|
HYDROMORPHONE (PF) 1 MG/ML IN 0.9 % SODIUM CHLORIDE INTRAVENOUS SOLN
|
Facility
|
OP
|
$99.02
|
|
|
Service Code
|
HCPCS J7999
|
| Hospital Charge Code |
185738
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.61 |
| Max. Negotiated Rate |
$89.12 |
| Rate for Payer: Aetna Commercial |
$84.17
|
| Rate for Payer: Aetna Medicare |
$49.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.36
|
| Rate for Payer: BCBS Complete |
$39.61
|
| Rate for Payer: Cash Price |
$79.22
|
| Rate for Payer: Cofinity Advantage |
$69.31
|
| Rate for Payer: Cofinity Commercial |
$85.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$79.22
|
| Rate for Payer: Healthscope Commercial |
$89.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$79.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$74.27
|
| Rate for Payer: PHP Commercial |
$84.17
|
| Rate for Payer: Priority Health SBD |
$62.38
|
|
|
HYDROMORPHONE VARIABLE DOSE
|
Facility
|
IP
|
$14.07
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
150712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.86 |
| Max. Negotiated Rate |
$12.66 |
| Rate for Payer: Aetna Commercial |
$11.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.15
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cofinity Advantage |
$9.85
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$12.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.55
|
| Rate for Payer: PHP Commercial |
$11.96
|
| Rate for Payer: Priority Health SBD |
$8.86
|
|
|
HYDROMORPHONE VARIABLE DOSE
|
Facility
|
OP
|
$14.07
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
150712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$12.66 |
| Rate for Payer: Aetna Commercial |
$11.96
|
| Rate for Payer: Aetna Medicare |
$7.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.15
|
| Rate for Payer: BCBS Complete |
$5.63
|
| Rate for Payer: BCBS Trust/PPO |
$0.34
|
| Rate for Payer: BCN Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cofinity Advantage |
$9.85
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$12.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.55
|
| Rate for Payer: PHP Commercial |
$11.96
|
| Rate for Payer: Priority Health SBD |
$8.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.23
|
| Rate for Payer: UHC Core |
$0.23
|
| Rate for Payer: UHC Exchange |
$0.23
|
|
|
HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,118.85
|
|
|
Service Code
|
HCPCS J3424
|
| Hospital Charge Code |
155400
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$2,806.97 |
| Rate for Payer: Aetna Commercial |
$2,651.02
|
| Rate for Payer: Aetna Medicare |
$5.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,027.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.80
|
| Rate for Payer: BCBS Complete |
$2.99
|
| Rate for Payer: BCBS MAPPO |
$5.44
|
| Rate for Payer: BCBS Trust/PPO |
$13.12
|
| Rate for Payer: BCN Commercial |
$13.12
|
| Rate for Payer: BCN Medicare Advantage |
$5.44
|
| Rate for Payer: Cash Price |
$2,495.08
|
| Rate for Payer: Cash Price |
$2,495.08
|
| Rate for Payer: Cofinity Advantage |
$2,183.20
|
| Rate for Payer: Cofinity Commercial |
$2,682.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,495.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.44
|
| Rate for Payer: Healthscope Commercial |
$2,806.97
|
| Rate for Payer: Mclaren Medicaid |
$2.85
|
| Rate for Payer: Mclaren Medicare |
$5.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.71
|
| Rate for Payer: Meridian Medicaid |
$5.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,651.02
|
| Rate for Payer: Nomi Health Commercial |
$16.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,339.14
|
| Rate for Payer: PACE Medicare |
$5.17
|
| Rate for Payer: PACE SWMI |
$5.44
|
| Rate for Payer: PHP Commercial |
$2,651.02
|
| Rate for Payer: PHP Medicare Advantage |
$5.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$16.35
|
| Rate for Payer: Priority Health Medicare |
$5.44
|
| Rate for Payer: Priority Health SBD |
$1,964.88
|
| Rate for Payer: Priority Health Tiered Network |
$13.08
|
| Rate for Payer: Railroad Medicare Medicare |
$5.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.98
|
| Rate for Payer: UHC Core |
$8.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.44
|
| Rate for Payer: UHC Exchange |
$8.98
|
| Rate for Payer: UHC Medicaid |
$2.85
|
| Rate for Payer: UHCCP Medicaid |
$2.85
|
| Rate for Payer: VA VA |
$5.44
|
|
|
HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,118.85
|
|
|
Service Code
|
HCPCS J3424
|
| Hospital Charge Code |
155400
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,964.88 |
| Max. Negotiated Rate |
$2,806.97 |
| Rate for Payer: Aetna Commercial |
$2,651.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,027.25
|
| Rate for Payer: Cash Price |
$2,495.08
|
| Rate for Payer: Cofinity Advantage |
$2,183.20
|
| Rate for Payer: Cofinity Commercial |
$2,682.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,495.08
|
| Rate for Payer: Healthscope Commercial |
