|
HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,118.85
|
|
|
Service Code
|
HCPCS J3424
|
| Hospital Charge Code |
155400
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$549.85 |
| Max. Negotiated Rate |
$2,806.97 |
| Rate for Payer: Aetna Commercial |
$2,651.02
|
| Rate for Payer: Aetna Medicare |
$810.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$974.64
|
| Rate for Payer: Amish Plain Church Group Commercial |
$974.64
|
| Rate for Payer: BCBS Complete |
$577.30
|
| Rate for Payer: BCBS MAPPO |
$779.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,564.01
|
| Rate for Payer: BCN Commercial |
$2,564.01
|
| Rate for Payer: BCN Medicare Advantage |
$779.71
|
| Rate for Payer: Cash Price |
$2,495.08
|
| Rate for Payer: Cofinity Commercial |
$2,682.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,495.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$779.71
|
| Rate for Payer: Healthscope Commercial |
$2,806.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,339.14
|
| Rate for Payer: Mclaren Medicaid |
$549.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$818.70
|
| Rate for Payer: Meridian Medicaid |
$577.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$896.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$857.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,651.02
|
| Rate for Payer: Nomi Health Commercial |
$2,557.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,339.14
|
| Rate for Payer: PACE Senior Care Partners |
$740.73
|
| Rate for Payer: PACE SWMI |
$779.71
|
| Rate for Payer: PHP Commercial |
$2,651.02
|
| Rate for Payer: PHP Medicare Advantage |
$779.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$549.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2,713.40
|
| Rate for Payer: Priority Health Medicare |
$787.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,170.72
|
| Rate for Payer: Railroad Medicare Medicare |
$779.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,744.59
|
| Rate for Payer: UHC Core |
$2,604.24
|
| Rate for Payer: UHC Exchange |
$779.71
|
| Rate for Payer: UHC Medicaid |
$549.85
|
| Rate for Payer: UHC Medicare Advantage |
$779.71
|
| Rate for Payer: UHCCP Medicaid |
$549.85
|
| Rate for Payer: VA VA |
$779.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,339.14
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$584.64
|
|
|
Service Code
|
NDC 00904704661
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.07 |
| Max. Negotiated Rate |
$526.18 |
| Rate for Payer: Aetna Commercial |
$496.94
|
| Rate for Payer: Aetna Medicare |
$152.01
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$182.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$182.70
|
| Rate for Payer: BCBS Complete |
$108.22
|
| Rate for Payer: BCBS MAPPO |
$146.16
|
| Rate for Payer: BCBS Trust/PPO |
$480.63
|
| Rate for Payer: BCN Commercial |
$480.63
|
| Rate for Payer: BCN Medicare Advantage |
$146.16
|
| Rate for Payer: Cash Price |
$467.71
|
| Rate for Payer: Cofinity Commercial |
$502.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.16
|
| Rate for Payer: Healthscope Commercial |
$526.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.48
|
| Rate for Payer: Mclaren Medicaid |
$103.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$153.47
|
| Rate for Payer: Meridian Medicaid |
$108.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$168.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$160.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.94
|
| Rate for Payer: Nomi Health Commercial |
$479.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$438.48
|
| Rate for Payer: PACE Senior Care Partners |
$138.85
|
| Rate for Payer: PACE SWMI |
$146.16
|
| Rate for Payer: PHP Commercial |
$496.94
|
| Rate for Payer: PHP Medicare Advantage |
$146.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$103.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$508.64
|
| Rate for Payer: Priority Health Medicare |
$147.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$406.91
|
| Rate for Payer: Railroad Medicare Medicare |
$146.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$514.48
|
| Rate for Payer: UHC Core |
$488.17
|
| Rate for Payer: UHC Exchange |
$146.16
|
| Rate for Payer: UHC Medicaid |
$103.07
|
| Rate for Payer: UHC Medicare Advantage |
$146.16
|
| Rate for Payer: UHCCP Medicaid |
$103.07
|
| Rate for Payer: VA VA |
$146.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.48
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$643.20
|
|
|
Service Code
|
NDC 68084026901
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$578.88 |
