|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL OINTMENT
|
Facility
|
IP
|
$84.22
|
|
|
Service Code
|
NDC 45802-054-05
|
| Hospital Charge Code |
8117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.06 |
| Max. Negotiated Rate |
$75.80 |
| Rate for Payer: Aetna American Axle |
$54.74
|
| Rate for Payer: Aetna Commercial |
$71.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.74
|
| Rate for Payer: Cash Price |
$67.38
|
| Rate for Payer: Cofinity Commercial |
$58.95
|
| Rate for Payer: Cofinity Commercial |
$72.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.38
|
| Rate for Payer: Healthscope Commercial |
$75.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.59
|
| Rate for Payer: PHP Commercial |
$71.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.95
|
| Rate for Payer: Priority Health SBD |
$53.06
|
| Rate for Payer: UMR Bronson Commercial |
$37.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.16
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
NDC 64980-320-05
|
| Hospital Charge Code |
8121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.84 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna American Axle |
$55.90
|
| Rate for Payer: Aetna Commercial |
$73.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.90
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cofinity Commercial |
$60.20
|
| Rate for Payer: Cofinity Commercial |
$73.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.80
|
| Rate for Payer: Healthscope Commercial |
$77.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$60.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$64.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$73.10
|
| Rate for Payer: PHP Commercial |
$73.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.20
|
| Rate for Payer: Priority Health SBD |
$54.18
|
| Rate for Payer: UMR Bronson Commercial |
$37.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$64.50
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE
|
Facility
|
IP
|
$209.86
|
|
|
Service Code
|
NDC 0713-0655-40
|
| Hospital Charge Code |
8121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.34 |
| Max. Negotiated Rate |
$188.87 |
| Rate for Payer: Aetna American Axle |
$136.41
|
| Rate for Payer: Aetna Commercial |
$178.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.41
|
| Rate for Payer: Cash Price |
$167.89
|
| Rate for Payer: Cofinity Commercial |
$146.90
|
| Rate for Payer: Cofinity Commercial |
$180.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$167.89
|
| Rate for Payer: Healthscope Commercial |
$188.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$146.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$157.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$178.38
|
| Rate for Payer: PHP Commercial |
$178.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.90
|
| Rate for Payer: Priority Health SBD |
$132.21
|
| Rate for Payer: UMR Bronson Commercial |
$92.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.40
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE
|
Facility
|
IP
|
$207.59
|
|
|
Service Code
|
NDC 51672-1267-5
|
| Hospital Charge Code |
8121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.34 |
| Max. Negotiated Rate |
$186.83 |
| Rate for Payer: Aetna American Axle |
$134.93
|
| Rate for Payer: Aetna Commercial |
$176.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.93
|
| Rate for Payer: Cash Price |
$166.07
|
| Rate for Payer: Cofinity Commercial |
$145.31
|
| Rate for Payer: Cofinity Commercial |
$178.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.07
|
| Rate for Payer: Healthscope Commercial |
$186.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.45
|
| Rate for Payer: PHP Commercial |
$176.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.31
|
| Rate for Payer: Priority Health SBD |
$130.78
|
| Rate for Payer: UMR Bronson Commercial |
$91.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.69
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % LOTION
|
Facility
|
IP
|
$51.03
|
|
|
Service Code
|
NDC 70752-130-05
|
| Hospital Charge Code |
8116
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.45 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna American Axle |
$33.17
|
| Rate for Payer: Aetna Commercial |
$43.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.17
|
| Rate for Payer: Cash Price |
$40.82
|
| Rate for Payer: Cofinity Commercial |
$35.72
|
| Rate for Payer: Cofinity Commercial |
$43.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$40.82
|
| Rate for Payer: Healthscope Commercial |
$45.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$35.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$38.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$43.38
|
| Rate for Payer: PHP Commercial |