$2,806.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,651.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,339.14
|
| Rate for Payer: PHP Commercial |
$2,651.02
|
| Rate for Payer: Priority Health SBD |
$1,964.88
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$244.80
|
|
|
Service Code
|
NDC 63304029601
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.22 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna Commercial |
$208.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.12
|
| Rate for Payer: Cash Price |
$195.84
|
| Rate for Payer: Cofinity Advantage |
$171.36
|
| Rate for Payer: Cofinity Commercial |
$210.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.84
|
| Rate for Payer: Healthscope Commercial |
$220.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.60
|
| Rate for Payer: PHP Commercial |
$208.08
|
| Rate for Payer: Priority Health SBD |
$154.22
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$643.20
|
|
|
Service Code
|
NDC 68084026911
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$252.78 |
| Max. Negotiated Rate |
$578.88 |
| Rate for Payer: Aetna Commercial |
$546.72
|
| Rate for Payer: Aetna Medicare |
$321.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$418.08
|
| Rate for Payer: BCBS Complete |
$257.28
|
| Rate for Payer: Cash Price |
$514.56
|
| Rate for Payer: Cofinity Advantage |
$450.24
|
| Rate for Payer: Cofinity Commercial |
$553.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.56
|
| Rate for Payer: Healthscope Commercial |
$578.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$514.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.40
|
| Rate for Payer: PHP Commercial |
$546.72
|
| Rate for Payer: Priority Health SBD |
$405.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.08
|
| Rate for Payer: UHC Core |
$335.11
|
| Rate for Payer: UHC Exchange |
$252.78
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$643.20
|
|
|
Service Code
|
NDC 68084026911
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$405.22 |
| Max. Negotiated Rate |
$578.88 |
| Rate for Payer: Aetna Commercial |
$546.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$418.08
|
| Rate for Payer: Cash Price |
$514.56
|
| Rate for Payer: Cofinity Advantage |
$450.24
|
| Rate for Payer: Cofinity Commercial |
$553.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.56
|
| Rate for Payer: Healthscope Commercial |
$578.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.40
|
| Rate for Payer: PHP Commercial |
$546.72
|
| Rate for Payer: Priority Health SBD |
$405.22
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$306.72
|
|
|
Service Code
|
NDC 68382009601
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$193.23 |
| Max. Negotiated Rate |
$276.05 |
| Rate for Payer: Aetna Commercial |
$260.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.37
|
| Rate for Payer: Cash Price |
$245.38
|
| Rate for Payer: Cofinity Advantage |
$214.70
|
| Rate for Payer: Cofinity Commercial |
$263.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.38
|
| Rate for Payer: Healthscope Commercial |
$276.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.04
|
| Rate for Payer: PHP Commercial |
$260.71
|
| Rate for Payer: Priority Health SBD |
$193.23
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$643.20
|
|
|
Service Code
|
NDC 68084026901
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$252.78 |
| Max. Negotiated Rate |
$578.88 |
| Rate for Payer: Aetna Commercial |
$546.72
|
| Rate for Payer: Aetna Medicare |
$321.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$418.08
|
| Rate for Payer: BCBS Complete |
$257.28
|
| Rate for Payer: Cash Price |
$514.56
|
| Rate for Payer: Cofinity Advantage |
$450.24
|
| Rate for Payer: Cofinity Commercial |
$553.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.56
|
| Rate for Payer: Healthscope Commercial |
$578.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$514.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.40
|
| Rate for Payer: PHP Commercial |
$546.72
|
| Rate for Payer: Priority Health SBD |
$405.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$418.08
|
| Rate for Payer: UHC Core |
$335.11
|
| Rate for Payer: UHC Exchange |
$252.78
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$643.20
|
|
|
Service Code
|
NDC 68084026901
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$405.22 |
| Max. Negotiated Rate |
$578.88 |
| Rate for Payer: Aetna Commercial |
$546.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$418.08
|
| Rate for Payer: Cash Price |
$514.56
|
| Rate for Payer: Cofinity Advantage |
$450.24
|
| Rate for Payer: Cofinity Commercial |
$553.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.56
|
| Rate for Payer: Healthscope Commercial |
$578.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.40
|
| Rate for Payer: PHP Commercial |
$546.72
|
| Rate for Payer: Priority Health SBD |
$405.22
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$244.80
|
|
|
Service Code
|
NDC 63304029601
