|
HYDROCORTISONE 0.5 % TOPICAL CREAM
|
Facility
|
IP
|
$21.60
|
|
|
Service Code
|
NDC 51672-2010-2
|
| Hospital Charge Code |
3725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$19.44 |
| Rate for Payer: Aetna American Axle |
$14.04
|
| Rate for Payer: Aetna Commercial |
$18.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.04
|
| Rate for Payer: Cash Price |
$17.28
|
| Rate for Payer: Cofinity Commercial |
$15.12
|
| Rate for Payer: Cofinity Commercial |
$18.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.28
|
| Rate for Payer: Healthscope Commercial |
$19.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.36
|
| Rate for Payer: PHP Commercial |
$18.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.12
|
| Rate for Payer: Priority Health SBD |
$13.61
|
| Rate for Payer: UMR Bronson Commercial |
$9.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.20
|
|
|
HYDROCORTISONE 100 MG/60 ML ENEMA
|
Facility
|
IP
|
$136.77
|
|
|
Service Code
|
NDC 62559-138-07
|
| Hospital Charge Code |
10210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.18 |
| Max. Negotiated Rate |
$123.09 |
| Rate for Payer: Aetna American Axle |
$88.90
|
| Rate for Payer: Aetna Commercial |
$116.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.90
|
| Rate for Payer: Cash Price |
$109.42
|
| Rate for Payer: Cofinity Commercial |
$117.62
|
| Rate for Payer: Cofinity Commercial |
$95.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.42
|
| Rate for Payer: Healthscope Commercial |
$123.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.25
|
| Rate for Payer: PHP Commercial |
$116.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.74
|
| Rate for Payer: Priority Health SBD |
$86.17
|
| Rate for Payer: UMR Bronson Commercial |
$60.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.58
|
|
|
HYDROCORTISONE 100 MG/60 ML ENEMA
|
Facility
|
IP
|
$136.77
|
|
|
Service Code
|
NDC 62559-138-11
|
| Hospital Charge Code |
10210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.18 |
| Max. Negotiated Rate |
$123.09 |
| Rate for Payer: Aetna American Axle |
$88.90
|
| Rate for Payer: Aetna Commercial |
$116.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.90
|
| Rate for Payer: Cash Price |
$109.42
|
| Rate for Payer: Cofinity Commercial |
$117.62
|
| Rate for Payer: Cofinity Commercial |
$95.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$109.42
|
| Rate for Payer: Healthscope Commercial |
$123.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$95.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$102.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$116.25
|
| Rate for Payer: PHP Commercial |
$116.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.74
|
| Rate for Payer: Priority Health SBD |
$86.17
|
| Rate for Payer: UMR Bronson Commercial |
$60.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$102.58
|
|
|
HYDROCORTISONE 1 %-PRAMOXINE 1 % RECTAL FOAM
|
Facility
|
IP
|
$539.42
|
|
|
Service Code
|
NDC 0037-6822-10
|
| Hospital Charge Code |
28849
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$237.34 |
| Max. Negotiated Rate |
$485.48 |
| Rate for Payer: Aetna American Axle |
$350.62
|
| Rate for Payer: Aetna Commercial |
$458.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$350.62
|
| Rate for Payer: Cash Price |
$431.54
|
| Rate for Payer: Cofinity Commercial |
$377.59
|
| Rate for Payer: Cofinity Commercial |
$463.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$431.54
|
| Rate for Payer: Healthscope Commercial |
$485.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$377.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$404.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$458.51
|
| Rate for Payer: PHP Commercial |
$458.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$377.59
|
| Rate for Payer: Priority Health SBD |
$339.83
|
| Rate for Payer: UMR Bronson Commercial |
$237.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$404.56
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$7.73
|
|
|
Service Code
|
NDC 0904-7623-31
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$6.96 |
| Rate for Payer: Aetna American Axle |
$5.02
|
| Rate for Payer: Aetna Commercial |
$6.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.02
|
| Rate for Payer: Cash Price |
$6.18
|
| Rate for Payer: Cofinity Commercial |
$5.41
|
| Rate for Payer: Cofinity Commercial |
$6.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.18
|
| Rate for Payer: Healthscope Commercial |
$6.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.57
|
| Rate for Payer: PHP Commercial |
$6.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.41
|
