|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$29.40
|
|
|
Service Code
|
NDC 64980032430
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.94 |
| Max. Negotiated Rate |
$26.46 |
| Rate for Payer: Aetna American Axle |
$19.11
|
| Rate for Payer: Aetna Commercial |
$24.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.11
|
| 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 |
$12.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.05
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
NDC 10631040701
|
| 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 |
$161.70
|
| Rate for Payer: Cofinity Commercial |
$198.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$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 Commercial |
$196.35
|
| Rate for Payer: PHP Commercial |
$196.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.15
|
| 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
|
OP
|
$231.00
|
|
|
Service Code
|
NDC 10631040701
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.47 |
| Max. Negotiated Rate |
$207.90 |
| Rate for Payer: Cofinity Commercial |
$198.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$161.70
|
| Rate for Payer: Aetna American Axle |
$150.15
|
| Rate for Payer: Aetna Commercial |
$196.35
|
| Rate for Payer: Aetna Medicare |
$115.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.15
|
| Rate for Payer: BCBS Complete |
$92.40
|
| Rate for Payer: Cash Price |
$184.80
|
| 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 Commercial |
$196.35
|
| Rate for Payer: PHP Commercial |
$196.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.15
|
| Rate for Payer: Priority Health SBD |
$145.53
|
| Rate for Payer: UMR Bronson Commercial |
$85.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$173.25
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
OP
|
$225.54
|
|
|
Service Code
|
NDC 62559043130
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.45 |
| Max. Negotiated Rate |
$202.99 |
| Rate for Payer: Aetna American Axle |
$146.60
|
| Rate for Payer: Aetna Commercial |
$191.71
|
| Rate for Payer: Aetna Medicare |
$112.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.60
|
| Rate for Payer: BCBS Complete |
$90.22
|
| 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 |
$83.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$169.16
|
|
|
HYDROCORTISONE 2.5 % TOPICAL CREAM WITH PERINEAL APPLICATOR
|
Facility
|
IP
|
$27.25
|
|
|
Service Code
|
NDC 69315031228
|
| Hospital Charge Code |
28824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$24.52 |
| Rate for Payer: Aetna American Axle |
$17.71
|
| Rate for Payer: Aetna Commercial |
$23.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.71
|
| 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 |
$11.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.44
|
|
|
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 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 |
$68.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$116.48
|
|
|
HYDROCORTISONE 5 MG TABLET
|
Facility
|
OP
|
$226.78
|
|
|
Service Code
|
NDC 00115169606
|
| Hospital Charge Code |
10209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.91 |
| Max. Negotiated Rate |
$204.10 |
| Rate for Payer: Aetna American Axle |
$147.41
|
| Rate for Payer: Aetna Commercial |
$192.76
|
| Rate for Payer: Aetna Medicare |
$113.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.41
|
| Rate for Payer: BCBS Complete |
$90.71
|
| Rate for Payer: Cash Price |
$181.42
|
| Rate for Payer: Cofinity Commercial |
$158.75
|
| Rate for Payer: Cofinity Commercial |
$195.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$158.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.42
|
| Rate for Payer: Healthscope Commercial |
$204.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.76
|
| Rate for Payer: PHP Commercial |
$192.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.41
|
| Rate for Payer: Priority Health SBD |
$142.87
|
| Rate for Payer: UMR Bronson Commercial |
$83.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.08
|
|
|
HYDROCORTISONE 5 MG TABLET
|
Facility
|
OP
|
$235.20
|
|
|
Service Code
|
NDC 00009001201
|
| Hospital Charge Code |
10209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.02 |
| Max. Negotiated Rate |
$211.68 |
| Rate for Payer: Aetna American Axle |
$152.88
|
| Rate for Payer: Aetna Commercial |
$199.92
|
| Rate for Payer: Aetna Medicare |
$117.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.88
|
| Rate for Payer: BCBS Complete |
$94.08
|
| Rate for Payer: Cash Price |
$188.16
|
| Rate for Payer: Cofinity Commercial |
$164.64
|
| Rate for Payer: Cofinity Commercial |
$202.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.16
|
| Rate for Payer: Healthscope Commercial |
$211.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.92
|
| Rate for Payer: PHP Commercial |
$199.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.88
|
| Rate for Payer: Priority Health SBD |
$148.18
|
| Rate for Payer: UMR Bronson Commercial |
$87.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.40
|
|
|
HYDROCORTISONE 5 MG TABLET
