|
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 Commercial |
$146.90
|
| Rate for Payer: Cofinity Commercial |
$180.48
|
| Rate for Payer: Cofinity Medicare Advantage |
$146.90
|
| 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: PHP Commercial |
$178.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.41
|
| 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
|
$87.47
|
|
|
Service Code
|
NDC 64980032005
|
| Hospital Charge Code |
8121
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.36 |
| Max. Negotiated Rate |
$78.72 |
| Rate for Payer: Aetna American Axle |
$56.86
|
| Rate for Payer: Aetna Commercial |
$74.35
|
| Rate for Payer: Aetna Medicare |
$43.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.86
|
| Rate for Payer: BCBS Complete |
$34.99
|
| Rate for Payer: Cash Price |
$69.98
|
| Rate for Payer: Cofinity Commercial |
$61.23
|
| Rate for Payer: Cofinity Commercial |
$75.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$61.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.98
|
| Rate for Payer: Healthscope Commercial |
$78.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$61.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$65.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.35
|
| Rate for Payer: PHP Commercial |
$74.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.86
|
| Rate for Payer: Priority Health SBD |
$55.11
|
| Rate for Payer: UMR Bronson Commercial |
$32.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$65.60
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE
|
Facility
|
IP
|
$207.59
|
|
|
Service Code
|
NDC 51672126705
|
| 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: Cofinity Medicare Advantage |
$145.31
|
| 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 Commercial |
$176.45
|
| Rate for Payer: PHP Commercial |
$176.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.93
|
| 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
|
$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 Commercial |
$74.82
|
| Rate for Payer: Cofinity Commercial |
$91.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.82
|
| 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: PHP Commercial |
$90.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.48
|
| 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
|
$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 |
$53.44
|
| 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 Commercial |
$74.82
|
| Rate for Payer: Cofinity Commercial |
$91.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$74.82
|
| 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: PHP Commercial |
$90.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.48
|
| Rate for Payer: Priority Health SBD |
$67.34
|
| 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
|
OP
|
$52.50
|
|
|
Service Code
|
NDC 70752013005
|
| Hospital Charge Code |
8116
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.42 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Aetna American Axle |
$34.12
|
| Rate for Payer: Aetna Commercial |
$44.62
|
| Rate for Payer: Aetna Medicare |
$26.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.12
|
| Rate for Payer: BCBS Complete |
$21.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cofinity Commercial |
$36.75
|
| Rate for Payer: Cofinity Commercial |
$45.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.00
|
| Rate for Payer: Healthscope Commercial |
$47.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.62
|
| Rate for Payer: PHP Commercial |
$44.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.12
|
| Rate for Payer: Priority Health SBD |
$33.08
|
| Rate for Payer: UMR Bronson Commercial |
$19.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.38
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % LOTION
|
Facility
|
IP
|
$52.50
|
|
|
Service Code
|
NDC 70752013005
|
| Hospital Charge Code |
8116
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.10 |
| Max. Negotiated Rate |
$47.25 |
| Rate for Payer: Aetna American Axle |
$34.12
|
| Rate for Payer: Aetna Commercial |
$44.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.12
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cofinity Commercial |
$36.75
|
| Rate for Payer: Cofinity Commercial |
$45.15
|
| Rate for Payer: Cofinity Medicare Advantage |
$36.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$42.00
|
| Rate for Payer: Healthscope Commercial |
$47.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$36.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$39.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44.62
|
| Rate for Payer: PHP Commercial |
$44.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.12
|
| Rate for Payer: Priority Health SBD |
$33.08
|
| Rate for Payer: UMR Bronson Commercial |
$23.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$39.38
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$57.21
|
|
|
Service Code
|
NDC 67877025145
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$51.49 |
| Rate for Payer: Aetna American Axle |
$37.19
|
| Rate for Payer: Aetna Commercial |
$48.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.19
|
| Rate for Payer: Cash Price |
$45.77
|
