|
HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY
|
Facility
|
IP
|
$474.82
|
|
|
Service Code
|
NDC 0713-0503-12
|
| Hospital Charge Code |
3738
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$289.59 |
| Max. Negotiated Rate |
$427.34 |
| Rate for Payer: Aetna Commercial |
$403.60
|
| Rate for Payer: BCBS Trust/PPO |
$366.94
|
| Rate for Payer: BCN Commercial |
$366.94
|
| Rate for Payer: Cash Price |
$379.86
|
| Rate for Payer: Cofinity Commercial |
$408.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$379.86
|
| Rate for Payer: Healthscope Commercial |
$427.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$356.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$403.60
|
| Rate for Payer: PHP Commercial |
$403.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$413.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$289.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$417.84
|
| Rate for Payer: UHC Core |
$396.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$356.12
|
|
|
HYDROCORTISONE-ACETIC ACID 1 %-2 % EAR DROPS
|
Facility
|
IP
|
$248.92
|
|
|
Service Code
|
NDC 50383-901-10
|
| Hospital Charge Code |
24385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$151.82 |
| Max. Negotiated Rate |
$224.03 |
| Rate for Payer: Aetna Commercial |
$211.58
|
| Rate for Payer: BCBS Trust/PPO |
$192.37
|
| Rate for Payer: BCN Commercial |
$192.37
|
| Rate for Payer: Cash Price |
$199.14
|
| Rate for Payer: Cofinity Commercial |
$214.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.14
|
| Rate for Payer: Healthscope Commercial |
$224.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$211.58
|
| Rate for Payer: PHP Commercial |
$211.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$174.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$216.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$219.05
|
| Rate for Payer: UHC Core |
$207.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.69
|
|
|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
IP
|
$8.07
|
|
|
Service Code
|
NDC 0536-1277-80
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$7.26 |
| Rate for Payer: Aetna Commercial |
$6.86
|
| Rate for Payer: BCBS Trust/PPO |
$6.24
|
| Rate for Payer: BCN Commercial |
$6.24
|
| Rate for Payer: Cash Price |
$6.46
|
| Rate for Payer: Cofinity Commercial |
$6.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6.46
|
| Rate for Payer: Healthscope Commercial |
$7.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$6.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6.86
|
| Rate for Payer: PHP Commercial |
$6.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.10
|
| Rate for Payer: UHC Core |
$6.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$6.05
|
|
|
HYDROCORTISONE-ALOE VERA 1 % TOPICAL CREAM
|
Facility
|
IP
|
$13.81
|
|
|
Service Code
|
NDC 51672-2013-2
|
| Hospital Charge Code |
14190
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$12.43 |
| Rate for Payer: Aetna Commercial |
$11.74
|
| Rate for Payer: BCBS Trust/PPO |
$10.67
|
| Rate for Payer: BCN Commercial |
$10.67
|
| Rate for Payer: Cash Price |
$11.05
|
| Rate for Payer: Cofinity Commercial |
$11.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.05
|
| Rate for Payer: Healthscope Commercial |
$12.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.74
|
| Rate for Payer: PHP Commercial |
$11.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.15
|
| Rate for Payer: UHC Core |
$11.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.36
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$84.42
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.49 |
| Max. Negotiated Rate |
$75.98 |
| Rate for Payer: Aetna Commercial |
$71.76
|
| Rate for Payer: Aetna Commercial |
$70.89
|
| Rate for Payer: BCBS Trust/PPO |
$64.45
|
| Rate for Payer: BCBS Trust/PPO |
$65.24
|
| Rate for Payer: BCN Commercial |
$64.45
|
| Rate for Payer: BCN Commercial |
$65.24
|
| Rate for Payer: Cash Price |
$67.54
|
| Rate for Payer: Cash Price |
$66.72
|
| Rate for Payer: Cofinity Commercial |
$71.72
|
| Rate for Payer: Cofinity Commercial |
$72.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.54
|
| Rate for Payer: Healthscope Commercial |
$75.98
|
| Rate for Payer: Healthscope Commercial |
$75.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$70.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.76
|
| Rate for Payer: PHP Commercial |
$71.76
|
| Rate for Payer: PHP Commercial |
$70.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$74.29
|
| Rate for Payer: UHC Core |
$69.64
|
| Rate for Payer: UHC Core |
$70.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.32
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE
|
Facility
|
IP
|
$16.48
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
166819
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$14.83 |
| Rate for Payer: Aetna Commercial |
$14.01
|
| Rate for Payer: Aetna Commercial |
$18.20
|
| Rate for Payer: Aetna Commercial |
$13.09
|
| Rate for Payer: Aetna Commercial |
$11.96
|
| Rate for Payer: BCBS Trust/PPO |
$16.55
|
| Rate for Payer: BCBS Trust/PPO |
$10.87
|
| Rate for Payer: BCBS Trust/PPO |
$11.90
|
