|
HYDROCORTISONE 100 MG/60 ML ENEMA
|
Facility
|
OP
|
$164.97
|
|
|
Service Code
|
NDC 62559013807
|
| Hospital Charge Code |
10210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.04 |
| Max. Negotiated Rate |
$148.47 |
| Rate for Payer: Aetna American Axle |
$107.23
|
| Rate for Payer: Aetna Commercial |
$140.22
|
| Rate for Payer: Aetna Medicare |
$82.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.23
|
| Rate for Payer: BCBS Complete |
$65.99
|
| Rate for Payer: Cash Price |
$131.98
|
| Rate for Payer: Cofinity Advantage |
$115.48
|
| Rate for Payer: Cofinity Commercial |
$141.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.98
|
| Rate for Payer: Healthscope Commercial |
$148.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$131.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$123.73
|
| Rate for Payer: PHP Commercial |
$140.22
|
| Rate for Payer: Priority Health SBD |
$103.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.23
|
| Rate for Payer: UHC Core |
$85.95
|
| Rate for Payer: UHC Exchange |
$64.83
|
| Rate for Payer: UMR Bronson Commercial |
$61.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.73
|
|
|
HYDROCORTISONE 1 %-PRAMOXINE 1 % RECTAL FOAM
|
Facility
|
OP
|
$594.72
|
|
|
Service Code
|
NDC 00037682210
|
| Hospital Charge Code |
28849
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.05 |
| Max. Negotiated Rate |
$535.25 |
| Rate for Payer: Aetna American Axle |
$386.57
|
| Rate for Payer: Aetna Commercial |
$505.51
|
| Rate for Payer: Aetna Medicare |
$297.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.57
|
| Rate for Payer: BCBS Complete |
$237.89
|
| Rate for Payer: Cash Price |
$475.78
|
| Rate for Payer: Cofinity Advantage |
$416.30
|
| Rate for Payer: Cofinity Commercial |
$511.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.78
|
| Rate for Payer: Healthscope Commercial |
$535.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$416.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$475.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.04
|
| Rate for Payer: PHP Commercial |
$505.51
|
| Rate for Payer: Priority Health SBD |
$374.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$386.57
|
| Rate for Payer: UHC Core |
$309.85
|
| Rate for Payer: UHC Exchange |
$233.72
|
| Rate for Payer: UMR Bronson Commercial |
$220.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.04
|
|
|
HYDROCORTISONE 1 %-PRAMOXINE 1 % RECTAL FOAM
|
Facility
|
IP
|
$594.72
|
|
|
Service Code
|
NDC 00037682210
|
| Hospital Charge Code |
28849
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$261.68 |
| Max. Negotiated Rate |
$535.25 |
| Rate for Payer: Aetna American Axle |
$386.57
|
| Rate for Payer: Aetna Commercial |
$505.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$386.57
|
| Rate for Payer: Cash Price |
$475.78
|
| Rate for Payer: Cofinity Advantage |
$416.30
|
| Rate for Payer: Cofinity Commercial |
$511.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.78
|
| Rate for Payer: Healthscope Commercial |
$535.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$416.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$446.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$505.51
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$446.04
|
| Rate for Payer: PHP Commercial |
$505.51
|
| Rate for Payer: Priority Health SBD |
$374.67
|
| Rate for Payer: UMR Bronson Commercial |
$261.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$446.04
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$9.46
|
|
|
Service Code
|
NDC 70000048501
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$8.51 |
| Rate for Payer: Aetna American Axle |
$6.15
|
| Rate for Payer: Aetna Commercial |
$8.04
|
| Rate for Payer: Aetna Medicare |
$4.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.15
|
| Rate for Payer: BCBS Complete |
$3.78
|
| Rate for Payer: Cash Price |
$7.57
|
| Rate for Payer: Cofinity Advantage |
$6.62
|
| Rate for Payer: Cofinity Commercial |
$8.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.57
|
| Rate for Payer: Healthscope Commercial |
$8.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.09
|
| Rate for Payer: PHP Commercial |
$8.04
|
| Rate for Payer: Priority Health SBD |
$5.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.15
|
| Rate for Payer: UHC Core |
$4.93
|
| Rate for Payer: UHC Exchange |
$3.72
|
| Rate for Payer: UMR Bronson Commercial |
$3.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.09
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$16.87