| Rate for Payer: Cofinity Commercial |
$40.05
|
| Rate for Payer: Cofinity Commercial |
$49.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.05
|
| 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: Multiplan/Beech St/PHCS Commercial |
$48.63
|
| Rate for Payer: PHP Commercial |
$48.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.19
|
| Rate for Payer: Priority Health SBD |
$36.04
|
| Rate for Payer: UMR Bronson Commercial |
$25.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$42.91
|
|
|
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 Commercial |
$44.49
|
| Rate for Payer: Cofinity Commercial |
$54.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.49
|
| 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: PHP Commercial |
$54.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.31
|
| 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
|
$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 Commercial |
$7.75
|
| Rate for Payer: Cofinity Commercial |
$9.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.75
|
| 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: PHP Commercial |
$9.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.20
|
| Rate for Payer: Priority Health SBD |
$6.97
|
| 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
|
$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 |
$6.78
|
| 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 Commercial |
$11.67
|
| Rate for Payer: Cofinity Commercial |
$9.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 Commercial |
$11.53
|
| Rate for Payer: PHP Commercial |
$11.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.82
|
| Rate for Payer: Priority Health SBD |
$8.55
|
| Rate for Payer: UMR Bronson Commercial |
$5.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.18
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM
|
Facility
|
IP
|
$10.33
|
|
|
Service Code
|
NDC 67877025115
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$9.30 |
| Rate for Payer: Aetna American Axle |
$6.71
|
| Rate for Payer: Aetna Commercial |
$8.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.71
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Cofinity Commercial |
$7.23
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$9.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.78
|
| Rate for Payer: PHP Commercial |
$8.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.71
|
| Rate for Payer: Priority Health SBD |
$6.51
|
| Rate for Payer: UMR Bronson Commercial |
$4.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.75
|
|
|
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 Commercial |
$7.75
|
| Rate for Payer: Cofinity Commercial |
$9.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.75
|
| 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: PHP Commercial |
$9.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.20
|
| 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
|
$57.21
|
|
|
Service Code
|
NDC 67877025145
|
| 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 |
$28.60
|
| 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 Commercial |
$40.05
|
| Rate for Payer: Cofinity Commercial |
$49.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.05
|
| 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: Multiplan/Beech St/PHCS Commercial |
$48.63
|
| Rate for Payer: PHP Commercial |
$48.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.19
|
| Rate for Payer: Priority Health SBD |
$36.04
|
| 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
|
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 Commercial |
$11.67
|
| Rate for Payer: Cofinity Commercial |
$9.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 Commercial |
$11.53
|
| Rate for Payer: PHP Commercial |
$11.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.82
|
| 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
|
$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 Commercial |
$11.67
|
| Rate for Payer: Cofinity Commercial |
$9.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 Commercial |
$11.53
|
| Rate for Payer: PHP Commercial |
$11.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.82
|
| 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
|
$13.57
|
|
|
Service Code
|
NDC 00713022515
|
| 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 |
$6.78
|
| 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 Commercial |
$11.67
|
| Rate for Payer: Cofinity Commercial |
$9.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 Commercial |
$11.53
|
| Rate for Payer: PHP Commercial |
$11.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.82
|
| Rate for Payer: Priority Health SBD |
$8.55
|
| Rate for Payer: UMR Bronson Commercial |
$5.02
|
| 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 Commercial |
$44.49
|
| Rate for Payer: Cofinity Commercial |
$54.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$44.49
|
| 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: PHP Commercial |
$54.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.31
|
| Rate for Payer: Priority Health SBD |
$40.04
|
| 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
|
OP
|
$10.33
|
|
|
Service Code
|
NDC 67877025115
|
| Hospital Charge Code |
8113
