|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
|
IP
|
$14,124.06
|
|
|
Service Code
|
APR-DRG 8904
|
| Min. Negotiated Rate |
$13,451.49 |
| Max. Negotiated Rate |
$14,124.06 |
| Rate for Payer: BCBS Complete |
$14,124.06
|
| Rate for Payer: Mclaren Medicaid |
$13,451.49
|
| Rate for Payer: Meridian Medicaid |
$14,124.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,451.49
|
| Rate for Payer: UHC Medicaid |
$13,451.49
|
| Rate for Payer: UHCCP Medicaid |
$13,451.49
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$4,088.93
|
|
|
Service Code
|
APR-DRG 8942
|
| Min. Negotiated Rate |
$3,894.22 |
| Max. Negotiated Rate |
$4,088.93 |
| Rate for Payer: BCBS Complete |
$4,088.93
|
| Rate for Payer: Mclaren Medicaid |
$3,894.22
|
| Rate for Payer: Meridian Medicaid |
$4,088.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,894.22
|
| Rate for Payer: UHC Medicaid |
$3,894.22
|
| Rate for Payer: UHCCP Medicaid |
$3,894.22
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$3,828.12
|
|
|
Service Code
|
APR-DRG 8941
|
| Min. Negotiated Rate |
$3,645.82 |
| Max. Negotiated Rate |
$3,828.12 |
| Rate for Payer: BCBS Complete |
$3,828.12
|
| Rate for Payer: Mclaren Medicaid |
$3,645.82
|
| Rate for Payer: Meridian Medicaid |
$3,828.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,645.82
|
| Rate for Payer: UHC Medicaid |
$3,645.82
|
| Rate for Payer: UHCCP Medicaid |
$3,645.82
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$7,089.90
|
|
|
Service Code
|
APR-DRG 8944
|
| Min. Negotiated Rate |
$6,752.29 |
| Max. Negotiated Rate |
$7,089.90 |
| Rate for Payer: BCBS Complete |
$7,089.90
|
| Rate for Payer: Mclaren Medicaid |
$6,752.29
|
| Rate for Payer: Meridian Medicaid |
$7,089.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,752.29
|
| Rate for Payer: UHC Medicaid |
$6,752.29
|
| Rate for Payer: UHCCP Medicaid |
$6,752.29
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$4,533.27
|
|
|
Service Code
|
APR-DRG 8943
|
| Min. Negotiated Rate |
$4,317.40 |
| Max. Negotiated Rate |
$4,533.27 |
| Rate for Payer: BCBS Complete |
$4,533.27
|
| Rate for Payer: Mclaren Medicaid |
$4,317.40
|
| Rate for Payer: Meridian Medicaid |
$4,533.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,317.40
|
| Rate for Payer: UHC Medicaid |
$4,317.40
|
| Rate for Payer: UHCCP Medicaid |
$4,317.40
|
|
|
HOSPICE AND PALLIATIVE CARE
|
Facility
|
IP
|
$1,036.43
|
|
|
Service Code
|
APR-DRG 8644
|
| Min. Negotiated Rate |
$987.08 |
| Max. Negotiated Rate |
$1,036.43 |
| Rate for Payer: BCBS Complete |
$1,036.43
|
| Rate for Payer: Mclaren Medicaid |
$987.08
|
| Rate for Payer: Meridian Medicaid |
$1,036.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$987.08
|
| Rate for Payer: UHC Medicaid |
$987.08
|
| Rate for Payer: UHCCP Medicaid |
$987.08
|
|
|
HOSPICE AND PALLIATIVE CARE
|
Facility
|
IP
|
$863.43
|
|
|
Service Code
|
APR-DRG 8641
|
| Min. Negotiated Rate |
$822.31 |
| Max. Negotiated Rate |
$863.43 |
| Rate for Payer: BCBS Complete |
$863.43
|
| Rate for Payer: Mclaren Medicaid |
$822.31
|
| Rate for Payer: Meridian Medicaid |
$863.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$822.31
|
| Rate for Payer: UHC Medicaid |
$822.31
|
| Rate for Payer: UHCCP Medicaid |
$822.31
|
|
|
HOSPICE AND PALLIATIVE CARE
|
Facility
|
IP
|
$889.20
|
|
|
Service Code
|
APR-DRG 8642
|
| Min. Negotiated Rate |
$846.85 |
| Max. Negotiated Rate |
$889.20 |
| Rate for Payer: BCBS Complete |
$889.20
|
| Rate for Payer: Mclaren Medicaid |
$846.85
|
| Rate for Payer: Meridian Medicaid |
$889.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$846.85
|
| Rate for Payer: UHC Medicaid |
$846.85
|
| Rate for Payer: UHCCP Medicaid |
$846.85
|
|
|
HOSPICE AND PALLIATIVE CARE
|
Facility
|
IP
|
$987.00
|
|
|
Service Code
|
APR-DRG 8643
|
| Min. Negotiated Rate |
$940.00 |
| Max. Negotiated Rate |
$987.00 |
| Rate for Payer: BCBS Complete |
$987.00
|
| Rate for Payer: Mclaren Medicaid |
$940.00
|
| Rate for Payer: Meridian Medicaid |
$987.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$940.00
|
| Rate for Payer: UHC Medicaid |
$940.00
|