|
|
|
Service Code
|
NDC 00316018601
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.42 |
| Max. Negotiated Rate |
$15.18 |
| Rate for Payer: Aetna American Axle |
$10.97
|
| Rate for Payer: Aetna Commercial |
$14.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.97
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cofinity Advantage |
$11.81
|
| Rate for Payer: Cofinity Commercial |
$14.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Healthscope Commercial |
$15.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.65
|
| Rate for Payer: PHP Commercial |
$14.34
|
| Rate for Payer: Priority Health SBD |
$10.63
|
| Rate for Payer: UMR Bronson Commercial |
$7.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.65
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$18.02
|
|
|
Service Code
|
NDC 51672206302
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.67 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: Aetna American Axle |
$11.71
|
| Rate for Payer: Aetna Commercial |
$15.32
|
| Rate for Payer: Aetna Medicare |
$9.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.71
|
| Rate for Payer: BCBS Complete |
$7.21
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cofinity Advantage |
$12.61
|
| Rate for Payer: Cofinity Commercial |
$15.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Healthscope Commercial |
$16.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.52
|
| Rate for Payer: PHP Commercial |
$15.32
|
| Rate for Payer: Priority Health SBD |
$11.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.71
|
| Rate for Payer: UHC Core |
$9.39
|
| Rate for Payer: UHC Exchange |
$7.08
|
| Rate for Payer: UMR Bronson Commercial |
$6.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.52
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$10.91
|
|
|
Service Code
|
NDC 09629513687
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$9.82 |
| Rate for Payer: Aetna American Axle |
$7.09
|
| Rate for Payer: Aetna Commercial |
$9.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.09
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: Cofinity Advantage |
$7.64
|
| Rate for Payer: Cofinity Commercial |
$9.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.73
|
| Rate for Payer: Healthscope Commercial |
$9.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.18
|
| Rate for Payer: PHP Commercial |
$9.27
|
| Rate for Payer: Priority Health SBD |
$6.87
|
| Rate for Payer: UMR Bronson Commercial |
$4.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.18
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$10.91
|
|
|
Service Code
|
NDC 09629513687
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.04 |
| Max. Negotiated Rate |
$9.82 |
| Rate for Payer: Aetna American Axle |
$7.09
|
| Rate for Payer: Aetna Commercial |
$9.27
|
| Rate for Payer: Aetna Medicare |
$5.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.09
|
| Rate for Payer: BCBS Complete |
$4.36
|
| Rate for Payer: Cash Price |
$8.73
|
| Rate for Payer: Cofinity Advantage |
$7.64
|
| Rate for Payer: Cofinity Commercial |
$9.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.73
|
| Rate for Payer: Healthscope Commercial |
$9.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.18
|
| Rate for Payer: PHP Commercial |
$9.27
|
| Rate for Payer: Priority Health SBD |
$6.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.09
|
| Rate for Payer: UHC Core |
$5.68
|
| Rate for Payer: UHC Exchange |
$4.29
|
| Rate for Payer: UMR Bronson Commercial |
$4.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.18
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$10.08
|
|
|
Service Code
|
NDC 00113054164
|
| 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 Advantage |
$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 Commercial |
$8.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.56
|
| Rate for Payer: PHP Commercial |
$8.57
|
| 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
|
OP
|
$16.87
|
|
|
Service Code
|
NDC 00316018601
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$15.18 |
| Rate for Payer: Aetna American Axle |
$10.97
|
| Rate for Payer: Aetna Commercial |
$14.34
|
| Rate for Payer: Aetna Medicare |
$8.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.97
|
| Rate for Payer: BCBS Complete |
$6.75
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cofinity Advantage |
$11.81
|
| Rate for Payer: Cofinity Commercial |
$14.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.50
