|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
OP
|
$9,254.07
|
|
|
Service Code
|
NDC 10370026801
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,424.01 |
| Max. Negotiated Rate |
$8,328.66 |
| Rate for Payer: Aetna American Axle |
$6,015.15
|
| Rate for Payer: Aetna Commercial |
$7,865.96
|
| Rate for Payer: Aetna Medicare |
$4,627.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,015.15
|
| Rate for Payer: BCBS Complete |
$3,701.63
|
| Rate for Payer: Cash Price |
$7,403.26
|
| Rate for Payer: Cofinity Advantage |
$6,477.85
|
| Rate for Payer: Cofinity Commercial |
$7,958.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,403.26
|
| Rate for Payer: Healthscope Commercial |
$8,328.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,477.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,940.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7,403.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,865.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,940.55
|
| Rate for Payer: PHP Commercial |
$7,865.96
|
| Rate for Payer: Priority Health SBD |
$5,830.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6,015.15
|
| Rate for Payer: UHC Core |
$4,821.37
|
| Rate for Payer: UHC Exchange |
$3,636.85
|
| Rate for Payer: UMR Bronson Commercial |
$3,424.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,940.55
|
|
|
TRETINOIN (ANTINEOPLASTIC) 10 MG CAPSULE
|
Facility
|
IP
|
$9,254.07
|
|
|
Service Code
|
NDC 00555080802
|
| Hospital Charge Code |
16005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,071.79 |
| Max. Negotiated Rate |
$8,328.66 |
| Rate for Payer: Aetna American Axle |
$6,015.15
|
| Rate for Payer: Aetna Commercial |
$7,865.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6,015.15
|
| Rate for Payer: Cash Price |
$7,403.26
|
| Rate for Payer: Cofinity Advantage |
$6,477.85
|
| Rate for Payer: Cofinity Commercial |
$7,958.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7,403.26
|
| Rate for Payer: Healthscope Commercial |
$8,328.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6,477.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6,940.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,865.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,940.55
|
| Rate for Payer: PHP Commercial |
$7,865.96
|
| Rate for Payer: Priority Health SBD |
$5,830.06
|
| Rate for Payer: UMR Bronson Commercial |
$4,071.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6,940.55
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL OINTMENT
|
Facility
|
OP
|
$20.73
|
|
|
Service Code
|
NDC 45802005435
|
| Hospital Charge Code |
8117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.67 |
| Max. Negotiated Rate |
$18.66 |
| Rate for Payer: Aetna American Axle |
$13.47
|
| Rate for Payer: Aetna Commercial |
$17.62
|
| Rate for Payer: Aetna Medicare |
$10.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.47
|
| Rate for Payer: BCBS Complete |
$8.29
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cofinity Advantage |
$14.51
|
| Rate for Payer: Cofinity Commercial |
$17.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$18.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.55
|
| Rate for Payer: PHP Commercial |
$17.62
|
| Rate for Payer: Priority Health SBD |
$13.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.47
|
| Rate for Payer: UHC Core |
$10.80
|
| Rate for Payer: UHC Exchange |
$8.15
|
| Rate for Payer: UMR Bronson Commercial |
$7.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.55
|
|
|
TRIAMCINOLONE ACETONIDE 0.025 % TOPICAL OINTMENT
|
Facility
|
IP
|
$20.73
|
|
|
Service Code
|
NDC 45802005435
|
| Hospital Charge Code |
8117
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$18.66 |
| Rate for Payer: Aetna American Axle |
$13.47
|
| Rate for Payer: Aetna Commercial |
$17.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.47
|
| Rate for Payer: Cash Price |
$16.58
|
| Rate for Payer: Cofinity Advantage |
$14.51
|
| Rate for Payer: Cofinity Commercial |
$17.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.58
|
| Rate for Payer: Healthscope Commercial |
$18.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.55
|
| Rate for Payer: PHP Commercial |
$17.62
|
| Rate for Payer: Priority Health SBD |
$13.06
|
| Rate for Payer: UMR Bronson Commercial |
$9.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.55
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE
|
Facility
|
IP
|
$89.29
|
|
|
Service Code
|
NDC 64980032005
|
| Hospital Charge Code |
8121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.29 |
| Max. Negotiated Rate |
$80.36 |
| Rate for Payer: Aetna American Axle |
$58.04
|
| Rate for Payer: Aetna Commercial |
$75.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.04
|
| Rate for Payer: Cash Price |
$71.43
|
| Rate for Payer: Cofinity Advantage |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$76.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.43
|
| Rate for Payer: Healthscope Commercial |
$80.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.97
|
| Rate for Payer: PHP Commercial |
$75.90
|
| Rate for Payer: Priority Health SBD |
$56.25
|
| Rate for Payer: UMR Bronson Commercial |
$39.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.97
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE
|
Facility
|
IP
|
$209.86
|
|
|
Service Code
|
NDC 00713065540
|
| 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 Advantage |
$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 Commercial |
$178.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.40
|
| Rate for Payer: PHP Commercial |
$178.38
|
| 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
|
$209.86
|
|
|
Service Code
|
NDC 51672126705
|
| 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 Advantage |
$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 Commercial |
$178.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.40
|
| Rate for Payer: PHP Commercial |
$178.38
|
| 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
|
OP
|
$89.29
|
|
|
Service Code
|
NDC 64980032005
|
| Hospital Charge Code |
8121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.04 |
| Max. Negotiated Rate |
$80.36 |
| Rate for Payer: Aetna American Axle |
$58.04
|
| Rate for Payer: Aetna Commercial |
$75.90
|
| Rate for Payer: Aetna Medicare |
$44.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.04
|
| Rate for Payer: BCBS Complete |
$35.72
|
| Rate for Payer: Cash Price |
$71.43
|
| Rate for Payer: Cofinity Advantage |
$62.50
|
| Rate for Payer: Cofinity Commercial |
$76.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.43
|
| Rate for Payer: Healthscope Commercial |
$80.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.97
|
| Rate for Payer: PHP Commercial |
$75.90
|
| Rate for Payer: Priority Health SBD |
$56.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.04
|
| Rate for Payer: UHC Core |
$46.52
|
| Rate for Payer: UHC Exchange |
$35.09
|
| Rate for Payer: UMR Bronson Commercial |
$33.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.97
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE
|
Facility
|
OP
|
$209.86
|
|
|
Service Code
|
NDC 00713065540
|
| Hospital Charge Code |
8121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.65 |
| Max. Negotiated Rate |
$188.87 |
| Rate for Payer: Aetna American Axle |
$136.41
|
| Rate for Payer: Aetna Commercial |
$178.38
|
| Rate for Payer: Aetna Medicare |
$104.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.41
|
| Rate for Payer: BCBS Complete |
$83.94
|
| Rate for Payer: Cash Price |
$167.89
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$167.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.40
|
| Rate for Payer: PHP Commercial |
$178.38
|
| Rate for Payer: Priority Health SBD |
$132.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.41
|
| Rate for Payer: UHC Core |
$109.34
|
| Rate for Payer: UHC Exchange |
$82.47
|
| Rate for Payer: UMR Bronson Commercial |
$77.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.40
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE
|
Facility
|
OP
|
$209.86
|
|
|
Service Code
|
NDC 51672126705
|
| Hospital Charge Code |
8121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.65 |
| Max. Negotiated Rate |
$188.87 |
| Rate for Payer: Aetna American Axle |
$136.41
|
| Rate for Payer: Aetna Commercial |
$178.38
|
| Rate for Payer: Aetna Medicare |
$104.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.41
|
| Rate for Payer: BCBS Complete |
$83.94
|
| Rate for Payer: Cash Price |
$167.89
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$167.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.40
|
| Rate for Payer: PHP Commercial |
$178.38
|
| Rate for Payer: Priority Health SBD |
$132.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.41
