Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

HYDROMORPHONE VARIABLE DOSE

Facility

$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 Commercial	$12.10
Rate for Payer: Cofinity Commercial	$9.85
Rate for Payer: Cofinity Medicare Advantage	$9.85
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: PHP Commercial	$11.96
Rate for Payer: Priority Health Cigna Priority Health	$9.15
Rate for Payer: Priority Health SBD	$8.86

HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION

Facility

$2,970.05

Service Code	HCPCS J3424
Hospital Charge Code	155400
Hospital Revenue Code	636
Min. Negotiated Rate	$1,871.13
Max. Negotiated Rate	$2,673.05
Rate for Payer: Aetna Commercial	$2,524.54
Rate for Payer: Aetna New Business (MI Preferred)	$1,930.53
Rate for Payer: Cash Price	$2,376.04
Rate for Payer: Cofinity Commercial	$2,079.03
Rate for Payer: Cofinity Commercial	$2,554.24
Rate for Payer: Cofinity Medicare Advantage	$2,079.03
Rate for Payer: Encore Health Key Benefits Commercial	$2,376.04
Rate for Payer: Healthscope Commercial	$2,673.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,524.54
Rate for Payer: PHP Commercial	$2,524.54
Rate for Payer: Priority Health Cigna Priority Health	$1,930.53
Rate for Payer: Priority Health SBD	$1,871.13

HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION

Facility

$2,970.05

Service Code	HCPCS J3424
Hospital Charge Code	155400
Hospital Revenue Code	636
Min. Negotiated Rate	$2.78
Max. Negotiated Rate	$2,673.05
Rate for Payer: Aetna Commercial	$2,524.54
Rate for Payer: Aetna Medicare	$5.40
Rate for Payer: Aetna New Business (MI Preferred)	$1,930.53
Rate for Payer: Allen County Amish Medical Aid Commercial	$6.49
Rate for Payer: Amish Plain Church Group Commercial	$6.49
Rate for Payer: BCBS Complete	$2.92
Rate for Payer: BCBS MAPPO	$5.19
Rate for Payer: BCN Medicare Advantage	$5.19
Rate for Payer: Cash Price	$2,376.04
Rate for Payer: Cash Price	$2,376.04
Rate for Payer: Cofinity Commercial	$2,554.24
Rate for Payer: Cofinity Commercial	$2,079.03
Rate for Payer: Cofinity Medicare Advantage	$2,079.03
Rate for Payer: Encore Health Key Benefits Commercial	$2,376.04
Rate for Payer: Health Alliance Plan Medicare Advantage	$5.19
Rate for Payer: Healthscope Commercial	$2,673.05
Rate for Payer: Mclaren Medicaid	$2.78
Rate for Payer: Mclaren Medicare	$5.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$5.45
Rate for Payer: Meridian Medicaid	$2.92
Rate for Payer: MI Amish Medical Board Commercial	$5.97
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,524.54
Rate for Payer: PACE Medicare	$4.93
Rate for Payer: PACE SWMI	$5.19
Rate for Payer: PHP Commercial	$2,524.54
Rate for Payer: PHP Medicare Advantage	$5.19
Rate for Payer: Priority Health Choice Medicaid	$2.78
Rate for Payer: Priority Health Cigna Priority Health	$1,930.53
Rate for Payer: Priority Health Medicare	$5.19
Rate for Payer: Priority Health SBD	$1,871.13
Rate for Payer: Railroad Medicare Medicare	$5.19
Rate for Payer: UHC All Payor (Choice/PPO)	$14.61
Rate for Payer: UHC Dual Complete DSNP	$5.19
Rate for Payer: UHC Medicare Advantage	$5.19
Rate for Payer: UHCCP Medicaid	$2.92
Rate for Payer: VA VA	$5.19

HYDROXYCHLOROQUINE 200 MG TABLET

Facility

$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 Commercial	$171.36
Rate for Payer: Cofinity Commercial	$210.53
Rate for Payer: Cofinity Medicare Advantage	$171.36
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: PHP Commercial	$208.08
Rate for Payer: Priority Health Cigna Priority Health	$159.12
Rate for Payer: Priority Health SBD	$154.22

HYDROXYCHLOROQUINE 200 MG TABLET

Facility

$306.72

Service Code	NDC 68382009601
Hospital Charge Code	10235
Hospital Revenue Code	637
Min. Negotiated Rate	$122.69
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 Commercial	$214.70
Rate for Payer: Cofinity Commercial	$263.78
Rate for Payer: Cofinity Medicare Advantage	$214.70
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: PHP Commercial	$260.71
Rate for Payer: Priority Health Cigna Priority Health	$199.37
Rate for Payer: Priority Health SBD	$193.23

