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Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

hydrocortisone 100 mg preservative-free Pow [HMC]

Facility

IP

$52.84

Service Code	HCPCS J1720
Hospital Charge Code	3809700
Hospital Revenue Code	250
Min. Negotiated Rate	$47.56
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$47.56
Rate for Payer: Aetna Commercial	$52.71
Rate for Payer: UnitedHealthcare Commercial	$55.64
Rate for Payer: UnitedHealthcare Commercial	$50.20
Rate for Payer: WPPA Medicare Advantage	$1,200.00
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hydrocortisone 100 mg preservative-free Pow [HMC]

Facility

OP

$58.57

Service Code	HCPCS J1720
Hospital Charge Code	3809700
Hospital Revenue Code	250
Min. Negotiated Rate	$22.06
Max. Negotiated Rate	$55.64
Rate for Payer: Aetna Commercial	$52.71
Rate for Payer: Aetna Commercial	$47.56
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$23.74
Rate for Payer: Blue Cross Blue Shield of Kansas Commercial	$23.74
Rate for Payer: Humana Medicare Advantage	$24.60
Rate for Payer: Humana Medicare Advantage	$22.19
Rate for Payer: UnitedHealthcare Commercial	$50.20
Rate for Payer: UnitedHealthcare Commercial	$55.64
Rate for Payer: UnitedHealthcare Medicaid	$22.06
Rate for Payer: UnitedHealthcare Medicaid	$22.06
Rate for Payer: WPPA Medicare Advantage	$35.14
Rate for Payer: WPPA Medicare Advantage	$31.70

hydrocortisone 10 mg Tab [HMC]

Facility

OP

$11.07

Service Code	NDC 50268040615
Hospital Charge Code	3800123
Hospital Revenue Code	250
Min. Negotiated Rate	$4.43
Max. Negotiated Rate	$10.52
Rate for Payer: Aetna Commercial	$9.96
Rate for Payer: Humana Medicare Advantage	$4.65
Rate for Payer: UnitedHealthcare Commercial	$10.52
Rate for Payer: UnitedHealthcare Medicaid	$4.43
Rate for Payer: WPPA Medicare Advantage	$6.64

hydrocortisone 10 mg Tab [HMC]

Facility

IP

$6.72

Service Code	NDC 59762007401
Hospital Charge Code	3800123
Hospital Revenue Code	250
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.05
Rate for Payer: UnitedHealthcare Commercial	$6.38
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hydrocortisone 10 mg Tab [HMC]

Facility

OP

$6.72

Service Code	NDC 00115169701
Hospital Charge Code	3800123
Hospital Revenue Code	250
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$6.38
Rate for Payer: Aetna Commercial	$6.05
Rate for Payer: Humana Medicare Advantage	$2.82
Rate for Payer: UnitedHealthcare Commercial	$6.38
Rate for Payer: UnitedHealthcare Medicaid	$2.69
Rate for Payer: WPPA Medicare Advantage	$4.03

hydrocortisone 10 mg Tab [HMC]

Facility

IP

$11.46

Service Code	NDC 00904718861
Hospital Charge Code	3800123
Hospital Revenue Code	250
Min. Negotiated Rate	$10.31
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$10.31
Rate for Payer: UnitedHealthcare Commercial	$10.89
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hydrocortisone 10 mg Tab [HMC]

Facility

IP

$6.72

Service Code	NDC 00115169701
Hospital Charge Code	3800123
Hospital Revenue Code	250
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$6.05
Rate for Payer: UnitedHealthcare Commercial	$6.38
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hydrocortisone 10 mg Tab [HMC]

Facility

OP

$11.46

Service Code	NDC 00904718861
Hospital Charge Code	3800123
Hospital Revenue Code	250
Min. Negotiated Rate	$4.58
Max. Negotiated Rate	$10.89
Rate for Payer: Aetna Commercial	$10.31
Rate for Payer: Humana Medicare Advantage	$4.81
Rate for Payer: UnitedHealthcare Commercial	$10.89
Rate for Payer: UnitedHealthcare Medicaid	$4.58
Rate for Payer: WPPA Medicare Advantage	$6.88

hydrocortisone 10 mg Tab [HMC]

