|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$13.61
|
|
|
Service Code
|
NDC 51672206902
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$13.61 |
| Rate for Payer: Aetna Commercial |
$12.25
|
| Rate for Payer: Aetna Medicare |
$5.03
|
| Rate for Payer: ASR ASR |
$13.20
|
| Rate for Payer: BCBS Complete |
$5.44
|
| Rate for Payer: BCBS Trust/PPO |
$11.22
|
| Rate for Payer: BCN Commercial |
$11.22
|
| Rate for Payer: Cash Price |
$10.89
|
| Rate for Payer: Cofinity Commercial |
$12.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.89
|
| Rate for Payer: Healthscope Commercial |
$13.20
|
| Rate for Payer: Healthscope Whirlpool |
$13.61
|
| Rate for Payer: Mclaren Commercial |
$12.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.57
|
| Rate for Payer: Nomi Health Commercial |
$11.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$11.92
|
| Rate for Payer: Priority Health Narrow Network |
$9.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.98
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$10.91
|
|
|
Service Code
|
NDC 9629513687
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$10.91 |
| Rate for Payer: Aetna Commercial |
$9.82
|
| Rate for Payer: ASR ASR |
$10.58
|
| Rate for Payer: BCBS Trust/PPO |
$8.96
|
| Rate for Payer: BCN Commercial |
$8.96
|
| Rate for Payer: Cash Price |
$8.72
|
| Rate for Payer: Cofinity Commercial |
$10.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.72
|
| Rate for Payer: Healthscope Commercial |
$10.58
|
| Rate for Payer: Healthscope Whirlpool |
$10.91
|
| Rate for Payer: Mclaren Commercial |
$9.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.27
|
| Rate for Payer: Nomi Health Commercial |
$8.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.60
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$116.73
|
|
|
Service Code
|
NDC 59741030112
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.19 |
| Max. Negotiated Rate |
$116.73 |
| Rate for Payer: Aetna Commercial |
$105.06
|
| Rate for Payer: Aetna Medicare |
$43.19
|
| Rate for Payer: ASR ASR |
$113.23
|
| Rate for Payer: BCBS Complete |
$46.69
|
| Rate for Payer: BCBS Trust/PPO |
$96.24
|
| Rate for Payer: BCN Commercial |
$96.24
|
| Rate for Payer: Cash Price |
$93.38
|
| Rate for Payer: Cofinity Commercial |
$109.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.38
|
| Rate for Payer: Healthscope Commercial |
$113.23
|
| Rate for Payer: Healthscope Whirlpool |
$116.73
|
| Rate for Payer: Mclaren Commercial |
$105.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.22
|
| Rate for Payer: Nomi Health Commercial |
$95.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$102.28
|
| Rate for Payer: Priority Health Narrow Network |
$81.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.72
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$39.57
|
|
|
Service Code
|
NDC 713050306
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.64 |
| Max. Negotiated Rate |
$39.57 |
| Rate for Payer: Aetna Commercial |
$35.61
|
| Rate for Payer: Aetna Medicare |
$14.64
|
| Rate for Payer: ASR ASR |
$38.38
|
| Rate for Payer: BCBS Complete |
$15.83
|
| Rate for Payer: BCBS Trust/PPO |
$32.62
|
| Rate for Payer: BCN Commercial |
$32.62
|
| Rate for Payer: Cash Price |
$31.65
|
| Rate for Payer: Cofinity Commercial |
$37.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.65
|
| Rate for Payer: Healthscope Commercial |
$38.38
|
| Rate for Payer: Healthscope Whirlpool |
$39.57
|
| Rate for Payer: Mclaren Commercial |
$35.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$31.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.63
|
| Rate for Payer: Nomi Health Commercial |
$32.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$34.67
|
| Rate for Payer: Priority Health Narrow Network |
$27.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.82
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$474.81
|
|
|
Service Code
|
NDC 713050312
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$356.11 |
| Max. Negotiated Rate |
$474.81 |
| Rate for Payer: Aetna Commercial |
$427.33
|