HYDROXYCHLOROQUINE 200 MG TABLET

Facility

$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 Commercial	$214.70
Rate for Payer: Cofinity Commercial	$263.78
Rate for Payer: Cofinity Medicare Advantage	$214.70
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: PHP Commercial	$260.71
Rate for Payer: Priority Health Cigna Priority Health	$199.37
Rate for Payer: Priority Health SBD	$193.23

HYDROXYCHLOROQUINE 200 MG TABLET

Facility

$576.96

Service Code	NDC 68084026911
Hospital Charge Code	10235
Hospital Revenue Code	637
Min. Negotiated Rate	$230.78
Max. Negotiated Rate	$519.26
Rate for Payer: Aetna Commercial	$490.42
Rate for Payer: Aetna Medicare	$288.48
Rate for Payer: Aetna New Business (MI Preferred)	$375.02
Rate for Payer: BCBS Complete	$230.78
Rate for Payer: Cash Price	$461.57
Rate for Payer: Cofinity Commercial	$403.87
Rate for Payer: Cofinity Commercial	$496.19
Rate for Payer: Cofinity Medicare Advantage	$403.87
Rate for Payer: Encore Health Key Benefits Commercial	$461.57
Rate for Payer: Healthscope Commercial	$519.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$490.42
Rate for Payer: PHP Commercial	$490.42
Rate for Payer: Priority Health Cigna Priority Health	$375.02
Rate for Payer: Priority Health SBD	$363.48

HYDROXYCHLOROQUINE 200 MG TABLET

Facility

$244.80

Service Code	NDC 63304029601
Hospital Charge Code	10235
Hospital Revenue Code	637
Min. Negotiated Rate	$97.92
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 Commercial	$171.36
Rate for Payer: Cofinity Commercial	$210.53
Rate for Payer: Cofinity Medicare Advantage	$171.36
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: PHP Commercial	$208.08
Rate for Payer: Priority Health Cigna Priority Health	$159.12
Rate for Payer: Priority Health SBD	$154.22

HYDROXYCHLOROQUINE 200 MG TABLET

Facility

$576.96

Service Code	NDC 68084026901
Hospital Charge Code	10235
Hospital Revenue Code	637
Min. Negotiated Rate	$363.48
Max. Negotiated Rate	$519.26
Rate for Payer: Aetna Commercial	$490.42
Rate for Payer: Aetna New Business (MI Preferred)	$375.02
Rate for Payer: Cash Price	$461.57
Rate for Payer: Cofinity Commercial	$403.87
Rate for Payer: Cofinity Commercial	$496.19
Rate for Payer: Cofinity Medicare Advantage	$403.87
Rate for Payer: Encore Health Key Benefits Commercial	$461.57
Rate for Payer: Healthscope Commercial	$519.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$490.42
Rate for Payer: PHP Commercial	$490.42
Rate for Payer: Priority Health Cigna Priority Health	$375.02
Rate for Payer: Priority Health SBD	$363.48

HYDROXYCHLOROQUINE 200 MG TABLET

Facility

$576.96

Service Code	NDC 68084026901
Hospital Charge Code	10235
Hospital Revenue Code	637
Min. Negotiated Rate	$230.78
Max. Negotiated Rate	$519.26
Rate for Payer: Aetna Commercial	$490.42
Rate for Payer: Aetna Medicare	$288.48
Rate for Payer: Aetna New Business (MI Preferred)	$375.02
Rate for Payer: BCBS Complete	$230.78
Rate for Payer: Cash Price	$461.57
Rate for Payer: Cofinity Commercial	$403.87
Rate for Payer: Cofinity Commercial	$496.19
Rate for Payer: Cofinity Medicare Advantage	$403.87
Rate for Payer: Encore Health Key Benefits Commercial	$461.57
Rate for Payer: Healthscope Commercial	$519.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$490.42
Rate for Payer: PHP Commercial	$490.42
Rate for Payer: Priority Health Cigna Priority Health	$375.02
Rate for Payer: Priority Health SBD	$363.48