Facility

IP

$11.07

Service Code	NDC 50268040615
Hospital Charge Code	3800123
Hospital Revenue Code	250
Min. Negotiated Rate	$9.96
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$9.96
Rate for Payer: UnitedHealthcare Commercial	$10.52
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hydrocortisone 10 mg Tab [HMC]

Facility

OP

$6.72

Service Code	NDC 59762007401
Hospital Charge Code	3800123
Hospital Revenue Code	250
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$6.38
Rate for Payer: Aetna Commercial	$6.05
Rate for Payer: Humana Medicare Advantage	$2.82
Rate for Payer: UnitedHealthcare Commercial	$6.38
Rate for Payer: UnitedHealthcare Medicaid	$2.69
Rate for Payer: WPPA Medicare Advantage	$4.03

hydrocortisone 25 mg Supp [HMC]

Facility

OP

$27.65

Service Code	NDC 00713050312
Hospital Charge Code	3800254
Hospital Revenue Code	250
Min. Negotiated Rate	$11.06
Max. Negotiated Rate	$26.27
Rate for Payer: Aetna Commercial	$24.89
Rate for Payer: Humana Medicare Advantage	$11.61
Rate for Payer: UnitedHealthcare Commercial	$26.27
Rate for Payer: UnitedHealthcare Medicaid	$11.06
Rate for Payer: WPPA Medicare Advantage	$16.59

hydrocortisone 25 mg Supp [HMC]

Facility

IP

$27.65

Service Code	NDC 00713050312
Hospital Charge Code	3800254
Hospital Revenue Code	250
Min. Negotiated Rate	$24.89
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$24.89
Rate for Payer: UnitedHealthcare Commercial	$26.27
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hydrocortisone 25 mg Supp [HMC]

Facility

OP

$26.51

Service Code	NDC 16571067642
Hospital Charge Code	3800254
Hospital Revenue Code	250
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$25.18
Rate for Payer: Aetna Commercial	$23.86
Rate for Payer: Humana Medicare Advantage	$11.13
Rate for Payer: UnitedHealthcare Commercial	$25.18
Rate for Payer: UnitedHealthcare Medicaid	$10.60
Rate for Payer: WPPA Medicare Advantage	$15.91

hydrocortisone 25 mg Supp [HMC]

Facility

IP

$26.51

Service Code	NDC 16571067642
Hospital Charge Code	3800254
Hospital Revenue Code	250
Min. Negotiated Rate	$23.86
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$23.86
Rate for Payer: UnitedHealthcare Commercial	$25.18
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hydrocortisone/neomycin/polymyxin B Ophth Susp [HMC]

Facility

OP

$272.59

Service Code	NDC 61314064175
Hospital Charge Code	3801335
Hospital Revenue Code	250
Min. Negotiated Rate	$109.04
Max. Negotiated Rate	$258.96
Rate for Payer: Aetna Commercial	$245.33
Rate for Payer: Humana Medicare Advantage	$114.49
Rate for Payer: UnitedHealthcare Commercial	$258.96
Rate for Payer: UnitedHealthcare Medicaid	$109.04
Rate for Payer: WPPA Medicare Advantage	$163.55

hydrocortisone/neomycin/polymyxin B Ophth Susp [HMC]

Facility

IP

$272.59

Service Code	NDC 61314064175
Hospital Charge Code	3801335
Hospital Revenue Code	250
Min. Negotiated Rate	$245.33
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$245.33
Rate for Payer: UnitedHealthcare Commercial	$258.96
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hydrocortisone/neomycin/polymyxin B Otic Sol [HMC]

Facility

IP

$161.59

Service Code	NDC 61314064610
Hospital Charge Code	3806375
Hospital Revenue Code	250
Min. Negotiated Rate	$145.43
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$145.43
Rate for Payer: UnitedHealthcare Commercial	$153.51
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hydrocortisone/neomycin/polymyxin B Otic Sol [HMC]

