|
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
|
$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
|
$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
|
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
|
IP
|
$13.57
|
|
|
Service Code
|
NDC 45802006435
|
| 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 OINTMENT
|
Facility
|
OP
|
$18.84
|
|
|
Service Code
|
NDC 45802005535
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$16.96 |
| Rate for Payer: Aetna American Axle |
$12.25
|
| Rate for Payer: Aetna Commercial |
$16.01
|
| Rate for Payer: Aetna Medicare |
$9.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.25
|
| Rate for Payer: BCBS Complete |
$7.54
|
| Rate for Payer: Cash Price |
$15.07
|
| Rate for Payer: Cofinity Advantage |
$13.19
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.07
|
| Rate for Payer: Healthscope Commercial |
$16.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.13
|
| Rate for Payer: PHP Commercial |
$16.01
|
| Rate for Payer: Priority Health SBD |
$11.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.25
|
| Rate for Payer: UHC Core |
$9.82
|
| Rate for Payer: UHC Exchange |
$7.40
|
| Rate for Payer: UMR Bronson Commercial |
$6.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.13
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
OP
|
$109.65
|
|
|
Service Code
|
NDC 45802005505
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$98.69 |
| Rate for Payer: Aetna American Axle |
$71.27
|
| Rate for Payer: Aetna Commercial |
$93.20
|
| Rate for Payer: Aetna Medicare |
$54.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.27
|
| Rate for Payer: BCBS Complete |
$43.86
|
| Rate for Payer: Cash Price |
$87.72
|
| Rate for Payer: Cofinity Advantage |
$76.75
|
| Rate for Payer: Cofinity Commercial |
$94.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.72
|
| Rate for Payer: Healthscope Commercial |
$98.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$87.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.24
|
| Rate for Payer: PHP Commercial |
$93.20
|
| Rate for Payer: Priority Health SBD |
$69.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$71.27
|
| Rate for Payer: UHC Core |
$57.13
|
| Rate for Payer: UHC Exchange |
$43.09
|
| Rate for Payer: UMR Bronson Commercial |
$40.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.24
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
IP
|
$18.84
|
|
|
Service Code
|
NDC 45802005535
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.29 |
| Max. Negotiated Rate |
$16.96 |
| Rate for Payer: Aetna American Axle |
$12.25
|
| Rate for Payer: Aetna Commercial |
$16.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.25
|
| Rate for Payer: Cash Price |
$15.07
|
| Rate for Payer: Cofinity Advantage |
$13.19
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.07
|
| Rate for Payer: Healthscope Commercial |
$16.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.13
|
| Rate for Payer: PHP Commercial |
$16.01
|
| Rate for Payer: Priority Health SBD |
$11.87
|
| Rate for Payer: UMR Bronson Commercial |
$8.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.13
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
IP
|
$109.65
|
|
|
Service Code
|
NDC 45802005505
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.25 |
| Max. Negotiated Rate |
$98.69 |
| Rate for Payer: Aetna American Axle |
$71.27
|
| Rate for Payer: Aetna Commercial |
$93.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.27
|
| Rate for Payer: Cash Price |
$87.72
|
| Rate for Payer: Cofinity Advantage |
$76.75
|
| Rate for Payer: Cofinity Commercial |
$94.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$87.72
|
| Rate for Payer: Healthscope Commercial |
$98.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$76.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$82.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$82.24
|
| Rate for Payer: PHP Commercial |
$93.20
|
| Rate for Payer: Priority Health SBD |
$69.08
|
| Rate for Payer: UMR Bronson Commercial |
$48.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$82.24
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
IP
|
$11.07
|
|
|
Service Code
|
NDC 33342033315
|
| Hospital Charge Code |
8118
|
|
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 OINTMENT
|
Facility
|
OP
|
$11.07
|
|
|
Service Code
|
NDC 33342033315
|
| Hospital Charge Code |
8118
|
|
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 0.5 % TOPICAL CREAM
|
Facility
|
IP
|
$26.67
|
|
|
Service Code
|
NDC 45802006578
|
| Hospital Charge Code |
8114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna American Axle |
$17.34
|
| Rate for Payer: Aetna Commercial |
$22.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.34
|
| Rate for Payer: Cash Price |
$21.34
|
| Rate for Payer: Cofinity Advantage |
$18.67
|
| Rate for Payer: Cofinity Commercial |
$22.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.34