HYDROXYCHLOROQUINE 200 MG TABLET

Facility

$576.96

Service Code	NDC 68084026911
Hospital Charge Code	10235
Hospital Revenue Code	637
Min. Negotiated Rate	$363.48
Max. Negotiated Rate	$519.26
Rate for Payer: Aetna Commercial	$490.42
Rate for Payer: Aetna New Business (MI Preferred)	$375.02
Rate for Payer: Cash Price	$461.57
Rate for Payer: Cofinity Commercial	$403.87
Rate for Payer: Cofinity Commercial	$496.19
Rate for Payer: Cofinity Medicare Advantage	$403.87
Rate for Payer: Encore Health Key Benefits Commercial	$461.57
Rate for Payer: Healthscope Commercial	$519.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$490.42
Rate for Payer: PHP Commercial	$490.42
Rate for Payer: Priority Health Cigna Priority Health	$375.02
Rate for Payer: Priority Health SBD	$363.48

HYDROXYUREA 500 MG CAPSULE

Facility

$3.76

Service Code	NDC 68084028411
Hospital Charge Code	10236
Hospital Revenue Code	637
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$3.20
Rate for Payer: Aetna Medicare	$1.88
Rate for Payer: Aetna New Business (MI Preferred)	$2.44
Rate for Payer: BCBS Complete	$1.50
Rate for Payer: Cash Price	$3.01
Rate for Payer: Cofinity Commercial	$2.63
Rate for Payer: Cofinity Commercial	$3.23
Rate for Payer: Cofinity Medicare Advantage	$2.63
Rate for Payer: Encore Health Key Benefits Commercial	$3.01
Rate for Payer: Healthscope Commercial	$3.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.20
Rate for Payer: PHP Commercial	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.44
Rate for Payer: Priority Health SBD	$2.37

HYDROXYUREA 500 MG CAPSULE

Facility

$375.36

Service Code	NDC 68084028401
Hospital Charge Code	10236
Hospital Revenue Code	637
Min. Negotiated Rate	$150.14
Max. Negotiated Rate	$337.82
Rate for Payer: Aetna Commercial	$319.06
Rate for Payer: Aetna Medicare	$187.68
Rate for Payer: Aetna New Business (MI Preferred)	$243.98
Rate for Payer: BCBS Complete	$150.14
Rate for Payer: Cash Price	$300.29
Rate for Payer: Cofinity Commercial	$262.75
Rate for Payer: Cofinity Commercial	$322.81
Rate for Payer: Cofinity Medicare Advantage	$262.75
Rate for Payer: Encore Health Key Benefits Commercial	$300.29
Rate for Payer: Healthscope Commercial	$337.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$319.06
Rate for Payer: PHP Commercial	$319.06
Rate for Payer: Priority Health Cigna Priority Health	$243.98
Rate for Payer: Priority Health SBD	$236.48

HYDROXYUREA 500 MG CAPSULE

Facility

$3.76

Service Code	NDC 68084028411
Hospital Charge Code	10236
Hospital Revenue Code	637
Min. Negotiated Rate	$2.37
Max. Negotiated Rate	$3.38
Rate for Payer: Aetna Commercial	$3.20
Rate for Payer: Aetna New Business (MI Preferred)	$2.44
Rate for Payer: Cash Price	$3.01
Rate for Payer: Cofinity Commercial	$2.63
Rate for Payer: Cofinity Commercial	$3.23
Rate for Payer: Cofinity Medicare Advantage	$2.63
Rate for Payer: Encore Health Key Benefits Commercial	$3.01
Rate for Payer: Healthscope Commercial	$3.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.20
Rate for Payer: PHP Commercial	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.44
Rate for Payer: Priority Health SBD	$2.37

HYDROXYUREA 500 MG CAPSULE

Facility

$250.08

Service Code	NDC 49884072401
Hospital Charge Code	10236
Hospital Revenue Code	637
Min. Negotiated Rate	$100.03
Max. Negotiated Rate	$225.07
Rate for Payer: Aetna Commercial	$212.57
Rate for Payer: Aetna Medicare	$125.04
Rate for Payer: Aetna New Business (MI Preferred)	$162.55
Rate for Payer: BCBS Complete	$100.03
Rate for Payer: Cash Price	$200.06
Rate for Payer: Cofinity Commercial	$175.06
Rate for Payer: Cofinity Commercial	$215.07
Rate for Payer: Cofinity Medicare Advantage	$175.06
Rate for Payer: Encore Health Key Benefits Commercial	$200.06
Rate for Payer: Healthscope Commercial	$225.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$212.57
Rate for Payer: PHP Commercial	$212.57
Rate for Payer: Priority Health Cigna Priority Health	$162.55
Rate for Payer: Priority Health SBD	$157.55