Facility

IP

$250.38

Service Code	NDC 24208063110
Hospital Charge Code	3806375
Hospital Revenue Code	250
Min. Negotiated Rate	$225.34
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$225.34
Rate for Payer: UnitedHealthcare Commercial	$237.86
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hydrocortisone/neomycin/polymyxin B Otic Sol [HMC]

Facility

OP

$250.38

Service Code	NDC 24208063110
Hospital Charge Code	3806375
Hospital Revenue Code	250
Min. Negotiated Rate	$100.15
Max. Negotiated Rate	$237.86
Rate for Payer: Aetna Commercial	$225.34
Rate for Payer: Humana Medicare Advantage	$105.16
Rate for Payer: UnitedHealthcare Commercial	$237.86
Rate for Payer: UnitedHealthcare Medicaid	$100.15
Rate for Payer: WPPA Medicare Advantage	$150.23

hydrocortisone/neomycin/polymyxin B Otic Sol [HMC]

Facility

OP

$161.59

Service Code	NDC 61314064610
Hospital Charge Code	3806375
Hospital Revenue Code	250
Min. Negotiated Rate	$64.64
Max. Negotiated Rate	$153.51
Rate for Payer: Aetna Commercial	$145.43
Rate for Payer: Humana Medicare Advantage	$67.87
Rate for Payer: UnitedHealthcare Commercial	$153.51
Rate for Payer: UnitedHealthcare Medicaid	$64.64
Rate for Payer: WPPA Medicare Advantage	$96.95

hydrocortisone/neomycin/polymyxin B Otic Susp [HMC]

Facility

OP

$250.38

Service Code	NDC 24208063562
Hospital Charge Code	3803232
Hospital Revenue Code	250
Min. Negotiated Rate	$100.15
Max. Negotiated Rate	$237.86
Rate for Payer: Aetna Commercial	$225.34
Rate for Payer: Humana Medicare Advantage	$105.16
Rate for Payer: UnitedHealthcare Commercial	$237.86
Rate for Payer: UnitedHealthcare Medicaid	$100.15
Rate for Payer: WPPA Medicare Advantage	$150.23

hydrocortisone/neomycin/polymyxin B Otic Susp [HMC]

Facility

IP

$250.38

Service Code	NDC 24208063562
Hospital Charge Code	3803232
Hospital Revenue Code	250
Min. Negotiated Rate	$225.34
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$225.34
Rate for Payer: UnitedHealthcare Commercial	$237.86
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hydrocortisone-pramoxine topical 1%-1% Foa [HMC]

Facility

IP

$174.47

Service Code	NDC 00037682410
Hospital Charge Code	3809262
Hospital Revenue Code	250
Min. Negotiated Rate	$157.02
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$157.02
Rate for Payer: UnitedHealthcare Commercial	$165.75
Rate for Payer: WPPA Medicare Advantage	$1,200.00

hydrocortisone-pramoxine topical 1%-1% Foa [HMC]

Facility

OP

$174.47

Service Code	NDC 00037682410
Hospital Charge Code	3809262
Hospital Revenue Code	250
Min. Negotiated Rate	$69.79
Max. Negotiated Rate	$165.75
Rate for Payer: Aetna Commercial	$157.02
Rate for Payer: Humana Medicare Advantage	$73.28
Rate for Payer: UnitedHealthcare Commercial	$165.75
Rate for Payer: UnitedHealthcare Medicaid	$69.79
Rate for Payer: WPPA Medicare Advantage	$104.68

hydrocortisone Top 1% Lotion [HMC]

Facility

OP

$37.46

Service Code	NDC 45802028306
Hospital Charge Code	3805724
Hospital Revenue Code	250
Min. Negotiated Rate	$14.98
Max. Negotiated Rate	$35.59
Rate for Payer: Aetna Commercial	$33.71
Rate for Payer: Humana Medicare Advantage	$15.73
Rate for Payer: UnitedHealthcare Commercial	$35.59
Rate for Payer: UnitedHealthcare Medicaid	$14.98
Rate for Payer: WPPA Medicare Advantage	$22.48

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