|
| Rate for Payer: Healthscope Commercial |
$24.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.00
|
| Rate for Payer: PHP Commercial |
$22.67
|
| Rate for Payer: Priority Health SBD |
$16.80
|
| Rate for Payer: UMR Bronson Commercial |
$11.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.00
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL CREAM
|
Facility
|
OP
|
$18.84
|
|
|
Service Code
|
NDC 67877031815
|
| Hospital Charge Code |
8114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$16.96 |
| Rate for Payer: Aetna American Axle |
$12.25
|
| Rate for Payer: Aetna Commercial |
$16.01
|
| Rate for Payer: Aetna Medicare |
$9.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.25
|
| Rate for Payer: BCBS Complete |
$7.54
|
| Rate for Payer: Cash Price |
$15.07
|
| Rate for Payer: Cofinity Advantage |
$13.19
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.07
|
| Rate for Payer: Healthscope Commercial |
$16.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.13
|
| Rate for Payer: PHP Commercial |
$16.01
|
| Rate for Payer: Priority Health SBD |
$11.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.25
|
| Rate for Payer: UHC Core |
$9.82
|
| Rate for Payer: UHC Exchange |
$7.40
|
| Rate for Payer: UMR Bronson Commercial |
$6.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.13
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL CREAM
|
Facility
|
OP
|
$26.67
|
|
|
Service Code
|
NDC 45802006535
|
| Hospital Charge Code |
8114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna American Axle |
$17.34
|
| Rate for Payer: Aetna Commercial |
$22.67
|
| Rate for Payer: Aetna Medicare |
$13.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.34
|
| Rate for Payer: BCBS Complete |
$10.67
|
| Rate for Payer: Cash Price |
$21.34
|
| Rate for Payer: Cofinity Advantage |
$18.67
|
| Rate for Payer: Cofinity Commercial |
$22.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.34
|
| Rate for Payer: Healthscope Commercial |
$24.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.00
|
| Rate for Payer: PHP Commercial |
$22.67
|
| Rate for Payer: Priority Health SBD |
$16.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.34
|
| Rate for Payer: UHC Core |
$13.90
|
| Rate for Payer: UHC Exchange |
$10.48
|
| Rate for Payer: UMR Bronson Commercial |
$9.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.00
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL CREAM
|
Facility
|
IP
|
$26.67
|
|
|
Service Code
|
NDC 45802006535
|
| Hospital Charge Code |
8114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna American Axle |
$17.34
|
| Rate for Payer: Aetna Commercial |
$22.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.34
|
| Rate for Payer: Cash Price |
$21.34
|
| Rate for Payer: Cofinity Advantage |
$18.67
|
| Rate for Payer: Cofinity Commercial |
$22.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.34
|
| Rate for Payer: Healthscope Commercial |
$24.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.00
|
| Rate for Payer: PHP Commercial |
$22.67
|
| Rate for Payer: Priority Health SBD |
$16.80
|
| Rate for Payer: UMR Bronson Commercial |
$11.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.00
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL CREAM
|
Facility
|
IP
|
$18.84
|
|
|
Service Code
|
NDC 67877031815
|
| Hospital Charge Code |
8114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.29 |
| Max. Negotiated Rate |
$16.96 |
| Rate for Payer: Aetna American Axle |
$12.25
|
| Rate for Payer: Aetna Commercial |
$16.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.25
|
| Rate for Payer: Cash Price |
$15.07
|
| Rate for Payer: Cofinity Advantage |
$13.19
|
| Rate for Payer: Cofinity Commercial |
$16.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.07
|
| Rate for Payer: Healthscope Commercial |
$16.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.13
|
| Rate for Payer: PHP Commercial |
$16.01
|
| Rate for Payer: Priority Health SBD |
$11.87
|
| Rate for Payer: UMR Bronson Commercial |
$8.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.13
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL CREAM
|
Facility
|
OP
|
$26.67
|
|
|
Service Code
|
NDC 45802006578
|
| Hospital Charge Code |
8114
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna American Axle |
$17.34
|
| Rate for Payer: Aetna Commercial |
$22.67
|
| Rate for Payer: Aetna Medicare |
$13.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.34
|
| Rate for Payer: BCBS Complete |
$10.67
|
| Rate for Payer: Cash Price |
$21.34
|
| Rate for Payer: Cofinity Advantage |
$18.67
|
| Rate for Payer: Cofinity Commercial |
$22.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.34
|
| Rate for Payer: Healthscope Commercial |
$24.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$21.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.00
|
| Rate for Payer: PHP Commercial |