| Rate for Payer: Aetna Commercial |
$546.72
|
| Rate for Payer: Aetna Medicare |
$167.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$201.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$201.00
|
| Rate for Payer: BCBS Complete |
$119.06
|
| Rate for Payer: BCBS MAPPO |
$160.80
|
| Rate for Payer: BCBS Trust/PPO |
$528.77
|
| Rate for Payer: BCN Commercial |
$528.77
|
| Rate for Payer: BCN Medicare Advantage |
$160.80
|
| Rate for Payer: Cash Price |
$514.56
|
| Rate for Payer: Cofinity Commercial |
$553.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.80
|
| Rate for Payer: Healthscope Commercial |
$578.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.40
|
| Rate for Payer: Mclaren Medicaid |
$113.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.84
|
| Rate for Payer: Meridian Medicaid |
$119.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$176.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.72
|
| Rate for Payer: Nomi Health Commercial |
$527.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.40
|
| Rate for Payer: PACE Senior Care Partners |
$152.76
|
| Rate for Payer: PACE SWMI |
$160.80
|
| Rate for Payer: PHP Commercial |
$546.72
|
| Rate for Payer: PHP Medicare Advantage |
$160.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$559.58
|
| Rate for Payer: Priority Health Medicare |
$162.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$447.67
|
| Rate for Payer: Railroad Medicare Medicare |
$160.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$566.02
|
| Rate for Payer: UHC Core |
$537.07
|
| Rate for Payer: UHC Exchange |
$160.80
|
| Rate for Payer: UHC Medicaid |
$113.40
|
| Rate for Payer: UHC Medicare Advantage |
$160.80
|
| Rate for Payer: UHCCP Medicaid |
$113.40
|
| Rate for Payer: VA VA |
$160.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.40
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$643.20
|
|
|
Service Code
|
NDC 68084026901
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$447.67 |
| Max. Negotiated Rate |
$578.88 |
| Rate for Payer: Aetna Commercial |
$546.72
|
| Rate for Payer: BCBS Trust/PPO |
$531.22
|
| Rate for Payer: BCN Commercial |
$531.22
|
| Rate for Payer: Cash Price |
$514.56
|
| Rate for Payer: Cofinity Commercial |
$553.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.56
|
| Rate for Payer: Healthscope Commercial |
$578.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.72
|
| Rate for Payer: Nomi Health Commercial |
$527.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.40
|
| Rate for Payer: PHP Commercial |
$546.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$559.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$447.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$566.02
|
| Rate for Payer: UHC Core |
$537.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.40
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$643.20
|
|
|
Service Code
|
NDC 68084026911
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$578.88 |
| Rate for Payer: Aetna Commercial |
$546.72
|
| Rate for Payer: Aetna Medicare |
$167.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$201.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$201.00
|
| Rate for Payer: BCBS Complete |
$119.06
|
| Rate for Payer: BCBS MAPPO |
$160.80
|
| Rate for Payer: BCBS Trust/PPO |
$528.77
|
| Rate for Payer: BCN Commercial |
$528.77
|
| Rate for Payer: BCN Medicare Advantage |
$160.80
|
| Rate for Payer: Cash Price |
$514.56
|
| Rate for Payer: Cofinity Commercial |
$553.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$160.80
|
| Rate for Payer: Healthscope Commercial |
$578.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.40
|
| Rate for Payer: Mclaren Medicaid |
$113.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$168.84
|
| Rate for Payer: Meridian Medicaid |
$119.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$184.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$176.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.72
|
| Rate for Payer: Nomi Health Commercial |
$527.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.40
|
| Rate for Payer: PACE Senior Care Partners |
$152.76
|
| Rate for Payer: PACE SWMI |
$160.80
|
| Rate for Payer: PHP Commercial |
$546.72
|
| Rate for Payer: PHP Medicare Advantage |
$160.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$113.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$559.58
|
| Rate for Payer: Priority Health Medicare |
$162.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$447.67
|
| Rate for Payer: Railroad Medicare Medicare |