|
| Rate for Payer: Healthscope Commercial |
$15.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$11.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.65
|
| Rate for Payer: PHP Commercial |
$14.34
|
| Rate for Payer: Priority Health SBD |
$10.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.97
|
| Rate for Payer: UHC Core |
$8.79
|
| Rate for Payer: UHC Exchange |
$6.63
|
| Rate for Payer: UMR Bronson Commercial |
$6.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.65
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$18.02
|
|
|
Service Code
|
NDC 51672206302
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.93 |
| Max. Negotiated Rate |
$16.22 |
| Rate for Payer: Aetna American Axle |
$11.71
|
| Rate for Payer: Aetna Commercial |
$15.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.71
|
| Rate for Payer: Cash Price |
$14.42
|
| Rate for Payer: Cofinity Advantage |
$12.61
|
| Rate for Payer: Cofinity Commercial |
$15.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.42
|
| Rate for Payer: Healthscope Commercial |
$16.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$12.61
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$13.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$13.52
|
| Rate for Payer: PHP Commercial |
$15.32
|
| Rate for Payer: Priority Health SBD |
$11.35
|
| Rate for Payer: UMR Bronson Commercial |
$7.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$13.52
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$13.61
|
|
|
Service Code
|
NDC 51672206902
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$12.25 |
| Rate for Payer: Aetna American Axle |
$8.85
|
| Rate for Payer: Aetna Commercial |
$11.57
|
| Rate for Payer: Aetna Medicare |
$6.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.85
|
| Rate for Payer: BCBS Complete |
$5.44
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cofinity Advantage |
$9.53
|
| Rate for Payer: Cofinity Commercial |
$11.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.89
|
| Rate for Payer: Healthscope Commercial |
$12.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.21
|
| Rate for Payer: PHP Commercial |
$11.57
|
| Rate for Payer: Priority Health SBD |
$8.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.85
|
| Rate for Payer: UHC Core |
$7.09
|
| Rate for Payer: UHC Exchange |
$5.35
|
| Rate for Payer: UMR Bronson Commercial |
$5.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.21
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$10.08
|
|
|
Service Code
|
NDC 00113054164
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$9.07 |
| Rate for Payer: Aetna American Axle |
$6.55
|
| Rate for Payer: Aetna Commercial |
$8.57
|
| Rate for Payer: Aetna Medicare |
$5.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.55
|
| Rate for Payer: BCBS Complete |
$4.03
|
| Rate for Payer: Cash Price |
$8.06
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$8.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.56
|
| Rate for Payer: PHP Commercial |
$8.57
|
| Rate for Payer: Priority Health SBD |
$6.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.55
|
| Rate for Payer: UHC Core |
$5.25
|
| Rate for Payer: UHC Exchange |
$3.96
|
| Rate for Payer: UMR Bronson Commercial |
$3.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.56
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$9.46
|
|
|
Service Code
|
NDC 70000048501
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$8.51 |
| Rate for Payer: Aetna American Axle |
$6.15
|
| Rate for Payer: Aetna Commercial |
$8.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.15
|
| Rate for Payer: Cash Price |
$7.57
|
| Rate for Payer: Cofinity Advantage |
$6.62
|
| Rate for Payer: Cofinity Commercial |
$8.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.57
|
| Rate for Payer: Healthscope Commercial |
$8.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.09
|
| Rate for Payer: PHP Commercial |
$8.04
|
| Rate for Payer: Priority Health SBD |
$5.96
|
| Rate for Payer: UMR Bronson Commercial |
$4.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.09
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$13.61
|
|
|
Service Code
|
NDC 51672206902
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.99 |
| Max. Negotiated Rate |
$12.25 |
| Rate for Payer: Aetna American Axle |
$8.85
|
| Rate for Payer: Aetna Commercial |
$11.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.85
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cofinity Advantage |