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.21 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna Commercial |
$208.08
|
| Rate for Payer: Aetna Medicare |
$122.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.12
|
| Rate for Payer: BCBS Complete |
$97.92
|
| Rate for Payer: Cash Price |
$195.84
|
| Rate for Payer: Cofinity Advantage |
$171.36
|
| Rate for Payer: Cofinity Commercial |
$210.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$195.84
|
| Rate for Payer: Healthscope Commercial |
$220.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$195.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$183.60
|
| Rate for Payer: PHP Commercial |
$208.08
|
| Rate for Payer: Priority Health SBD |
$154.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.12
|
| Rate for Payer: UHC Core |
$127.54
|
| Rate for Payer: UHC Exchange |
$96.21
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$306.72
|
|
|
Service Code
|
NDC 68382009601
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.54 |
| Max. Negotiated Rate |
$276.05 |
| Rate for Payer: Aetna Commercial |
$260.71
|
| Rate for Payer: Aetna Medicare |
$153.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.37
|
| Rate for Payer: BCBS Complete |
$122.69
|
| Rate for Payer: Cash Price |
$245.38
|
| Rate for Payer: Cofinity Advantage |
$214.70
|
| Rate for Payer: Cofinity Commercial |
$263.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$245.38
|
| Rate for Payer: Healthscope Commercial |
$276.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$245.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$260.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$230.04
|
| Rate for Payer: PHP Commercial |
$260.71
|
| Rate for Payer: Priority Health SBD |
$193.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.37
|
| Rate for Payer: UHC Core |
$159.80
|
| Rate for Payer: UHC Exchange |
$120.54
|
|
|
HYDROXYUREA 500 MG CAPSULE
|
Facility
|
IP
|
$353.40
|
|
|
Service Code
|
NDC 49884072401
|
| Hospital Charge Code |
10236
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.64 |
| Max. Negotiated Rate |
$318.06 |
| Rate for Payer: Aetna Commercial |
$300.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.71
|
| Rate for Payer: Cash Price |
$282.72
|
| Rate for Payer: Cofinity Advantage |
$247.38
|
| Rate for Payer: Cofinity Commercial |
$303.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.72
|
| Rate for Payer: Healthscope Commercial |
$318.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.05
|
| Rate for Payer: PHP Commercial |
$300.39
|
| Rate for Payer: Priority Health SBD |
$222.64
|
|
|
HYDROXYUREA 500 MG CAPSULE
|
Facility
|
IP
|
$447.84
|
|
|
Service Code
|
NDC 68084028401
|
| Hospital Charge Code |
10236
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$282.14 |
| Max. Negotiated Rate |
$403.06 |
| Rate for Payer: Aetna Commercial |
$380.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.10
|
| Rate for Payer: Cash Price |
$358.27
|
| Rate for Payer: Cofinity Advantage |
$313.49
|
| Rate for Payer: Cofinity Commercial |
$385.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.27
|
| Rate for Payer: Healthscope Commercial |
$403.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.88
|
| Rate for Payer: PHP Commercial |
$380.66
|
| Rate for Payer: Priority Health SBD |
$282.14
|
|
|
HYDROXYUREA 500 MG CAPSULE
|
Facility
|
OP
|
$447.84
|
|
|
Service Code
|
NDC 68084028401
|
| Hospital Charge Code |
10236
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$176.00 |
| Max. Negotiated Rate |
$403.06 |
| Rate for Payer: Aetna Commercial |
$380.66
|
| Rate for Payer: Aetna Medicare |
$223.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$291.10
|
| Rate for Payer: BCBS Complete |
$179.14
|
| Rate for Payer: Cash Price |
$358.27
|
| Rate for Payer: Cofinity Advantage |
$313.49
|
| Rate for Payer: Cofinity Commercial |
$385.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$358.27
|
| Rate for Payer: Healthscope Commercial |
$403.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$358.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$380.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$335.88
|
| Rate for Payer: PHP Commercial |
$380.66
|
| Rate for Payer: Priority Health SBD |
$282.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$291.10
|
| Rate for Payer: UHC Core |
$233.32
|
| Rate for Payer: UHC Exchange |
$176.00
|
|
|
HYDROXYUREA 500 MG CAPSULE
|
Facility
|
OP
|
$353.40
|
|
|
Service Code
|
NDC 49884072401
|
| Hospital Charge Code |
10236
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.89 |
| Max. Negotiated Rate |
$318.06 |
| Rate for Payer: Aetna Commercial |
$300.39
|
| Rate for Payer: Aetna Medicare |
$176.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.71
|
| Rate for Payer: BCBS Complete |
$141.36
|
| Rate for Payer: Cash Price |
$282.72
|
| Rate for Payer: Cofinity Advantage |
$247.38
|
| Rate for Payer: Cofinity Commercial |
$303.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.72
|
| Rate for Payer: Healthscope Commercial |
$318.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.39