$22.67
|
| Rate for Payer: Priority Health SBD |
$16.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.34
|
| Rate for Payer: UHC Core |
$13.90
|
| Rate for Payer: UHC Exchange |
$10.48
|
| Rate for Payer: UMR Bronson Commercial |
$9.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.00
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL OINTMENT
|
Facility
|
IP
|
$18.36
|
|
|
Service Code
|
NDC 45802004935
|
| Hospital Charge Code |
8119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Aetna American Axle |
$11.93
|
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.93
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cofinity Advantage |
$12.85
|
| Rate for Payer: Cofinity Commercial |
$15.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.77
|
| Rate for Payer: PHP Commercial |
$15.61
|
| Rate for Payer: Priority Health SBD |
$11.57
|
| Rate for Payer: UMR Bronson Commercial |
$8.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.77
|
|
|
TRIAMCINOLONE ACETONIDE 0.5 % TOPICAL OINTMENT
|
Facility
|
OP
|
$18.36
|
|
|
Service Code
|
NDC 45802004935
|
| Hospital Charge Code |
8119
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Aetna American Axle |
$11.93
|
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: Aetna Medicare |
$9.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.93
|
| Rate for Payer: BCBS Complete |
$7.34
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Cofinity Advantage |
$12.85
|
| Rate for Payer: Cofinity Commercial |
$15.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.69
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.77
|
| Rate for Payer: PHP Commercial |
$15.61
|
| Rate for Payer: Priority Health SBD |
$11.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.93
|
| Rate for Payer: UHC Core |
$9.57
|
| Rate for Payer: UHC Exchange |
$7.22
|
| Rate for Payer: UMR Bronson Commercial |
$6.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.77
|
|
|
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 Advantage |
$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 Commercial |
$70.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.38
|
| Rate for Payer: PHP Commercial |
$70.70
|
| 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 10 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
OP
|
$83.18
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
11584
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$74.86 |
| Rate for Payer: Aetna American Axle |
$54.07
|
| Rate for Payer: Aetna Commercial |
$70.70
|
| Rate for Payer: Aetna Medicare |
$41.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.07
|
| Rate for Payer: BCBS Complete |
$33.27
|
| Rate for Payer: BCBS Trust/PPO |
$2.39
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: Cash Price |
$66.54
|
| Rate for Payer: Cash Price |
$66.54
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$66.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.38
|
| Rate for Payer: PHP Commercial |
$70.70
|
| Rate for Payer: Priority Health SBD |
$52.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.22
|
| Rate for Payer: UHC Core |
$1.22
|
| Rate for Payer: UHC Exchange |
$1.22
|
| Rate for Payer: UMR Bronson Commercial |
$30.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.38
|
|
|
TRIAMCINOLONE ACETONIDE 40 MG/ML SUSPENSION FOR INJECTION
|
Facility
|
IP
|
$25.61
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
8120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$23.05 |
| Rate for Payer: Aetna American Axle |
$16.65
|
| Rate for Payer: Aetna American Axle |
$12.30
|
| Rate for Payer: Aetna American Axle |
$25.17
|
| Rate for Payer: Aetna American Axle |
$10.58
|
| Rate for Payer: Aetna Commercial |
$32.91
|
| Rate for Payer: Aetna Commercial |
$21.77
|
| Rate for Payer: Aetna Commercial |
$13.84
|
| Rate for Payer: Aetna Commercial |
$16.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.58
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cash Price |
$30.98
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: Cash Price |
$20.49
|
| Rate for Payer: Cofinity Advantage |
$13.25
|
| Rate for Payer: Cofinity Advantage |
$11.40
|
| Rate for Payer: Cofinity Advantage |
$17.93
|
| Rate for Payer: Cofinity Advantage |
$27.10
|
| Rate for Payer: Cofinity Commercial |
$22.02
|
| Rate for Payer: Cofinity Commercial |
$14.00
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Cofinity Commercial |
$33.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.14
|
| Rate for Payer: Healthscope Commercial |
$17.04
|
| Rate for Payer: Healthscope Commercial |
$34.85
|
| Rate for Payer: Healthscope Commercial |
$23.05
|
| Rate for Payer: Healthscope Commercial |
$14.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.21
|
| Rate for Payer: PHP Commercial |
$13.84
|
| Rate for Payer: PHP Commercial |
$21.77
|
| Rate for Payer: PHP Commercial |
$16.09
|
| Rate for Payer: PHP Commercial |
$32.91
|