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$9.30 |
| Rate for Payer: Aetna American Axle |
$6.71
|
| Rate for Payer: Aetna Commercial |
$8.78
|
| Rate for Payer: Aetna Medicare |
$5.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.71
|
| Rate for Payer: BCBS Complete |
$4.13
|
| Rate for Payer: Cash Price |
$8.26
|
| Rate for Payer: Cofinity Commercial |
$7.23
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.26
|
| Rate for Payer: Healthscope Commercial |
$9.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.78
|
| Rate for Payer: PHP Commercial |
$8.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.71
|
| Rate for Payer: Priority Health SBD |
$6.51
|
| Rate for Payer: UMR Bronson Commercial |
$3.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.75
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
OP
|
$19.24
|
|
|
Service Code
|
NDC 45802005535
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.12 |
| Max. Negotiated Rate |
$17.32 |
| Rate for Payer: Aetna American Axle |
$12.51
|
| Rate for Payer: Aetna Commercial |
$16.35
|
| Rate for Payer: Aetna Medicare |
$9.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.51
|
| Rate for Payer: BCBS Complete |
$7.70
|
| Rate for Payer: Cash Price |
$15.39
|
| Rate for Payer: Cofinity Commercial |
$13.47
|
| Rate for Payer: Cofinity Commercial |
$16.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.47
|
| 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 Commercial |
$16.35
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.51
|
| Rate for Payer: Priority Health SBD |
$12.12
|
| Rate for Payer: UMR Bronson Commercial |
$7.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.43
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
IP
|
$19.24
|
|
|
Service Code
|
NDC 45802005535
|
| 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: Cofinity Medicare Advantage |
$13.47
|
| 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 Commercial |
$16.35
|
| Rate for Payer: PHP Commercial |
$16.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.51
|
| 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
|
$111.23
|
|
|
Service Code
|
NDC 45802005505
|
| 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: Cofinity Medicare Advantage |
$77.86
|
| 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 Commercial |
$94.55
|
| Rate for Payer: PHP Commercial |
$94.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.30
|
| 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
|
OP
|
$111.23
|
|
|
Service Code
|
NDC 45802005505
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$100.11 |
| Rate for Payer: Aetna American Axle |
$72.30
|
| Rate for Payer: Aetna Commercial |
$94.55
|
| Rate for Payer: Aetna Medicare |
$55.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.30
|
| Rate for Payer: BCBS Complete |
$44.49
|
| Rate for Payer: Cash Price |
$88.98
|
| Rate for Payer: Cofinity Commercial |
$77.86
|
| Rate for Payer: Cofinity Commercial |
$95.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$77.86
|
| 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 Commercial |
$94.55
|
| Rate for Payer: PHP Commercial |
$94.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.30
|
| Rate for Payer: Priority Health SBD |
$70.07
|
| Rate for Payer: UMR Bronson Commercial |
$41.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$83.42
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
OP
|
$11.61
|
|
|
Service Code
|
NDC 33342033315
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Aetna American Axle |
$7.55
|
| Rate for Payer: Aetna Commercial |
$9.87
|
| Rate for Payer: Aetna Medicare |
$5.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.55
|
| Rate for Payer: BCBS Complete |
$4.64
|
| Rate for Payer: Cash Price |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Cofinity Commercial |
$9.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.29
|
| Rate for Payer: Healthscope Commercial |
$10.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.87
|
| Rate for Payer: PHP Commercial |
$9.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.55
|
| Rate for Payer: Priority Health SBD |
$7.31
|
| Rate for Payer: UMR Bronson Commercial |
$4.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.71
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT
|
Facility
|
IP
|
$11.61
|
|
|
Service Code
|
NDC 33342033315
|
| Hospital Charge Code |
8118
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.11 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Aetna American Axle |
$7.55
|
| Rate for Payer: Aetna Commercial |
$9.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.55
|
| Rate for Payer: Cash Price |
$9.29
|
| Rate for Payer: Cofinity Commercial |
$8.13
|
| Rate for Payer: Cofinity Commercial |
$9.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$8.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.29
|
| Rate for Payer: Healthscope Commercial |
$10.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.87
|
| Rate for Payer: PHP Commercial |
$9.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.55
|
| Rate for Payer: Priority Health SBD |
$7.31
|
| Rate for Payer: UMR Bronson Commercial |
$5.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.71
|
|
