|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$42.44
|
|
|
Service Code
|
NDC 00121077204
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.98 |
| Max. Negotiated Rate |
$42.44 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: Aetna Medicare |
$21.22
|
| Rate for Payer: ASR ASR |
$41.17
|
| Rate for Payer: ASR Commercial |
$41.17
|
| Rate for Payer: BCBS Complete |
$16.98
|
| Rate for Payer: BCBS Trust/PPO |
$34.75
|
| Rate for Payer: BCN Commercial |
$32.90
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.95
|
| Rate for Payer: Healthscope Commercial |
$42.44
|
| Rate for Payer: Healthscope Whirlpool |
$41.17
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.07
|
| Rate for Payer: Nomi Health Commercial |
$34.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.19
|
| Rate for Payer: Priority Health Narrow Network |
$29.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.35
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$10.12
|
|
|
Service Code
|
NDC 09900000653
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.58 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Aetna Commercial |
$9.11
|
| Rate for Payer: ASR ASR |
$9.82
|
| Rate for Payer: ASR Commercial |
$9.82
|
| Rate for Payer: BCBS Trust/PPO |
$8.25
|
| Rate for Payer: BCN Commercial |
$7.85
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cofinity Commercial |
$9.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.10
|
| Rate for Payer: Healthscope Commercial |
$10.12
|
| Rate for Payer: Healthscope Whirlpool |
$9.82
|
| Rate for Payer: Mclaren Commercial |
$9.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.60
|
| Rate for Payer: Nomi Health Commercial |
$8.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.91
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$14.86
|
|
|
Service Code
|
NDC 60687041771
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$14.86 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: ASR ASR |
$14.41
|
| Rate for Payer: ASR Commercial |
$14.41
|
| Rate for Payer: BCBS Trust/PPO |
$12.11
|
| Rate for Payer: BCN Commercial |
$11.52
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$14.86
|
| Rate for Payer: Healthscope Whirlpool |
$14.41
|
| Rate for Payer: Mclaren Commercial |
$13.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.08
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
OP
|
$14.86
|
|
|
Service Code
|
NDC 60687041771
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$14.86 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Medicare |
$7.43
|
| Rate for Payer: ASR ASR |
$14.41
|
| Rate for Payer: ASR Commercial |
$14.41
|
| Rate for Payer: BCBS Complete |
$5.94
|
| Rate for Payer: BCBS Trust/PPO |
$12.17
|
| Rate for Payer: BCN Commercial |
$11.52
|
| Rate for Payer: Cash Price |
$11.89
|
| Rate for Payer: Cofinity Commercial |
$13.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.89
|
| Rate for Payer: Healthscope Commercial |
$14.86
|
| Rate for Payer: Healthscope Whirlpool |
$14.41
|
| Rate for Payer: Mclaren Commercial |
$13.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.63
|
| Rate for Payer: Nomi Health Commercial |
$12.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.02
|
| Rate for Payer: Priority Health Narrow Network |
$10.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.08
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG/15 ML ORAL SOLUTION
|
Facility
|
IP
|
$42.44
|
|
|
Service Code
|
NDC 00121077204
|
| Hospital Charge Code |
37848
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$42.44 |
| Rate for Payer: Aetna Commercial |
$38.20
|
| Rate for Payer: ASR ASR |
$41.17
|
| Rate for Payer: ASR Commercial |
$41.17
|
| Rate for Payer: BCBS Trust/PPO |
$34.58
|
| Rate for Payer: BCN Commercial |
$32.90
|
| Rate for Payer: Cash Price |
$33.96
|
| Rate for Payer: Cofinity Commercial |
$39.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$33.95
|
| Rate for Payer: Healthscope Commercial |
$42.44
|
| Rate for Payer: Healthscope Whirlpool |
$41.17
|
| Rate for Payer: Mclaren Commercial |
$38.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$36.07
|
| Rate for Payer: Nomi Health Commercial |
$34.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$37.35
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$235.38
|
|
|
Service Code
|
NDC 50268040015
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$235.38 |
| Rate for Payer: Aetna Commercial |
$211.84
|
| Rate for Payer: ASR ASR |
$228.32
|
| Rate for Payer: ASR Commercial |