HYDROXYUREA 500 MG CAPSULE

Facility

$375.36

Service Code	NDC 68084028401
Hospital Charge Code	10236
Hospital Revenue Code	637
Min. Negotiated Rate	$236.48
Max. Negotiated Rate	$337.82
Rate for Payer: Aetna Commercial	$319.06
Rate for Payer: Aetna New Business (MI Preferred)	$243.98
Rate for Payer: Cash Price	$300.29
Rate for Payer: Cofinity Commercial	$262.75
Rate for Payer: Cofinity Commercial	$322.81
Rate for Payer: Cofinity Medicare Advantage	$262.75
Rate for Payer: Encore Health Key Benefits Commercial	$300.29
Rate for Payer: Healthscope Commercial	$337.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$319.06
Rate for Payer: PHP Commercial	$319.06
Rate for Payer: Priority Health Cigna Priority Health	$243.98
Rate for Payer: Priority Health SBD	$236.48

HYDROXYUREA 500 MG CAPSULE

Facility

$250.08

Service Code	NDC 49884072401
Hospital Charge Code	10236
Hospital Revenue Code	637
Min. Negotiated Rate	$157.55
Max. Negotiated Rate	$225.07
Rate for Payer: Aetna Commercial	$212.57
Rate for Payer: Aetna New Business (MI Preferred)	$162.55
Rate for Payer: Cash Price	$200.06
Rate for Payer: Cofinity Commercial	$175.06
Rate for Payer: Cofinity Commercial	$215.07
Rate for Payer: Cofinity Medicare Advantage	$175.06
Rate for Payer: Encore Health Key Benefits Commercial	$200.06
Rate for Payer: Healthscope Commercial	$225.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$212.57
Rate for Payer: PHP Commercial	$212.57
Rate for Payer: Priority Health Cigna Priority Health	$162.55
Rate for Payer: Priority Health SBD	$157.55

HYDROXYZINE HCL 10 MG TABLET

Facility

$387.75

Service Code	NDC 60687066401
Hospital Charge Code	3772
Hospital Revenue Code	637
Min. Negotiated Rate	$244.28
Max. Negotiated Rate	$348.98
Rate for Payer: Aetna Commercial	$329.59
Rate for Payer: Aetna New Business (MI Preferred)	$252.04
Rate for Payer: Cash Price	$310.20
Rate for Payer: Cofinity Commercial	$271.43
Rate for Payer: Cofinity Commercial	$333.46
Rate for Payer: Cofinity Medicare Advantage	$271.43
Rate for Payer: Encore Health Key Benefits Commercial	$310.20
Rate for Payer: Healthscope Commercial	$348.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$329.59
Rate for Payer: PHP Commercial	$329.59
Rate for Payer: Priority Health Cigna Priority Health	$252.04
Rate for Payer: Priority Health SBD	$244.28

HYDROXYZINE HCL 10 MG TABLET

Facility

$178.60

Service Code	NDC 10702001001
Hospital Charge Code	3772
Hospital Revenue Code	637
Min. Negotiated Rate	$71.44
Max. Negotiated Rate	$160.74
Rate for Payer: Aetna Commercial	$151.81
Rate for Payer: Aetna Medicare	$89.30
Rate for Payer: Aetna New Business (MI Preferred)	$116.09
Rate for Payer: BCBS Complete	$71.44
Rate for Payer: Cash Price	$142.88
Rate for Payer: Cofinity Commercial	$125.02
Rate for Payer: Cofinity Commercial	$153.60
Rate for Payer: Cofinity Medicare Advantage	$125.02
Rate for Payer: Encore Health Key Benefits Commercial	$142.88
Rate for Payer: Healthscope Commercial	$160.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$151.81
Rate for Payer: PHP Commercial	$151.81
Rate for Payer: Priority Health Cigna Priority Health	$116.09
Rate for Payer: Priority Health SBD	$112.52

HYDROXYZINE HCL 10 MG TABLET

Facility

$352.50

Service Code	NDC 63739048310
Hospital Charge Code	3772
Hospital Revenue Code	637
Min. Negotiated Rate	$141.00
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 Commercial	$246.75
Rate for Payer: Cofinity Commercial	$303.15
Rate for Payer: Cofinity Medicare Advantage	$246.75
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: PHP Commercial	$299.62
Rate for Payer: Priority Health Cigna Priority Health	$229.12
Rate for Payer: Priority Health SBD	$222.07