$9.53
|
| Rate for Payer: Cofinity Commercial |
$11.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.89
|
| Rate for Payer: Healthscope Commercial |
$12.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.21
|
| Rate for Payer: PHP Commercial |
$11.57
|
| Rate for Payer: Priority Health SBD |
$8.57
|
| Rate for Payer: UMR Bronson Commercial |
$5.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.21
|
|
|
HYDROCORTISONE 20 MG TABLET
|
Facility
|
IP
|
$416.10
|
|
|
Service Code
|
NDC 00115170001
|
| Hospital Charge Code |
3734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$183.08 |
| Max. Negotiated Rate |
$374.49 |
| Rate for Payer: Aetna American Axle |
$270.46
|
| Rate for Payer: Aetna Commercial |
$353.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.46
|
| Rate for Payer: Cash Price |
$332.88
|
| Rate for Payer: Cofinity Advantage |
$291.27
|
| Rate for Payer: Cofinity Commercial |
$357.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.88
|
| Rate for Payer: Healthscope Commercial |
$374.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.07
|
| Rate for Payer: PHP Commercial |
$353.69
|
| Rate for Payer: Priority Health SBD |
$262.14
|
| Rate for Payer: UMR Bronson Commercial |
$183.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.07
|
|
|
HYDROCORTISONE 20 MG TABLET
|
Facility
|
OP
|
$450.30
|
|
|
Service Code
|
NDC 42543014201
|
| Hospital Charge Code |
3734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.61 |
| Max. Negotiated Rate |
$405.27 |
| Rate for Payer: Aetna American Axle |
$292.69
|
| Rate for Payer: Aetna Commercial |
$382.75
|
| Rate for Payer: Aetna Medicare |
$225.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.69
|
| Rate for Payer: BCBS Complete |
$180.12
|
| Rate for Payer: Cash Price |
$360.24
|
| Rate for Payer: Cofinity Advantage |
$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 |
$337.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$360.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.73
|
| Rate for Payer: PHP Commercial |
$382.75
|
| Rate for Payer: Priority Health SBD |
$283.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.69
|
| Rate for Payer: UHC Core |
$234.61
|
| Rate for Payer: UHC Exchange |
$176.97
|
| Rate for Payer: UMR Bronson Commercial |
$166.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.73
|
|
|
HYDROCORTISONE 20 MG TABLET
|
Facility
|
OP
|
$454.10
|
|
|
Service Code
|
NDC 59762007501
|
| Hospital Charge Code |
3734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.02 |
| Max. Negotiated Rate |
$408.69 |
| Rate for Payer: Aetna American Axle |
$295.17
|
| Rate for Payer: Aetna Commercial |
$385.99
|
| Rate for Payer: Aetna Medicare |
$227.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.17
|
| Rate for Payer: BCBS Complete |
$181.64
|
| Rate for Payer: Cash Price |
$363.28
|
| Rate for Payer: Cofinity Advantage |
$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 |
$340.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$363.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.57
|
| Rate for Payer: PHP Commercial |
$385.99
|
| Rate for Payer: Priority Health SBD |
$286.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$295.17
|
| Rate for Payer: UHC Core |
$236.59
|
| Rate for Payer: UHC Exchange |
$178.46
|
| Rate for Payer: UMR Bronson Commercial |
$168.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.57
|
|
|
HYDROCORTISONE 20 MG TABLET
|
Facility
|
OP
|
$416.10
|
|
|
Service Code
|
NDC 00115170001
|
| Hospital Charge Code |
3734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.96 |
| Max. Negotiated Rate |
$374.49 |
| Rate for Payer: Aetna American Axle |
$270.46
|
| Rate for Payer: Aetna Commercial |
$353.69
|
| Rate for Payer: Aetna Medicare |
$208.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.46
|
| Rate for Payer: BCBS Complete |
$166.44
|
| Rate for Payer: Cash Price |
$332.88
|
| Rate for Payer: Cofinity Advantage |
$291.27
|
| Rate for Payer: Cofinity Commercial |
$357.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.88
|
| Rate for Payer: Healthscope Commercial |
$374.49
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$291.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$312.07
|
| Rate for Payer: PHP Commercial |
$353.69
|
| Rate for Payer: Priority Health SBD |
$262.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.46
|
| Rate for Payer: UHC Core |
$216.79
|
| Rate for Payer: UHC Exchange |
$163.53
|
| Rate for Payer: UMR Bronson Commercial |