$228.32
|
| Rate for Payer: BCBS Trust/PPO |
$191.81
|
| Rate for Payer: BCN Commercial |
$182.49
|
| Rate for Payer: Cash Price |
$188.30
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.30
|
| Rate for Payer: Healthscope Commercial |
$235.38
|
| Rate for Payer: Healthscope Whirlpool |
$228.32
|
| Rate for Payer: Mclaren Commercial |
$211.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.07
|
| Rate for Payer: Nomi Health Commercial |
$193.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.13
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$4.71
|
|
|
Service Code
|
NDC 50268040011
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$4.71 |
| Rate for Payer: Aetna Commercial |
$4.24
|
| Rate for Payer: Aetna Medicare |
$2.36
|
| Rate for Payer: ASR ASR |
$4.57
|
| Rate for Payer: ASR Commercial |
$4.57
|
| Rate for Payer: BCBS Complete |
$1.88
|
| Rate for Payer: BCBS Trust/PPO |
$3.86
|
| Rate for Payer: BCN Commercial |
$3.65
|
| Rate for Payer: Cash Price |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$4.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.77
|
| Rate for Payer: Healthscope Commercial |
$4.71
|
| Rate for Payer: Healthscope Whirlpool |
$4.57
|
| Rate for Payer: Mclaren Commercial |
$4.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.00
|
| Rate for Payer: Nomi Health Commercial |
$3.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.13
|
| Rate for Payer: Priority Health Narrow Network |
$3.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.14
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$235.38
|
|
|
Service Code
|
NDC 50268040015
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.15 |
| Max. Negotiated Rate |
$235.38 |
| Rate for Payer: Aetna Commercial |
$211.84
|
| Rate for Payer: Aetna Medicare |
$117.69
|
| Rate for Payer: ASR ASR |
$228.32
|
| Rate for Payer: ASR Commercial |
$228.32
|
| Rate for Payer: BCBS Complete |
$94.15
|
| Rate for Payer: BCBS Trust/PPO |
$192.75
|
| Rate for Payer: BCN Commercial |
$182.49
|
| Rate for Payer: Cash Price |
$188.30
|
| Rate for Payer: Cofinity Commercial |
$221.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.30
|
| Rate for Payer: Healthscope Commercial |
$235.38
|
| Rate for Payer: Healthscope Whirlpool |
$228.32
|
| Rate for Payer: Mclaren Commercial |
$211.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.07
|
| Rate for Payer: Nomi Health Commercial |
$193.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.24
|
| Rate for Payer: Priority Health Narrow Network |
$165.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.13
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$4.71
|
|
|
Service Code
|
NDC 50268040011
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$4.71 |
| Rate for Payer: Aetna Commercial |
$4.24
|
| Rate for Payer: ASR ASR |
$4.57
|
| Rate for Payer: ASR Commercial |
$4.57
|
| Rate for Payer: BCBS Trust/PPO |
$3.84
|
| Rate for Payer: BCN Commercial |
$3.65
|
| Rate for Payer: Cash Price |
$3.77
|
| Rate for Payer: Cofinity Commercial |
$4.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.77
|
| Rate for Payer: Healthscope Commercial |
$4.71
|
| Rate for Payer: Healthscope Whirlpool |
$4.57
|
| Rate for Payer: Mclaren Commercial |
$4.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.00
|
| Rate for Payer: Nomi Health Commercial |
$3.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.14
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$757.75
|
|
|
Service Code
|
NDC 00406012462
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$303.10 |
| Max. Negotiated Rate |
$757.75 |
| Rate for Payer: Aetna Commercial |
$681.98
|
| Rate for Payer: Aetna Medicare |
$378.88
|
| Rate for Payer: ASR ASR |
$735.02
|
| Rate for Payer: ASR Commercial |
$735.02
|
| Rate for Payer: BCBS Complete |
$303.10
|
| Rate for Payer: BCBS Trust/PPO |
$620.52
|
| Rate for Payer: BCN Commercial |
$587.48
|
| Rate for Payer: Cash Price |
$606.20
|
| Rate for Payer: Cofinity Commercial |
$712.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.20
|
| Rate for Payer: Healthscope Commercial |
$757.75
|
| Rate for Payer: Healthscope Whirlpool |
$735.02
|
| Rate for Payer: Mclaren Commercial |
$681.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.09
|
| Rate for Payer: Nomi Health Commercial |
$621.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.54
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$663.94
|
| Rate for Payer: Priority Health Narrow Network |
$531.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$666.82