| Rate for Payer: Priority Health SBD |
$4.87
|
| Rate for Payer: UMR Bronson Commercial |
$3.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.80
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$10.08
|
|
|
Service Code
|
NDC 0113-0541-64
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$9.07 |
| Rate for Payer: Aetna American Axle |
$6.55
|
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.55
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cofinity Commercial |
$7.06
|
| Rate for Payer: Cofinity Commercial |
$8.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.06
|
| Rate for Payer: Healthscope Commercial |
$9.07
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$8.57
|
| Rate for Payer: PHP Commercial |
$8.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.06
|
| Rate for Payer: Priority Health SBD |
$6.35
|
| Rate for Payer: UMR Bronson Commercial |
$4.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.56
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$19.05
|
|
|
Service Code
|
NDC 51672-2063-2
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Aetna American Axle |
$12.38
|
| Rate for Payer: Aetna Commercial |
$16.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.38
|
| Rate for Payer: Cash Price |
$15.24
|
| Rate for Payer: Cofinity Commercial |
$13.34
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.24
|
| Rate for Payer: Healthscope Commercial |
$17.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.19
|
| Rate for Payer: PHP Commercial |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.34
|
| Rate for Payer: Priority Health SBD |
$12.00
|
| Rate for Payer: UMR Bronson Commercial |
$8.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.29
|
|
|
HYDROCORTISONE 1 % TOPICAL OINTMENT
|
Facility
|
IP
|
$17.51
|
|
|
Service Code
|
NDC 51672-2018-2
|
| Hospital Charge Code |
3731
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.70 |
| Max. Negotiated Rate |
$15.76 |
| Rate for Payer: Aetna American Axle |
$11.38
|
| Rate for Payer: Aetna Commercial |
$14.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.38
|
| Rate for Payer: Cash Price |
$14.01
|
| Rate for Payer: Cofinity Commercial |
$12.26
|
| Rate for Payer: Cofinity Commercial |
$15.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.01
|
| Rate for Payer: Healthscope Commercial |
$15.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.88
|
| Rate for Payer: PHP Commercial |
$14.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.26
|
| Rate for Payer: Priority Health SBD |
$11.03
|
| Rate for Payer: UMR Bronson Commercial |
$7.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.13
|
|
|
HYDROCORTISONE 1 % TOPICAL OINTMENT
|
Facility
|
IP
|
$7.74
|
|
|
Service Code
|
NDC 59390-080-17
|
| Hospital Charge Code |
3731
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$6.97 |
| Rate for Payer: Aetna American Axle |
$5.03
|
| Rate for Payer: Aetna Commercial |
$6.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.03
|
| Rate for Payer: Cash Price |
$6.19
|
| Rate for Payer: Cofinity Commercial |
$5.42
|
| Rate for Payer: Cofinity Commercial |
$6.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.19
|
| Rate for Payer: Healthscope Commercial |
$6.97
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.58
|
| Rate for Payer: PHP Commercial |
$6.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.42
|
| Rate for Payer: Priority Health SBD |
$4.88
|
| Rate for Payer: UMR Bronson Commercial |
$3.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.80
|
|
|
HYDROCORTISONE 20 MG TABLET
|
Facility
|
IP
|
$334.40
|
|
|
Service Code
|
NDC 0115-1700-01
|
| Hospital Charge Code |
3734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.14 |
| Max. Negotiated Rate |
$300.96 |
| Rate for Payer: Aetna American Axle |
$217.36
|
| Rate for Payer: Aetna Commercial |
$284.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.36
|
| Rate for Payer: Cash Price |
$267.52
|
| Rate for Payer: Cofinity Commercial |
$234.08
|
| Rate for Payer: Cofinity Commercial |
$287.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$267.52
|
| Rate for Payer: Healthscope Commercial |
$300.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$234.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$284.24
|
| Rate for Payer: PHP Commercial |
$284.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.08
|
| Rate for Payer: Priority Health SBD |
$210.67
|
| Rate for Payer: UMR Bronson Commercial |
$147.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.80
|
|
|
HYDROCORTISONE 20 MG TABLET
|
Facility
|
IP
|
$450.30
|
|
|
Service Code
|
NDC 42543-142-01
|
| Hospital Charge Code |