HYDROXYZINE HCL 10 MG TABLET

Facility

$178.60

Service Code	NDC 10702001001
Hospital Charge Code	3772
Hospital Revenue Code	637
Min. Negotiated Rate	$112.52
Max. Negotiated Rate	$160.74
Rate for Payer: Aetna Commercial	$151.81
Rate for Payer: Aetna New Business (MI Preferred)	$116.09
Rate for Payer: Cash Price	$142.88
Rate for Payer: Cofinity Commercial	$125.02
Rate for Payer: Cofinity Commercial	$153.60
Rate for Payer: Cofinity Medicare Advantage	$125.02
Rate for Payer: Encore Health Key Benefits Commercial	$142.88
Rate for Payer: Healthscope Commercial	$160.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$151.81
Rate for Payer: PHP Commercial	$151.81
Rate for Payer: Priority Health Cigna Priority Health	$116.09
Rate for Payer: Priority Health SBD	$112.52

HYDROXYZINE HCL 10 MG TABLET

Facility

$427.70

Service Code	NDC 68084025311
Hospital Charge Code	3772
Hospital Revenue Code	637
Min. Negotiated Rate	$171.08
Max. Negotiated Rate	$384.93
Rate for Payer: Aetna Commercial	$363.55
Rate for Payer: Aetna Medicare	$213.85
Rate for Payer: Aetna New Business (MI Preferred)	$278.00
Rate for Payer: BCBS Complete	$171.08
Rate for Payer: Cash Price	$342.16
Rate for Payer: Cofinity Commercial	$299.39
Rate for Payer: Cofinity Commercial	$367.82
Rate for Payer: Cofinity Medicare Advantage	$299.39
Rate for Payer: Encore Health Key Benefits Commercial	$342.16
Rate for Payer: Healthscope Commercial	$384.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$363.55
Rate for Payer: PHP Commercial	$363.55
Rate for Payer: Priority Health Cigna Priority Health	$278.00
Rate for Payer: Priority Health SBD	$269.45

HYDROXYZINE HCL 10 MG TABLET

Facility

$427.70

Service Code	NDC 68084025301
Hospital Charge Code	3772
Hospital Revenue Code	637
Min. Negotiated Rate	$171.08
Max. Negotiated Rate	$384.93
Rate for Payer: Aetna Commercial	$363.55
Rate for Payer: Aetna Medicare	$213.85
Rate for Payer: Aetna New Business (MI Preferred)	$278.00
Rate for Payer: BCBS Complete	$171.08
Rate for Payer: Cash Price	$342.16
Rate for Payer: Cofinity Commercial	$299.39
Rate for Payer: Cofinity Commercial	$367.82
Rate for Payer: Cofinity Medicare Advantage	$299.39
Rate for Payer: Encore Health Key Benefits Commercial	$342.16
Rate for Payer: Healthscope Commercial	$384.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$363.55
Rate for Payer: PHP Commercial	$363.55
Rate for Payer: Priority Health Cigna Priority Health	$278.00
Rate for Payer: Priority Health SBD	$269.45

HYDROXYZINE HCL 10 MG TABLET

Facility

$3.88

Service Code	NDC 60687066411
Hospital Charge Code	3772
Hospital Revenue Code	637
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$3.49
Rate for Payer: Aetna Commercial	$3.30
Rate for Payer: Aetna New Business (MI Preferred)	$2.52
Rate for Payer: Cash Price	$3.10
Rate for Payer: Cofinity Commercial	$2.72
Rate for Payer: Cofinity Commercial	$3.34
Rate for Payer: Cofinity Medicare Advantage	$2.72
Rate for Payer: Encore Health Key Benefits Commercial	$3.10
Rate for Payer: Healthscope Commercial	$3.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.30
Rate for Payer: PHP Commercial	$3.30
Rate for Payer: Priority Health Cigna Priority Health	$2.52
Rate for Payer: Priority Health SBD	$2.44

HYDROXYZINE HCL 10 MG TABLET

Facility

$3.88

Service Code	NDC 60687066411
Hospital Charge Code	3772
Hospital Revenue Code	637
Min. Negotiated Rate	$1.55
Max. Negotiated Rate	$3.49
Rate for Payer: Aetna Commercial	$3.30
Rate for Payer: Aetna Medicare	$1.94
Rate for Payer: Aetna New Business (MI Preferred)	$2.52
Rate for Payer: BCBS Complete	$1.55
Rate for Payer: Cash Price	$3.10
Rate for Payer: Cofinity Commercial	$2.72
Rate for Payer: Cofinity Commercial	$3.34
Rate for Payer: Cofinity Medicare Advantage	$2.72
Rate for Payer: Encore Health Key Benefits Commercial	$3.10
Rate for Payer: Healthscope Commercial	$3.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.30
Rate for Payer: PHP Commercial	$3.30
Rate for Payer: Priority Health Cigna Priority Health	$2.52
Rate for Payer: Priority Health SBD	$2.44

Know your out-of-pocket cost for care.

All Charges