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$7.58
|
|
|
Service Code
|
NDC 00406012423
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$7.58 |
| Rate for Payer: Aetna Commercial |
$6.82
|
| Rate for Payer: Aetna Medicare |
$3.79
|
| Rate for Payer: ASR ASR |
$7.35
|
| Rate for Payer: ASR Commercial |
$7.35
|
| Rate for Payer: BCBS Complete |
$3.03
|
| Rate for Payer: BCBS Trust/PPO |
$6.21
|
| Rate for Payer: BCN Commercial |
$5.88
|
| Rate for Payer: Cash Price |
$6.06
|
| Rate for Payer: Cofinity Commercial |
$7.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.06
|
| Rate for Payer: Healthscope Commercial |
$7.58
|
| Rate for Payer: Healthscope Whirlpool |
$7.35
|
| Rate for Payer: Mclaren Commercial |
$6.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.44
|
| Rate for Payer: Nomi Health Commercial |
$6.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.64
|
| Rate for Payer: Priority Health Narrow Network |
$5.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.67
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$7.58
|
|
|
Service Code
|
NDC 00406012423
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$7.58 |
| Rate for Payer: Aetna Commercial |
$6.82
|
| Rate for Payer: ASR ASR |
$7.35
|
| Rate for Payer: ASR Commercial |
$7.35
|
| Rate for Payer: BCBS Trust/PPO |
$6.18
|
| Rate for Payer: BCN Commercial |
$5.88
|
| Rate for Payer: Cash Price |
$6.06
|
| Rate for Payer: Cofinity Commercial |
$7.13
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.06
|
| Rate for Payer: Healthscope Commercial |
$7.58
|
| Rate for Payer: Healthscope Whirlpool |
$7.35
|
| Rate for Payer: Mclaren Commercial |
$6.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.44
|
| Rate for Payer: Nomi Health Commercial |
$6.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.67
|
|
|
HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$757.75
|
|
|
Service Code
|
NDC 00406012462
|
| Hospital Charge Code |
34544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$492.54 |
| Max. Negotiated Rate |
$757.75 |
| Rate for Payer: Aetna Commercial |
$681.98
|
| Rate for Payer: ASR ASR |
$735.02
|
| Rate for Payer: ASR Commercial |
$735.02
|
| Rate for Payer: BCBS Trust/PPO |
$617.49
|
| Rate for Payer: BCN Commercial |
$587.48
|
| Rate for Payer: Cash Price |
$606.20
|
| Rate for Payer: Cofinity Commercial |
$712.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$606.20
|
| Rate for Payer: Healthscope Commercial |
$757.75
|
| Rate for Payer: Healthscope Whirlpool |
$735.02
|
| Rate for Payer: Mclaren Commercial |
$681.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$644.09
|
| Rate for Payer: Nomi Health Commercial |
$621.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$666.82
|
|
|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
IP
|
$650.88
|
|
|
Service Code
|
NDC 00904718861
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$423.07 |
| Max. Negotiated Rate |
$650.88 |
| Rate for Payer: Aetna Commercial |
$585.79
|
| Rate for Payer: ASR ASR |
$631.35
|
| Rate for Payer: ASR Commercial |
$631.35
|
| Rate for Payer: BCBS Trust/PPO |
$530.40
|
| Rate for Payer: BCN Commercial |
$504.63
|
| Rate for Payer: Cash Price |
$520.70
|
| Rate for Payer: Cofinity Commercial |
$611.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.70
|
| Rate for Payer: Healthscope Commercial |
$650.88
|
| Rate for Payer: Healthscope Whirlpool |
$631.35
|
| Rate for Payer: Mclaren Commercial |
$585.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.25
|
| Rate for Payer: Nomi Health Commercial |
$533.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$572.77
|
|
|
HYDROCORTISONE 10 MG TABLET
|
Facility
|
OP
|
$650.88
|
|
|
Service Code
|
NDC 00904718861
|
| Hospital Charge Code |
3733
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.35 |
| Max. Negotiated Rate |
$650.88 |
| Rate for Payer: Aetna Commercial |
$585.79
|
| Rate for Payer: Aetna Medicare |
$325.44
|
| Rate for Payer: ASR ASR |
$631.35
|
| Rate for Payer: ASR Commercial |
$631.35
|
| Rate for Payer: BCBS Complete |
$260.35
|
| Rate for Payer: BCBS Trust/PPO |
$533.01
|
| Rate for Payer: BCN Commercial |
$504.63
|
| Rate for Payer: Cash Price |
$520.70
|
| Rate for Payer: Cofinity Commercial |
$611.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.70
|
| Rate for Payer: Healthscope Commercial |
$650.88
|
| Rate for Payer: Healthscope Whirlpool |
$631.35
|
| Rate for Payer: Mclaren Commercial |
$585.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$553.25