|
Facility
|
OP
|
$186.83
|
|
|
Service Code
|
NDC 42543014050
|
| Hospital Charge Code |
10209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.13 |
| Max. Negotiated Rate |
$168.15 |
| Rate for Payer: Aetna American Axle |
$121.44
|
| Rate for Payer: Aetna Commercial |
$158.81
|
| Rate for Payer: Aetna Medicare |
$93.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.44
|
| Rate for Payer: BCBS Complete |
$74.73
|
| Rate for Payer: Cash Price |
$149.46
|
| Rate for Payer: Cofinity Commercial |
$130.78
|
| Rate for Payer: Cofinity Commercial |
$160.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$130.78
|
| 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 Commercial |
$158.81
|
| Rate for Payer: PHP Commercial |
$158.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.44
|
| Rate for Payer: Priority Health SBD |
$117.70
|
| Rate for Payer: UMR Bronson Commercial |
$69.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$140.12
|
|
|
HYDROCORTISONE 5 MG TABLET
|
Facility
|
IP
|
$186.83
|
|
|
Service Code
|
NDC 42543014050
|
| 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: Cofinity Medicare Advantage |
$130.78
|
| 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 Commercial |
$158.81
|
| Rate for Payer: PHP Commercial |
$158.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.44
|
| 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 5 MG TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 59762007301
|
| 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: Cofinity Medicare Advantage |
$131.60
|
| 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 Commercial |
$159.80
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| 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
|
$226.78
|
|
|
Service Code
|
NDC 00115169606
|
| Hospital Charge Code |
10209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.78 |
| Max. Negotiated Rate |
$204.10 |
| Rate for Payer: Aetna American Axle |
$147.41
|
| Rate for Payer: Aetna Commercial |
$192.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.41
|
| Rate for Payer: Cash Price |
$181.42
|
| Rate for Payer: Cofinity Commercial |
$158.75
|
| Rate for Payer: Cofinity Commercial |
$195.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$158.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.42
|
| Rate for Payer: Healthscope Commercial |
$204.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.76
|
| Rate for Payer: PHP Commercial |
$192.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.41
|
| Rate for Payer: Priority Health SBD |
$142.87
|
| Rate for Payer: UMR Bronson Commercial |
$99.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.08
|
|
|
HYDROCORTISONE 5 MG TABLET
|
Facility
|
IP
|
$235.20
|
|
|
Service Code
|
NDC 00009001201
|
| Hospital Charge Code |
10209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.49 |
| Max. Negotiated Rate |
$211.68 |
| Rate for Payer: Aetna American Axle |
$152.88
|
| Rate for Payer: Aetna Commercial |
$199.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.88
|
| Rate for Payer: Cash Price |
$188.16
|
| Rate for Payer: Cofinity Commercial |
$164.64
|
| Rate for Payer: Cofinity Commercial |
$202.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$164.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.16
|
| Rate for Payer: Healthscope Commercial |
$211.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.92
|
| Rate for Payer: PHP Commercial |
$199.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.88
|
| Rate for Payer: Priority Health SBD |
$148.18
|
| Rate for Payer: UMR Bronson Commercial |
$103.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.40
|
|
|
HYDROCORTISONE 5 MG TABLET
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 59762007301
|
| Hospital Charge Code |
10209
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.56 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna American Axle |
$122.20
|
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna Medicare |
$94.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.60
|
| 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 Commercial |
$159.80
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health SBD |
$118.44
|
| Rate for Payer: UMR Bronson Commercial |
$69.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
HYDROCORTISONE ACETATE 10 % (80 MG) RECTAL FOAM
|
Facility
|
OP
|
$1,342.01
|
|
|
Service Code
|
NDC 00037683015
|
| Hospital Charge Code |
19732
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$496.54 |
| Max. Negotiated Rate |
$1,207.81 |
| Rate for Payer: Aetna American Axle |
$872.31
|
| Rate for Payer: Aetna Commercial |
$1,140.71
|
| Rate for Payer: Aetna Medicare |
$671.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$872.31
|
| Rate for Payer: BCBS Complete |
$536.80
|
| Rate for Payer: Cash Price |
$1,073.61
|
| Rate for Payer: Cofinity Commercial |
$1,154.13
|
| Rate for Payer: Cofinity Commercial |
$939.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$939.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.61
|
| Rate for Payer: Healthscope Commercial |
