|
HYDROCODONE-HOMATROPINE 5 MG-1.5 MG/5 ML ORAL SYRUP
|
Facility
|
IP
|
$620.82
|
|
|
Service Code
|
NDC 50383004316
|
| Hospital Charge Code |
3724
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.16 |
| Max. Negotiated Rate |
$558.74 |
| Rate for Payer: Aetna American Axle |
$403.53
|
| Rate for Payer: Aetna Commercial |
$527.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$403.53
|
| Rate for Payer: Cash Price |
$496.66
|
| Rate for Payer: Cofinity Commercial |
$434.57
|
| Rate for Payer: Cofinity Commercial |
$533.91
|
| Rate for Payer: Cofinity Medicare Advantage |
$434.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$496.66
|
| Rate for Payer: Healthscope Commercial |
$558.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$434.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$465.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$527.70
|
| Rate for Payer: PHP Commercial |
$527.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$403.53
|
| Rate for Payer: Priority Health SBD |
$391.12
|
| Rate for Payer: UMR Bronson Commercial |
$273.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$465.62
|
|
|
HYDROCOLLOID DRESSING 4" X 4"
|
Facility
|
IP
|
$7.74
|
|
|
Service Code
|
NDC 68455010697
|
| Hospital Charge Code |
110996
|
|
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: Cofinity Medicare Advantage |
$5.42
|
| 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 Commercial |
$6.58
|
| Rate for Payer: PHP Commercial |
$6.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.03
|
| 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
|
|
|
HYDROCOLLOID DRESSING 4" X 4"
|
Facility
|
OP
|
$7.74
|
|
|
Service Code
|
NDC 68455010697
|
| Hospital Charge Code |
110996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.86 |
| Max. Negotiated Rate |
$6.97 |
| Rate for Payer: Aetna American Axle |
$5.03
|
| Rate for Payer: Aetna Commercial |
$6.58
|
| Rate for Payer: Aetna Medicare |
$3.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.03
|
| Rate for Payer: BCBS Complete |
$3.10
|
| Rate for Payer: Cash Price |
$6.19
|
| Rate for Payer: Cofinity Commercial |
$5.42
|
| Rate for Payer: Cofinity Commercial |
$6.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.42
|
| 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 Commercial |
$6.58
|
| Rate for Payer: PHP Commercial |
$6.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.03
|
| Rate for Payer: Priority Health SBD |
$4.88
|
| Rate for Payer: UMR Bronson Commercial |
$2.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.80
|
|
|
HYDROCOLLOID DRESSING 4" X 4"
|
Facility
|
IP
|
$6.95
|
|
|
Service Code
|
NDC 68455010691
|
| Hospital Charge Code |
110996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$6.26 |
| Rate for Payer: Aetna American Axle |
$4.52
|
| Rate for Payer: Aetna Commercial |
$5.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.52
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cofinity Commercial |
$4.86
|
| Rate for Payer: Cofinity Commercial |
$5.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.56
|
| Rate for Payer: Healthscope Commercial |
$6.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.91
|
| Rate for Payer: PHP Commercial |
$5.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.52
|
| Rate for Payer: Priority Health SBD |
$4.38
|
| Rate for Payer: UMR Bronson Commercial |
$3.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.21
|
|
|
HYDROCOLLOID DRESSING 4" X 4"
|
Facility
|
OP
|
$6.95
|
|
|
Service Code
|
NDC 68455010691
|
| Hospital Charge Code |
110996
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$6.26 |
| Rate for Payer: Aetna American Axle |
$4.52
|
| Rate for Payer: Aetna Commercial |
$5.91
|
| Rate for Payer: Aetna Medicare |
$3.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.52
|
| Rate for Payer: BCBS Complete |
$2.78
|
| Rate for Payer: Cash Price |
$5.56
|
| Rate for Payer: Cofinity Commercial |
$4.86
|
| Rate for Payer: Cofinity Commercial |
$5.98
|
| Rate for Payer: Cofinity Medicare Advantage |
$4.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.56
|
| Rate for Payer: Healthscope Commercial |
$6.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$4.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.91
|
| Rate for Payer: PHP Commercial |
$5.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.52
|
| Rate for Payer: Priority Health SBD |
$4.38
|
| Rate for Payer: UMR Bronson Commercial |
$2.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.21
|
|
|
HYDROCORTISONE 100 MG/60 ML ENEMA
|
Facility
|
OP
|
$138.18
|
|
|
Service Code
|
NDC 62559013807
|
| Hospital Charge Code |
10210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.13 |
| Max. Negotiated Rate |
$124.36 |
| Rate for Payer: Aetna American Axle |
$89.82
|
| Rate for Payer: Aetna Commercial |
$117.45
|
| Rate for Payer: Aetna Medicare |
$69.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.82
|
| Rate for Payer: BCBS Complete |
$55.27
|
| Rate for Payer: Cash Price |
$110.54
|
| Rate for Payer: Cofinity Commercial |
$118.83
|
| Rate for Payer: Cofinity Commercial |
$96.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.54
|
| Rate for Payer: Healthscope Commercial |
$124.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.45
|