|
| Rate for Payer: Nomi Health Commercial |
$533.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$570.30
|
| Rate for Payer: Priority Health Narrow Network |
$456.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$572.77
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$9.45
|
|
|
Service Code
|
NDC 45802043803
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: ASR ASR |
$9.17
|
| Rate for Payer: ASR Commercial |
$9.17
|
| Rate for Payer: BCBS Trust/PPO |
$7.70
|
| Rate for Payer: BCN Commercial |
$7.33
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Healthscope Commercial |
$9.45
|
| Rate for Payer: Healthscope Whirlpool |
$9.17
|
| Rate for Payer: Mclaren Commercial |
$8.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.03
|
| Rate for Payer: Nomi Health Commercial |
$7.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.32
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$14.62
|
|
|
Service Code
|
NDC 51672206902
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.85 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.16
|
| Rate for Payer: Aetna Medicare |
$7.31
|
| Rate for Payer: ASR ASR |
$14.18
|
| Rate for Payer: ASR Commercial |
$14.18
|
| Rate for Payer: BCBS Complete |
$5.85
|
| Rate for Payer: BCBS Trust/PPO |
$11.97
|
| Rate for Payer: BCN Commercial |
$11.33
|
| Rate for Payer: Cash Price |
$11.69
|
| Rate for Payer: Cofinity Commercial |
$13.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.70
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Healthscope Whirlpool |
$14.18
|
| Rate for Payer: Mclaren Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.43
|
| Rate for Payer: Nomi Health Commercial |
$11.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.81
|
| Rate for Payer: Priority Health Narrow Network |
$10.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.87
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
OP
|
$9.45
|
|
|
Service Code
|
NDC 45802043803
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Aetna Commercial |
$8.50
|
| Rate for Payer: Aetna Medicare |
$4.72
|
| Rate for Payer: ASR ASR |
$9.17
|
| Rate for Payer: ASR Commercial |
$9.17
|
| Rate for Payer: BCBS Complete |
$3.78
|
| Rate for Payer: BCBS Trust/PPO |
$7.74
|
| Rate for Payer: BCN Commercial |
$7.33
|
| Rate for Payer: Cash Price |
$7.56
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.56
|
| Rate for Payer: Healthscope Commercial |
$9.45
|
| Rate for Payer: Healthscope Whirlpool |
$9.17
|
| Rate for Payer: Mclaren Commercial |
$8.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.03
|
| Rate for Payer: Nomi Health Commercial |
$7.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.28
|
| Rate for Payer: Priority Health Narrow Network |
$6.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.32
|
|
|
HYDROCORTISONE 1 % TOPICAL CREAM
|
Facility
|
IP
|
$14.62
|
|
|
Service Code
|
NDC 51672206902
|
| Hospital Charge Code |
3726
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$14.62 |
| Rate for Payer: Aetna Commercial |
$13.16
|
| Rate for Payer: ASR ASR |
$14.18
|
| Rate for Payer: ASR Commercial |
$14.18
|
| Rate for Payer: BCBS Trust/PPO |
$11.91
|
| Rate for Payer: BCN Commercial |
$11.33
|
| Rate for Payer: Cash Price |
$11.69
|
| Rate for Payer: Cofinity Commercial |
$13.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.70
|
| Rate for Payer: Healthscope Commercial |
$14.62
|
| Rate for Payer: Healthscope Whirlpool |
$14.18
|
| Rate for Payer: Mclaren Commercial |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.43
|
| Rate for Payer: Nomi Health Commercial |
$11.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.87
|
|
|
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 |
$25.72 |
| Max. Negotiated Rate |
$39.57 |
| Rate for Payer: Aetna Commercial |
$35.61
|
| Rate for Payer: ASR ASR |
$38.38
|
| Rate for Payer: ASR Commercial |
$38.38
|
| Rate for Payer: BCBS Trust/PPO |
$32.25
|
| Rate for Payer: BCN Commercial |
$30.68
|
| Rate for Payer: Cash Price |
$31.65
|
| Rate for Payer: Cofinity Commercial |
$37.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.66
|
| Rate for Payer: Healthscope Commercial |
$39.57
|
| Rate for Payer: Healthscope Whirlpool |
$38.38
|
| 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: Priority Health Cigna Priority Health |
$25.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.82
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$89.17
|
|
|
Service Code
|
NDC 16571067621