$1,207.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$939.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,006.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,140.71
|
| Rate for Payer: PHP Commercial |
$1,140.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.31
|
| Rate for Payer: Priority Health SBD |
$845.47
|
| Rate for Payer: UMR Bronson Commercial |
$496.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,006.51
|
|
|
HYDROCORTISONE ACETATE 10 % (80 MG) RECTAL FOAM
|
Facility
|
IP
|
$1,342.01
|
|
|
Service Code
|
NDC 00037683015
|
| Hospital Charge Code |
19732
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$590.48 |
| Max. Negotiated Rate |
$1,207.81 |
| Rate for Payer: Aetna American Axle |
$872.31
|
| Rate for Payer: Aetna Commercial |
$1,140.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$872.31
|
| Rate for Payer: Cash Price |
$1,073.61
|
| Rate for Payer: Cofinity Commercial |
$1,154.13
|
| Rate for Payer: Cofinity Commercial |
$939.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$939.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,073.61
|
| Rate for Payer: Healthscope Commercial |
$1,207.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$939.41
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,006.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,140.71
|
| Rate for Payer: PHP Commercial |
$1,140.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$872.31
|
| Rate for Payer: Priority Health SBD |
$845.47
|
| Rate for Payer: UMR Bronson Commercial |
$590.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,006.51
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$39.57
|
|
|
Service Code
|
NDC 00713050306
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.41 |
| Max. Negotiated Rate |
$35.61 |
| Rate for Payer: Aetna American Axle |
$25.72
|
| Rate for Payer: Aetna Commercial |
$33.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.72
|
| Rate for Payer: Cash Price |
$31.66
|
| Rate for Payer: Cofinity Commercial |
$27.70
|
| Rate for Payer: Cofinity Commercial |
$34.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.66
|
| Rate for Payer: Healthscope Commercial |
$35.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.63
|
| Rate for Payer: PHP Commercial |
$33.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.72
|
| Rate for Payer: Priority Health SBD |
$24.93
|
| Rate for Payer: UMR Bronson Commercial |
$17.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.68
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$474.82
|
|
|
Service Code
|
NDC 00713050312
|
| 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: Cofinity Medicare Advantage |
$332.37
|
| 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 Commercial |
$403.60
|
| Rate for Payer: PHP Commercial |
$403.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.63
|
| 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
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$474.82
|
|
|
Service Code
|
NDC 00713050312
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.68 |
| Max. Negotiated Rate |
$427.34 |
| Rate for Payer: Aetna American Axle |
$308.63
|
| Rate for Payer: Aetna Commercial |
$403.60
|
| Rate for Payer: Aetna Medicare |
$237.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$308.63
|
| Rate for Payer: BCBS Complete |
$189.93
|
| Rate for Payer: Cash Price |
$379.86
|
| Rate for Payer: Cofinity Commercial |
$332.37
|
| Rate for Payer: Cofinity Commercial |
$408.35
|
| Rate for Payer: Cofinity Medicare Advantage |
$332.37
|
| 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 Commercial |
$403.60
|
| Rate for Payer: PHP Commercial |
$403.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.63
|
| Rate for Payer: Priority Health SBD |
$299.14
|
| Rate for Payer: UMR Bronson Commercial |
$175.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.12
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$476.55
|
|
|
Service Code
|
NDC 00574709012
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$209.68 |
| Max. Negotiated Rate |
$428.90 |
| Rate for Payer: Aetna American Axle |
$309.76
|
| Rate for Payer: Aetna Commercial |
$405.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.76
|
| Rate for Payer: Cash Price |
$381.24
|
| Rate for Payer: Cofinity Commercial |
$333.58
|
| Rate for Payer: Cofinity Commercial |
$409.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$333.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.24
|
| Rate for Payer: Healthscope Commercial |
$428.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$333.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.07
|
| Rate for Payer: PHP Commercial |
$405.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.76
|
| Rate for Payer: Priority Health SBD |
$300.23
|
| Rate for Payer: UMR Bronson Commercial |
$209.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.41
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$3,157.58
|
|
|
Service Code
|
NDC 00713050301
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,389.34 |
| Max. Negotiated Rate |
$2,841.82 |
| Rate for Payer: Aetna American Axle |
$2,052.43
|
