advantage |
$7.14
|
| Rate for Payer: UHCCP Medicaid |
$5.04
|
| Rate for Payer: VA VA |
$7.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.42
|
|
|
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 |
$18.05 |
| Max. Negotiated Rate |
$23.35 |
| Rate for Payer: Aetna Commercial |
$22.05
|
| Rate for Payer: BCBS Trust/PPO |
$21.42
|
| Rate for Payer: BCN Commercial |
$21.42
|
| Rate for Payer: Cash Price |
$20.75
|
| 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: Lakeland Regional Health Systems Commercial |
$19.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.05
|
| Rate for Payer: Nomi Health Commercial |
$21.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.45
|
| Rate for Payer: PHP Commercial |
$22.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.83
|
| Rate for Payer: UHC Core |
$21.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.45
|
|
|
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 |
$108.09 |
| Max. Negotiated Rate |
$139.77 |
| Rate for Payer: Aetna Commercial |
$132.00
|
| Rate for Payer: BCBS Trust/PPO |
$128.26
|
| Rate for Payer: BCN Commercial |
$128.26
|
| 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 |
$116.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.00
|
| Rate for Payer: Nomi Health Commercial |
$127.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.47
|
| Rate for Payer: PHP Commercial |
$132.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$135.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.09
|
| 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 |
$116.47
|
|
|
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 |
$18.08 |
| Max. Negotiated Rate |
$23.37 |
| Rate for Payer: Aetna Commercial |
$22.07
|
| Rate for Payer: BCBS Trust/PPO |
$21.45
|
| Rate for Payer: BCN Commercial |
$21.45
|
| Rate for Payer: Cash Price |
$20.78
|
| 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: Lakeland Regional Health Systems Commercial |
$19.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.07
|
| Rate for Payer: Nomi Health Commercial |
$21.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.48
|
| Rate for Payer: PHP Commercial |
$22.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$22.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.85
|
| Rate for Payer: UHC Core |
$21.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.48
|
|
|
HYDROCORTISONE 5 MG TABLET
|
Facility
|
OP
|
$102.13
|
|
|
Service Code
|
NDC 00115169606
|
| Hospital Charge Code |
10209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.01 |
| Max. Negotiated Rate |
$91.92 |
| Rate for Payer: Aetna Commercial |
$86.81
|
| Rate for Payer: Aetna Medicare |
$26.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$31.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$31.92
|
| Rate for Payer: BCBS Complete |
$18.90
|
| Rate for Payer: BCBS MAPPO |
$25.53
|
| Rate for Payer: BCBS Trust/PPO |
$83.96
|
| Rate for Payer: BCN Commercial |
$83.96
|
| Rate for Payer: BCN Medicare Advantage |
$25.53
|
| Rate for Payer: Cash Price |
$81.70
|
| Rate for Payer: Cofinity Commercial |
$87.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$25.53
|
| Rate for Payer: Healthscope Commercial |
$91.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.60
|
| Rate for Payer: Mclaren Medicaid |
$18.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$26.81
|
| Rate for Payer: Meridian Medicaid |
$18.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$29.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$28.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.81
|
| Rate for Payer: Nomi Health Commercial |
$83.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.60
|
| Rate for Payer: PACE Senior Care Partners |
$24.26
|
| Rate for Payer: PACE SWMI |
$25.53
|
| Rate for Payer: PHP Commercial |
$86.81
|
| Rate for Payer: PHP Medicare Advantage |
$25.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$88.85
|
| Rate for Payer: Priority Health Medicare |
$25.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.08
|
| Rate for Payer: Railroad Medicare Medicare |
$25.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.87
|
| Rate for Payer: UHC Core |
$85.28
|
| Rate for Payer: UHC Exchange |
$25.53
|
| Rate for Payer: UHC Medicaid |
$18.01
|
| Rate for Payer: UHC Medicare Advantage |
$25.53
|
| Rate for Payer: UHCCP Medicaid |
$18.01
|
| Rate for Payer: VA VA |
$25.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.60
|
|
|
HYDROCORTISONE 5 MG TABLET
|
Facility
|
IP
|
$102.13
|
|
|
Service Code
|
NDC 00115169606
|
| Hospital Charge Code |
10209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.08 |
| Max. Negotiated Rate |
$91.92 |
| Rate for Payer: Aetna Commercial |
$86.81
|
| Rate for Payer: BCBS Trust/PPO |
$84.35
|
| Rate for Payer: BCN Commercial |
$84.35
|
| Rate for Payer: Cash Price |
$81.70
|
| Rate for Payer: Cofinity Commercial |