3734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.13 |
| Max. Negotiated Rate |
$405.27 |
| Rate for Payer: Aetna American Axle |
$292.70
|
| Rate for Payer: Aetna Commercial |
$382.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.70
|
| Rate for Payer: Cash Price |
$360.24
|
| Rate for Payer: Cofinity Commercial |
$315.21
|
| Rate for Payer: Cofinity Commercial |
$387.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$360.24
|
| Rate for Payer: Healthscope Commercial |
$405.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$315.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$337.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$382.76
|
| Rate for Payer: PHP Commercial |
$382.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.21
|
| Rate for Payer: Priority Health SBD |
$283.69
|
| Rate for Payer: UMR Bronson Commercial |
$198.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.72
|
|
|
HYDROCORTISONE 20 MG TABLET
|
Facility
|
IP
|
$454.10
|
|
|
Service Code
|
NDC 59762-0075-1
|
| Hospital Charge Code |
3734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.80 |
| Max. Negotiated Rate |
$408.69 |
| Rate for Payer: Aetna American Axle |
$295.16
|
| Rate for Payer: Aetna Commercial |
$385.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.16
|
| Rate for Payer: Cash Price |
$363.28
|
| Rate for Payer: Cofinity Commercial |
$317.87
|
| Rate for Payer: Cofinity Commercial |
$390.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$363.28
|
| Rate for Payer: Healthscope Commercial |
$408.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$385.98
|
| Rate for Payer: PHP Commercial |
$385.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.87
|
| Rate for Payer: Priority Health SBD |
$286.08
|
| Rate for Payer: UMR Bronson Commercial |
$199.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.58
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM
|
Facility
|
IP
|
$9.18
|
|
|
Service Code
|
NDC 0168-0080-31
|
| Hospital Charge Code |
3727
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$8.26 |
| Rate for Payer: Aetna American Axle |
$5.97
|
| Rate for Payer: Aetna Commercial |
$7.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.97
|
| Rate for Payer: Cash Price |
$7.34
|
| Rate for Payer: Cofinity Commercial |
$6.43
|
| Rate for Payer: Cofinity Commercial |
$7.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.34
|
| Rate for Payer: Healthscope Commercial |
$8.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$7.80
|
| Rate for Payer: PHP Commercial |
$7.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.43
|
| Rate for Payer: Priority Health SBD |
$5.78
|
| Rate for Payer: UMR Bronson Commercial |
$4.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.88
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
NDC 10631-407-01
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.64 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Aetna American Axle |
$150.15
|
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.15
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$198.66
|
| Rate for Payer: Cofinity Commercial |
$161.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.80
|
| Rate for Payer: Healthscope Commercial |
$207.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$173.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$196.35
|
| Rate for Payer: PHP Commercial |
$196.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.70
|
| Rate for Payer: Priority Health SBD |
$145.53
|
| Rate for Payer: UMR Bronson Commercial |
$101.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.25
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$229.11
|
|
|
Service Code
|
NDC 69315-302-30
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.81 |
| Max. Negotiated Rate |
$206.20 |
| Rate for Payer: Aetna American Axle |
$148.92
|
| Rate for Payer: Aetna Commercial |
$194.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.92
|
| Rate for Payer: Cash Price |
$183.29
|
| Rate for Payer: Cofinity Commercial |
$197.03
|
| Rate for Payer: Cofinity Commercial |
$160.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$183.29
|
| Rate for Payer: Healthscope Commercial |
$206.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$160.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$171.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$194.74
|
| Rate for Payer: PHP Commercial |
$194.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.38
|
| Rate for Payer: Priority Health SBD |
$144.34
|
| Rate for Payer: UMR Bronson Commercial |
$100.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$171.83
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$26.76