| Rate for Payer: Aetna Commercial |
$2,683.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,052.43
|
| Rate for Payer: Cash Price |
$2,526.06
|
| Rate for Payer: Cofinity Commercial |
$2,210.31
|
| Rate for Payer: Cofinity Commercial |
$2,715.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,210.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,526.06
|
| Rate for Payer: Healthscope Commercial |
$2,841.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,210.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,368.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,683.94
|
| Rate for Payer: PHP Commercial |
$2,683.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,052.43
|
| Rate for Payer: Priority Health SBD |
$1,989.28
|
| Rate for Payer: UMR Bronson Commercial |
$1,389.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,368.18
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$3,157.58
|
|
|
Service Code
|
NDC 00713050301
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,168.30 |
| Max. Negotiated Rate |
$2,841.82 |
| Rate for Payer: Aetna American Axle |
$2,052.43
|
| Rate for Payer: Aetna Commercial |
$2,683.94
|
| Rate for Payer: Aetna Medicare |
$1,578.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,052.43
|
| Rate for Payer: BCBS Complete |
$1,263.03
|
| Rate for Payer: Cash Price |
$2,526.06
|
| Rate for Payer: Cofinity Commercial |
$2,210.31
|
| Rate for Payer: Cofinity Commercial |
$2,715.52
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,210.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,526.06
|
| Rate for Payer: Healthscope Commercial |
$2,841.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,210.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,368.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,683.94
|
| Rate for Payer: PHP Commercial |
$2,683.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,052.43
|
| Rate for Payer: Priority Health SBD |
$1,989.28
|
| Rate for Payer: UMR Bronson Commercial |
$1,168.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,368.18
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$39.57
|
|
|
Service Code
|
NDC 00713050306
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$35.61 |
| Rate for Payer: Aetna American Axle |
$25.72
|
| Rate for Payer: Aetna Commercial |
$33.63
|
| Rate for Payer: Aetna Medicare |
$19.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.72
|
| Rate for Payer: BCBS Complete |
$15.83
|
| Rate for Payer: Cash Price |
$31.66
|
| Rate for Payer: Cofinity Commercial |
$27.70
|
| Rate for Payer: Cofinity Commercial |
$34.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.66
|
| Rate for Payer: Healthscope Commercial |
$35.61
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.63
|
| Rate for Payer: PHP Commercial |
$33.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.72
|
| Rate for Payer: Priority Health SBD |
$24.93
|
| Rate for Payer: UMR Bronson Commercial |
$14.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.68
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$476.55
|
|
|
Service Code
|
NDC 00574709012
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.32 |
| Max. Negotiated Rate |
$428.90 |
| Rate for Payer: Aetna American Axle |
$309.76
|
| Rate for Payer: Aetna Commercial |
$405.07
|
| Rate for Payer: Aetna Medicare |
$238.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$309.76
|
| Rate for Payer: BCBS Complete |
$190.62
|
| Rate for Payer: Cash Price |
$381.24
|
| Rate for Payer: Cofinity Commercial |
$333.58
|
| Rate for Payer: Cofinity Commercial |
$409.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$333.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.24
|
| Rate for Payer: Healthscope Commercial |
$428.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$333.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$357.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.07
|
| Rate for Payer: PHP Commercial |
$405.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.76
|
| Rate for Payer: Priority Health SBD |
$300.23
|
| Rate for Payer: UMR Bronson Commercial |
$176.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$357.41
|
|
|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
OP
|
$7.90
|
|
|
Service Code
|
NDC 00536140795
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$7.11 |
| Rate for Payer: Aetna American Axle |
$5.14
|
| Rate for Payer: Aetna Commercial |
$6.72
|
| Rate for Payer: Aetna Medicare |
$3.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.14
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cofinity Commercial |
$5.53
|
| Rate for Payer: Cofinity Commercial |
$6.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$5.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.32
|
| Rate for Payer: Healthscope Commercial |
$7.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.72
|
| Rate for Payer: PHP Commercial |
$6.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.14
|
| Rate for Payer: Priority Health SBD |
$4.98
|
| Rate for Payer: UMR Bronson Commercial |
$2.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5.92
|
|