|
| Rate for Payer: UHC Core |
$109.34
|
| Rate for Payer: UHC Exchange |
$82.47
|
| Rate for Payer: UMR Bronson Commercial |
$77.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$157.40
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % LOTION
|
Facility
|
OP
|
$106.89
|
|
|
Service Code
|
NDC 60432056160
|
| Hospital Charge Code |
8116
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.55 |
| Max. Negotiated Rate |
$96.20 |
| Rate for Payer: Aetna American Axle |
$69.48
|
| Rate for Payer: Aetna Commercial |
$90.86
|
| Rate for Payer: Aetna Medicare |
$53.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.48
|
| Rate for Payer: BCBS Complete |
$42.76
|
| Rate for Payer: Cash Price |
$85.51
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$85.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$90.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.17
|
| Rate for Payer: PHP Commercial |
$90.86
|
| Rate for Payer: Priority Health SBD |
$67.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.48
|
| Rate for Payer: UHC Core |
$55.69
|
| Rate for Payer: UHC Exchange |
$42.01
|
| Rate for Payer: UMR Bronson Commercial |
$39.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$80.17
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % LOTION
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
NDC 70752013005
|
| Hospital Charge Code |
8116
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: Aetna American Axle |
$40.95
|
| Rate for Payer: Aetna Commercial |
$53.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.95
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cofinity Advantage |
$44.10
|
| Rate for Payer: Cofinity Commercial |
$54.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.40
|
| Rate for Payer: Healthscope Commercial |
$56.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.25
|
| Rate for Payer: PHP Commercial |
$53.55
|
| Rate for Payer: Priority Health SBD |
$39.69
|
| Rate for Payer: UMR Bronson Commercial |
$27.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.25
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % LOTION
|
Facility
|
IP
|
$106.89
|
|
|
Service Code
|
NDC 60432056160
|
| 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 Advantage |
$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 Commercial |
$90.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.17
|
| Rate for Payer: PHP Commercial |
$90.86
|
| 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 % LOTION
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
NDC 70752013005
|
| Hospital Charge Code |
8116
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.31 |
| Max. Negotiated Rate |
$56.70 |
| Rate for Payer: Aetna American Axle |
$40.95
|
| Rate for Payer: Aetna Commercial |
$53.55
|
| Rate for Payer: Aetna Medicare |
$31.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.95
|
| Rate for Payer: BCBS Complete |
$25.20
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cofinity Advantage |
$44.10
|
| Rate for Payer: Cofinity Commercial |
$54.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.40
|
| Rate for Payer: Healthscope Commercial |
$56.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$44.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$47.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.25
|
| Rate for Payer: PHP Commercial |
$53.55
|
| Rate for Payer: Priority Health SBD |
$39.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.95
|
| Rate for Payer: UHC Core |
$32.82
|
| Rate for Payer: UHC Exchange |
$24.76
|
| Rate for Payer: UMR Bronson Commercial |
$23.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.25
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$17.76
|
|
|
Service Code
|
NDC 67877025115
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$15.98 |
| Rate for Payer: Aetna American Axle |
$11.54
|
| Rate for Payer: Aetna Commercial |
$15.10
|
| Rate for Payer: Aetna Medicare |
$8.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.54
|
| Rate for Payer: BCBS Complete |
$7.10
|
| Rate for Payer: Cash Price |
$14.21
|
| Rate for Payer: Cofinity Advantage |
$12.43
|
| Rate for Payer: Cofinity Commercial |
$15.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.21
|
| Rate for Payer: Healthscope Commercial |
$15.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.32
|
| Rate for Payer: PHP Commercial |
$15.10
|
| Rate for Payer: Priority Health SBD |