| Rate for Payer: PHP Commercial |
$117.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.82
|
| Rate for Payer: Priority Health SBD |
$87.05
|
| Rate for Payer: UMR Bronson Commercial |
$51.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.64
|
|
|
HYDROCORTISONE 100 MG/60 ML ENEMA
|
Facility
|
OP
|
$138.18
|
|
|
Service Code
|
NDC 62559013811
|
| Hospital Charge Code |
10210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.13 |
| Max. Negotiated Rate |
$124.36 |
| Rate for Payer: Aetna American Axle |
$89.82
|
| Rate for Payer: Aetna Commercial |
$117.45
|
| Rate for Payer: Aetna Medicare |
$69.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.82
|
| Rate for Payer: BCBS Complete |
$55.27
|
| Rate for Payer: Cash Price |
$110.54
|
| Rate for Payer: Cofinity Commercial |
$118.83
|
| Rate for Payer: Cofinity Commercial |
$96.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.54
|
| Rate for Payer: Healthscope Commercial |
$124.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.45
|
| Rate for Payer: PHP Commercial |
$117.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.82
|
| Rate for Payer: Priority Health SBD |
$87.05
|
| Rate for Payer: UMR Bronson Commercial |
$51.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.64
|
|
|
HYDROCORTISONE 100 MG/60 ML ENEMA
|
Facility
|
IP
|
$138.18
|
|
|
Service Code
|
NDC 62559013807
|
| Hospital Charge Code |
10210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$124.36 |
| Rate for Payer: Aetna American Axle |
$89.82
|
| Rate for Payer: Aetna Commercial |
$117.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.82
|
| Rate for Payer: Cash Price |
$110.54
|
| Rate for Payer: Cofinity Commercial |
$118.83
|
| Rate for Payer: Cofinity Commercial |
$96.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.54
|
| Rate for Payer: Healthscope Commercial |
$124.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.45
|
| Rate for Payer: PHP Commercial |
$117.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.82
|
| Rate for Payer: Priority Health SBD |
$87.05
|
| Rate for Payer: UMR Bronson Commercial |
$60.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.64
|
|
|
HYDROCORTISONE 100 MG/60 ML ENEMA
|
Facility
|
IP
|
$138.18
|
|
|
Service Code
|
NDC 62559013811
|
| Hospital Charge Code |
10210
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$124.36 |
| Rate for Payer: Aetna American Axle |
$89.82
|
| Rate for Payer: Aetna Commercial |
$117.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.82
|
| Rate for Payer: Cash Price |
$110.54
|
| Rate for Payer: Cofinity Commercial |
$118.83
|
| Rate for Payer: Cofinity Commercial |
$96.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$96.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.54
|
| Rate for Payer: Healthscope Commercial |
$124.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$96.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.45
|
| Rate for Payer: PHP Commercial |
$117.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.82
|
| Rate for Payer: Priority Health SBD |
$87.05
|
| Rate for Payer: UMR Bronson Commercial |
$60.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.64
|
|
|
HYDROCORTISONE 1 %-PRAMOXINE 1 % RECTAL FOAM
|
Facility
|
IP
|
$566.41
|
|
|
Service Code
|
NDC 00037682210
|
| Hospital Charge Code |
28849
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$249.22 |
| Max. Negotiated Rate |
$509.77 |
| Rate for Payer: PHP Commercial |
$481.45
|
| Rate for Payer: Aetna American Axle |
$368.17
|
| Rate for Payer: Aetna Commercial |
$481.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$368.17
|
| Rate for Payer: Cash Price |
$453.13
|
| Rate for Payer: Cofinity Commercial |
$396.49
|
| Rate for Payer: Cofinity Commercial |
$487.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$396.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$453.13
|
| Rate for Payer: Healthscope Commercial |
$509.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$396.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$424.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.17
|
| Rate for Payer: Priority Health SBD |
$356.84
|
| Rate for Payer: UMR Bronson Commercial |
$249.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$424.81
|
|
|
HYDROCORTISONE 1 %-PRAMOXINE 1 % RECTAL FOAM
|
Facility
|
OP
|
$566.41
|
|
|
Service Code
|
NDC 00037682210
|
| Hospital Charge Code |
28849
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.57 |
| Max. Negotiated Rate |
$509.77 |
| Rate for Payer: Aetna American Axle |
$368.17
|
| Rate for Payer: Aetna Commercial |
$481.45
|
| Rate for Payer: Aetna Medicare |
$283.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$368.17
|
| Rate for Payer: BCBS Complete |
$226.56
|
| Rate for Payer: Cash Price |
$453.13
|
| Rate for Payer: Cofinity Commercial |
$396.49
|
| Rate for Payer: Cofinity Commercial |
$487.11
|
| Rate for Payer: Cofinity Medicare Advantage |
$396.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$453.13
|
| Rate for Payer: Healthscope Commercial |
$509.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$396.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$424.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$481.45
|
| Rate for Payer: PHP Commercial |
$481.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$368.17