|
|
|
Service Code
|
NDC 69315-312-28
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$24.08 |
| Rate for Payer: Aetna American Axle |
$17.39
|
| Rate for Payer: Aetna Commercial |
$22.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.39
|
| Rate for Payer: Cash Price |
$21.41
|
| Rate for Payer: Cofinity Commercial |
$18.73
|
| Rate for Payer: Cofinity Commercial |
$23.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.41
|
| Rate for Payer: Healthscope Commercial |
$24.08
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.75
|
| Rate for Payer: PHP Commercial |
$22.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.73
|
| Rate for Payer: Priority Health SBD |
$16.86
|
| Rate for Payer: UMR Bronson Commercial |
$11.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.07
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$155.30
|
|
|
Service Code
|
NDC 64980-301-30
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.33 |
| Max. Negotiated Rate |
$139.77 |
| Rate for Payer: Aetna American Axle |
$100.94
|
| Rate for Payer: Aetna Commercial |
$132.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.94
|
| Rate for Payer: Cash Price |
$124.24
|
| Rate for Payer: Cofinity Commercial |
$108.71
|
| Rate for Payer: Cofinity Commercial |
$133.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$124.24
|
| Rate for Payer: Healthscope Commercial |
$139.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$108.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$116.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$132.00
|
| Rate for Payer: PHP Commercial |
$132.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.71
|
| Rate for Payer: Priority Health SBD |
$97.84
|
| Rate for Payer: UMR Bronson Commercial |
$68.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.48
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$28.88
|
|
|
Service Code
|
NDC 64980-324-30
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$25.99 |
| Rate for Payer: Aetna American Axle |
$18.77
|
| Rate for Payer: Aetna Commercial |
$24.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.77
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cofinity Commercial |
$20.22
|
| Rate for Payer: Cofinity Commercial |
$24.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.10
|
| Rate for Payer: Healthscope Commercial |
$25.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$24.55
|
| Rate for Payer: PHP Commercial |
$24.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.22
|
| Rate for Payer: Priority Health SBD |
$18.19
|
| Rate for Payer: UMR Bronson Commercial |
$12.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.66
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$230.48
|
|
|
Service Code
|
NDC 62559-431-30
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.41 |
| Max. Negotiated Rate |
$207.43 |
| Rate for Payer: Aetna American Axle |
$149.81
|
| Rate for Payer: Aetna Commercial |
$195.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$149.81
|
| Rate for Payer: Cash Price |
$184.38
|
| Rate for Payer: Cofinity Commercial |
$161.34
|
| Rate for Payer: Cofinity Commercial |
$198.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$184.38
|
| Rate for Payer: Healthscope Commercial |
$207.43
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$161.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$172.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$195.91
|
| Rate for Payer: PHP Commercial |
$195.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.34
|
| Rate for Payer: Priority Health SBD |
$145.20
|
| Rate for Payer: UMR Bronson Commercial |
$101.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$172.86
|
|
|
HYDROCORTISONE 5 MG TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 59762-0073-1
|
| Hospital Charge Code |
10209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.72 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna American Axle |
$122.20
|
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$159.80
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.60
|
| Rate for Payer: Priority Health SBD |
$118.44
|
| Rate for Payer: UMR Bronson Commercial |
$82.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
HYDROCORTISONE 5 MG TABLET
|
Facility
|
IP
|
$224.40
|
|
|
Service Code
|
NDC 0009-0012-01
|
| Hospital Charge Code |
10209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.74 |
| Max. Negotiated Rate |
$201.96 |
| Rate for Payer: Aetna American Axle |
$145.86
|
| Rate for Payer: Aetna Commercial |
$190.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.86
|
| Rate for Payer: Cash Price |
$179.52
|
| Rate for Payer: Cofinity Commercial |