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.05
|
| Rate for Payer: PHP Commercial |
$300.39
|
| Rate for Payer: Priority Health SBD |
$222.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.71
|
| Rate for Payer: UHC Core |
$184.12
|
| Rate for Payer: UHC Exchange |
$138.89
|
|
|
HYDROXYUREA 500 MG CAPSULE
|
Facility
|
IP
|
$4.48
|
|
|
Service Code
|
NDC 68084028411
|
| Hospital Charge Code |
10236
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.91
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cofinity Advantage |
$3.14
|
| Rate for Payer: Cofinity Commercial |
$3.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$4.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.36
|
| Rate for Payer: PHP Commercial |
$3.81
|
| Rate for Payer: Priority Health SBD |
$2.82
|
|
|
HYDROXYUREA 500 MG CAPSULE
|
Facility
|
OP
|
$4.48
|
|
|
Service Code
|
NDC 68084028411
|
| Hospital Charge Code |
10236
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$4.03 |
| Rate for Payer: Aetna Commercial |
$3.81
|
| Rate for Payer: Aetna Medicare |
$2.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.91
|
| Rate for Payer: BCBS Complete |
$1.79
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cofinity Advantage |
$3.14
|
| Rate for Payer: Cofinity Commercial |
$3.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$4.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.36
|
| Rate for Payer: PHP Commercial |
$3.81
|
| Rate for Payer: Priority Health SBD |
$2.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.91
|
| Rate for Payer: UHC Core |
$2.33
|
| Rate for Payer: UHC Exchange |
$1.76
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
OP
|
$173.90
|
|
|
Service Code
|
NDC 10702001001
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.34 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna Medicare |
$86.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| Rate for Payer: BCBS Complete |
$69.56
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Advantage |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.43
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health SBD |
$109.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.03
|
| Rate for Payer: UHC Core |
$90.60
|
| Rate for Payer: UHC Exchange |
$68.34
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
OP
|
$91.65
|
|
|
Service Code
|
NDC 23155050001
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.02 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Medicare |
$45.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.57
|
| Rate for Payer: BCBS Complete |
$36.66
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Advantage |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.74
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health SBD |
$57.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.57
|
| Rate for Payer: UHC Core |
$47.75
|
| Rate for Payer: UHC Exchange |
$36.02
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
OP
|
$352.50
|
|
|
Service Code
|
NDC 63739048310
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$138.53 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Aetna Commercial |
$299.62
|
| Rate for Payer: Aetna Medicare |
$176.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.12
|
| Rate for Payer: BCBS Complete |
$141.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cofinity Advantage |
$246.75
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.00
|
| Rate for Payer: Healthscope Commercial |
$317.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$264.38
|
| Rate for Payer: PHP Commercial |
$299.62
|
| Rate for Payer: Priority Health SBD |
$222.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.12
|
| Rate for Payer: UHC Core |
$183.65
|
| Rate for Payer: UHC Exchange |
$138.53
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
IP
|
$91.65
|
|
|
Service Code
|
NDC 23155050001
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.57
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Advantage |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.74
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health SBD |
$57.74
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
IP
|
$2.36
|
|
|
Service Code
|
NDC 60687066411
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna Commercial |
$2.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.53
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cofinity Advantage |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$2.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.89
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.77
|
| Rate for Payer: PHP Commercial |
$2.01
|
| Rate for Payer: Priority Health SBD |
$1.49
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 10702001001
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.56 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Advantage |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.43
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health SBD |
$109.56
|
|