$87.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$81.70
|
| Rate for Payer: Healthscope Commercial |
$91.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$76.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$86.81
|
| Rate for Payer: Nomi Health Commercial |
$83.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.60
|
| Rate for Payer: PHP Commercial |
$86.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$88.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$89.87
|
| Rate for Payer: UHC Core |
$85.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$76.60
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$474.82
|
|
|
Service Code
|
NDC 00713050312
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$330.47 |
| Max. Negotiated Rate |
$427.34 |
| Rate for Payer: Aetna Commercial |
$403.60
|
| Rate for Payer: BCBS Trust/PPO |
$392.15
|
| Rate for Payer: BCN Commercial |
$392.15
|
| Rate for Payer: Cash Price |
$379.86
|
| Rate for Payer: Cofinity Commercial |
$408.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$379.86
|
| Rate for Payer: Healthscope Commercial |
$427.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.60
|
| Rate for Payer: Nomi Health Commercial |
$389.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$356.12
|
| Rate for Payer: PHP Commercial |
$403.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$413.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$417.84
|
| Rate for Payer: UHC Core |
$396.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.12
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$7.44
|
|
|
Service Code
|
NDC 16571067616
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.32
|
| Rate for Payer: Aetna Medicare |
$1.93
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.33
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.33
|
| Rate for Payer: BCBS Complete |
$1.38
|
| Rate for Payer: BCBS MAPPO |
$1.86
|
| Rate for Payer: BCBS Trust/PPO |
$6.12
|
| Rate for Payer: BCN Commercial |
$6.12
|
| Rate for Payer: BCN Medicare Advantage |
$1.86
|
| Rate for Payer: Cash Price |
$5.95
|
| Rate for Payer: Cofinity Commercial |
$6.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$6.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.58
|
| Rate for Payer: Mclaren Medicaid |
$1.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.95
|
| Rate for Payer: Meridian Medicaid |
$1.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.32
|
| Rate for Payer: Nomi Health Commercial |
$6.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.58
|
| Rate for Payer: PACE Senior Care Partners |
$1.77
|
| Rate for Payer: PACE SWMI |
$1.86
|
| Rate for Payer: PHP Commercial |
$6.32
|
| Rate for Payer: PHP Medicare Advantage |
$1.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.47
|
| Rate for Payer: Priority Health Medicare |
$1.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.18
|
| Rate for Payer: Railroad Medicare Medicare |
$1.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.55
|
| Rate for Payer: UHC Core |
$6.21
|
| Rate for Payer: UHC Exchange |
$1.86
|
| Rate for Payer: UHC Medicaid |
$1.31
|
| Rate for Payer: UHC Medicare Advantage |
$1.86
|
| Rate for Payer: UHCCP Medicaid |
$1.31
|
| Rate for Payer: VA VA |
$1.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.58
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$89.23
|
|
|
Service Code
|
NDC 16571067621
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.73 |
| Max. Negotiated Rate |
$80.31 |
| Rate for Payer: Aetna Commercial |
$75.85
|
| Rate for Payer: Aetna Medicare |
$23.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.88
|
| Rate for Payer: BCBS Complete |
$16.52
|
| Rate for Payer: BCBS MAPPO |
$22.31
|
| Rate for Payer: BCBS Trust/PPO |
$73.36
|
| Rate for Payer: BCN Commercial |
$73.36
|
| Rate for Payer: BCN Medicare Advantage |
$22.31
|
| Rate for Payer: Cash Price |
$71.38
|
| Rate for Payer: Cofinity Commercial |
$76.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.31
|
| Rate for Payer: Healthscope Commercial |
$80.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.92
|
| Rate for Payer: Mclaren Medicaid |
$15.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.42
|
| Rate for Payer: Meridian Medicaid |
$16.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$24.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.85
|
| Rate for Payer: Nomi Health Commercial |
$73.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.92
|
| Rate for Payer: PACE Senior Care Partners |
$21.19
|
| Rate for Payer: PACE SWMI |
$22.31
|
| Rate for Payer: PHP Commercial |
$75.85
|
| Rate for Payer: PHP Medicare Advantage |
$22.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$77.63
|
| Rate for Payer: Priority Health Medicare |
$22.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.10
|
| Rate for Payer: Railroad Medicare Medicare |