| Rate for Payer: UHCCP Medicaid |
$940.00
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE-LANS 500 UNIT IV SOLUTION
|
Facility
|
OP
|
$5.82
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
204903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$5.24 |
| Rate for Payer: Aetna Commercial |
$4.95
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.82
|
| Rate for Payer: BCBS Complete |
$1.08
|
| Rate for Payer: BCBS MAPPO |
$1.46
|
| Rate for Payer: BCBS Trust/PPO |
$4.78
|
| Rate for Payer: BCN Commercial |
$4.78
|
| Rate for Payer: BCN Medicare Advantage |
$1.46
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cofinity Commercial |
$5.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.46
|
| Rate for Payer: Healthscope Commercial |
$5.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.37
|
| Rate for Payer: Mclaren Medicaid |
$1.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.53
|
| Rate for Payer: Meridian Medicaid |
$1.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.95
|
| Rate for Payer: Nomi Health Commercial |
$4.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.37
|
| Rate for Payer: PACE Senior Care Partners |
$1.38
|
| Rate for Payer: PACE SWMI |
$1.46
|
| Rate for Payer: PHP Commercial |
$4.95
|
| Rate for Payer: PHP Medicare Advantage |
$1.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.06
|
| Rate for Payer: Priority Health Medicare |
$1.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.05
|
| Rate for Payer: Railroad Medicare Medicare |
$1.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.12
|
| Rate for Payer: UHC Core |
$4.86
|
| Rate for Payer: UHC Exchange |
$1.46
|
| Rate for Payer: UHC Medicaid |
$1.03
|
| Rate for Payer: UHC Medicare Advantage |
$1.46
|
| Rate for Payer: UHCCP Medicaid |
$1.03
|
| Rate for Payer: VA VA |
$1.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.37
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE-LANS 500 UNIT IV SOLUTION
|
Facility
|
IP
|
$5.82
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
204903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$5.24 |
| Rate for Payer: Aetna Commercial |
$4.95
|
| Rate for Payer: BCBS Trust/PPO |
$4.81
|
| Rate for Payer: BCN Commercial |
$4.81
|
| Rate for Payer: Cash Price |
$4.66
|
| Rate for Payer: Cofinity Commercial |
$5.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.66
|
| Rate for Payer: Healthscope Commercial |
$5.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.95
|
| Rate for Payer: Nomi Health Commercial |
$4.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.37
|
| Rate for Payer: PHP Commercial |
$4.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$5.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.12
|
| Rate for Payer: UHC Core |
$4.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.37
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$212.46
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
76338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.46 |
| Max. Negotiated Rate |
$191.21 |
| Rate for Payer: Aetna Commercial |
$180.59
|
| Rate for Payer: Aetna Medicare |
$55.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.39
|
| Rate for Payer: BCBS Complete |
$39.33
|
| Rate for Payer: BCBS MAPPO |
$53.12
|
| Rate for Payer: BCBS Trust/PPO |
$174.66
|
| Rate for Payer: BCN Commercial |
$174.66
|
| Rate for Payer: BCN Medicare Advantage |
$53.12
|
| Rate for Payer: Cash Price |
$169.97
|
| Rate for Payer: Cofinity Commercial |
$182.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.12
|
| Rate for Payer: Healthscope Commercial |
$191.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.34
|
| Rate for Payer: Mclaren Medicaid |
$37.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.77
|
| Rate for Payer: Meridian Medicaid |
$39.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$61.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$58.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.59
|
| Rate for Payer: Nomi Health Commercial |
$174.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.34
|
| Rate for Payer: PACE Senior Care Partners |