$153.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.07
|
|
|
HYDROCORTISONE 20 MG TABLET
|
Facility
|
IP
|
$450.30
|
|
|
Service Code
|
NDC 42543014201
|
| Hospital Charge Code |
3734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$198.13 |
| Max. Negotiated Rate |
$405.27 |
| Rate for Payer: Aetna American Axle |
$292.69
|
| Rate for Payer: Aetna Commercial |
$382.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.69
|
| Rate for Payer: Cash Price |
$360.24
|
| Rate for Payer: Cofinity Advantage |
$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 |
$337.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$382.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$337.73
|
| Rate for Payer: PHP Commercial |
$382.75
|
| 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 |
$337.73
|
|
|
HYDROCORTISONE 20 MG TABLET
|
Facility
|
IP
|
$454.10
|
|
|
Service Code
|
NDC 59762007501
|
| Hospital Charge Code |
3734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.80 |
| Max. Negotiated Rate |
$408.69 |
| Rate for Payer: Aetna American Axle |
$295.17
|
| Rate for Payer: Aetna Commercial |
$385.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.17
|
| Rate for Payer: Cash Price |
$363.28
|
| Rate for Payer: Cofinity Advantage |
$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 |
$340.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.57
|
| Rate for Payer: PHP Commercial |
$385.99
|
| 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 |
$340.57
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$25.97
|
|
|
Service Code
|
NDC 69315031228
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$23.37 |
| Rate for Payer: Aetna American Axle |
$16.88
|
| Rate for Payer: Aetna Commercial |
$22.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.88
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Cofinity Advantage |
$18.18
|
| Rate for Payer: Cofinity Commercial |
$22.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.78
|
| Rate for Payer: Healthscope Commercial |
$23.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.07
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.48
|
| Rate for Payer: PHP Commercial |
$22.07
|
| Rate for Payer: Priority Health SBD |
$16.36
|
| Rate for Payer: UMR Bronson Commercial |
$11.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.48
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$28.56
|
|
|
Service Code
|
NDC 62559043130
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$25.70 |
| Rate for Payer: Aetna American Axle |
$18.56
|
| Rate for Payer: Aetna Commercial |
$24.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.56
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cofinity Advantage |
$19.99
|
| Rate for Payer: Cofinity Commercial |
$24.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.85
|
| Rate for Payer: Healthscope Commercial |
$25.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.42
|
| Rate for Payer: PHP Commercial |
$24.28
|
| Rate for Payer: Priority Health SBD |
$17.99
|
| Rate for Payer: UMR Bronson Commercial |
$12.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.42
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$155.30
|
|
|
Service Code
|
NDC 64980030130
|
| 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 Advantage |
$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 |
$116.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$132.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$116.47
|
| Rate for Payer: PHP Commercial |
$132.00
|
| 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 |
$116.47
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$227.83
|
|
|
Service Code
|
NDC 10631040701
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.25 |
| Max. Negotiated Rate |
$205.05 |
| Rate for Payer: Aetna American Axle |
$148.09
|
| Rate for Payer: Aetna Commercial |
$193.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.09
|
| Rate for Payer: Cash Price |
$182.26
|
| Rate for Payer: Cofinity Advantage |
$159.48
|
| Rate for Payer: Cofinity Commercial |
$195.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.26
|
| Rate for Payer: Healthscope Commercial |
$205.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$159.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.87
|
| Rate for Payer: PHP Commercial |
$193.66
|
| Rate for Payer: Priority Health SBD |
$143.53
|
| Rate for Payer: UMR Bronson Commercial |
$100.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.87
|
|
