|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
OP
|
$2.36
|
|
|
Service Code
|
NDC 60687066411
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna Commercial |
$2.01
|
| Rate for Payer: Aetna Medicare |
$1.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.53
|
| Rate for Payer: BCBS Complete |
$0.94
|
| 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: MI Amish Medical Board Commercial |
$1.89
|
| 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
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.53
|
| Rate for Payer: UHC Core |
$1.23
|
| Rate for Payer: UHC Exchange |
$0.93
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
IP
|
$352.50
|
|
|
Service Code
|
NDC 63739048310
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$222.07 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Aetna Commercial |
$299.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$229.12
|
| 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: 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
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
OP
|
$235.60
|
|
|
Service Code
|
NDC 60687066401
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.59 |
| Max. Negotiated Rate |
$212.04 |
| Rate for Payer: Aetna Commercial |
$200.26
|
| Rate for Payer: Aetna Medicare |
$117.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.14
|
| Rate for Payer: BCBS Complete |
$94.24
|
| Rate for Payer: Cash Price |
$188.48
|
| Rate for Payer: Cofinity Advantage |
$164.92
|
| Rate for Payer: Cofinity Commercial |
$202.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.48
|
| Rate for Payer: Healthscope Commercial |
$212.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.70
|
| Rate for Payer: PHP Commercial |
$200.26
|
| Rate for Payer: Priority Health SBD |
$148.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.14
|
| Rate for Payer: UHC Core |
$122.75
|
| Rate for Payer: UHC Exchange |
$92.59
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
IP
|
$235.60
|
|
|
Service Code
|
NDC 60687066401
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.43 |
| Max. Negotiated Rate |
$212.04 |
| Rate for Payer: Aetna Commercial |
$200.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.14
|
| Rate for Payer: Cash Price |
$188.48
|
| Rate for Payer: Cofinity Advantage |
$164.92
|
| Rate for Payer: Cofinity Commercial |
$202.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.48
|
| Rate for Payer: Healthscope Commercial |
$212.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.70
|
| Rate for Payer: PHP Commercial |
$200.26
|
| Rate for Payer: Priority Health SBD |
$148.43
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
IP
|
$453.55
|
|
|
Service Code
|
NDC 00904661761
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$285.74 |
| Max. Negotiated Rate |
$408.19 |
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.81
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Advantage |
$317.49
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Healthscope Commercial |
$408.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.16
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health SBD |
$285.74
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
OP
|
$453.55
|
|
|
Service Code
|
NDC 00904661761
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$178.25 |
| Max. Negotiated Rate |
$408.19 |
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna Medicare |
$226.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.81
|
| Rate for Payer: BCBS Complete |
$181.42
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Advantage |
$317.49
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Healthscope Commercial |
$408.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$362.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.16
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health SBD |
$285.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.81
|
| Rate for Payer: UHC Core |
$236.30
|
| Rate for Payer: UHC Exchange |
$178.25
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
IP
|
$162.15
|
|
|
Service Code
|
NDC 00093506101
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.15 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.40
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Advantage |
$113.50
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.61
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: Priority Health SBD |
$102.15
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
OP
|
$441.80
|
|
|
Service Code
|
NDC 63739048610
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$173.63 |
| Max. Negotiated Rate |
$397.62 |
| Rate for Payer: Aetna Commercial |
$375.53
|
| Rate for Payer: Aetna Medicare |
$220.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.17
|
| Rate for Payer: BCBS Complete |
$176.72
|
| Rate for Payer: Cash Price |
$353.44
|
| Rate for Payer: Cofinity Advantage |
$309.26
|
| Rate for Payer: Cofinity Commercial |
$379.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.44
|
| Rate for Payer: Healthscope Commercial |
$397.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$353.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.35
|
| Rate for Payer: PHP Commercial |
$375.53
|
| Rate for Payer: Priority Health SBD |
$278.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.17
|
| Rate for Payer: UHC Core |
$230.18
|
| Rate for Payer: UHC Exchange |
$173.63
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
OP
|
$216.20
|
|
|
Service Code
|
NDC 10702001101
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.97 |
| Max. Negotiated Rate |
$194.58 |
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna Medicare |
$108.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.53
|
| Rate for Payer: BCBS Complete |
$86.48
|
| Rate for Payer: Cash Price |
$172.96
|
| Rate for Payer: Cofinity Advantage |
$151.34
|