$43.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.72
|
| Rate for Payer: Priority Health SBD |
$32.15
|
| Rate for Payer: UMR Bronson Commercial |
$22.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$38.27
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % LOTION
|
Facility
|
IP
|
$106.89
|
|
|
Service Code
|
NDC 60432-561-60
|
| Hospital Charge Code |
8116
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.03 |
| Max. Negotiated Rate |
$96.20 |
| Rate for Payer: Aetna American Axle |
$69.48
|
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.48
|
| Rate for Payer: Cash Price |
$85.51
|
| Rate for Payer: Cofinity Commercial |
$74.82
|
| Rate for Payer: Cofinity Commercial |
$91.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$85.51
|
| Rate for Payer: Healthscope Commercial |
$96.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$74.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$80.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$90.86
|
| Rate for Payer: PHP Commercial |
$90.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.82
|
| Rate for Payer: Priority Health SBD |
$67.34
|
| Rate for Payer: UMR Bronson Commercial |
$47.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.17
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$55.62
|
|
|
Service Code
|
NDC 67877-251-45
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.47 |
| Max. Negotiated Rate |
$50.06 |
| Rate for Payer: Aetna American Axle |
$36.15
|
| Rate for Payer: Aetna Commercial |
$47.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$36.15
|
| Rate for Payer: Cash Price |
$44.50
|
| Rate for Payer: Cofinity Commercial |
$38.93
|
| Rate for Payer: Cofinity Commercial |
$47.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$44.50
|
| Rate for Payer: Healthscope Commercial |
$50.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$38.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$41.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$47.28
|
| Rate for Payer: PHP Commercial |
$47.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.93
|
| Rate for Payer: Priority Health SBD |
$35.04
|
| Rate for Payer: UMR Bronson Commercial |
$24.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$41.72
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$13.57
|
|
|
Service Code
|
NDC 45802-064-35
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$12.21 |
| Rate for Payer: Aetna American Axle |
$8.82
|
| Rate for Payer: Aetna Commercial |
$11.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.82
|
| Rate for Payer: Cash Price |
$10.86
|
| Rate for Payer: Cofinity Commercial |
$11.67
|
| Rate for Payer: Cofinity Commercial |
$9.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.86
|
| Rate for Payer: Healthscope Commercial |
$12.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.53
|
| Rate for Payer: PHP Commercial |
$11.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.50
|
| Rate for Payer: Priority Health SBD |
$8.55
|
| Rate for Payer: UMR Bronson Commercial |
$5.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.18
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$12.56
|
|
|
Service Code
|
NDC 0168-0004-15
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$11.30 |
| Rate for Payer: Aetna American Axle |
$8.16
|
| Rate for Payer: Aetna Commercial |
$10.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.16
|
| Rate for Payer: Cash Price |
$10.05
|
| Rate for Payer: Cofinity Commercial |
$10.80
|
| Rate for Payer: Cofinity Commercial |
$8.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.05
|
| Rate for Payer: Healthscope Commercial |
$11.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.68
|
| Rate for Payer: PHP Commercial |
$10.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.79
|
| Rate for Payer: Priority Health SBD |
$7.91
|
| Rate for Payer: UMR Bronson Commercial |
$5.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.42
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$13.57
|
|
|
Service Code
|
NDC 0713-0225-15
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$12.21 |
| Rate for Payer: Aetna American Axle |
$8.82
|
| Rate for Payer: Aetna Commercial |
$11.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.82
|
| Rate for Payer: Cash Price |
$10.86
|
| Rate for Payer: Cofinity Commercial |
$11.67
|
| Rate for Payer: Cofinity Commercial |
$9.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.86
|
| Rate for Payer: Healthscope Commercial |
$12.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.53
|
| Rate for Payer: PHP Commercial |
$11.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.50
|
| Rate for Payer: Priority Health SBD |
$8.55
|
| Rate for Payer: UMR Bronson Commercial |
$5.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.18