$22.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.52
|
| Rate for Payer: UHC Core |
$74.51
|
| Rate for Payer: UHC Exchange |
$22.31
|
| Rate for Payer: UHC Medicaid |
$15.73
|
| Rate for Payer: UHC Medicare Advantage |
$22.31
|
| Rate for Payer: UHCCP Medicaid |
$15.73
|
| Rate for Payer: VA VA |
$22.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.92
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$474.82
|
|
|
Service Code
|
NDC 00713050312
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.71 |
| Max. Negotiated Rate |
$427.34 |
| Rate for Payer: Aetna Commercial |
$403.60
|
| Rate for Payer: Aetna Medicare |
$123.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$148.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$148.38
|
| Rate for Payer: BCBS Complete |
$87.89
|
| Rate for Payer: BCBS MAPPO |
$118.70
|
| Rate for Payer: BCBS Trust/PPO |
$390.35
|
| Rate for Payer: BCN Commercial |
$390.35
|
| Rate for Payer: BCN Medicare Advantage |
$118.70
|
| Rate for Payer: Cash Price |
$379.86
|
| Rate for Payer: Cofinity Commercial |
$408.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$379.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.70
|
| Rate for Payer: Healthscope Commercial |
$427.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.12
|
| Rate for Payer: Mclaren Medicaid |
$83.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.64
|
| Rate for Payer: Meridian Medicaid |
$87.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$130.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.60
|
| Rate for Payer: Nomi Health Commercial |
$389.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$356.12
|
| Rate for Payer: PACE Senior Care Partners |
$112.77
|
| Rate for Payer: PACE SWMI |
$118.70
|
| Rate for Payer: PHP Commercial |
$403.60
|
| Rate for Payer: PHP Medicare Advantage |
$118.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$83.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$413.09
|
| Rate for Payer: Priority Health Medicare |
$119.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$330.47
|
| Rate for Payer: Railroad Medicare Medicare |
$118.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$417.84
|
| Rate for Payer: UHC Core |
$396.47
|
| Rate for Payer: UHC Exchange |
$118.70
|
| Rate for Payer: UHC Medicaid |
$83.71
|
| Rate for Payer: UHC Medicare Advantage |
$118.70
|
| Rate for Payer: UHCCP Medicaid |
$83.71
|
| Rate for Payer: VA VA |
$118.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.12
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$7.44
|
|
|
Service Code
|
NDC 16571067616
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.32
|
| Rate for Payer: BCBS Trust/PPO |
$6.14
|
| Rate for Payer: BCN Commercial |
$6.14
|
| Rate for Payer: Cash Price |
$5.95
|
| Rate for Payer: Cofinity Commercial |
$6.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.95
|
| Rate for Payer: Healthscope Commercial |
$6.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.32
|
| Rate for Payer: Nomi Health Commercial |
$6.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.58
|
| Rate for Payer: PHP Commercial |
$6.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.55
|
| Rate for Payer: UHC Core |
$6.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.58
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$476.55
|
|
|
Service Code
|
NDC 00574709012
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$331.68 |
| Max. Negotiated Rate |
$428.89 |
| Rate for Payer: Aetna Commercial |
$405.07
|
| Rate for Payer: BCBS Trust/PPO |
$393.58
|
| Rate for Payer: BCN Commercial |
$393.58
|
| Rate for Payer: Cash Price |
$381.24
|
| Rate for Payer: Cofinity Commercial |
$409.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.24
|
| Rate for Payer: Healthscope Commercial |
$428.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.07
|
| Rate for Payer: Nomi Health Commercial |
$390.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$357.41
|
| Rate for Payer: PHP Commercial |
$405.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$414.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$331.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$419.36
|
| Rate for Payer: UHC Core |
$397.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.41
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$89.23
|
|
|
Service Code
|
NDC 16571067621
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$80.31 |
| Rate for Payer: Aetna Commercial |
$75.85
|
| Rate for Payer: BCBS Trust/PPO |
$73.70
|
| Rate for Payer: BCN Commercial |
$73.70
|
| Rate for Payer: Cash Price |
$71.38
|
| Rate for Payer: Cofinity Commercial |
$76.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.38
|
| Rate for Payer: Healthscope Commercial |
$80.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.85
|
| Rate for Payer: Nomi Health Commercial |