$50.46
|
| Rate for Payer: PACE SWMI |
$53.12
|
| Rate for Payer: PHP Commercial |
$180.59
|
| Rate for Payer: PHP Medicare Advantage |
$53.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$184.84
|
| Rate for Payer: Priority Health Medicare |
$53.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.87
|
| Rate for Payer: Railroad Medicare Medicare |
$53.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.96
|
| Rate for Payer: UHC Core |
$177.40
|
| Rate for Payer: UHC Exchange |
$53.12
|
| Rate for Payer: UHC Medicaid |
$37.46
|
| Rate for Payer: UHC Medicare Advantage |
$53.12
|
| Rate for Payer: UHCCP Medicaid |
$37.46
|
| Rate for Payer: VA VA |
$53.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.34
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$212.46
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
76338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$147.87 |
| Max. Negotiated Rate |
$191.21 |
| Rate for Payer: Aetna Commercial |
$180.59
|
| Rate for Payer: BCBS Trust/PPO |
$175.47
|
| Rate for Payer: BCN Commercial |
$175.47
|
| Rate for Payer: Cash Price |
$169.97
|
| Rate for Payer: Cofinity Commercial |
$182.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.97
|
| Rate for Payer: Healthscope Commercial |
$191.21
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.59
|
| Rate for Payer: Nomi Health Commercial |
$174.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.34
|
| Rate for Payer: PHP Commercial |
$180.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$184.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.96
|
| Rate for Payer: UHC Core |
$177.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.34
|
|
|
HYDRALAZINE 100 MG TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 23155083501
|
| Hospital Charge Code |
3699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.85 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: BCBS Trust/PPO |
$155.27
|
| Rate for Payer: BCN Commercial |
$155.27
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$163.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.44
|
| Rate for Payer: UHC Core |
$156.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
HYDRALAZINE 100 MG TABLET
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 23155083501
|
| Hospital Charge Code |
3699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.14 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna Medicare |
$48.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.75
|
| Rate for Payer: BCBS Complete |
$34.80
|
| Rate for Payer: BCBS MAPPO |
$47.00
|
| Rate for Payer: BCBS Trust/PPO |
$154.55
|
| Rate for Payer: BCN Commercial |
$154.55
|
| Rate for Payer: BCN Medicare Advantage |
$47.00
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.00
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Mclaren Medicaid |
$33.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.35
|
| Rate for Payer: Meridian Medicaid |
$34.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Nomi Health Commercial |
$154.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PACE Senior Care Partners |
$44.65
|
| Rate for Payer: PACE SWMI |
$47.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: PHP Medicare Advantage |
$47.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$163.56
|
| Rate for Payer: Priority Health Medicare |
$47.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$130.85
|
| Rate for Payer: Railroad Medicare Medicare |
$47.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.44
|
| Rate for Payer: UHC Core |
$156.98
|
| Rate for Payer: UHC Exchange |
$47.00
|
| Rate for Payer: UHC Medicaid |
$33.14
|
| Rate for Payer: UHC Medicare Advantage |
$47.00
|
| Rate for Payer: UHCCP Medicaid |
$33.14
|
| Rate for Payer: VA VA |
$47.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
OP
|
$345.45
|
|
|
Service Code
|
NDC 68084044711
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.90 |
| Max. Negotiated Rate |
$310.90 |
| Rate for Payer: Aetna Commercial |
$293.63
|
| Rate for Payer: Aetna Medicare |