| Rate for Payer: BCBS Trust/PPO |
$12.74
|
| Rate for Payer: BCN Commercial |
$11.90
|
| Rate for Payer: BCN Commercial |
$16.55
|
| Rate for Payer: BCN Commercial |
$10.87
|
| Rate for Payer: BCN Commercial |
$12.74
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$17.13
|
| Rate for Payer: Cofinity Commercial |
$12.10
|
| Rate for Payer: Cofinity Commercial |
$13.24
|
| Rate for Payer: Cofinity Commercial |
$14.17
|
| Rate for Payer: Cofinity Commercial |
$18.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.13
|
| Rate for Payer: Healthscope Commercial |
$13.86
|
| Rate for Payer: Healthscope Commercial |
$14.83
|
| Rate for Payer: Healthscope Commercial |
$12.66
|
| Rate for Payer: Healthscope Commercial |
$19.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$12.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$14.01
|
| Rate for Payer: PHP Commercial |
$14.01
|
| Rate for Payer: PHP Commercial |
$13.09
|
| Rate for Payer: PHP Commercial |
$18.20
|
| Rate for Payer: PHP Commercial |
$11.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.84
|
| Rate for Payer: UHC Core |
$17.88
|
| Rate for Payer: UHC Core |
$11.75
|
| Rate for Payer: UHC Core |
$13.76
|
| Rate for Payer: UHC Core |
$12.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$12.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.06
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$29.60
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
112193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Aetna Commercial |
$25.16
|
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Aetna Commercial |
$18.59
|
| Rate for Payer: BCBS Trust/PPO |
$16.90
|
| Rate for Payer: BCBS Trust/PPO |
$22.87
|
| Rate for Payer: BCBS Trust/PPO |
$15.55
|
| Rate for Payer: BCN Commercial |
$15.55
|
| Rate for Payer: BCN Commercial |
$16.90
|
| Rate for Payer: BCN Commercial |
$22.87
|
| Rate for Payer: Cash Price |
$23.68
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$17.50
|
| Rate for Payer: Cofinity Commercial |
$18.81
|
| Rate for Payer: Cofinity Commercial |
$17.30
|
| Rate for Payer: Cofinity Commercial |
$25.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.50
|
| Rate for Payer: Healthscope Commercial |
$19.68
|
| Rate for Payer: Healthscope Commercial |
$18.11
|
| Rate for Payer: Healthscope Commercial |
$26.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$22.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$25.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.10
|
| Rate for Payer: PHP Commercial |
$17.10
|
| Rate for Payer: PHP Commercial |
$18.59
|
| Rate for Payer: PHP Commercial |
$25.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.03
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.05
|
| Rate for Payer: UHC Core |
$16.80
|
| Rate for Payer: UHC Core |
$18.26
|
| Rate for Payer: UHC Core |
$24.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$22.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.40
|
|
|
HYDROMORPHONE 2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$24.39
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
3758
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.88 |
| Max. Negotiated Rate |
$21.95 |
| Rate for Payer: Aetna Commercial |
$20.73
|
| Rate for Payer: BCBS Trust/PPO |
$18.85
|
| Rate for Payer: BCN Commercial |
$18.85
|
| Rate for Payer: Cash Price |
$19.51
|
| Rate for Payer: Cofinity Commercial |
$20.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.51
|
| Rate for Payer: Healthscope Commercial |
$21.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.73
|
| Rate for Payer: PHP Commercial |
$20.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.46
|
| Rate for Payer: UHC Core |
$20.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.29
|
|
|
HYDROMORPHONE 2 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$22.51
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
110943
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$20.26 |
| Rate for Payer: Aetna Commercial |
$19.13
|
| Rate for Payer: Aetna Commercial |
$23.13
|
| Rate for Payer: Aetna Commercial |
$26.77
|
| Rate for Payer: BCBS Trust/PPO |
$21.03
|
| Rate for Payer: BCBS Trust/PPO |
$17.40
|
| Rate for Payer: BCBS Trust/PPO |
$24.34
|
| Rate for Payer: BCN Commercial |
$17.40
|
| Rate for Payer: BCN Commercial |
$24.34
|
| Rate for Payer: BCN Commercial |
$21.03
|
| Rate for Payer: Cash Price |
$18.01
|
| Rate for Payer: Cash Price |
$21.77
|
| Rate for Payer: Cash Price |
$25.19
|
| Rate for Payer: Cofinity Commercial |
$19.36
|
| Rate for Payer: Cofinity Commercial |
$27.08
|
| Rate for Payer: Cofinity Commercial |
$23.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.77
|
| Rate for Payer: Healthscope Commercial |
$24.49
|
| Rate for Payer: Healthscope Commercial |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$28.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$26.77
|
| Rate for Payer: PHP Commercial |
$19.13
|
| Rate for Payer: PHP Commercial |
$23.13
|
| Rate for Payer: PHP Commercial |
$26.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.81
|
| Rate for Payer: UHC Core |
$18.80
|
| Rate for Payer: UHC Core |
$22.72
|
| Rate for Payer: UHC Core |
