|
HYDROCOLLOID DRESSING 4" X 4"
|
Facility
|
IP
|
$149.85
|
|
|
Service Code
|
NDC 68455010270
|
| Hospital Charge Code |
110996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.40 |
| Max. Negotiated Rate |
$134.86 |
| Rate for Payer: Aetna Commercial |
$127.37
|
| Rate for Payer: BCBS Trust/PPO |
$122.32
|
| 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 Commercial |
$127.37
|
| Rate for Payer: Nomi Health Commercial |
$122.88
|
| Rate for Payer: PHP Commercial |
$127.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.40
|
| Rate for Payer: Priority Health HMO/PPO |
$130.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.40
|
| 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
|
IP
|
$68.55
|
|
|
Service Code
|
NDC 68455010271
|
| Hospital Charge Code |
111013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.56 |
| Max. Negotiated Rate |
$61.70 |
| Rate for Payer: Aetna Commercial |
$58.27
|
| Rate for Payer: BCBS Trust/PPO |
$55.96
|
| 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 Commercial |
$58.27
|
| Rate for Payer: Nomi Health Commercial |
$56.21
|
| Rate for Payer: PHP Commercial |
$58.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.56
|
| Rate for Payer: Priority Health HMO/PPO |
$59.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.93
|
| 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
|
|
|
HYDROCOLLOID DRESSING 6" X 6"
|
Facility
|
OP
|
$68.55
|
|
|
Service Code
|
NDC 68455010271
|
| Hospital Charge Code |
111013
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.28 |
| Max. Negotiated Rate |
$61.70 |
| Rate for Payer: Aetna Commercial |
$58.27
|
| Rate for Payer: Aetna Medicare |
$17.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21.42
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21.42
|
| Rate for Payer: BCBS Complete |
$27.42
|
| Rate for Payer: BCBS MAPPO |
$17.14
|
| Rate for Payer: BCBS Trust/PPO |
$56.35
|
| Rate for Payer: BCN Commercial |
$53.30
|
| Rate for Payer: BCN Medicare Advantage |
$17.14
|
| 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: Health Alliance Plan Medicare Advantage |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$61.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$51.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$19.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.27
|
| Rate for Payer: Nomi Health Commercial |
$56.21
|
| Rate for Payer: PACE Senior Care Partners |
$16.28
|
| Rate for Payer: PACE SWMI |
$17.14
|
| Rate for Payer: PHP Commercial |
$58.27
|
| Rate for Payer: PHP Medicare Advantage |
$17.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.56
|
| Rate for Payer: Priority Health HMO/PPO |
$59.64
|
| Rate for Payer: Priority Health Medicare |
$17.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.93
|
| Rate for Payer: Railroad Medicare Medicare |
$17.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.32
|
| Rate for Payer: UHC Core |
$57.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.14
|
| Rate for Payer: UHC Exchange |
$17.14
|
| Rate for Payer: UHC Medicare Advantage |
$17.14
|
| Rate for Payer: VA VA |
$17.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$51.41
|
|
|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
IP
|
$650.88
|
|
|
Service Code
|
NDC 00904718861
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$423.07 |
| Max. Negotiated Rate |
$585.79 |
| Rate for Payer: Aetna Commercial |
$553.25
|
| Rate for Payer: BCBS Trust/PPO |
$531.31
|
| Rate for Payer: BCN Commercial |
$503.00
|
| Rate for Payer: Cash Price |
$520.70
|
| Rate for Payer: Cofinity Commercial |
$559.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.70
|
| Rate for Payer: Healthscope Commercial |
$585.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.25
|
| Rate for Payer: Nomi Health Commercial |
$533.72
|
| Rate for Payer: PHP Commercial |
$553.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.07
|
| Rate for Payer: Priority Health HMO/PPO |
$566.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$436.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$572.77
|
| Rate for Payer: UHC Core |
$543.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.16
|
|
|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
OP
|
$650.88
|
|
|
Service Code
|
NDC 00904718861
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.58 |
| Max. Negotiated Rate |
$585.79 |
| Rate for Payer: Aetna Commercial |
$553.25
|
| Rate for Payer: Aetna Medicare |
$169.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$203.40
|
| Rate for Payer: Amish Plain Church Group Commercial |
$203.40
|
| Rate for Payer: BCBS Complete |
$260.35
|
| Rate for Payer: BCBS MAPPO |