| Rate for Payer: ASR ASR |
$460.57
|
| Rate for Payer: BCBS Trust/PPO |
$389.92
|
| Rate for Payer: BCN Commercial |
$389.92
|
| Rate for Payer: Cash Price |
$379.85
|
| Rate for Payer: Cofinity Commercial |
$446.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$379.85
|
| Rate for Payer: Healthscope Commercial |
$460.57
|
| Rate for Payer: Healthscope Whirlpool |
$474.81
|
| Rate for Payer: Mclaren Commercial |
$427.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.59
|
| Rate for Payer: Nomi Health Commercial |
$389.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$356.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$417.84
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$476.55
|
|
|
Service Code
|
NDC 574709012
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$357.41 |
| Max. Negotiated Rate |
$476.55 |
| Rate for Payer: Aetna Commercial |
$428.89
|
| Rate for Payer: ASR ASR |
$462.25
|
| Rate for Payer: BCBS Trust/PPO |
$391.34
|
| Rate for Payer: BCN Commercial |
$391.34
|
| Rate for Payer: Cash Price |
$381.24
|
| Rate for Payer: Cofinity Commercial |
$447.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.24
|
| Rate for Payer: Healthscope Commercial |
$462.25
|
| Rate for Payer: Healthscope Whirlpool |
$476.55
|
| Rate for Payer: Mclaren Commercial |
$428.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.06
|
| Rate for Payer: Nomi Health Commercial |
$390.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$357.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$419.36
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$89.22
|
|
|
Service Code
|
NDC 16571067621
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$66.92 |
| Max. Negotiated Rate |
$89.22 |
| Rate for Payer: Aetna Commercial |
$80.30
|
| Rate for Payer: ASR ASR |
$86.55
|
| Rate for Payer: BCBS Trust/PPO |
$73.27
|
| Rate for Payer: BCN Commercial |
$73.27
|
| Rate for Payer: Cash Price |
$71.38
|
| Rate for Payer: Cofinity Commercial |
$83.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.38
|
| Rate for Payer: Healthscope Commercial |
$86.55
|
| Rate for Payer: Healthscope Whirlpool |
$89.22
|
| Rate for Payer: Mclaren Commercial |
$80.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.84
|
| Rate for Payer: Nomi Health Commercial |
$73.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.52
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$7.44
|
|
|
Service Code
|
NDC 16571067616
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$7.44 |
| Rate for Payer: Aetna Commercial |
$6.69
|
| Rate for Payer: ASR ASR |
$7.21
|
| Rate for Payer: BCBS Trust/PPO |
$6.11
|
| Rate for Payer: BCN Commercial |
$6.11
|
| Rate for Payer: Cash Price |
$5.95
|
| Rate for Payer: Cofinity Commercial |
$6.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.95
|
| Rate for Payer: Healthscope Commercial |
$7.21
|
| Rate for Payer: Healthscope Whirlpool |
$7.44
|
| Rate for Payer: Mclaren Commercial |
$6.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.32
|
| Rate for Payer: Nomi Health Commercial |
$6.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.54
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$474.81
|
|
|
Service Code
|
NDC 713050312
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.68 |
| Max. Negotiated Rate |
$474.81 |
| Rate for Payer: Aetna Commercial |
$427.33
|
| Rate for Payer: Aetna Medicare |
$175.68
|
| Rate for Payer: ASR ASR |
$460.57
|
| Rate for Payer: BCBS Complete |
$189.93
|
| Rate for Payer: BCBS Trust/PPO |
$391.48
|
| Rate for Payer: BCN Commercial |
$391.48
|
| Rate for Payer: Cash Price |
$379.85
|
| Rate for Payer: Cofinity Commercial |
$446.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$379.85
|
| Rate for Payer: Healthscope Commercial |
$460.57
|
| Rate for Payer: Healthscope Whirlpool |
$474.81
|
| Rate for Payer: Mclaren Commercial |
$427.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$379.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.59
|
| Rate for Payer: Nomi Health Commercial |
$389.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$356.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$416.03