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$63.56
|
|
|
Service Code
|
NDC 45802-064-05
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$57.20 |
| Rate for Payer: Aetna American Axle |
$41.31
|
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.31
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cofinity Commercial |
$44.49
|
| Rate for Payer: Cofinity Commercial |
$54.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.85
|
| Rate for Payer: Healthscope Commercial |
$57.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$54.03
|
| Rate for Payer: PHP Commercial |
$54.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.49
|
| Rate for Payer: Priority Health SBD |
$40.04
|
| Rate for Payer: UMR Bronson Commercial |
$27.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.67
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$10.08
|
|
|
Service Code
|
NDC 67877-251-15
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$9.07 |
| Rate for Payer: Aetna American Axle |
$6.55
|
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.55
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cofinity Commercial |
$7.06
|
| Rate for Payer: Cofinity Commercial |
$8.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.06
|
| Rate for Payer: Healthscope Commercial |
$9.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.06
|
| 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 SBD |
$6.35
|
| Rate for Payer: UMR Bronson Commercial |
$4.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.56
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
IP
|
$111.23
|
|
|
Service Code
|
NDC 45802-055-05
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.94 |
| Max. Negotiated Rate |
$100.11 |
| Rate for Payer: Aetna American Axle |
$72.30
|
| Rate for Payer: Aetna Commercial |
$94.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.30
|
| Rate for Payer: Cash Price |
$88.98
|
| Rate for Payer: Cofinity Commercial |
$77.86
|
| Rate for Payer: Cofinity Commercial |
$95.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$88.98
|
| Rate for Payer: Healthscope Commercial |
$100.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$77.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$83.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$94.55
|
| Rate for Payer: PHP Commercial |
$94.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.86
|
| Rate for Payer: Priority Health SBD |
$70.07
|
| Rate for Payer: UMR Bronson Commercial |
$48.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.42
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
IP
|
$19.24
|
|
|
Service Code
|
NDC 45802-055-35
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.47 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna American Axle |
$12.51
|
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.51
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Cofinity Commercial |
$16.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.39
|
| Rate for Payer: Healthscope Commercial |
$17.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.35
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.47
|
| Rate for Payer: Priority Health SBD |
$12.12
|
| Rate for Payer: UMR Bronson Commercial |
$8.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.43
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
IP
|
$11.34
|
|
|
Service Code
|
NDC 33342-333-15
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.99 |
| Max. Negotiated Rate |
$10.21 |
| Rate for Payer: Aetna American Axle |
$7.37
|
| Rate for Payer: Aetna Commercial |
$9.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.37
|
| Rate for Payer: Cash Price |
$9.07
|
| Rate for Payer: Cofinity Commercial |
$7.94
|
| Rate for Payer: Cofinity Commercial |
$9.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.07
|
| Rate for Payer: Healthscope Commercial |
$10.21
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.64
|
| Rate for Payer: PHP Commercial |
$9.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.94
|
| Rate for Payer: Priority Health SBD |
$7.14
|
| Rate for Payer: UMR Bronson Commercial |
$4.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.50
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL CREAM
|
Facility
|
IP
|
$26.36
|
|
|
Service Code
|
NDC 45802-065-78
|
| Hospital Charge Code |
8114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$23.72 |
| Rate for Payer: Aetna American Axle |
$17.13
|
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.13
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cofinity Commercial |
$18.45
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.09
|
| Rate for Payer: Healthscope Commercial |
$23.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.41
|
| Rate for Payer: PHP Commercial |
$22.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.45