$162.72
|
| Rate for Payer: BCBS Trust/PPO |
$535.09
|
| Rate for Payer: BCN Commercial |
$506.06
|
| Rate for Payer: BCN Medicare Advantage |
$162.72
|
| Rate for Payer: Cash Price |
$520.70
|
| Rate for Payer: Cofinity Commercial |
$559.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.72
|
| Rate for Payer: Healthscope Commercial |
$585.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$488.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$187.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.25
|
| Rate for Payer: Nomi Health Commercial |
$533.72
|
| Rate for Payer: PACE Senior Care Partners |
$154.58
|
| Rate for Payer: PACE SWMI |
$162.72
|
| Rate for Payer: PHP Commercial |
$553.25
|
| Rate for Payer: PHP Medicare Advantage |
$162.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.07
|
| Rate for Payer: Priority Health HMO/PPO |
$566.27
|
| Rate for Payer: Priority Health Medicare |
$164.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$436.09
|
| Rate for Payer: Railroad Medicare Medicare |
$162.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$572.77
|
| Rate for Payer: UHC Core |
$543.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.72
|
| Rate for Payer: UHC Exchange |
$162.72
|
| Rate for Payer: UHC Medicare Advantage |
$162.72
|
| Rate for Payer: VA VA |
$162.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$488.16
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
OP
|
$29.40
|
|
|
Service Code
|
NDC 64980032430
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$26.46 |
| Rate for Payer: Aetna Commercial |
$24.99
|
| Rate for Payer: Aetna Medicare |
$7.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.19
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: BCBS MAPPO |
$7.35
|
| Rate for Payer: BCBS Trust/PPO |
$24.17
|
| Rate for Payer: BCN Commercial |
$22.86
|
| Rate for Payer: BCN Medicare Advantage |
$7.35
|
| Rate for Payer: Cash Price |
$23.52
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.35
|
| Rate for Payer: Healthscope Commercial |
$26.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.99
|
| Rate for Payer: Nomi Health Commercial |
$24.11
|
| Rate for Payer: PACE Senior Care Partners |
$6.98
|
| Rate for Payer: PACE SWMI |
$7.35
|
| Rate for Payer: PHP Commercial |
$24.99
|
| Rate for Payer: PHP Medicare Advantage |
$7.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.11
|
| Rate for Payer: Priority Health HMO/PPO |
$25.58
|
| Rate for Payer: Priority Health Medicare |
$7.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.70
|
| Rate for Payer: Railroad Medicare Medicare |
$7.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.87
|
| Rate for Payer: UHC Core |
$24.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.35
|
| Rate for Payer: UHC Exchange |
$7.35
|
| Rate for Payer: UHC Medicare Advantage |
$7.35
|
| Rate for Payer: VA VA |
$7.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.05
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$27.25
|
|
|
Service Code
|
NDC 69315031228
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$24.52 |
| Rate for Payer: Aetna Commercial |
$23.16
|
| Rate for Payer: BCBS Trust/PPO |
$22.24
|
| Rate for Payer: BCN Commercial |
$21.06
|
| Rate for Payer: Cash Price |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$23.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.80
|
| Rate for Payer: Healthscope Commercial |
$24.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.16
|
| Rate for Payer: Nomi Health Commercial |
$22.34
|
| Rate for Payer: PHP Commercial |
$23.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.71
|
| Rate for Payer: Priority Health HMO/PPO |
$23.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.98
|
| Rate for Payer: UHC Core |
$22.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.44
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$225.54
|
|
|
Service Code
|
NDC 62559043130
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$146.60 |
| Max. Negotiated Rate |
$202.99 |
| Rate for Payer: Aetna Commercial |
$191.71
|
| Rate for Payer: BCBS Trust/PPO |
$184.11
|
| Rate for Payer: BCN Commercial |
$174.30
|
| Rate for Payer: Cash Price |
$180.43
|
| Rate for Payer: Cofinity Commercial |
$193.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.43
|
| Rate for Payer: Healthscope Commercial |
$202.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.71
|
| Rate for Payer: Nomi Health Commercial |
$184.94
|
| Rate for Payer: PHP Commercial |
$191.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.60
|
| Rate for Payer: Priority Health HMO/PPO |
$196.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.48
|