$89.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$107.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$107.95
|
| Rate for Payer: BCBS Complete |
$63.94
|
| Rate for Payer: BCBS MAPPO |
$86.36
|
| Rate for Payer: BCBS Trust/PPO |
$283.99
|
| Rate for Payer: BCN Commercial |
$283.99
|
| Rate for Payer: BCN Medicare Advantage |
$86.36
|
| 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: Health Alliance Plan Medicare Advantage |
$86.36
|
| Rate for Payer: Healthscope Commercial |
$310.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.09
|
| Rate for Payer: Mclaren Medicaid |
$60.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.68
|
| Rate for Payer: Meridian Medicaid |
$63.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.63
|
| Rate for Payer: Nomi Health Commercial |
$283.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.09
|
| Rate for Payer: PACE Senior Care Partners |
$82.04
|
| Rate for Payer: PACE SWMI |
$86.36
|
| Rate for Payer: PHP Commercial |
$293.63
|
| Rate for Payer: PHP Medicare Advantage |
$86.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$60.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$300.54
|
| Rate for Payer: Priority Health Medicare |
$87.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.43
|
| Rate for Payer: Railroad Medicare Medicare |
$86.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.00
|
| Rate for Payer: UHC Core |
$288.45
|
| Rate for Payer: UHC Exchange |
$86.36
|
| Rate for Payer: UHC Medicaid |
$60.90
|
| Rate for Payer: UHC Medicare Advantage |
$86.36
|
| Rate for Payer: UHCCP Medicaid |
$60.90
|
| Rate for Payer: VA VA |
$86.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.09
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
OP
|
$227.95
|
|
|
Service Code
|
NDC 00904644061
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.19 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$193.76
|
| Rate for Payer: Aetna Medicare |
$59.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$71.23
|
| Rate for Payer: Amish Plain Church Group Commercial |
$71.23
|
| Rate for Payer: BCBS Complete |
$42.19
|
| Rate for Payer: BCBS MAPPO |
$56.99
|
| Rate for Payer: BCBS Trust/PPO |
$187.40
|
| Rate for Payer: BCN Commercial |
$187.40
|
| Rate for Payer: BCN Medicare Advantage |
$56.99
|
| Rate for Payer: Cash Price |
$182.36
|
| Rate for Payer: Cofinity Commercial |
$196.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.99
|
| Rate for Payer: Healthscope Commercial |
$205.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.96
|
| Rate for Payer: Mclaren Medicaid |
$40.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.84
|
| Rate for Payer: Meridian Medicaid |
$42.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$62.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.76
|
| Rate for Payer: Nomi Health Commercial |
$186.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.96
|
| Rate for Payer: PACE Senior Care Partners |
$54.14
|
| Rate for Payer: PACE SWMI |
$56.99
|
| Rate for Payer: PHP Commercial |
$193.76
|
| Rate for Payer: PHP Medicare Advantage |
$56.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$198.32
|
| Rate for Payer: Priority Health Medicare |
$57.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.65
|
| Rate for Payer: Railroad Medicare Medicare |
$56.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.60
|
| Rate for Payer: UHC Core |
$190.34
|
| Rate for Payer: UHC Exchange |
$56.99
|
| Rate for Payer: UHC Medicaid |
$40.19
|
| Rate for Payer: UHC Medicare Advantage |
$56.99
|
| Rate for Payer: UHCCP Medicaid |
$40.19
|
| Rate for Payer: VA VA |
$56.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.96
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
IP
|
$345.45
|
|
|
Service Code
|
NDC 68084044711
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$240.43 |
| Max. Negotiated Rate |
$310.90 |
| Rate for Payer: Aetna Commercial |
$293.63
|
| Rate for Payer: BCBS Trust/PPO |
$285.31
|
| Rate for Payer: BCN Commercial |
$285.31
|
| 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 Commercial |
$293.63
|
| Rate for Payer: Nomi Health Commercial |