|
| Rate for Payer: Priority Health SBD |
$16.61
|
| Rate for Payer: UMR Bronson Commercial |
$11.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.77
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL CREAM
|
Facility
|
IP
|
$17.89
|
|
|
Service Code
|
NDC 67877-318-15
|
| Hospital Charge Code |
8114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$16.10 |
| Rate for Payer: Aetna American Axle |
$11.63
|
| Rate for Payer: Aetna Commercial |
$15.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.63
|
| Rate for Payer: Cash Price |
$14.31
|
| Rate for Payer: Cofinity Commercial |
$12.52
|
| Rate for Payer: Cofinity Commercial |
$15.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.31
|
| Rate for Payer: Healthscope Commercial |
$16.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$15.21
|
| Rate for Payer: PHP Commercial |
$15.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.52
|
| Rate for Payer: Priority Health SBD |
$11.27
|
| Rate for Payer: UMR Bronson Commercial |
$7.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.42
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL CREAM
|
Facility
|
IP
|
$26.36
|
|
|
Service Code
|
NDC 45802-065-35
|
| Hospital Charge Code |
8114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$23.72 |
| Rate for Payer: Aetna American Axle |
$17.13
|
| Rate for Payer: Aetna Commercial |
$22.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.13
|
| Rate for Payer: Cash Price |
$21.09
|
| Rate for Payer: Cofinity Commercial |
$18.45
|
| Rate for Payer: Cofinity Commercial |
$22.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.09
|
| Rate for Payer: Healthscope Commercial |
$23.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.41
|
| Rate for Payer: PHP Commercial |
$22.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.45
|
| Rate for Payer: Priority Health SBD |
$16.61
|
| Rate for Payer: UMR Bronson Commercial |
$11.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.77
|
|
|
TRIAMCINOLONE ACETONIDE 10 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$83.18
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
11584
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$74.86 |
| Rate for Payer: Aetna American Axle |
$54.07
|
| Rate for Payer: Aetna Commercial |
$70.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.07
|
| Rate for Payer: Cash Price |
$66.54
|
| Rate for Payer: Cofinity Commercial |
$58.23
|
| Rate for Payer: Cofinity Commercial |
$71.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.54
|
| Rate for Payer: Healthscope Commercial |
$74.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.70
|
| Rate for Payer: PHP Commercial |
$70.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.23
|
| Rate for Payer: Priority Health SBD |
$52.40
|
| Rate for Payer: UMR Bronson Commercial |
$36.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.38
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$23.77
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
8120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$21.39 |
| Rate for Payer: Aetna American Axle |
$15.45
|
| Rate for Payer: Aetna American Axle |
$25.17
|
| Rate for Payer: Aetna American Axle |
$15.59
|
| Rate for Payer: Aetna Commercial |
$32.91
|
| Rate for Payer: Aetna Commercial |
$20.20
|
| Rate for Payer: Aetna Commercial |
$20.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.59
|
| Rate for Payer: Cash Price |
$30.98
|
| Rate for Payer: Cash Price |
$19.18
|
| Rate for Payer: Cash Price |
$19.02
|
| Rate for Payer: Cofinity Commercial |
$16.64
|
| Rate for Payer: Cofinity Commercial |
$27.10
|
| Rate for Payer: Cofinity Commercial |
$16.79
|
| Rate for Payer: Cofinity Commercial |
$20.44
|
| Rate for Payer: Cofinity Commercial |
$20.62
|
| Rate for Payer: Cofinity Commercial |
$33.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.18
|
| Rate for Payer: Healthscope Commercial |
$21.39
|
| Rate for Payer: Healthscope Commercial |
$21.58
|
| Rate for Payer: Healthscope Commercial |
$34.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.91
|
| Rate for Payer: PHP Commercial |
$20.20
|
| Rate for Payer: PHP Commercial |
$32.91
|
| Rate for Payer: PHP Commercial |
$20.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.10
|
| Rate for Payer: Priority Health SBD |
$14.98
|
| Rate for Payer: Priority Health SBD |
$15.11
|
| Rate for Payer: Priority Health SBD |
$24.39
|
| Rate for Payer: UMR Bronson Commercial |
$10.46
|
| Rate for Payer: UMR Bronson Commercial |
$10.55
|
| Rate for Payer: UMR Bronson Commercial |
$17.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.98
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$38.72
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
8120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: Aetna American Axle |