| Rate for Payer: UHC Core |
$188.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.16
|
|
|
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 |
$100.94 |
| Max. Negotiated Rate |
$139.77 |
| Rate for Payer: Aetna Commercial |
$132.00
|
| Rate for Payer: BCBS Trust/PPO |
$126.77
|
| 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 Commercial |
$132.00
|
| Rate for Payer: Nomi Health Commercial |
$127.35
|
| Rate for Payer: PHP Commercial |
$132.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.94
|
| Rate for Payer: Priority Health HMO/PPO |
$135.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.05
|
| 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 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
OP
|
$27.25
|
|
|
Service Code
|
NDC 69315031228
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$24.52 |
| Rate for Payer: Aetna Commercial |
$23.16
|
| Rate for Payer: Aetna Medicare |
$7.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.52
|
| Rate for Payer: BCBS Complete |
$10.90
|
| Rate for Payer: BCBS MAPPO |
$6.81
|
| Rate for Payer: BCBS Trust/PPO |
$22.40
|
| Rate for Payer: BCN Commercial |
$21.19
|
| Rate for Payer: BCN Medicare Advantage |
$6.81
|
| Rate for Payer: Cash Price |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$23.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.81
|
| Rate for Payer: Healthscope Commercial |
$24.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.16
|
| Rate for Payer: Nomi Health Commercial |
$22.34
|
| Rate for Payer: PACE Senior Care Partners |
$6.47
|
| Rate for Payer: PACE SWMI |
$6.81
|
| Rate for Payer: PHP Commercial |
$23.16
|
| Rate for Payer: PHP Medicare Advantage |
$6.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.71
|
| Rate for Payer: Priority Health HMO/PPO |
$23.71
|
| Rate for Payer: Priority Health Medicare |
$6.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.26
|
| Rate for Payer: Railroad Medicare Medicare |
$6.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.98
|
| Rate for Payer: UHC Core |
$22.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.81
|
| Rate for Payer: UHC Exchange |
$6.81
|
| Rate for Payer: UHC Medicare Advantage |
$6.81
|
| Rate for Payer: VA VA |
$6.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.44
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$29.40
|
|
|
Service Code
|
NDC 64980032430
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.11 |
| Max. Negotiated Rate |
$26.46 |
| Rate for Payer: Aetna Commercial |
$24.99
|
| Rate for Payer: BCBS Trust/PPO |
$24.00
|
| Rate for Payer: BCN Commercial |
$22.72
|
| Rate for Payer: Cash Price |
$23.52
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.52
|
| Rate for Payer: Healthscope Commercial |
$26.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.99
|
| Rate for Payer: Nomi Health Commercial |
$24.11
|
| Rate for Payer: PHP Commercial |
$24.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.11
|
| Rate for Payer: Priority Health HMO/PPO |
$25.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.87
|
| Rate for Payer: UHC Core |
$24.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.05
|
|
|
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 |
$36.88 |
| 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 |
$62.12
|
| Rate for Payer: BCBS MAPPO |
$38.82
|
| Rate for Payer: BCBS Trust/PPO |
$127.67
|
| Rate for Payer: BCN Commercial |
$120.75
|
| Rate for Payer: BCN Medicare Advantage |
$38.82
|
| 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 |
$38.82
|
| Rate for Payer: Healthscope Commercial |
$139.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.00
|
| Rate for Payer: Nomi Health Commercial |
$127.35
|
| Rate for Payer: PACE Senior Care Partners |
$36.88
|
| Rate for Payer: PACE SWMI |
$38.82
|
| Rate for Payer: PHP Commercial |
$132.00
|
| Rate for Payer: PHP Medicare Advantage |
$38.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.94
|
| Rate for Payer: Priority Health HMO/PPO |
$135.11
|
| Rate for Payer: Priority Health Medicare |
$39.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.05
|
| Rate for Payer: Railroad Medicare Medicare |
$38.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.66
|
| Rate for Payer: UHC Core |
$129.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.82
|
| Rate for Payer: UHC Exchange |
$38.82
|
| Rate for Payer: UHC Medicare Advantage |
$38.82
|
| Rate for Payer: VA VA |
$38.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.48
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
OP
|
$225.54
|
|
|
Service Code
|
NDC 62559043130
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.57 |
| Max. Negotiated Rate |
$202.99 |