$283.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.09
|
| Rate for Payer: PHP Commercial |
$293.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$300.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.43
|
| 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
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
OP
|
$392.45
|
|
|
Service Code
|
NDC 00904744761
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.19 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: Aetna Medicare |
$102.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$122.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$122.64
|
| Rate for Payer: BCBS Complete |
$72.64
|
| Rate for Payer: BCBS MAPPO |
$98.11
|
| Rate for Payer: BCBS Trust/PPO |
$322.63
|
| Rate for Payer: BCN Commercial |
$322.63
|
| Rate for Payer: BCN Medicare Advantage |
$98.11
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.11
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Mclaren Medicaid |
$69.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.02
|
| Rate for Payer: Meridian Medicaid |
$72.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$107.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Nomi Health Commercial |
$321.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.34
|
| Rate for Payer: PACE Senior Care Partners |
$93.21
|
| Rate for Payer: PACE SWMI |
$98.11
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: PHP Medicare Advantage |
$98.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$341.43
|
| Rate for Payer: Priority Health Medicare |
$99.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.15
|
| Rate for Payer: Railroad Medicare Medicare |
$98.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.36
|
| Rate for Payer: UHC Core |
$327.70
|
| Rate for Payer: UHC Exchange |
$98.11
|
| Rate for Payer: UHC Medicaid |
$69.19
|
| Rate for Payer: UHC Medicare Advantage |
$98.11
|
| Rate for Payer: UHCCP Medicaid |
$69.19
|
| Rate for Payer: VA VA |
$98.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
IP
|
$227.95
|
|
|
Service Code
|
NDC 00904644061
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$158.65 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$193.76
|
| Rate for Payer: BCBS Trust/PPO |
$188.26
|
| Rate for Payer: BCN Commercial |
$188.26
|
| Rate for Payer: Cash Price |
$182.36
|
| Rate for Payer: Cofinity Commercial |
$196.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$182.36
|
| Rate for Payer: Healthscope Commercial |
$205.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.76
|
| Rate for Payer: Nomi Health Commercial |
$186.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.96
|
| Rate for Payer: PHP Commercial |
$193.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$198.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$158.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$200.60
|
| Rate for Payer: UHC Core |
$190.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.96
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
IP
|
$392.45
|
|
|
Service Code
|
NDC 00904744761
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$273.15 |
| Max. Negotiated Rate |
$353.20 |
| Rate for Payer: Aetna Commercial |
$333.58
|
| Rate for Payer: BCBS Trust/PPO |
$324.12
|
| Rate for Payer: BCN Commercial |
$324.12
|
| Rate for Payer: Cash Price |
$313.96
|
| Rate for Payer: Cofinity Commercial |
$337.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$313.96
|
| Rate for Payer: Healthscope Commercial |
$353.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$294.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$333.58
|
| Rate for Payer: Nomi Health Commercial |
$321.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$294.34
|
| Rate for Payer: PHP Commercial |
$333.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$341.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$273.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.36
|
| Rate for Payer: UHC Core |
$327.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$294.34
|
|
|
HYDRALAZINE 20 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$20.70