| Rate for Payer: Cofinity Commercial |
$185.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.96
|
| Rate for Payer: Healthscope Commercial |
$194.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.15
|
| Rate for Payer: PHP Commercial |
$183.77
|
| Rate for Payer: Priority Health SBD |
$136.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.53
|
| Rate for Payer: UHC Core |
$112.64
|
| Rate for Payer: UHC Exchange |
$84.97
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
OP
|
$124.55
|
|
|
Service Code
|
NDC 23155050101
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.95 |
| Max. Negotiated Rate |
$112.09 |
| Rate for Payer: Aetna Commercial |
$105.87
|
| Rate for Payer: Aetna Medicare |
$62.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.96
|
| Rate for Payer: BCBS Complete |
$49.82
|
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Cofinity Advantage |
$87.19
|
| Rate for Payer: Cofinity Commercial |
$107.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$112.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.41
|
| Rate for Payer: PHP Commercial |
$105.87
|
| Rate for Payer: Priority Health SBD |
$78.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.96
|
| Rate for Payer: UHC Core |
$64.89
|
| Rate for Payer: UHC Exchange |
$48.95
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
OP
|
$162.15
|
|
|
Service Code
|
NDC 00093506101
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.72 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Aetna Medicare |
$81.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.40
|
| Rate for Payer: BCBS Complete |
$64.86
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Advantage |
$113.50
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.61
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: Priority Health SBD |
$102.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.40
|
| Rate for Payer: UHC Core |
$84.48
|
| Rate for Payer: UHC Exchange |
$63.72
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
IP
|
$441.80
|
|
|
Service Code
|
NDC 63739048610
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.33 |
| Max. Negotiated Rate |
$397.62 |
| Rate for Payer: Aetna Commercial |
$375.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.17
|
| Rate for Payer: Cash Price |
$353.44
|
| Rate for Payer: Cofinity Advantage |
$309.26
|
| Rate for Payer: Cofinity Commercial |
$379.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.44
|
| Rate for Payer: Healthscope Commercial |
$397.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.35
|
| Rate for Payer: PHP Commercial |
$375.53
|
| Rate for Payer: Priority Health SBD |
$278.33
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
IP
|
$124.55
|
|
|
Service Code
|
NDC 23155050101
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.47 |
| Max. Negotiated Rate |
$112.09 |
| Rate for Payer: Aetna Commercial |
$105.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.96
|
| Rate for Payer: Cash Price |
$99.64
|
| Rate for Payer: Cofinity Advantage |
$87.19
|
| Rate for Payer: Cofinity Commercial |
$107.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$99.64
|
| Rate for Payer: Healthscope Commercial |
$112.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$105.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.41
|
| Rate for Payer: PHP Commercial |
$105.87
|
| Rate for Payer: Priority Health SBD |
$78.47
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
IP
|
$216.20
|
|
|
Service Code
|
NDC 10702001101
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.21 |
| Max. Negotiated Rate |
$194.58 |
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.53
|
| Rate for Payer: Cash Price |
$172.96
|
| Rate for Payer: Cofinity Advantage |
$151.34
|
| Rate for Payer: Cofinity Commercial |
$185.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.96
|
| Rate for Payer: Healthscope Commercial |
$194.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.15
|
| Rate for Payer: PHP Commercial |
$183.77
|
| Rate for Payer: Priority Health SBD |
$136.21
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$398.05
|
|
|
Service Code
|
NDC 42192033901
|
| Hospital Charge Code |
17023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$156.43 |
| Max. Negotiated Rate |
$358.25 |
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna Medicare |
$199.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.73
|
| Rate for Payer: BCBS Complete |
$159.22
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Advantage |
$278.63
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$318.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.54
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health SBD |
$250.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.73
|
| Rate for Payer: UHC Core |
$207.38
|
| Rate for Payer: UHC Exchange |
$156.43
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$398.05
|
|
|
Service Code
|
NDC 42192033901
|
| Hospital Charge Code |
17023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.77 |
| Max. Negotiated Rate |
$358.25 |
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.73
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Advantage |
$278.63
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.54
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health SBD |
$250.77
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$203.30
|
|
|
Service Code
|
NDC 70156010501
|
| Hospital Charge Code |
17023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.08 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna Commercial |
$172.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.15
|
| Rate for Payer: Cash Price |
$162.64
|
| Rate for Payer: Cofinity Advantage |
$142.31
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.64
|
| Rate for Payer: Healthscope Commercial |
$182.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.47
|