$25.17
|
| Rate for Payer: Aetna Commercial |
$32.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.17
|
| Rate for Payer: BCBS Complete |
$15.49
|
| Rate for Payer: BCBS Trust/PPO |
$3.04
|
| Rate for Payer: Cash Price |
$30.98
|
| Rate for Payer: Cash Price |
$30.98
|
| Rate for Payer: Cofinity Commercial |
$27.10
|
| Rate for Payer: Cofinity Commercial |
$33.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.98
|
| Rate for Payer: Healthscope Commercial |
$34.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$32.91
|
| Rate for Payer: PHP Commercial |
$32.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.10
|
| Rate for Payer: Priority Health SBD |
$24.39
|
| Rate for Payer: UMR Bronson Commercial |
$14.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.04
|
|
|
TRIAMCINOLONE ACETONIDE 80 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$77.48
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
190715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$69.73 |
| Rate for Payer: Aetna American Axle |
$50.36
|
| Rate for Payer: Aetna Commercial |
$65.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.36
|
| Rate for Payer: BCBS Complete |
$30.99
|
| Rate for Payer: BCBS Trust/PPO |
$3.04
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$69.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.86
|
| Rate for Payer: PHP Commercial |
$65.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.24
|
| Rate for Payer: Priority Health SBD |
$48.81
|
| Rate for Payer: UMR Bronson Commercial |
$28.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.11
|
|
|
TRIAMCINOLONE ACETONIDE 80 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$77.48
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
190715
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.09 |
| Max. Negotiated Rate |
$69.73 |
| Rate for Payer: Aetna American Axle |
$50.36
|
| Rate for Payer: Aetna Commercial |
$65.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.36
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Commercial |
$54.24
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.98
|
| Rate for Payer: Healthscope Commercial |
$69.73
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$54.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$58.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$65.86
|
| Rate for Payer: PHP Commercial |
$65.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.24
|
| Rate for Payer: Priority Health SBD |
$48.81
|
| Rate for Payer: UMR Bronson Commercial |
$34.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.11
|
|
|
TRIAMCINOLONE ACETONIDE (PF) 40 MG/ML INTRAOCULAR SUSPENSION
|
Facility
|
IP
|
$524.34
|
|
|
Service Code
|
HCPCS J3300
|
| Hospital Charge Code |
89128
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$230.71 |
| Max. Negotiated Rate |
$471.91 |
| Rate for Payer: Aetna American Axle |
$340.82
|
| Rate for Payer: Aetna Commercial |
$445.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.82
|
| Rate for Payer: Cash Price |
$419.47
|
| Rate for Payer: Cofinity Commercial |
$367.04
|
| Rate for Payer: Cofinity Commercial |
$450.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$419.47
|
| Rate for Payer: Healthscope Commercial |
$471.91
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$367.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$393.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$445.69
|
| Rate for Payer: PHP Commercial |
$445.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$367.04
|
| Rate for Payer: Priority Health SBD |
$330.33
|
| Rate for Payer: UMR Bronson Commercial |
$230.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$393.26
|
|
|
TRIAMTERENE 37.5 MG-HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$243.20
|
|
|
Service Code
|
NDC 60505-2656-1
|
| Hospital Charge Code |
8132
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.01 |
| Max. Negotiated Rate |
$218.88 |
| Rate for Payer: Aetna American Axle |
$158.08
|
| Rate for Payer: Aetna Commercial |
$206.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.08
|
| Rate for Payer: Cash Price |
$194.56
|
| Rate for Payer: Cofinity Commercial |
$170.24
|
| Rate for Payer: Cofinity Commercial |
$209.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$194.56
|
| Rate for Payer: Healthscope Commercial |
$218.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$170.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$182.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$206.72
|
| Rate for Payer: PHP Commercial |
$206.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.24
|
| Rate for Payer: Priority Health SBD |
$153.22
|
| Rate for Payer: UMR Bronson Commercial |
$107.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$182.40
|
|