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
3697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Commercial |
$19.78
|
| Rate for Payer: Aetna Commercial |
$18.13
|
| Rate for Payer: Aetna Medicare |
$6.05
|
| Rate for Payer: Aetna Medicare |
$5.38
|
| Rate for Payer: Aetna Medicare |
$5.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.67
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.47
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.27
|
| Rate for Payer: BCBS Complete |
$3.95
|
| Rate for Payer: BCBS Complete |
$3.83
|
| Rate for Payer: BCBS Complete |
$4.31
|
| Rate for Payer: BCBS MAPPO |
$5.82
|
| Rate for Payer: BCBS MAPPO |
$5.17
|
| Rate for Payer: BCBS MAPPO |
$5.33
|
| Rate for Payer: BCBS Trust/PPO |
$17.02
|
| Rate for Payer: BCBS Trust/PPO |
$17.54
|
| Rate for Payer: BCBS Trust/PPO |
$19.13
|
| Rate for Payer: BCN Commercial |
$17.54
|
| Rate for Payer: BCN Commercial |
$19.13
|
| Rate for Payer: BCN Commercial |
$17.02
|
| Rate for Payer: BCN Medicare Advantage |
$5.82
|
| Rate for Payer: BCN Medicare Advantage |
$5.33
|
| Rate for Payer: BCN Medicare Advantage |
$5.17
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Cofinity Commercial |
$20.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.17
|
| Rate for Payer: Healthscope Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$20.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.00
|
| Rate for Payer: Mclaren Medicaid |
$3.65
|
| Rate for Payer: Mclaren Medicaid |
$4.10
|
| Rate for Payer: Mclaren Medicaid |
$3.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.11
|
| Rate for Payer: Meridian Medicaid |
$4.31
|
| Rate for Payer: Meridian Medicaid |
$3.83
|
| Rate for Payer: Meridian Medicaid |
$3.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$6.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.13
|
| Rate for Payer: Nomi Health Commercial |
$19.08
|
| Rate for Payer: Nomi Health Commercial |
$17.49
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: PACE Senior Care Partners |
$5.07
|
| Rate for Payer: PACE Senior Care Partners |
$4.92
|
| Rate for Payer: PACE Senior Care Partners |
$5.53
|
| Rate for Payer: PACE SWMI |
$5.82
|
| Rate for Payer: PACE SWMI |
$5.33
|
| Rate for Payer: PACE SWMI |
$5.17
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: PHP Commercial |
$19.78
|
| Rate for Payer: PHP Commercial |
$18.13
|
| Rate for Payer: PHP Medicare Advantage |
$5.33
|
| Rate for Payer: PHP Medicare Advantage |
$5.17
|
| Rate for Payer: PHP Medicare Advantage |
$5.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.24
|
| Rate for Payer: Priority Health Medicare |
$5.88
|
| Rate for Payer: Priority Health Medicare |
$5.39
|
| Rate for Payer: Priority Health Medicare |
$5.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.41
|
| Rate for Payer: Railroad Medicare Medicare |
$5.33
|
| Rate for Payer: Railroad Medicare Medicare |
$5.82
|
| Rate for Payer: Railroad Medicare Medicare |
$5.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.22
|
| Rate for Payer: UHC Core |
$17.28
|
| Rate for Payer: UHC Core |
$19.43
|
| Rate for Payer: UHC Core |
$17.81
|
| Rate for Payer: UHC Exchange |
$5.82
|
| Rate for Payer: UHC Exchange |
$5.33
|
| Rate for Payer: UHC Exchange |
$5.17
|
| Rate for Payer: UHC Medicaid |
$3.65
|
| Rate for Payer: UHC Medicaid |
$4.10
|
| Rate for Payer: UHC Medicaid |
$3.76
|
| Rate for Payer: UHC Medicare Advantage |
$5.33
|
| Rate for Payer: UHC Medicare Advantage |
$5.17
|
| Rate for Payer: UHC Medicare Advantage |
$5.82
|
| Rate for Payer: UHCCP Medicaid |
$3.76
|
| Rate for Payer: UHCCP Medicaid |
$3.65
|
| Rate for Payer: UHCCP Medicaid |
$4.10
|
| Rate for Payer: VA VA |
$5.17
|
| Rate for Payer: VA VA |
$5.82
|
| Rate for Payer: VA VA |
$5.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.45
|
|
|
HYDRALAZINE 20 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$20.70
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
3697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Aetna Commercial |
$17.59
|
| Rate for Payer: Aetna Commercial |
$18.13
|