$73.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.92
|
| Rate for Payer: PHP Commercial |
$75.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$77.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.52
|
| Rate for Payer: UHC Core |
$74.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.92
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$476.55
|
|
|
Service Code
|
NDC 00574709012
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.02 |
| Max. Negotiated Rate |
$428.89 |
| Rate for Payer: Aetna Commercial |
$405.07
|
| Rate for Payer: Aetna Medicare |
$123.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$148.92
|
| Rate for Payer: Amish Plain Church Group Commercial |
$148.92
|
| Rate for Payer: BCBS Complete |
$88.21
|
| Rate for Payer: BCBS MAPPO |
$119.14
|
| Rate for Payer: BCBS Trust/PPO |
$391.77
|
| Rate for Payer: BCN Commercial |
$391.77
|
| Rate for Payer: BCN Medicare Advantage |
$119.14
|
| Rate for Payer: Cash Price |
$381.24
|
| Rate for Payer: Cofinity Commercial |
$409.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.14
|
| Rate for Payer: Healthscope Commercial |
$428.89
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.41
|
| Rate for Payer: Mclaren Medicaid |
$84.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.09
|
| Rate for Payer: Meridian Medicaid |
$88.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$137.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$131.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.07
|
| Rate for Payer: Nomi Health Commercial |
$390.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$357.41
|
| Rate for Payer: PACE Senior Care Partners |
$113.18
|
| Rate for Payer: PACE SWMI |
$119.14
|
| Rate for Payer: PHP Commercial |
$405.07
|
| Rate for Payer: PHP Medicare Advantage |
$119.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$84.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$414.60
|
| Rate for Payer: Priority Health Medicare |
$120.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$331.68
|
| Rate for Payer: Railroad Medicare Medicare |
$119.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$419.36
|
| Rate for Payer: UHC Core |
$397.92
|
| Rate for Payer: UHC Exchange |
$119.14
|
| Rate for Payer: UHC Medicaid |
$84.02
|
| Rate for Payer: UHC Medicare Advantage |
$119.14
|
| Rate for Payer: UHCCP Medicaid |
$84.02
|
| Rate for Payer: VA VA |
$119.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.41
|
|
|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
IP
|
$10.48
|
|
|
Service Code
|
NDC 51672533002
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.29 |
| Max. Negotiated Rate |
$9.43 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: BCBS Trust/PPO |
$8.66
|
| Rate for Payer: BCN Commercial |
$8.66
|
| Rate for Payer: Cash Price |
$8.38
|
| Rate for Payer: Cofinity Commercial |
$9.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.38
|
| Rate for Payer: Healthscope Commercial |
$9.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.91
|
| Rate for Payer: Nomi Health Commercial |
$8.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.86
|
| Rate for Payer: PHP Commercial |
$8.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.22
|
| Rate for Payer: UHC Core |
$8.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.86
|
|
|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 51672201302
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$9.35
|
| Rate for Payer: Aetna Medicare |
$2.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.44
|
| Rate for Payer: BCBS Complete |
$2.04
|
| Rate for Payer: BCBS MAPPO |
$2.75
|
| Rate for Payer: BCBS Trust/PPO |
$9.04
|
| Rate for Payer: BCN Commercial |
$9.04
|
| Rate for Payer: BCN Medicare Advantage |
$2.75
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$9.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.75
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.25
|
| Rate for Payer: Mclaren Medicaid |
$1.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.89
|
| Rate for Payer: Meridian Medicaid |
$2.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.35
|
| Rate for Payer: Nomi Health Commercial |
$9.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.25
|
| Rate for Payer: PACE Senior Care Partners |
$2.61
|
| Rate for Payer: PACE SWMI |
$2.75
|
| Rate for Payer: PHP Commercial |
$9.35
|
| Rate for Payer: PHP Medicare Advantage |
$2.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.57
|
| Rate for Payer: Priority Health Medicare |
$2.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.66
|
| Rate for Payer: Railroad Medicare Medicare |
$2.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.68
|
| Rate for Payer: UHC Core |
$9.19
|
| Rate for Payer: UHC Exchange |
$2.75
|
| Rate for Payer: UHC Medicaid |
$1.94
|
| Rate for Payer: UHC Medicare Advantage |
$2.75
|
| Rate for Payer: UHCCP Medicaid |
$1.94
|