|
| Rate for Payer: Priority Health Narrow Network |
$332.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$417.84
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$476.55
|
|
|
Service Code
|
NDC 574709012
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.32 |
| Max. Negotiated Rate |
$476.55 |
| Rate for Payer: Aetna Commercial |
$428.89
|
| Rate for Payer: Aetna Medicare |
$176.32
|
| Rate for Payer: ASR ASR |
$462.25
|
| Rate for Payer: BCBS Complete |
$190.62
|
| Rate for Payer: BCBS Trust/PPO |
$392.91
|
| Rate for Payer: BCN Commercial |
$392.91
|
| Rate for Payer: Cash Price |
$381.24
|
| Rate for Payer: Cofinity Commercial |
$447.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.24
|
| Rate for Payer: Healthscope Commercial |
$462.25
|
| Rate for Payer: Healthscope Whirlpool |
$476.55
|
| Rate for Payer: Mclaren Commercial |
$428.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$381.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.06
|
| Rate for Payer: Nomi Health Commercial |
$390.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$357.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$417.55
|
| Rate for Payer: Priority Health Narrow Network |
$334.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$419.36
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$116.73
|
|
|
Service Code
|
NDC 59741030112
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.55 |
| Max. Negotiated Rate |
$116.73 |
| Rate for Payer: Aetna Commercial |
$105.06
|
| Rate for Payer: ASR ASR |
$113.23
|
| Rate for Payer: BCBS Trust/PPO |
$95.86
|
| Rate for Payer: BCN Commercial |
$95.86
|
| Rate for Payer: Cash Price |
$93.38
|
| Rate for Payer: Cofinity Commercial |
$109.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.38
|
| Rate for Payer: Healthscope Commercial |
$113.23
|
| Rate for Payer: Healthscope Whirlpool |
$116.73
|
| Rate for Payer: Mclaren Commercial |
$105.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.22
|
| Rate for Payer: Nomi Health Commercial |
$95.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$102.72
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$39.57
|
|
|
Service Code
|
NDC 713050306
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$29.68 |
| Max. Negotiated Rate |
$39.57 |
| Rate for Payer: Aetna Commercial |
$35.61
|
| Rate for Payer: ASR ASR |
$38.38
|
| Rate for Payer: BCBS Trust/PPO |
$32.49
|
| Rate for Payer: BCN Commercial |
$32.49
|
| Rate for Payer: Cash Price |
$31.65
|
| Rate for Payer: Cofinity Commercial |
$37.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.65
|
| Rate for Payer: Healthscope Commercial |
$38.38
|
| Rate for Payer: Healthscope Whirlpool |
$39.57
|
| Rate for Payer: Mclaren Commercial |
$35.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.63
|
| Rate for Payer: Nomi Health Commercial |
$32.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.82
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$89.22
|
|
|
Service Code
|
NDC 16571067621
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.01 |
| Max. Negotiated Rate |
$89.22 |
| Rate for Payer: Aetna Commercial |
$80.30
|
| Rate for Payer: Aetna Medicare |
$33.01
|
| Rate for Payer: ASR ASR |
$86.55
|
| Rate for Payer: BCBS Complete |
$35.69
|
| Rate for Payer: BCBS Trust/PPO |
$73.56
|
| Rate for Payer: BCN Commercial |
$73.56
|
| Rate for Payer: Cash Price |
$71.38
|
| Rate for Payer: Cofinity Commercial |
$83.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.38
|
| Rate for Payer: Healthscope Commercial |
$86.55
|
| Rate for Payer: Healthscope Whirlpool |
$89.22
|
| Rate for Payer: Mclaren Commercial |
$80.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.84
|
| Rate for Payer: Nomi Health Commercial |
$73.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$78.18
|
| Rate for Payer: Priority Health Narrow Network |
$62.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.52
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$7.44
|
|
|
Service Code
|
NDC 16571067616
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.75 |