$26.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.62
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
IP
|
$269.50
|
|
|
Service Code
|
NDC 42858-301-25
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.37 |
| Max. Negotiated Rate |
$242.55 |
| Rate for Payer: Aetna Commercial |
$229.08
|
| Rate for Payer: BCBS Trust/PPO |
$208.27
|
| Rate for Payer: BCN Commercial |
$208.27
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cofinity Commercial |
$231.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$215.60
|
| Rate for Payer: Healthscope Commercial |
$242.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$202.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$229.08
|
| Rate for Payer: PHP Commercial |
$229.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$234.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.16
|
| Rate for Payer: UHC Core |
$225.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$202.12
|
|
|
HYDROMORPHONE 4 MG TABLET
|
Facility
|
IP
|
$453.55
|
|
|
Service Code
|
NDC 42858-302-25
|
| Hospital Charge Code |
3761
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$276.62 |
| Max. Negotiated Rate |
$408.20 |
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: BCBS Trust/PPO |
$350.50
|
| Rate for Payer: BCN Commercial |
$350.50
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Healthscope Commercial |
$408.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$385.52
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$394.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$276.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$399.12
|
| Rate for Payer: UHC Core |
$378.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.16
|
|
|
HYDROMORPHONE (PF) 10 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$40.50
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
10224
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.70 |
| Max. Negotiated Rate |
$36.45 |
| Rate for Payer: Aetna Commercial |
$34.42
|
| Rate for Payer: BCBS Trust/PPO |
$31.30
|
| Rate for Payer: BCN Commercial |
$31.30
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cofinity Commercial |
$34.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$36.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$30.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$34.42
|
| Rate for Payer: PHP Commercial |
$34.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$24.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.64
|
| Rate for Payer: UHC Core |
$33.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$30.38
|
|
|
HYDROMORPHONE (PF) 2 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$26.64
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
117123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$23.98 |
| Rate for Payer: Aetna Commercial |
$22.64
|
| Rate for Payer: Aetna Commercial |
$16.92
|
| Rate for Payer: BCBS Trust/PPO |
$15.39
|
| Rate for Payer: BCBS Trust/PPO |
$20.59
|
| Rate for Payer: BCN Commercial |
$15.39
|
| Rate for Payer: BCN Commercial |
$20.59
|
| Rate for Payer: Cash Price |
$21.31
|
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: Cofinity Commercial |
$22.91
|
| Rate for Payer: Cofinity Commercial |
$17.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.31
|
| Rate for Payer: Healthscope Commercial |
$23.98
|
| Rate for Payer: Healthscope Commercial |
$17.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$22.64
|
| Rate for Payer: PHP Commercial |
$22.64
|
| Rate for Payer: PHP Commercial |
$16.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.52
|
| Rate for Payer: UHC Core |
$16.62
|
| Rate for Payer: UHC Core |
$22.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.98
|
|
|
HYDROMORPHONE VARIABLE DOSE
|
Facility
|
IP
|
$14.07
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
150712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.58 |
| Max. Negotiated Rate |
$12.66 |
| Rate for Payer: Aetna Commercial |
$11.96
|
| Rate for Payer: BCBS Trust/PPO |
$10.87
|
| Rate for Payer: BCN Commercial |
$10.87
|
| Rate for Payer: Cash Price |
$11.26
|
| 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: Lakeland Regional Health Systems Commercial |
$10.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$11.96
|
| Rate for Payer: PHP Commercial |
$11.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.38
|
| Rate for Payer: UHC Core |
$11.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.55
|
|
|
HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$2,650.82
|
|
|
Service Code
|
NDC 11704-370-01
|
| Hospital Charge Code |
155400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,616.74 |
| Max. Negotiated Rate |
$2,385.74 |
| Rate for Payer: Aetna Commercial |
$2,253.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,048.55
|
| Rate for Payer: BCN Commercial |
$2,048.55
|
| Rate for Payer: Cash Price |
$2,120.66
|
| Rate for Payer: Cofinity Commercial |
$2,279.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,120.66
|
| Rate for Payer: Healthscope Commercial |
$2,385.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,988.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2,253.20