| Rate for Payer: Aetna Commercial |
$191.71
|
| Rate for Payer: Aetna Medicare |
$58.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.48
|
| Rate for Payer: BCBS Complete |
$90.22
|
| Rate for Payer: BCBS MAPPO |
$56.38
|
| Rate for Payer: BCBS Trust/PPO |
$185.42
|
| Rate for Payer: BCN Commercial |
$175.36
|
| Rate for Payer: BCN Medicare Advantage |
$56.38
|
| Rate for Payer: Cash Price |
$180.43
|
| Rate for Payer: Cofinity Commercial |
$193.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.38
|
| Rate for Payer: Healthscope Commercial |
$202.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.71
|
| Rate for Payer: Nomi Health Commercial |
$184.94
|
| Rate for Payer: PACE Senior Care Partners |
$53.57
|
| Rate for Payer: PACE SWMI |
$56.38
|
| Rate for Payer: PHP Commercial |
$191.71
|
| Rate for Payer: PHP Medicare Advantage |
$56.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.60
|
| Rate for Payer: Priority Health HMO/PPO |
$196.22
|
| Rate for Payer: Priority Health Medicare |
$56.95
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.11
|
| Rate for Payer: Railroad Medicare Medicare |
$56.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.48
|
| Rate for Payer: UHC Core |
$188.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.38
|
| Rate for Payer: UHC Exchange |
$56.38
|
| Rate for Payer: UHC Medicare Advantage |
$56.38
|
| Rate for Payer: VA VA |
$56.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.16
|
|
|
HYDROCORTISONE 5 MG TABLET
|
Facility
|
IP
|
$226.78
|
|
|
Service Code
|
NDC 00115169606
|
| Hospital Charge Code |
10209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.41 |
| Max. Negotiated Rate |
$204.10 |
| Rate for Payer: Aetna Commercial |
$192.76
|
| Rate for Payer: BCBS Trust/PPO |
$185.12
|
| Rate for Payer: BCN Commercial |
$175.26
|
| Rate for Payer: Cash Price |
$181.42
|
| Rate for Payer: Cofinity Commercial |
$195.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.42
|
| Rate for Payer: Healthscope Commercial |
$204.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.76
|
| Rate for Payer: Nomi Health Commercial |
$185.96
|
| Rate for Payer: PHP Commercial |
$192.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.41
|
| Rate for Payer: Priority Health HMO/PPO |
$197.30
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.57
|
| Rate for Payer: UHC Core |
$189.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.08
|
|
|
HYDROCORTISONE 5 MG TABLET
|
Facility
|
OP
|
$226.78
|
|
|
Service Code
|
NDC 00115169606
|
| Hospital Charge Code |
10209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.86 |
| Max. Negotiated Rate |
$204.10 |
| Rate for Payer: Aetna Commercial |
$192.76
|
| Rate for Payer: Aetna Medicare |
$58.96
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$70.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$70.87
|
| Rate for Payer: BCBS Complete |
$90.71
|
| Rate for Payer: BCBS MAPPO |
$56.70
|
| Rate for Payer: BCBS Trust/PPO |
$186.44
|
| Rate for Payer: BCN Commercial |
$176.32
|
| Rate for Payer: BCN Medicare Advantage |
$56.70
|
| Rate for Payer: Cash Price |
$181.42
|
| Rate for Payer: Cofinity Commercial |
$195.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.70
|
| Rate for Payer: Healthscope Commercial |
$204.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.76
|
| Rate for Payer: Nomi Health Commercial |
$185.96
|
| Rate for Payer: PACE Senior Care Partners |
$53.86
|
| Rate for Payer: PACE SWMI |
$56.70
|
| Rate for Payer: PHP Commercial |
$192.76
|
| Rate for Payer: PHP Medicare Advantage |
$56.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.41
|
| Rate for Payer: Priority Health HMO/PPO |
$197.30
|
| Rate for Payer: Priority Health Medicare |
$57.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.94
|
| Rate for Payer: Railroad Medicare Medicare |
$56.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.57
|
| Rate for Payer: UHC Core |
$189.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.70
|
| Rate for Payer: UHC Exchange |
$56.70
|
| Rate for Payer: UHC Medicare Advantage |
$56.70
|
| Rate for Payer: VA VA |
$56.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.08
|
|
|
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 |
$113.18 |
| Max. Negotiated Rate |
$428.90 |
| 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 |
$190.62
|
| Rate for Payer: BCBS MAPPO |
$119.14
|
| Rate for Payer: BCBS Trust/PPO |
$391.77
|
| Rate for Payer: BCN Commercial |
$370.52
|
| 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 |
$428.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$137.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.07
|