|
| Rate for Payer: Priority Health SBD |
$356.84
|
| Rate for Payer: UMR Bronson Commercial |
$209.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$424.81
|
|
|
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 Commercial |
$7.06
|
| Rate for Payer: Cofinity Commercial |
$8.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.06
|
| 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: PHP Commercial |
$8.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.55
|
| Rate for Payer: Priority Health SBD |
$6.35
|
| 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
|
$19.05
|
|
|
Service Code
|
NDC 51672206302
|
| 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: Cofinity Medicare Advantage |
$13.34
|
| 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 Commercial |
$16.19
|
| Rate for Payer: PHP Commercial |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.38
|
| 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 CREAM
|
Facility
|
OP
|
$19.05
|
|
|
Service Code
|
NDC 51672206302
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$17.14 |
| Rate for Payer: Aetna American Axle |
$12.38
|
| Rate for Payer: Aetna Commercial |
$16.19
|
| Rate for Payer: Aetna Medicare |
$9.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.38
|
| Rate for Payer: BCBS Complete |
$7.62
|
| Rate for Payer: Cash Price |
$15.24
|
| Rate for Payer: Cofinity Commercial |
$13.34
|
| Rate for Payer: Cofinity Commercial |
$16.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.34
|
| 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 Commercial |
$16.19
|
| Rate for Payer: PHP Commercial |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.38
|
| Rate for Payer: Priority Health SBD |
$12.00
|
| Rate for Payer: UMR Bronson Commercial |
$7.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.29
|
|
|
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 Commercial |
$7.06
|
| Rate for Payer: Cofinity Commercial |
$8.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.06
|
| 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: PHP Commercial |
$8.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.55
|
| 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 20 MG TABLET
|
Facility
|
OP
|
$340.10
|
|
|
Service Code
|
NDC 00115170001
|
| Hospital Charge Code |
3734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.84 |
| Max. Negotiated Rate |
$306.09 |
| Rate for Payer: Aetna American Axle |
$221.06
|
| Rate for Payer: Aetna Commercial |
$289.08
|
| Rate for Payer: Aetna Medicare |
$170.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.06
|
| Rate for Payer: BCBS Complete |
$136.04
|
| Rate for Payer: Cash Price |
$272.08
|
| Rate for Payer: Cofinity Commercial |
$238.07
|
| Rate for Payer: Cofinity Commercial |
$292.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.08
|
| Rate for Payer: Healthscope Commercial |
$306.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.08
|
| Rate for Payer: PHP Commercial |
$289.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.06
|
| Rate for Payer: Priority Health SBD |
$214.26
|
| Rate for Payer: UMR Bronson Commercial |
$125.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.08
|
|
|
HYDROCORTISONE 20 MG TABLET
|
Facility
|
IP
|
$340.10
|
|
|
Service Code
|
NDC 00115170001
|
| Hospital Charge Code |
3734
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.64 |
| Max. Negotiated Rate |
$306.09 |
| Rate for Payer: Aetna American Axle |
$221.06
|
| Rate for Payer: Aetna Commercial |
$289.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.06
|
| Rate for Payer: Cash Price |
$272.08
|
| Rate for Payer: Cofinity Commercial |
$238.07
|
| Rate for Payer: Cofinity Commercial |
$292.49
|
| Rate for Payer: Cofinity Medicare Advantage |
$238.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$272.08
|
| Rate for Payer: Healthscope Commercial |
$306.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$238.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$289.08
|
| Rate for Payer: PHP Commercial |
$289.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$221.06
|
| Rate for Payer: Priority Health SBD |
$214.26
|
| Rate for Payer: UMR Bronson Commercial |
$149.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.08
|
|
|
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 |
$292.70
|
| Rate for Payer: Aetna Commercial |
$382.76
|
| Rate for Payer: Aetna Medicare |
$225.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.70
|
| Rate for Payer: BCBS Complete |
$180.12
|
| Rate for Payer: Cash Price |
$360.24
|
| Rate for Payer: Cofinity Commercial |
$315.21
|
| Rate for Payer: Cofinity Commercial |
$387.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$315.21
|
| 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 Commercial |
$382.76
|
| Rate for Payer: PHP Commercial |
$382.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.70
|
| Rate for Payer: Priority Health SBD |
$283.69
|
| Rate for Payer: UMR Bronson Commercial |
$166.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$337.72
|
|
|
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 |
$292.70
|
| 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: Cofinity Medicare Advantage |
$315.21
|
| 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 Commercial |