|
| Rate for Payer: PHP Commercial |
$2,253.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,855.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,306.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,616.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,332.72
|
| Rate for Payer: UHC Core |
$2,213.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,988.12
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$593.76
|
|
|
Service Code
|
NDC 68084-269-01
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$362.13 |
| Max. Negotiated Rate |
$534.38 |
| Rate for Payer: Aetna Commercial |
$504.70
|
| Rate for Payer: BCBS Trust/PPO |
$458.86
|
| Rate for Payer: BCN Commercial |
$458.86
|
| Rate for Payer: Cash Price |
$475.01
|
| Rate for Payer: Cofinity Commercial |
$510.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.01
|
| Rate for Payer: Healthscope Commercial |
$534.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$445.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$504.70
|
| Rate for Payer: PHP Commercial |
$504.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$415.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$516.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$522.51
|
| Rate for Payer: UHC Core |
$495.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$445.32
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$593.76
|
|
|
Service Code
|
NDC 68084-269-11
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$362.13 |
| Max. Negotiated Rate |
$534.38 |
| Rate for Payer: Aetna Commercial |
$504.70
|
| Rate for Payer: BCBS Trust/PPO |
$458.86
|
| Rate for Payer: BCN Commercial |
$458.86
|
| Rate for Payer: Cash Price |
$475.01
|
| Rate for Payer: Cofinity Commercial |
$510.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$475.01
|
| Rate for Payer: Healthscope Commercial |
$534.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$445.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$504.70
|
| Rate for Payer: PHP Commercial |
$504.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$415.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$516.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$362.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$522.51
|
| Rate for Payer: UHC Core |
$495.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$445.32
|
|
|
HYDROXYPROGESTERONE (PF)(PREGNANCY PRESERVING) 250 MG/ML (1 ML) IM OIL
|
Facility
|
IP
|
$2,031.27
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
178180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,238.87 |
| Max. Negotiated Rate |
$1,828.14 |
| Rate for Payer: Aetna Commercial |
$1,726.58
|
| Rate for Payer: Aetna Commercial |
$1,809.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,644.74
|
| Rate for Payer: BCBS Trust/PPO |
$1,569.77
|
| Rate for Payer: BCN Commercial |
$1,569.77
|
| Rate for Payer: BCN Commercial |
$1,644.74
|
| Rate for Payer: Cash Price |
$1,702.63
|
| Rate for Payer: Cash Price |
$1,625.02
|
| Rate for Payer: Cofinity Commercial |
$1,746.89
|
| Rate for Payer: Cofinity Commercial |
$1,830.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,625.02
|
| Rate for Payer: Healthscope Commercial |
$1,828.14
|
| Rate for Payer: Healthscope Commercial |
$1,915.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,596.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,523.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,809.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1,726.58
|
| Rate for Payer: PHP Commercial |
$1,726.58
|
| Rate for Payer: PHP Commercial |
$1,809.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,421.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,489.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,767.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,851.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,238.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,298.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,872.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,787.52
|
| Rate for Payer: UHC Core |
$1,696.11
|
| Rate for Payer: UHC Core |
$1,777.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,523.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,596.22
|
|
|
HYDROXYUREA 500 MG CAPSULE
|
Facility
|
IP
|
$250.08
|
|
|
Service Code
|
NDC 49884-724-01
|
| Hospital Charge Code |
10236
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.52 |
| Max. Negotiated Rate |
$225.07 |
| Rate for Payer: Aetna Commercial |
$212.57
|
| Rate for Payer: BCBS Trust/PPO |
$193.26
|
| Rate for Payer: BCN Commercial |
$193.26
|
| Rate for Payer: Cash Price |
$200.06
|
| Rate for Payer: Cofinity Commercial |
$215.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$200.06
|
| Rate for Payer: Healthscope Commercial |
$225.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$187.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$212.57
|
| Rate for Payer: PHP Commercial |
$212.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$220.07
|
| Rate for Payer: UHC Core |
$208.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$187.56
|
|
|
HYDROXYUREA 500 MG CAPSULE
|
Facility
|
IP