| Rate for Payer: VA VA |
$2.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.25
|
|
|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
OP
|
$7.90
|
|
|
Service Code
|
NDC 00536140795
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$7.11 |
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: Aetna Medicare |
$2.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.47
|
| Rate for Payer: BCBS Complete |
$1.46
|
| Rate for Payer: BCBS MAPPO |
$1.98
|
| Rate for Payer: BCBS Trust/PPO |
$6.49
|
| Rate for Payer: BCN Commercial |
$6.49
|
| Rate for Payer: BCN Medicare Advantage |
$1.98
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$7.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: Mclaren Medicaid |
$1.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.07
|
| Rate for Payer: Meridian Medicaid |
$1.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.27
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Nomi Health Commercial |
$6.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.92
|
| Rate for Payer: PACE Senior Care Partners |
$1.88
|
| Rate for Payer: PACE SWMI |
$1.98
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: PHP Medicare Advantage |
$1.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.87
|
| Rate for Payer: Priority Health Medicare |
$1.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.50
|
| Rate for Payer: Railroad Medicare Medicare |
$1.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.95
|
| Rate for Payer: UHC Core |
$6.60
|
| Rate for Payer: UHC Exchange |
$1.98
|
| Rate for Payer: UHC Medicaid |
$1.39
|
| Rate for Payer: UHC Medicare Advantage |
$1.98
|
| Rate for Payer: UHCCP Medicaid |
$1.39
|
| Rate for Payer: VA VA |
$1.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
|
|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 51672201302
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.66 |
| Max. Negotiated Rate |
$9.90 |
| Rate for Payer: Aetna Commercial |
$9.35
|
| Rate for Payer: BCBS Trust/PPO |
$9.08
|
| Rate for Payer: BCN Commercial |
$9.08
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$9.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.80
|
| Rate for Payer: Healthscope Commercial |
$9.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.35
|
| Rate for Payer: Nomi Health Commercial |
$9.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.25
|
| Rate for Payer: PHP Commercial |
$9.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.68
|
| Rate for Payer: UHC Core |
$9.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.25
|
|
|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
IP
|
$7.90
|
|
|
Service Code
|
NDC 00536140795
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$7.11 |
| Rate for Payer: Aetna Commercial |
$6.71
|
| Rate for Payer: BCBS Trust/PPO |
$6.52
|
| Rate for Payer: BCN Commercial |
$6.52
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.32
|
| Rate for Payer: Healthscope Commercial |
$7.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Nomi Health Commercial |
$6.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.92
|
| Rate for Payer: PHP Commercial |
$6.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$6.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.95
|
| Rate for Payer: UHC Core |
$6.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
|
|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
OP
|
$10.48
|
|
|
Service Code
|
NDC 51672533002
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$9.43 |
| Rate for Payer: Aetna Commercial |
$8.91
|
| Rate for Payer: Aetna Medicare |
$2.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.27
|
| Rate for Payer: BCBS Complete |
$1.94
|
| Rate for Payer: BCBS MAPPO |
$2.62
|
| Rate for Payer: BCBS Trust/PPO |
$8.62
|
| Rate for Payer: BCN Commercial |
$8.62
|
| Rate for Payer: BCN Medicare Advantage |
$2.62
|
| Rate for Payer: Cash Price |
$8.38
|
| Rate for Payer: Cofinity Commercial |
$9.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.62
|
| Rate for Payer: Healthscope Commercial |
$9.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.86
|
| Rate for Payer: Mclaren Medicaid |
$1.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.75
|
| Rate for Payer: Meridian Medicaid |
$1.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.91
|
| Rate for Payer: Nomi Health Commercial |
$8.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.86
|
| Rate for Payer: PACE Senior Care Partners |
$2.49
|
| Rate for Payer: PACE SWMI |
$2.62
|
| Rate for Payer: PHP Commercial |
$8.91
|
| Rate for Payer: PHP Medicare Advantage |
$2.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.12
|
| Rate for Payer: Priority Health Medicare |
$2.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.29
|
| Rate for Payer: Railroad Medicare Medicare |
$2.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.22
|
| Rate for Payer: UHC Core |