| Max. Negotiated Rate |
$7.44 |
| Rate for Payer: Aetna Commercial |
$6.69
|
| Rate for Payer: Aetna Medicare |
$2.75
|
| Rate for Payer: ASR ASR |
$7.21
|
| Rate for Payer: BCBS Complete |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$6.13
|
| Rate for Payer: BCN Commercial |
$6.13
|
| Rate for Payer: Cash Price |
$5.95
|
| Rate for Payer: Cofinity Commercial |
$6.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.95
|
| Rate for Payer: Healthscope Commercial |
$7.21
|
| Rate for Payer: Healthscope Whirlpool |
$7.44
|
| Rate for Payer: Mclaren Commercial |
$6.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.32
|
| Rate for Payer: Nomi Health Commercial |
$6.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.52
|
| Rate for Payer: Priority Health Narrow Network |
$5.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.54
|
|
|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
IP
|
$7.90
|
|
|
Service Code
|
NDC 536127780
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$7.90 |
| Rate for Payer: Aetna Commercial |
$7.11
|
| Rate for Payer: ASR ASR |
$7.66
|
| Rate for Payer: BCBS Trust/PPO |
$6.48
|
| Rate for Payer: BCN Commercial |
$6.48
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cofinity Commercial |
$7.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.32
|
| Rate for Payer: Healthscope Commercial |
$7.66
|
| Rate for Payer: Healthscope Whirlpool |
$7.90
|
| Rate for Payer: Mclaren Commercial |
$7.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Nomi Health Commercial |
$6.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.95
|
|
|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
OP
|
$7.90
|
|
|
Service Code
|
NDC 536127780
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$7.90 |
| Rate for Payer: Aetna Commercial |
$7.11
|
| Rate for Payer: Aetna Medicare |
$2.92
|
| Rate for Payer: ASR ASR |
$7.66
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: BCBS Trust/PPO |
$6.51
|
| Rate for Payer: BCN Commercial |
$6.51
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cofinity Commercial |
$7.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.32
|
| Rate for Payer: Healthscope Commercial |
$7.66
|
| Rate for Payer: Healthscope Whirlpool |
$7.90
|
| Rate for Payer: Mclaren Commercial |
$7.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Nomi Health Commercial |
$6.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.92
|
| Rate for Payer: Priority Health Narrow Network |
$5.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.95
|
|
|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
IP
|
$7.90
|
|
|
Service Code
|
NDC 536140795
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$7.90 |
| Rate for Payer: Aetna Commercial |
$7.11
|
| Rate for Payer: ASR ASR |
$7.66
|
| Rate for Payer: BCBS Trust/PPO |
$6.48
|
| Rate for Payer: BCN Commercial |
$6.48
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cofinity Commercial |
$7.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.32
|
| Rate for Payer: Healthscope Commercial |
$7.66
|
| Rate for Payer: Healthscope Whirlpool |
$7.90
|
| Rate for Payer: Mclaren Commercial |
$7.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Nomi Health Commercial |
$6.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.95
|
|
|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
OP
|
$7.90
|
|
|
Service Code
|
NDC 536140795
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$7.90 |
| Rate for Payer: Aetna Commercial |
$7.11
|
| Rate for Payer: Aetna Medicare |
$2.92
|
| Rate for Payer: ASR ASR |
$7.66
|
| Rate for Payer: BCBS Complete |
$3.16
|
| Rate for Payer: BCBS Trust/PPO |
$6.51
|
| Rate for Payer: BCN Commercial |
$6.51
|
| Rate for Payer: Cash Price |
$6.32
|
| Rate for Payer: Cofinity Commercial |
$7.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.32
|
| Rate for Payer: Healthscope Commercial |
$7.66
|
| Rate for Payer: Healthscope Whirlpool |
$7.90
|
| Rate for Payer: Mclaren Commercial |
$7.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.71
|
| Rate for Payer: Nomi Health Commercial |