|
$341.28
|
|
|
Service Code
|
NDC 0904-6939-61
|
| Hospital Charge Code |
10236
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$208.15 |
| Max. Negotiated Rate |
$307.15 |
| Rate for Payer: Aetna Commercial |
$290.09
|
| Rate for Payer: BCBS Trust/PPO |
$263.74
|
| Rate for Payer: BCN Commercial |
$263.74
|
| Rate for Payer: Cash Price |
$273.02
|
| Rate for Payer: Cofinity Commercial |
$293.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$273.02
|
| Rate for Payer: Healthscope Commercial |
$307.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$255.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$290.09
|
| Rate for Payer: PHP Commercial |
$290.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$296.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$208.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$300.33
|
| Rate for Payer: UHC Core |
$284.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$255.96
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
IP
|
$427.70
|
|
|
Service Code
|
NDC 68084-253-11
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.85 |
| Max. Negotiated Rate |
$384.93 |
| Rate for Payer: Aetna Commercial |
$363.54
|
| Rate for Payer: BCBS Trust/PPO |
$330.53
|
| Rate for Payer: BCN Commercial |
$330.53
|
| Rate for Payer: Cash Price |
$342.16
|
| Rate for Payer: Cofinity Commercial |
$367.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.16
|
| Rate for Payer: Healthscope Commercial |
$384.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$363.54
|
| Rate for Payer: PHP Commercial |
$363.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$372.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$376.38
|
| Rate for Payer: UHC Core |
$357.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.78
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
IP
|
$427.70
|
|
|
Service Code
|
NDC 68084-253-01
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$260.85 |
| Max. Negotiated Rate |
$384.93 |
| Rate for Payer: Aetna Commercial |
$363.54
|
| Rate for Payer: BCBS Trust/PPO |
$330.53
|
| Rate for Payer: BCN Commercial |
$330.53
|
| Rate for Payer: Cash Price |
$342.16
|
| Rate for Payer: Cofinity Commercial |
$367.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.16
|
| Rate for Payer: Healthscope Commercial |
$384.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$320.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$363.54
|
| Rate for Payer: PHP Commercial |
$363.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$299.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$372.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$260.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$376.38
|
| Rate for Payer: UHC Core |
$357.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$320.78
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
IP
|
$345.45
|
|
|
Service Code
|
NDC 63739-483-10
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.69 |
| Max. Negotiated Rate |
$310.90 |
| Rate for Payer: Aetna Commercial |
$293.63
|
| Rate for Payer: BCBS Trust/PPO |
$266.96
|
| Rate for Payer: BCN Commercial |
$266.96
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$297.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.36
|
| Rate for Payer: Healthscope Commercial |
$310.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$293.63
|
| Rate for Payer: PHP Commercial |
$293.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.82
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$300.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$210.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.00
|
| Rate for Payer: UHC Core |
$288.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.09
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
IP
|
$178.60
|
|
|
Service Code
|
NDC 10702-010-01
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$151.81
|
| Rate for Payer: BCBS Trust/PPO |
$138.02
|
| Rate for Payer: BCN Commercial |
$138.02
|
| Rate for Payer: Cash Price |
$142.88
|
| Rate for Payer: Cofinity Commercial |
$153.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.88
|
| Rate for Payer: Healthscope Commercial |
$160.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$151.81
|
| Rate for Payer: PHP Commercial |
$151.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.17
|
| Rate for Payer: UHC Core |
$149.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.95
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
IP
|
$281.20
|
|
|
Service Code
|
NDC 68084-254-01
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$253.08 |
| Rate for Payer: Aetna Commercial |
$239.02
|
| Rate for Payer: BCBS Trust/PPO |
$217.31
|
| Rate for Payer: BCN Commercial |
$217.31
|
| Rate for Payer: Cash Price |
$224.96
|
| Rate for Payer: Cofinity Commercial |
$241.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.96
|
| Rate for Payer: Healthscope Commercial |
$253.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$239.02
|
| Rate for Payer: PHP Commercial |
$239.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.46
|
| Rate for Payer: UHC Core |
$234.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.90
|
|