| Rate for Payer: PHP Commercial |
$172.81
|
| Rate for Payer: Priority Health SBD |
$128.08
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$203.30
|
|
|
Service Code
|
NDC 70156010501
|
| Hospital Charge Code |
17023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.90 |
| Max. Negotiated Rate |
$182.97 |
| Rate for Payer: Aetna Commercial |
$172.81
|
| Rate for Payer: Aetna Medicare |
$101.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.15
|
| Rate for Payer: BCBS Complete |
$81.32
|
| Rate for Payer: Cash Price |
$162.64
|
| Rate for Payer: Cofinity Advantage |
$142.31
|
| Rate for Payer: Cofinity Commercial |
$174.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.64
|
| Rate for Payer: Healthscope Commercial |
$182.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.47
|
| Rate for Payer: PHP Commercial |
$172.81
|
| Rate for Payer: Priority Health SBD |
$128.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.15
|
| Rate for Payer: UHC Core |
$105.92
|
| Rate for Payer: UHC Exchange |
$79.90
|
|
|
HYOSCYAMINE SULFATE 0.125 MG TABLET
|
Facility
|
IP
|
$222.30
|
|
|
Service Code
|
NDC 68047025201
|
| Hospital Charge Code |
3783
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.05 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.50
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Advantage |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$200.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.72
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health SBD |
$140.05
|
|
|
HYOSCYAMINE SULFATE 0.125 MG TABLET
|
Facility
|
OP
|
$222.30
|
|
|
Service Code
|
NDC 68047025201
|
| Hospital Charge Code |
3783
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$200.07 |
| Rate for Payer: Aetna Commercial |
$188.96
|
| Rate for Payer: Aetna Medicare |
$111.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.50
|
| Rate for Payer: BCBS Complete |
$88.92
|
| Rate for Payer: Cash Price |
$177.84
|
| Rate for Payer: Cofinity Advantage |
$155.61
|
| Rate for Payer: Cofinity Commercial |
$191.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$177.84
|
| Rate for Payer: Healthscope Commercial |
$200.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$177.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$188.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.72
|
| Rate for Payer: PHP Commercial |
$188.96
|
| Rate for Payer: Priority Health SBD |
$140.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.50
|
| Rate for Payer: UHC Core |
$115.82
|
| Rate for Payer: UHC Exchange |
$87.36
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$4,662.08
|
|
|
Service Code
|
APR-DRG 1992
|
| Min. Negotiated Rate |
$4,440.07 |
| Max. Negotiated Rate |
$4,662.08 |
| Rate for Payer: BCBS Complete |
$4,662.08
|
| Rate for Payer: Mclaren Medicaid |
$4,440.07
|
| Rate for Payer: Meridian Medicaid |
$4,662.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,440.07
|
| Rate for Payer: UHC Medicaid |
$4,440.07
|
| Rate for Payer: UHCCP Medicaid |
$4,440.07
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$11,061.82
|
|
|
Service Code
|
APR-DRG 1994
|
| Min. Negotiated Rate |
$10,535.07 |
| Max. Negotiated Rate |
$11,061.82 |
| Rate for Payer: BCBS Complete |
$11,061.82
|
| Rate for Payer: Mclaren Medicaid |
$10,535.07
|
| Rate for Payer: Meridian Medicaid |
$11,061.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$10,535.07
|
| Rate for Payer: UHC Medicaid |
$10,535.07
|
| Rate for Payer: UHCCP Medicaid |
$10,535.07
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$5,838.49
|
|
|
Service Code
|
APR-DRG 1993
|
| Min. Negotiated Rate |
$5,560.46 |
| Max. Negotiated Rate |
$5,838.49 |
| Rate for Payer: BCBS Complete |
$5,838.49
|
| Rate for Payer: Mclaren Medicaid |
$5,560.46
|
| Rate for Payer: Meridian Medicaid |
$5,838.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,560.46
|
| Rate for Payer: UHC Medicaid |
$5,560.46
|
| Rate for Payer: UHCCP Medicaid |
$5,560.46
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$4,308.92
|
|
|
Service Code
|
APR-DRG 1991
|
| Min. Negotiated Rate |
$4,103.74 |
| Max. Negotiated Rate |
$4,308.92 |
| Rate for Payer: BCBS Complete |
$4,308.92
|
| Rate for Payer: Mclaren Medicaid |
$4,103.74
|
| Rate for Payer: Meridian Medicaid |
$4,308.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,103.74
|
| Rate for Payer: UHC Medicaid |
$4,103.74
|
| Rate for Payer: UHCCP Medicaid |
$4,103.74
|
|
|
HYPERTENSION WITH MCC
|
Facility
|
IP
|
$26,060.13
|
|
|
Service Code
|
MSDRG 304
|
| Min. Negotiated Rate |
$9,286.80 |
| Max. Negotiated Rate |
$26,060.13 |
| Rate for Payer: Aetna Medicare |
$10,166.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,219.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,219.48
|
| Rate for Payer: BCBS MAPPO |
$9,775.58
|
| Rate for Payer: BCBS Trust/PPO |
$26,060.13
|
| Rate for Payer: BCN Commercial |
$26,060.13
|
| Rate for Payer: BCN Medicare Advantage |
$9,775.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,775.58
|
| Rate for Payer: Mclaren Medicare |
$9,775.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,264.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,241.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$10,753.14
|
| Rate for Payer: Nomi Health Commercial |
$15,351.00
|
| Rate for Payer: PACE Medicare |
$9,286.80
|
| Rate for Payer: PACE SWMI |
$9,775.58
|
| Rate for Payer: PHP Medicare Advantage |
$9,775.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$19,185.35
|
| Rate for Payer: Priority Health Medicare |
$9,775.58
|
| Rate for Payer: Priority Health Tiered Network |
$15,348.27
|
| Rate for Payer: Railroad Medicare Medicare |
$9,775.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19,397.00
|
| Rate for Payer: UHC Core |
$16,228.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$9,775.58
|
| Rate for Payer: UHC Exchange |
$13,253.03
|
| Rate for Payer: VA VA |
$9,775.58
|
|