| Rate for Payer: Aetna Commercial |
$19.78
|
| Rate for Payer: BCBS Trust/PPO |
$17.62
|
| Rate for Payer: BCBS Trust/PPO |
$17.10
|
| Rate for Payer: BCBS Trust/PPO |
$19.22
|
| Rate for Payer: BCN Commercial |
$17.62
|
| Rate for Payer: BCN Commercial |
$17.10
|
| Rate for Payer: BCN Commercial |
$19.22
|
| Rate for Payer: Cash Price |
$16.56
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cash Price |
$17.06
|
| Rate for Payer: Cofinity Commercial |
$20.01
|
| Rate for Payer: Cofinity Commercial |
$18.34
|
| Rate for Payer: Cofinity Commercial |
$17.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.62
|
| Rate for Payer: Healthscope Commercial |
$19.20
|
| Rate for Payer: Healthscope Commercial |
$18.63
|
| Rate for Payer: Healthscope Commercial |
$20.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.78
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$17.49
|
| Rate for Payer: Nomi Health Commercial |
$19.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.45
|
| Rate for Payer: PHP Commercial |
$17.59
|
| Rate for Payer: PHP Commercial |
$19.78
|
| Rate for Payer: PHP Commercial |
$18.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$20.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$18.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$16.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.22
|
| Rate for Payer: UHC Core |
$17.28
|
| Rate for Payer: UHC Core |
$19.43
|
| Rate for Payer: UHC Core |
$17.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.00
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$258.50
|
|
|
Service Code
|
NDC 00904644161
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: Aetna Commercial |
$219.72
|
| Rate for Payer: Aetna Medicare |
$67.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$80.78
|
| Rate for Payer: Amish Plain Church Group Commercial |
$80.78
|
| Rate for Payer: BCBS Complete |
$47.85
|
| Rate for Payer: BCBS MAPPO |
$64.62
|
| Rate for Payer: BCBS Trust/PPO |
$212.51
|
| Rate for Payer: BCN Commercial |
$212.51
|
| Rate for Payer: BCN Medicare Advantage |
$64.62
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cofinity Commercial |
$222.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.62
|
| Rate for Payer: Healthscope Commercial |
$232.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.88
|
| Rate for Payer: Mclaren Medicaid |
$45.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.86
|
| Rate for Payer: Meridian Medicaid |
$47.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.72
|
| Rate for Payer: Nomi Health Commercial |
$211.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.88
|
| Rate for Payer: PACE Senior Care Partners |
$61.39
|
| Rate for Payer: PACE SWMI |
$64.62
|
| Rate for Payer: PHP Commercial |
$219.72
|
| Rate for Payer: PHP Medicare Advantage |
$64.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$224.90
|
| Rate for Payer: Priority Health Medicare |
$65.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.92
|
| Rate for Payer: Railroad Medicare Medicare |
$64.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.48
|
| Rate for Payer: UHC Core |
$215.85
|
| Rate for Payer: UHC Exchange |
$64.62
|
| Rate for Payer: UHC Medicaid |
$45.57
|
| Rate for Payer: UHC Medicare Advantage |
$64.62
|
| Rate for Payer: UHCCP Medicaid |
$45.57
|
| Rate for Payer: VA VA |
$64.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.88
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$260.85
|
|
|
Service Code
|
NDC 63739032710
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$181.55 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: BCBS Trust/PPO |
$215.44
|
| Rate for Payer: BCN Commercial |
$215.44
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$224.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.72
|
| Rate for Payer: Nomi Health Commercial |
$213.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.64
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$226.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.55
|
| Rate for Payer: UHC Core |
$217.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.64
|
|