$157.08
|
| Rate for Payer: Cofinity Commercial |
$192.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$179.52
|
| Rate for Payer: Healthscope Commercial |
$201.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$190.74
|
| Rate for Payer: PHP Commercial |
$190.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.08
|
| Rate for Payer: Priority Health SBD |
$141.37
|
| Rate for Payer: UMR Bronson Commercial |
$98.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.30
|
|
|
HYDROCORTISONE 5 MG TABLET
|
Facility
|
IP
|
$223.25
|
|
|
Service Code
|
NDC 0115-1696-06
|
| Hospital Charge Code |
10209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.23 |
| Max. Negotiated Rate |
$200.92 |
| Rate for Payer: Aetna American Axle |
$145.11
|
| Rate for Payer: Aetna Commercial |
$189.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.11
|
| Rate for Payer: Cash Price |
$178.60
|
| Rate for Payer: Cofinity Commercial |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$156.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$178.60
|
| Rate for Payer: Healthscope Commercial |
$200.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$156.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$167.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$189.76
|
| Rate for Payer: PHP Commercial |
$189.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.28
|
| Rate for Payer: Priority Health SBD |
$140.65
|
| Rate for Payer: UMR Bronson Commercial |
$98.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$167.44
|
|
|
HYDROCORTISONE 5 MG TABLET
|
Facility
|
IP
|
$186.83
|
|
|
Service Code
|
NDC 42543-140-50
|
| Hospital Charge Code |
10209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.21 |
| Max. Negotiated Rate |
$168.15 |
| Rate for Payer: Aetna American Axle |
$121.44
|
| Rate for Payer: Aetna Commercial |
$158.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.44
|
| Rate for Payer: Cash Price |
$149.46
|
| Rate for Payer: Cofinity Commercial |
$130.78
|
| Rate for Payer: Cofinity Commercial |
$160.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$149.46
|
| Rate for Payer: Healthscope Commercial |
$168.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$130.78
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$140.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$158.81
|
| Rate for Payer: PHP Commercial |
$158.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.78
|
| Rate for Payer: Priority Health SBD |
$117.70
|
| Rate for Payer: UMR Bronson Commercial |
$82.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.12
|
|
|
HYDROCORTISONE ACETATE 10 % (80 MG) RECTAL FOAM
|
Facility
|
IP
|
$1,278.06
|
|
|
Service Code
|
NDC 0037-6830-15
|
| Hospital Charge Code |
19732
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$562.35 |
| Max. Negotiated Rate |
$1,150.25 |
| Rate for Payer: Aetna American Axle |
$830.74
|
| Rate for Payer: Aetna Commercial |
$1,086.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$830.74
|
| Rate for Payer: Cash Price |
$1,022.45
|
| Rate for Payer: Cofinity Commercial |
$1,099.13
|
| Rate for Payer: Cofinity Commercial |
$894.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,022.45
|
| Rate for Payer: Healthscope Commercial |
$1,150.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$894.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$958.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,086.35
|
| Rate for Payer: PHP Commercial |
$1,086.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$894.64
|
| Rate for Payer: Priority Health SBD |
$805.18
|
| Rate for Payer: UMR Bronson Commercial |
$562.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$958.54
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$474.82
|
|
|
Service Code
|
NDC 0713-0503-12
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.92 |
| Max. Negotiated Rate |
$427.34 |
| Rate for Payer: Aetna American Axle |
$308.63
|
| Rate for Payer: Aetna Commercial |
$403.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.63
|
| Rate for Payer: Cash Price |
$379.86
|
| Rate for Payer: Cofinity Commercial |
$332.37
|
| Rate for Payer: Cofinity Commercial |
$408.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$379.86
|
| Rate for Payer: Healthscope Commercial |
$427.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$332.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$403.60
|
| Rate for Payer: PHP Commercial |
$403.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.37
|
| Rate for Payer: Priority Health SBD |
$299.14
|
| Rate for Payer: UMR Bronson Commercial |
$208.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.12
|
|