$11.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.54
|
| Rate for Payer: UHC Core |
$9.25
|
| Rate for Payer: UHC Exchange |
$6.98
|
| Rate for Payer: UMR Bronson Commercial |
$6.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.32
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$63.56
|
|
|
Service Code
|
NDC 45802006405
|
| 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 Advantage |
$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 Commercial |
$54.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.67
|
| Rate for Payer: PHP Commercial |
$54.03
|
| 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
|
OP
|
$57.21
|
|
|
Service Code
|
NDC 21922006230
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.17 |
| Max. Negotiated Rate |
$51.49 |
| Rate for Payer: Aetna American Axle |
$37.19
|
| Rate for Payer: Aetna Commercial |
$48.63
|
| Rate for Payer: Aetna Medicare |
$28.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.19
|
| Rate for Payer: BCBS Complete |
$22.88
|
| Rate for Payer: Cash Price |
$45.77
|
| Rate for Payer: Cofinity Advantage |
$40.05
|
| Rate for Payer: Cofinity Commercial |
$49.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$45.77
|
| Rate for Payer: Healthscope Commercial |
$51.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$42.91
|
| Rate for Payer: MI Amish Medical Board Commercial |
$45.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.91
|
| Rate for Payer: PHP Commercial |
$48.63
|
| Rate for Payer: Priority Health SBD |
$36.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.19
|
| Rate for Payer: UHC Core |
$29.81
|
| Rate for Payer: UHC Exchange |
$22.48
|
| Rate for Payer: UMR Bronson Commercial |
$21.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.91
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$10.26
|
|
|
Service Code
|
NDC 21922006204
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$9.23 |
| Rate for Payer: Aetna American Axle |
$6.67
|
| Rate for Payer: Aetna Commercial |
$8.72
|
| Rate for Payer: Aetna Medicare |
$5.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.67
|
| Rate for Payer: BCBS Complete |
$4.10
|
| Rate for Payer: Cash Price |
$8.21
|
| Rate for Payer: Cofinity Advantage |
$7.18
|
| Rate for Payer: Cofinity Commercial |
$8.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.21
|
| Rate for Payer: Healthscope Commercial |
$9.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.70
|
| Rate for Payer: PHP Commercial |
$8.72
|
| Rate for Payer: Priority Health SBD |
$6.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.67
|
| Rate for Payer: UHC Core |
$5.35
|
| Rate for Payer: UHC Exchange |
$4.03
|
| Rate for Payer: UMR Bronson Commercial |
$3.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.70
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$13.57
|
|
|
Service Code
|
NDC 00713022515
|
| 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 Advantage |
$9.50
|
| Rate for Payer: Cofinity Commercial |
$11.67
|
| 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 Commercial |
$11.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.18
|
| Rate for Payer: PHP Commercial |
$11.53
|
| 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
|
OP
|
$63.56
|
|
|
Service Code
|
NDC 45802006405
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$57.20 |
| Rate for Payer: Aetna American Axle |
$41.31
|
| Rate for Payer: Aetna Commercial |
$54.03
|
| Rate for Payer: Aetna Medicare |
$31.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.31
|
| Rate for Payer: BCBS Complete |
$25.42
|
| Rate for Payer: Cash Price |
$50.85
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$50.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.67
|
| Rate for Payer: PHP Commercial |
$54.03
|
| Rate for Payer: Priority Health SBD |
$40.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.31
|
| Rate for Payer: UHC Core |
$33.11
|
| Rate for Payer: UHC Exchange |
$24.98
|
| Rate for Payer: UMR Bronson Commercial |
$23.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$47.67
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$73.10
|
|
|
Service Code
|
NDC 67877025145
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$65.79 |
| Rate for Payer: Aetna American Axle |
$47.52
|
| Rate for Payer: Aetna Commercial |
$62.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.52
|
| Rate for Payer: Cash Price |