$382.76
|
| Rate for Payer: PHP Commercial |
$382.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$292.70
|
| 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 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 |
$295.16
|
| 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: Cofinity Medicare Advantage |
$317.87
|
| 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 Commercial |
$385.98
|
| Rate for Payer: PHP Commercial |
$385.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.16
|
| 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 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 |
$295.16
|
| Rate for Payer: Aetna Commercial |
$385.98
|
| Rate for Payer: Aetna Medicare |
$227.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$295.16
|
| Rate for Payer: BCBS Complete |
$181.64
|
| Rate for Payer: Cash Price |
$363.28
|
| Rate for Payer: Cofinity Commercial |
$317.87
|
| Rate for Payer: Cofinity Commercial |
$390.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$317.87
|
| 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 Commercial |
$385.98
|
| Rate for Payer: PHP Commercial |
$385.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.16
|
| Rate for Payer: Priority Health SBD |
$286.08
|
| Rate for Payer: UMR Bronson Commercial |
$168.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.58
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
OP
|
$29.40
|
|
|
Service Code
|
NDC 64980032430
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.88 |
| Max. Negotiated Rate |
$26.46 |
| Rate for Payer: Aetna American Axle |
$19.11
|
| Rate for Payer: Aetna Commercial |
$24.99
|
| Rate for Payer: Aetna Medicare |
$14.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.11
|
| Rate for Payer: BCBS Complete |
$11.76
|
| Rate for Payer: Cash Price |
$23.52
|
| Rate for Payer: Cofinity Commercial |
$20.58
|
| Rate for Payer: Cofinity Commercial |
$25.28
|
| Rate for Payer: Cofinity Medicare Advantage |
$20.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.52
|
| Rate for Payer: Healthscope Commercial |
$26.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.99
|
| Rate for Payer: PHP Commercial |
$24.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.11
|
| Rate for Payer: Priority Health SBD |
$18.52
|
| Rate for Payer: UMR Bronson Commercial |
$10.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.05
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
OP
|
$27.25
|
|
|
Service Code
|
NDC 69315031228
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$24.52 |
| Rate for Payer: Aetna American Axle |
$17.71
|
| Rate for Payer: Aetna Commercial |
$23.16
|
| Rate for Payer: Aetna Medicare |
$13.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.71
|
| Rate for Payer: BCBS Complete |
$10.90
|
| Rate for Payer: Cash Price |
$21.80
|
| Rate for Payer: Cofinity Commercial |
$19.08
|
| Rate for Payer: Cofinity Commercial |
$23.44
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.80
|
| Rate for Payer: Healthscope Commercial |
$24.52
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.16
|
| Rate for Payer: PHP Commercial |
$23.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.71
|
| Rate for Payer: Priority Health SBD |
$17.17
|
| Rate for Payer: UMR Bronson Commercial |
$10.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.44
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
OP
|
$155.30
|
|
|
Service Code
|
NDC 64980030130
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.46 |
| Max. Negotiated Rate |
$139.77 |
| Rate for Payer: Aetna American Axle |
$100.94
|
| Rate for Payer: Aetna Commercial |
$132.00
|
| Rate for Payer: Aetna Medicare |
$77.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$100.94
|
| Rate for Payer: BCBS Complete |
$62.12
|
| Rate for Payer: Cash Price |
$124.24
|
| Rate for Payer: Cofinity Commercial |
$108.71
|
| Rate for Payer: Cofinity Commercial |
$133.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$108.71
|
| 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 Commercial |
$132.00
|
| Rate for Payer: PHP Commercial |
$132.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.94
|
| Rate for Payer: Priority Health SBD |
$97.84
|
| Rate for Payer: UMR Bronson Commercial |
$57.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.48
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$225.54
|
|
|
Service Code
|
NDC 62559043130
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.24 |
| Max. Negotiated Rate |
$202.99 |
| Rate for Payer: Aetna American Axle |
$146.60
|
| Rate for Payer: Aetna Commercial |
$191.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.60
|
| Rate for Payer: Cash Price |
$180.43
|
| Rate for Payer: Cofinity Commercial |
$157.88
|
| Rate for Payer: Cofinity Commercial |
$193.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.43
|
| Rate for Payer: Healthscope Commercial |
$202.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$169.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.71
|
| Rate for Payer: PHP Commercial |
$191.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.60
|
| Rate for Payer: Priority Health SBD |
$142.09
|
| Rate for Payer: UMR Bronson Commercial |
$99.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.16
|
|