$6.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$6.92
|
| Rate for Payer: Priority Health Narrow Network |
$5.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.95
|
|
|
HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$86.15
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
108970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.61 |
| Max. Negotiated Rate |
$86.15 |
| Rate for Payer: Aetna Commercial |
$77.54
|
| Rate for Payer: ASR ASR |
$83.57
|
| Rate for Payer: BCBS Trust/PPO |
$70.75
|
| Rate for Payer: BCN Commercial |
$70.75
|
| Rate for Payer: Cash Price |
$68.92
|
| Rate for Payer: Cofinity Commercial |
$80.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.92
|
| Rate for Payer: Healthscope Commercial |
$83.57
|
| Rate for Payer: Healthscope Whirlpool |
$86.15
|
| Rate for Payer: Mclaren Commercial |
$77.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.23
|
| Rate for Payer: Nomi Health Commercial |
$70.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.81
|
|
|
HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$86.15
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
108970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.31 |
| Max. Negotiated Rate |
$86.15 |
| Rate for Payer: Aetna Commercial |
$77.54
|
| Rate for Payer: Aetna Medicare |
$31.88
|
| Rate for Payer: ASR ASR |
$83.57
|
| Rate for Payer: BCBS Complete |
$34.46
|
| Rate for Payer: BCBS Trust/PPO |
$71.03
|
| Rate for Payer: BCN Commercial |
$71.03
|
| Rate for Payer: Cash Price |
$68.92
|
| Rate for Payer: Cash Price |
$68.92
|
| Rate for Payer: Cofinity Commercial |
$80.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$68.92
|
| Rate for Payer: Healthscope Commercial |
$83.57
|
| Rate for Payer: Healthscope Whirlpool |
$86.15
|
| Rate for Payer: Mclaren Commercial |
$77.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.23
|
| Rate for Payer: Nomi Health Commercial |
$70.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$64.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.89
|
| Rate for Payer: Priority Health Narrow Network |
$18.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.81
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 1,000 MG/8 ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$695.02
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119666
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.31 |
| Max. Negotiated Rate |
$695.02 |
| Rate for Payer: Aetna Commercial |
$625.52
|
| Rate for Payer: Aetna Medicare |
$257.16
|
| Rate for Payer: ASR ASR |
$674.17
|
| Rate for Payer: BCBS Complete |
$278.01
|
| Rate for Payer: BCBS Trust/PPO |
$573.04
|
| Rate for Payer: BCN Commercial |
$573.04
|
| Rate for Payer: Cash Price |
$556.02
|
| Rate for Payer: Cash Price |
$556.02
|
| Rate for Payer: Cofinity Commercial |
$653.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$556.02
|
| Rate for Payer: Healthscope Commercial |
$674.17
|
| Rate for Payer: Healthscope Whirlpool |
$695.02
|
| Rate for Payer: Mclaren Commercial |
$625.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$556.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$590.77
|
| Rate for Payer: Nomi Health Commercial |
$569.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$521.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.89
|
| Rate for Payer: Priority Health Narrow Network |
$18.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$611.62
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 1,000 MG/8 ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$695.02
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119666
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$521.26 |
| Max. Negotiated Rate |
$695.02 |
| Rate for Payer: Aetna Commercial |
$625.52
|
| Rate for Payer: ASR ASR |
$674.17
|
| Rate for Payer: BCBS Trust/PPO |
$570.75
|
| Rate for Payer: BCN Commercial |
$570.75
|
| Rate for Payer: Cash Price |
$556.02
|
| Rate for Payer: Cofinity Commercial |
$653.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$556.02
|
| Rate for Payer: Healthscope Commercial |
$674.17
