Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$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

$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

HYDROCODONE 7.5 MG-ACETAMINOPHEN 325 MG TABLET

Facility

$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

HYDROCORTISONE 10 MG TABLET

Facility

$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 10 MG TABLET

Facility

$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 1 % TOPICAL CREAM

Facility

$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	$8.51
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	$8.51
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

$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 1 % TOPICAL CREAM

Facility

$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

$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	$8.51
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	$8.51
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 ACETATE 25 MG RECTAL SUPPOSITORY

Facility

$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	$44.59
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

$116.73

Service Code	NDC 59741030112
Hospital Charge Code	3738
Hospital Revenue Code	637
Min. Negotiated Rate	$46.69
Max. Negotiated Rate	$116.73
Rate for Payer: Aetna Commercial	$105.06
Rate for Payer: Aetna Medicare	$58.37
Rate for Payer: ASR ASR	$113.23
Rate for Payer: ASR Commercial	$113.23
Rate for Payer: BCBS Complete	$46.69
Rate for Payer: BCBS Trust/PPO	$95.59
Rate for Payer: BCN Commercial	$90.50
Rate for Payer: Cash Price	$93.38
Rate for Payer: Cofinity Commercial	$109.73
Rate for Payer: Encore Health Key Benefits Commercial	$93.38
Rate for Payer: Healthscope Commercial	$116.73
Rate for Payer: Healthscope Whirlpool	$113.23
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: Priority Health Cigna Priority Health	$75.87
Rate for Payer: 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

$39.57

Service Code	NDC 00713050306
Hospital Charge Code	3738
Hospital Revenue Code	637
Min. Negotiated Rate	$15.83
Max. Negotiated Rate	$39.57
Rate for Payer: Aetna Commercial	$35.61
Rate for Payer: Aetna Medicare	$19.79
Rate for Payer: ASR ASR	$38.38
Rate for Payer: ASR Commercial	$38.38
Rate for Payer: BCBS Complete	$15.83
Rate for Payer: BCBS Trust/PPO	$32.40
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: 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

$474.81

Service Code	NDC 00713050312
Hospital Charge Code	3738
Hospital Revenue Code	637
Min. Negotiated Rate	$189.92
Max. Negotiated Rate	$474.81
Rate for Payer: Aetna Commercial	$427.33
Rate for Payer: Aetna Medicare	$237.41
Rate for Payer: ASR ASR	$460.57
Rate for Payer: ASR Commercial	$460.57
Rate for Payer: BCBS Complete	$189.92
Rate for Payer: BCBS Trust/PPO	$388.82
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: 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	$417.83

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY

Facility

$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	$3.71
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

$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	$428.89
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	$428.89
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

$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

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY

Facility

$116.73

Service Code	NDC 59741030112
Hospital Charge Code	3738
Hospital Revenue Code	637
Min. Negotiated Rate	$75.87
Max. Negotiated Rate	$116.73
Rate for Payer: Aetna Commercial	$105.06
Rate for Payer: ASR ASR	$113.23
Rate for Payer: ASR Commercial	$113.23
Rate for Payer: BCBS Trust/PPO	$95.12
Rate for Payer: BCN Commercial	$90.50
Rate for Payer: Cash Price	$93.38
Rate for Payer: Cofinity Commercial	$109.73
Rate for Payer: Encore Health Key Benefits Commercial	$93.38
Rate for Payer: Healthscope Commercial	$116.73
Rate for Payer: Healthscope Whirlpool	$113.23
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: Priority Health Cigna Priority Health	$75.87
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$102.72

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY

Facility

$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

$476.55

Service Code	NDC 00574709012
Hospital Charge Code	3738
Hospital Revenue Code	637
Min. Negotiated Rate	$309.76
Max. Negotiated Rate	$476.55
Rate for Payer: Aetna Commercial	$428.89
Rate for Payer: ASR ASR	$462.25
Rate for Payer: ASR Commercial	$462.25
Rate for Payer: BCBS Trust/PPO	$388.34
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	$428.89
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: UHC All Payor (Choice/PPO) + Core	$419.36

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY

Facility

$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

$89.17

Service Code	NDC 16571067621
Hospital Charge Code	3738
Hospital Revenue Code	637
Min. Negotiated Rate	$57.96
Max. Negotiated Rate	$89.17
Rate for Payer: Aetna Commercial	$80.25
Rate for Payer: ASR ASR	$86.49
Rate for Payer: ASR Commercial	$86.49
Rate for Payer: BCBS Trust/PPO	$72.66
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: UHC All Payor (Choice/PPO) + Core	$78.47

HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM

Facility

$7.90

Service Code	NDC 00536140795
Hospital Charge Code	14190
Hospital Revenue Code	637
Min. Negotiated Rate	$5.13
Max. Negotiated Rate	$7.90
Rate for Payer: Aetna Commercial	$7.11
Rate for Payer: ASR ASR	$7.66
Rate for Payer: ASR Commercial	$7.66
Rate for Payer: BCBS Trust/PPO	$6.44
Rate for Payer: BCN Commercial	$6.12
Rate for Payer: Cash Price	$6.32
Rate for Payer: Cofinity Commercial	$7.43
Rate for Payer: Encore Health Key Benefits Commercial	$6.32
Rate for Payer: Healthscope Commercial	$7.90
Rate for Payer: Healthscope Whirlpool	$7.66
Rate for Payer: Mclaren Commercial	$7.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.71
Rate for Payer: Nomi Health Commercial	$6.48
Rate for Payer: Priority Health Cigna Priority Health	$5.13
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$6.95

HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM

Facility

$7.90

Service Code	NDC 00536140795
Hospital Charge Code	14190
Hospital Revenue Code	637
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$7.90
Rate for Payer: Aetna Commercial	$7.11
Rate for Payer: Aetna Medicare	$3.95
Rate for Payer: ASR ASR	$7.66
Rate for Payer: ASR Commercial	$7.66
Rate for Payer: BCBS Complete	$3.16
Rate for Payer: BCBS Trust/PPO	$6.47
Rate for Payer: BCN Commercial	$6.12
Rate for Payer: Cash Price	$6.32
Rate for Payer: Cofinity Commercial	$7.43
Rate for Payer: Encore Health Key Benefits Commercial	$6.32
Rate for Payer: Healthscope Commercial	$7.90
Rate for Payer: Healthscope Whirlpool	$7.66
Rate for Payer: Mclaren Commercial	$7.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.71
Rate for Payer: Nomi Health Commercial	$6.48
Rate for Payer: Priority Health Cigna Priority Health	$5.13
Rate for Payer: 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

$7.90

Service Code	NDC 00536127780
Hospital Charge Code	14190
Hospital Revenue Code	637
Min. Negotiated Rate	$3.16
Max. Negotiated Rate	$7.90
Rate for Payer: Aetna Commercial	$7.11
Rate for Payer: Aetna Medicare	$3.95
Rate for Payer: ASR ASR	$7.66
Rate for Payer: ASR Commercial	$7.66
Rate for Payer: BCBS Complete	$3.16
Rate for Payer: BCBS Trust/PPO	$6.47
Rate for Payer: BCN Commercial	$6.12
Rate for Payer: Cash Price	$6.32
Rate for Payer: Cofinity Commercial	$7.43
Rate for Payer: Encore Health Key Benefits Commercial	$6.32
Rate for Payer: Healthscope Commercial	$7.90
Rate for Payer: Healthscope Whirlpool	$7.66
Rate for Payer: Mclaren Commercial	$7.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.71
Rate for Payer: Nomi Health Commercial	$6.48
Rate for Payer: Priority Health Cigna Priority Health	$5.13
Rate for Payer: 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

$7.90

Service Code	NDC 00536127780
Hospital Charge Code	14190
Hospital Revenue Code	637
Min. Negotiated Rate	$5.13
Max. Negotiated Rate	$7.90
Rate for Payer: Aetna Commercial	$7.11
Rate for Payer: ASR ASR	$7.66
Rate for Payer: ASR Commercial	$7.66
Rate for Payer: BCBS Trust/PPO	$6.44
Rate for Payer: BCN Commercial	$6.12
Rate for Payer: Cash Price	$6.32
Rate for Payer: Cofinity Commercial	$7.43
Rate for Payer: Encore Health Key Benefits Commercial	$6.32
Rate for Payer: Healthscope Commercial	$7.90
Rate for Payer: Healthscope Whirlpool	$7.66
Rate for Payer: Mclaren Commercial	$7.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.71
Rate for Payer: Nomi Health Commercial	$6.48
Rate for Payer: Priority Health Cigna Priority Health	$5.13
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$6.95

Know your out-of-pocket cost for care.

All Charges