| Rate for Payer: Nomi Health Commercial |
$390.77
|
| 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 Cigna Priority Health |
$309.76
|
| Rate for Payer: Priority Health HMO/PPO |
$414.60
|
| Rate for Payer: Priority Health Medicare |
$120.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$319.29
|
| 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 Dual Complete DSNP |
$119.14
|
| Rate for Payer: UHC Exchange |
$119.14
|
| Rate for Payer: UHC Medicare Advantage |
$119.14
|
| Rate for Payer: VA VA |
$119.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.41
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$89.17
|
|
|
Service Code
|
NDC 16571067621
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.96 |
| Max. Negotiated Rate |
$80.25 |
| Rate for Payer: Aetna Commercial |
$75.79
|
| Rate for Payer: BCBS Trust/PPO |
$72.79
|
| Rate for Payer: BCN Commercial |
$68.91
|
| Rate for Payer: Cash Price |
$71.34
|
| Rate for Payer: Cofinity Commercial |
$76.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.34
|
| Rate for Payer: Healthscope Commercial |
$80.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.79
|
| Rate for Payer: Nomi Health Commercial |
$73.12
|
| Rate for Payer: PHP Commercial |
$75.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.96
|
| Rate for Payer: Priority Health HMO/PPO |
$77.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.47
|
| Rate for Payer: UHC Core |
$74.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.88
|
|
|
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 |
$112.77 |
| 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 |
$189.93
|
| Rate for Payer: BCBS MAPPO |
$118.70
|
| Rate for Payer: BCBS Trust/PPO |
$390.35
|
| Rate for Payer: BCN Commercial |
$369.17
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$136.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.60
|
| Rate for Payer: Nomi Health Commercial |
$389.35
|
| 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 Cigna Priority Health |
$308.63
|
| Rate for Payer: Priority Health HMO/PPO |
$413.09
|
| Rate for Payer: Priority Health Medicare |
$119.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$318.13
|
| 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 Dual Complete DSNP |
$118.70
|
| Rate for Payer: UHC Exchange |
$118.70
|
| Rate for Payer: UHC Medicare Advantage |
$118.70
|
| 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 |
$4.84 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.32
|
| Rate for Payer: BCBS Trust/PPO |
$6.07
|
| Rate for Payer: BCN Commercial |
$5.75
|
| 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: PHP Commercial |
$6.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.84
|
| Rate for Payer: Priority Health HMO/PPO |
$6.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.98
|
| 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
|
OP
|
$89.17
|
|
|
Service Code
|
NDC 16571067621
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.18 |
| Max. Negotiated Rate |
$80.25 |
| Rate for Payer: Aetna Commercial |
$75.79
|
| Rate for Payer: Aetna Medicare |
$23.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$27.87
|
| Rate for Payer: Amish Plain Church Group Commercial |
$27.87
|
| Rate for Payer: BCBS Complete |
$35.67
|
| Rate for Payer: BCBS MAPPO |
$22.29
|
| Rate for Payer: BCBS Trust/PPO |
$73.31
|
| Rate for Payer: BCN Commercial |
$69.33
|
| Rate for Payer: BCN Medicare Advantage |
$22.29
|
| Rate for Payer: Cash Price |
$71.34
|
| Rate for Payer: Cofinity Commercial |
$76.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.29
|
| Rate for Payer: Healthscope Commercial |
$80.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.79
|
| Rate for Payer: Nomi Health Commercial |
$73.12
|
| Rate for Payer: PACE Senior Care Partners |
$21.18
|
| Rate for Payer: PACE SWMI |
$22.29
|
| Rate for Payer: PHP Commercial |
$75.79
|
| Rate for Payer: PHP Medicare Advantage |
$22.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.96
|
| Rate for Payer: Priority Health HMO/PPO |
$77.58
|
| Rate for Payer: Priority Health Medicare |
$22.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.74
|
| Rate for Payer: Railroad Medicare Medicare |
$22.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.47
|
| Rate for Payer: UHC Core |
$74.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.29
|
| Rate for Payer: UHC Exchange |
$22.29
|
| Rate for Payer: UHC Medicare Advantage |
$22.29
|
| Rate for Payer: VA VA |
$22.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.88
|
|
|
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 |
$308.63 |
| Max. Negotiated Rate |
$427.34 |
| Rate for Payer: Aetna Commercial |
$403.60
|