| Rate for Payer: Priority Health SBD |
$24.39
|
| Rate for Payer: Priority Health SBD |
$10.26
|
| Rate for Payer: Priority Health SBD |
$16.13
|
| Rate for Payer: Priority Health SBD |
$11.93
|
| Rate for Payer: UMR Bronson Commercial |
$8.33
|
| Rate for Payer: UMR Bronson Commercial |
$11.27
|
| Rate for Payer: UMR Bronson Commercial |
$7.16
|
| Rate for Payer: UMR Bronson Commercial |
$17.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.04
|
|
|
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 |
$1.22 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: Aetna American Axle |
$25.17
|
| Rate for Payer: Aetna American Axle |
$10.58
|
| Rate for Payer: Aetna American Axle |
$12.30
|
| Rate for Payer: Aetna American Axle |
$16.65
|
| Rate for Payer: Aetna Commercial |
$32.91
|
| Rate for Payer: Aetna Commercial |
$21.77
|
| Rate for Payer: Aetna Commercial |
$13.84
|
| Rate for Payer: Aetna Commercial |
$16.09
|
| Rate for Payer: Aetna Medicare |
$12.80
|
| Rate for Payer: Aetna Medicare |
$9.46
|
| Rate for Payer: Aetna Medicare |
$19.36
|
| Rate for Payer: Aetna Medicare |
$8.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.65
|
| Rate for Payer: BCBS Complete |
$6.51
|
| Rate for Payer: BCBS Complete |
$7.57
|
| Rate for Payer: BCBS Complete |
$10.24
|
| Rate for Payer: BCBS Complete |
$15.49
|
| Rate for Payer: BCBS Trust/PPO |
$2.39
|
| Rate for Payer: BCBS Trust/PPO |
$2.39
|
| Rate for Payer: BCBS Trust/PPO |
$2.39
|
| Rate for Payer: BCBS Trust/PPO |
$2.39
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: Cash Price |
$20.49
|
| Rate for Payer: Cash Price |
$30.98
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cash Price |
$30.98
|
| Rate for Payer: Cash Price |
$20.49
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: Cash Price |
$13.02
|
| Rate for Payer: Cofinity Advantage |
$27.10
|
| Rate for Payer: Cofinity Advantage |
$17.93
|
| Rate for Payer: Cofinity Advantage |
$13.25
|
| Rate for Payer: Cofinity Advantage |
$11.40
|
| Rate for Payer: Cofinity Commercial |
$16.28
|
| Rate for Payer: Cofinity Commercial |
$22.02
|
| Rate for Payer: Cofinity Commercial |
$33.30
|
| Rate for Payer: Cofinity Commercial |
$14.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$30.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.02
|
| Rate for Payer: Healthscope Commercial |
$23.05
|
| Rate for Payer: Healthscope Commercial |
$14.65
|
| Rate for Payer: Healthscope Commercial |
$17.04
|
| Rate for Payer: Healthscope Commercial |
$34.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$17.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$30.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.02
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.04
|
| Rate for Payer: PHP Commercial |
$13.84
|
| Rate for Payer: PHP Commercial |
$21.77
|
| Rate for Payer: PHP Commercial |
$32.91
|
| Rate for Payer: PHP Commercial |
$16.09
|
| Rate for Payer: Priority Health SBD |
$16.13
|
| Rate for Payer: Priority Health SBD |
$10.26
|
| Rate for Payer: Priority Health SBD |
$11.93
|
| Rate for Payer: Priority Health SBD |
$24.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.22
|
| Rate for Payer: UHC Core |
$1.22
|
| Rate for Payer: UHC Core |
$1.22
|
| Rate for Payer: UHC Core |
$1.22
|
| Rate for Payer: UHC Core |
$1.22
|
| Rate for Payer: UHC Exchange |
$1.22
|
| Rate for Payer: UHC Exchange |
$1.22
|
| Rate for Payer: UHC Exchange |
$1.22
|
| Rate for Payer: UHC Exchange |
$1.22
|
| Rate for Payer: UMR Bronson Commercial |
$14.33
|
| Rate for Payer: UMR Bronson Commercial |
$6.02
|
| Rate for Payer: UMR Bronson Commercial |
$7.00
|
| Rate for Payer: UMR Bronson Commercial |
$9.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.04
|
|
|
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 Advantage |
$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 Commercial |
$65.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.11
|
| Rate for Payer: PHP Commercial |
$65.86
|
| 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 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 |
$1.22 |
| Max. Negotiated Rate |
$69.73 |
| Rate for Payer: Aetna American Axle |
$50.36
|
| Rate for Payer: Aetna Commercial |
$65.86
|
| Rate for Payer: Aetna Medicare |
$38.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.36
|
| Rate for Payer: BCBS Complete |
$30.99
|
| Rate for Payer: BCBS Trust/PPO |
$2.39
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cash Price |
$61.98
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$61.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$58.11
|
| Rate for Payer: PHP Commercial |
$65.86
|
| Rate for Payer: Priority Health SBD |
$48.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.22
|
| Rate for Payer: UHC Core |
$1.22
|
| Rate for Payer: UHC Exchange |
$1.22
|
| Rate for Payer: UMR Bronson Commercial |
$28.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$58.11
|
|