$8.75
|
| Rate for Payer: UHC Exchange |
$2.62
|
| Rate for Payer: UHC Medicaid |
$1.85
|
| Rate for Payer: UHC Medicare Advantage |
$2.62
|
| Rate for Payer: UHCCP Medicaid |
$1.85
|
| Rate for Payer: VA VA |
$2.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.86
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$107.59
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.88 |
| Max. Negotiated Rate |
$96.83 |
| Rate for Payer: Aetna Commercial |
$91.45
|
| Rate for Payer: Aetna Commercial |
$92.26
|
| Rate for Payer: BCBS Trust/PPO |
$88.86
|
| Rate for Payer: BCBS Trust/PPO |
$89.64
|
| Rate for Payer: BCN Commercial |
$88.86
|
| Rate for Payer: BCN Commercial |
$89.64
|
| Rate for Payer: Cash Price |
$86.07
|
| Rate for Payer: Cash Price |
$86.83
|
| Rate for Payer: Cofinity Commercial |
$93.34
|
| Rate for Payer: Cofinity Commercial |
$92.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.07
|
| Rate for Payer: Healthscope Commercial |
$96.83
|
| Rate for Payer: Healthscope Commercial |
$97.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.26
|
| Rate for Payer: Nomi Health Commercial |
$88.22
|
| Rate for Payer: Nomi Health Commercial |
$89.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.41
|
| Rate for Payer: PHP Commercial |
$92.26
|
| Rate for Payer: PHP Commercial |
$91.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$94.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$93.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.52
|
| Rate for Payer: UHC Core |
$89.84
|
| Rate for Payer: UHC Core |
$90.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.41
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$107.59
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$96.83 |
| Rate for Payer: Aetna Commercial |
$91.45
|
| Rate for Payer: Aetna Commercial |
$92.26
|
| Rate for Payer: Aetna Medicare |
$28.22
|
| Rate for Payer: Aetna Medicare |
$27.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$33.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$33.92
|
| Rate for Payer: BCBS Complete |
$19.91
|
| Rate for Payer: BCBS Complete |
$20.09
|
| Rate for Payer: BCBS MAPPO |
$26.90
|
| Rate for Payer: BCBS MAPPO |
$27.14
|
| Rate for Payer: BCBS Trust/PPO |
$88.45
|
| Rate for Payer: BCBS Trust/PPO |
$89.23
|
| Rate for Payer: BCN Commercial |
$89.23
|
| Rate for Payer: BCN Commercial |
$88.45
|
| Rate for Payer: BCN Medicare Advantage |
$27.14
|
| Rate for Payer: BCN Medicare Advantage |
$26.90
|
| Rate for Payer: Cash Price |
$86.07
|
| Rate for Payer: Cash Price |
$86.83
|
| Rate for Payer: Cofinity Commercial |
$92.53
|
| Rate for Payer: Cofinity Commercial |
$93.34
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.90
|
| Rate for Payer: Healthscope Commercial |
$96.83
|
| Rate for Payer: Healthscope Commercial |
$97.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$81.41
|
| Rate for Payer: Mclaren Medicaid |
$19.14
|
| Rate for Payer: Mclaren Medicaid |
$18.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$28.24
|
| Rate for Payer: Meridian Medicaid |
$19.91
|
| Rate for Payer: Meridian Medicaid |
$20.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$29.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.45
|
| Rate for Payer: Nomi Health Commercial |
$89.00
|
| Rate for Payer: Nomi Health Commercial |
$88.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.41
|
| Rate for Payer: PACE Senior Care Partners |
$25.78
|
| Rate for Payer: PACE Senior Care Partners |
$25.55
|
| Rate for Payer: PACE SWMI |
$27.14
|
| Rate for Payer: PACE SWMI |
$26.90
|
| Rate for Payer: PHP Commercial |
$91.45
|
| Rate for Payer: PHP Commercial |
$92.26
|
| Rate for Payer: PHP Medicare Advantage |
$26.90
|
| Rate for Payer: PHP Medicare Advantage |
$27.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$94.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$93.60
|
| Rate for Payer: Priority Health Medicare |
$27.41
|
| Rate for Payer: Priority Health Medicare |
$27.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$74.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$75.54
|
| Rate for Payer: Railroad Medicare Medicare |
$26.90
|
| Rate for Payer: Railroad Medicare Medicare |
$27.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.52
|
| Rate for Payer: UHC Core |
$90.63
|
| Rate for Payer: UHC Core |
$89.84
|
| Rate for Payer: UHC Exchange |
$27.14
|
| Rate for Payer: UHC Exchange |
$26.90
|
| Rate for Payer: UHC Medicaid |
$19.14
|
| Rate for Payer: UHC Medicaid |
$18.97
|
| Rate for Payer: UHC Medicare Advantage |
$26.90
|
| Rate for Payer: UHC Medicare Advantage |
$27.14
|
| Rate for Payer: UHCCP Medicaid |
$18.97
|
| Rate for Payer: UHCCP Medicaid |
$19.14
|
| Rate for Payer: VA VA |
$26.90
|
| Rate for Payer: VA VA |
$27.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$81.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.69
|
|