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$89.17 |
| Rate for Payer: Aetna Commercial |
$80.25
|
| Rate for Payer: Aetna Medicare |
$44.58
|
| Rate for Payer: ASR ASR |
$86.49
|
| Rate for Payer: ASR Commercial |
$86.49
|
| Rate for Payer: BCBS Complete |
$35.67
|
| Rate for Payer: BCBS Trust/PPO |
$73.02
|
| Rate for Payer: BCN Commercial |
$69.13
|
| Rate for Payer: Cash Price |
$71.33
|
| Rate for Payer: Cofinity Commercial |
$83.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.34
|
| Rate for Payer: Healthscope Commercial |
$89.17
|
| Rate for Payer: Healthscope Whirlpool |
$86.49
|
| Rate for Payer: Mclaren Commercial |
$80.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.79
|
| Rate for Payer: Nomi Health Commercial |
$73.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.13
|
| Rate for Payer: Priority Health Narrow Network |
$62.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.47
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$7.43
|
|
|
Service Code
|
NDC 16571067616
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$7.43 |
| Rate for Payer: Aetna Commercial |
$6.69
|
| Rate for Payer: ASR ASR |
$7.21
|
| Rate for Payer: ASR Commercial |
$7.21
|
| Rate for Payer: BCBS Trust/PPO |
$6.05
|
| Rate for Payer: BCN Commercial |
$5.76
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cofinity Commercial |
$6.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.94
|
| Rate for Payer: Healthscope Commercial |
$7.43
|
| Rate for Payer: Healthscope Whirlpool |
$7.21
|
| Rate for Payer: Mclaren Commercial |
$6.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.32
|
| Rate for Payer: Nomi Health Commercial |
$6.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.54
|
|
|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
OP
|
$7.43
|
|
|
Service Code
|
NDC 16571067616
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$7.43 |
| Rate for Payer: Aetna Commercial |
$6.69
|
| Rate for Payer: Aetna Medicare |
$3.72
|
| Rate for Payer: ASR ASR |
$7.21
|
| Rate for Payer: ASR Commercial |
$7.21
|
| Rate for Payer: BCBS Complete |
$2.97
|
| Rate for Payer: BCBS Trust/PPO |
$6.08
|
| Rate for Payer: BCN Commercial |
$5.76
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cofinity Commercial |
$6.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.94
|
| Rate for Payer: Healthscope Commercial |
$7.43
|
| Rate for Payer: Healthscope Whirlpool |
$7.21
|
| Rate for Payer: Mclaren Commercial |
$6.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.32
|
| Rate for Payer: Nomi Health Commercial |
$6.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.51
|
| Rate for Payer: Priority Health Narrow Network |
$5.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.54
|
|
|
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 |
$190.62 |
| Max. Negotiated Rate |
$476.55 |
| Rate for Payer: Aetna Commercial |
$428.90
|
| Rate for Payer: Aetna Medicare |
$238.28
|
| Rate for Payer: ASR ASR |
$462.25
|
| Rate for Payer: ASR Commercial |
$462.25
|
| Rate for Payer: BCBS Complete |
$190.62
|
| Rate for Payer: BCBS Trust/PPO |
$390.25
|
| Rate for Payer: BCN Commercial |
$369.47
|
| Rate for Payer: Cash Price |
$381.24
|
| Rate for Payer: Cofinity Commercial |
$447.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$381.24
|
| Rate for Payer: Healthscope Commercial |
$476.55
|
| Rate for Payer: Healthscope Whirlpool |
$462.25
|
| Rate for Payer: Mclaren Commercial |
$428.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$405.07
|
| Rate for Payer: Nomi Health Commercial |
$390.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$309.76
|
| Rate for Payer: 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
|
$474.81
|
|
|
Service Code
|
NDC 00713050312
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$308.63 |
| Max. Negotiated Rate |
$474.81 |
| Rate for Payer: Aetna Commercial |
$427.33
|
| Rate for Payer: ASR ASR |
$460.57
|
| Rate for Payer: ASR Commercial |
$460.57
|
| Rate for Payer: BCBS Trust/PPO |
$386.92
|
| Rate for Payer: BCN Commercial |
$368.12
|
| Rate for Payer: Cash Price |
$379.85
|
| Rate for Payer: Cofinity Commercial |
$446.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$379.85
|
| Rate for Payer: Healthscope Commercial |
$474.81
|
| Rate for Payer: Healthscope Whirlpool |
$460.57
|
| Rate for Payer: Mclaren Commercial |
$427.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$403.59
|
| Rate for Payer: Nomi Health Commercial |
$389.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$417.83
|
|