| Rate for Payer: BCBS Trust/PPO |
$387.60
|
| Rate for Payer: BCN Commercial |
$366.94
|
| 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: PHP Commercial |
$403.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.63
|
| Rate for Payer: Priority Health HMO/PPO |
$413.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$318.13
|
| 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 |
$1.77 |
| 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 |
$2.32
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.32
|
| Rate for Payer: BCBS Complete |
$2.98
|
| Rate for Payer: BCBS MAPPO |
$1.86
|
| Rate for Payer: BCBS Trust/PPO |
$6.12
|
| Rate for Payer: BCN Commercial |
$5.78
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.32
|
| Rate for Payer: Nomi Health Commercial |
$6.10
|
| 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 Cigna Priority Health |
$4.84
|
| Rate for Payer: Priority Health HMO/PPO |
$6.47
|
| Rate for Payer: Priority Health Medicare |
$1.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.98
|
| 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 Dual Complete DSNP |
$1.86
|
| Rate for Payer: UHC Exchange |
$1.86
|
| Rate for Payer: UHC Medicare Advantage |
$1.86
|
| 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
|
IP
|
$476.55
|
|
|
Service Code
|
NDC 00574709012
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$309.76 |
| Max. Negotiated Rate |
$428.90 |
| Rate for Payer: Aetna Commercial |
$405.07
|
| Rate for Payer: BCBS Trust/PPO |
$389.01
|
| Rate for Payer: BCN Commercial |
$368.28
|
| 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 |
$428.90
|
| 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: PHP Commercial |
$405.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.76
|
| Rate for Payer: Priority Health HMO/PPO |
$414.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$319.29
|
| 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-ACETIC ACID 1 %-2 % EAR DROPS
|
Facility
|
IP
|
$248.92
|
|
|
Service Code
|
NDC 50383090110
|
| Hospital Charge Code |
24385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$161.80 |
| Max. Negotiated Rate |
$224.03 |
| Rate for Payer: Aetna Commercial |
$211.58
|
| Rate for Payer: BCBS Trust/PPO |
$203.19
|
| Rate for Payer: BCN Commercial |
$192.37
|
| Rate for Payer: Cash Price |
$199.14
|
| Rate for Payer: Cofinity Commercial |
$214.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.14
|
| Rate for Payer: Healthscope Commercial |
$224.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.58
|
| Rate for Payer: Nomi Health Commercial |
$204.11
|
| Rate for Payer: PHP Commercial |
$211.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.80
|
| Rate for Payer: Priority Health HMO/PPO |
$216.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.05
|
| Rate for Payer: UHC Core |
$207.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.69
|
|
|
HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS
|
Facility
|
OP
|
$248.92
|
|
|
Service Code
|
NDC 50383090110
|
| Hospital Charge Code |
24385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.12 |
| Max. Negotiated Rate |
$224.03 |
| Rate for Payer: Aetna Commercial |
$211.58
|
| Rate for Payer: Aetna Medicare |
$64.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$77.79
|
| Rate for Payer: Amish Plain Church Group Commercial |
$77.79
|
| Rate for Payer: BCBS Complete |
$99.57
|
| Rate for Payer: BCBS MAPPO |
$62.23
|
| Rate for Payer: BCBS Trust/PPO |
$204.64
|
| Rate for Payer: BCN Commercial |
$193.54
|
| Rate for Payer: BCN Medicare Advantage |
$62.23
|
| Rate for Payer: Cash Price |
$199.14
|
| Rate for Payer: Cofinity Commercial |
$214.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.23
|
| Rate for Payer: Healthscope Commercial |
$224.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.58
|
| Rate for Payer: Nomi Health Commercial |
$204.11
|
| Rate for Payer: PACE Senior Care Partners |
$59.12
|
| Rate for Payer: PACE SWMI |
$62.23
|
| Rate for Payer: PHP Commercial |
$211.58
|
| Rate for Payer: PHP Medicare Advantage |
$62.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.80
|
| Rate for Payer: Priority Health HMO/PPO |
$216.56
|
| Rate for Payer: Priority Health Medicare |
$62.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.78
|
| Rate for Payer: Railroad Medicare Medicare |
$62.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.05
|
| Rate for Payer: UHC Core |
$207.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.23
|
| Rate for Payer: UHC Exchange |
$62.23
|
| Rate for Payer: UHC Medicare Advantage |
$62.23
|
| Rate for Payer: VA VA |
$62.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.69
|
|