$58.48
|
| Rate for Payer: Cofinity Advantage |
$51.17
|
| Rate for Payer: Cofinity Commercial |
$62.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.48
|
| Rate for Payer: Healthscope Commercial |
$65.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.83
|
| Rate for Payer: PHP Commercial |
$62.13
|
| Rate for Payer: Priority Health SBD |
$46.05
|
| Rate for Payer: UMR Bronson Commercial |
$32.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.83
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$11.07
|
|
|
Service Code
|
NDC 00168000415
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$9.96 |
| Rate for Payer: Aetna American Axle |
$7.20
|
| Rate for Payer: Aetna Commercial |
$9.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.20
|
| Rate for Payer: Cash Price |
$8.86
|
| Rate for Payer: Cofinity Advantage |
$7.75
|
| Rate for Payer: Cofinity Commercial |
$9.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.86
|
| Rate for Payer: Healthscope Commercial |
$9.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.30
|
| Rate for Payer: PHP Commercial |
$9.41
|
| Rate for Payer: Priority Health SBD |
$6.97
|
| Rate for Payer: UMR Bronson Commercial |
$4.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.30
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$11.07
|
|
|
Service Code
|
NDC 00168000415
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$9.96 |
| Rate for Payer: Aetna American Axle |
$7.20
|
| Rate for Payer: Aetna Commercial |
$9.41
|
| Rate for Payer: Aetna Medicare |
$5.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.20
|
| Rate for Payer: BCBS Complete |
$4.43
|
| Rate for Payer: Cash Price |
$8.86
|
| Rate for Payer: Cofinity Advantage |
$7.75
|
| Rate for Payer: Cofinity Commercial |
$9.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.86
|
| Rate for Payer: Healthscope Commercial |
$9.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.30
|
| Rate for Payer: PHP Commercial |
$9.41
|
| Rate for Payer: Priority Health SBD |
$6.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.20
|
| Rate for Payer: UHC Core |
$5.77
|
| Rate for Payer: UHC Exchange |
$4.35
|
| Rate for Payer: UMR Bronson Commercial |
$4.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.30
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$73.10
|
|
|
Service Code
|
NDC 67877025145
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.05 |
| Max. Negotiated Rate |
$65.79 |
| Rate for Payer: Aetna American Axle |
$47.52
|
| Rate for Payer: Aetna Commercial |
$62.13
|
| Rate for Payer: Aetna Medicare |
$36.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.52
|
| Rate for Payer: BCBS Complete |
$29.24
|
| Rate for Payer: Cash Price |
$58.48
|
| Rate for Payer: Cofinity Advantage |
$51.17
|
| Rate for Payer: Cofinity Commercial |
$62.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$58.48
|
| Rate for Payer: Healthscope Commercial |
$65.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.17
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.83
|
| Rate for Payer: PHP Commercial |
$62.13
|
| Rate for Payer: Priority Health SBD |
$46.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$47.52
|
| Rate for Payer: UHC Core |
$38.09
|
| Rate for Payer: UHC Exchange |
$28.73
|
| Rate for Payer: UMR Bronson Commercial |
$27.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.83
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
OP
|
$13.57
|
|
|
Service Code
|
NDC 45802006435
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$12.21 |
| Rate for Payer: Aetna American Axle |
$8.82
|
| Rate for Payer: Aetna Commercial |
$11.53
|
| Rate for Payer: Aetna Medicare |
$6.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.82
|
| Rate for Payer: BCBS Complete |
$5.43
|
| Rate for Payer: Cash Price |
$10.86
|
| Rate for Payer: Cofinity Advantage |
$9.50
|
| Rate for Payer: Cofinity Commercial |
$11.67
|
| 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: MI Amish Medical Board Commercial |
$10.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.18
|
| Rate for Payer: PHP Commercial |
$11.53
|
| Rate for Payer: Priority Health SBD |
$8.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.82
|
| Rate for Payer: UHC Core |
$7.07
|
| Rate for Payer: UHC Exchange |
$5.33
|
| Rate for Payer: UMR Bronson Commercial |
$5.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.18
|
|