|
| Rate for Payer: Healthscope Whirlpool |
$695.02
|
| Rate for Payer: Mclaren Commercial |
$625.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$590.77
|
| Rate for Payer: Nomi Health Commercial |
$569.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$521.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$611.62
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$107.58
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.69 |
| Max. Negotiated Rate |
$107.58 |
| Rate for Payer: Aetna Commercial |
$96.83
|
| Rate for Payer: Aetna Commercial |
$97.68
|
| Rate for Payer: ASR ASR |
$105.28
|
| Rate for Payer: ASR ASR |
$104.36
|
| Rate for Payer: BCBS Trust/PPO |
$89.13
|
| Rate for Payer: BCBS Trust/PPO |
$88.35
|
| Rate for Payer: BCN Commercial |
$89.13
|
| Rate for Payer: BCN Commercial |
$88.35
|
| Rate for Payer: Cash Price |
$86.83
|
| Rate for Payer: Cash Price |
$86.07
|
| Rate for Payer: Cofinity Commercial |
$101.13
|
| Rate for Payer: Cofinity Commercial |
$102.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.07
|
| Rate for Payer: Healthscope Commercial |
$104.36
|
| Rate for Payer: Healthscope Commercial |
$105.28
|
| Rate for Payer: Healthscope Whirlpool |
$108.54
|
| Rate for Payer: Healthscope Whirlpool |
$107.58
|
| Rate for Payer: Mclaren Commercial |
$97.68
|
| Rate for Payer: Mclaren Commercial |
$96.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.45
|
| Rate for Payer: Nomi Health Commercial |
$89.00
|
| Rate for Payer: Nomi Health Commercial |
$88.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.51
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$108.54
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.31 |
| Max. Negotiated Rate |
$108.54 |
| Rate for Payer: Aetna Commercial |
$97.68
|
| Rate for Payer: Aetna Commercial |
$96.83
|
| Rate for Payer: Aetna Medicare |
$39.81
|
| Rate for Payer: Aetna Medicare |
$40.16
|
| Rate for Payer: ASR ASR |
$105.28
|
| Rate for Payer: ASR ASR |
$104.36
|
| Rate for Payer: BCBS Complete |
$43.03
|
| Rate for Payer: BCBS Complete |
$43.41
|
| Rate for Payer: BCBS Trust/PPO |
$89.49
|
| Rate for Payer: BCBS Trust/PPO |
$88.70
|
| Rate for Payer: BCN Commercial |
$88.70
|
| Rate for Payer: BCN Commercial |
$89.49
|
| Rate for Payer: Cash Price |
$86.83
|
| Rate for Payer: Cash Price |
$86.07
|
| Rate for Payer: Cash Price |
$86.83
|
| Rate for Payer: Cash Price |
$86.07
|
| Rate for Payer: Cofinity Commercial |
$101.13
|
| Rate for Payer: Cofinity Commercial |
$102.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.07
|
| Rate for Payer: Healthscope Commercial |
$105.28
|
| Rate for Payer: Healthscope Commercial |
$104.36
|
| Rate for Payer: Healthscope Whirlpool |
$108.54
|
| Rate for Payer: Healthscope Whirlpool |
$107.58
|
| Rate for Payer: Mclaren Commercial |
$97.68
|
| Rate for Payer: Mclaren Commercial |
$96.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$91.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.26
|
| Rate for Payer: Nomi Health Commercial |
$88.22
|
| Rate for Payer: Nomi Health Commercial |
$89.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.89
|
| Rate for Payer: Priority Health Narrow Network |
$18.31
|
| Rate for Payer: Priority Health Narrow Network |
$18.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.51
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$221.12
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$165.84 |
| Max. Negotiated Rate |
$221.12 |
| Rate for Payer: Aetna Commercial |
$199.01
|
| Rate for Payer: ASR ASR |
$214.49
|
| Rate for Payer: BCBS Trust/PPO |
$181.58
|
| Rate for Payer: BCN Commercial |
$181.58
|
| Rate for Payer: Cash Price |
$176.90
|
| Rate for Payer: Cofinity Commercial |
$207.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.90
|
| Rate for Payer: Healthscope Commercial |
$214.49
|
| Rate for Payer: Healthscope Whirlpool |
$221.12
|
| Rate for Payer: Mclaren Commercial |
$199.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.95
|
| Rate for Payer: Nomi Health Commercial |
$181.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.59
|
|