$160.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$566.02
|
| Rate for Payer: UHC Core |
$537.07
|
| Rate for Payer: UHC Exchange |
$160.80
|
| Rate for Payer: UHC Medicaid |
$113.40
|
| Rate for Payer: UHC Medicare Advantage |
$160.80
|
| Rate for Payer: UHCCP Medicaid |
$113.40
|
| Rate for Payer: VA VA |
$160.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.40
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$584.64
|
|
|
Service Code
|
NDC 00904704661
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$406.91 |
| Max. Negotiated Rate |
$526.18 |
| Rate for Payer: Aetna Commercial |
$496.94
|
| Rate for Payer: BCBS Trust/PPO |
$482.85
|
| Rate for Payer: BCN Commercial |
$482.85
|
| Rate for Payer: Cash Price |
$467.71
|
| Rate for Payer: Cofinity Commercial |
$502.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$467.71
|
| Rate for Payer: Healthscope Commercial |
$526.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$438.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$496.94
|
| Rate for Payer: Nomi Health Commercial |
$479.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$438.48
|
| Rate for Payer: PHP Commercial |
$496.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$508.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$406.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$514.48
|
| Rate for Payer: UHC Core |
$488.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$438.48
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$643.20
|
|
|
Service Code
|
NDC 68084026911
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$447.67 |
| Max. Negotiated Rate |
$578.88 |
| Rate for Payer: Aetna Commercial |
$546.72
|
| Rate for Payer: BCBS Trust/PPO |
$531.22
|
| Rate for Payer: BCN Commercial |
$531.22
|
| Rate for Payer: Cash Price |
$514.56
|
| Rate for Payer: Cofinity Commercial |
$553.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$514.56
|
| Rate for Payer: Healthscope Commercial |
$578.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$482.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$546.72
|
| Rate for Payer: Nomi Health Commercial |
$527.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$482.40
|
| Rate for Payer: PHP Commercial |
$546.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$559.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$447.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$566.02
|
| Rate for Payer: UHC Core |
$537.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$482.40
|
|
|
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 |
$1,413.76 |
| 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 |
$1,677.63
|
| Rate for Payer: BCBS Trust/PPO |
$1,757.75
|
| Rate for Payer: BCN Commercial |
$1,677.63
|
| Rate for Payer: BCN Commercial |
$1,757.75
|
| Rate for Payer: Cash Price |
$1,625.02
|
| Rate for Payer: Cash Price |
$1,702.63
|
| Rate for Payer: Cofinity Commercial |
$1,830.33
|
| Rate for Payer: Cofinity Commercial |
$1,746.89
|
| 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 |
$1,523.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,596.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,809.05
|
| Rate for Payer: Nomi Health Commercial |
$1,665.64
|
| Rate for Payer: Nomi Health Commercial |
$1,745.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,523.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,596.22
|
| Rate for Payer: PHP Commercial |
$1,809.05
|
| Rate for Payer: PHP Commercial |
$1,726.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,851.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,767.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,413.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,481.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,787.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,872.90
|
| 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
|
|
|
HYDROXYPROGESTERONE (PF)(PREGNANCY PRESERVING) 250 MG/ML (1 ML) IM OIL
|
Facility
|
OP
|
$2,031.27
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
178180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$358.11 |
| 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: Aetna Medicare |
$553.36
|
| Rate for Payer: Aetna Medicare |
$528.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$665.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$634.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$634.77
|
| Rate for Payer: Amish Plain Church Group Commercial |
$665.09
|
| Rate for Payer: BCBS Complete |
$375.99
|
| Rate for Payer: BCBS Complete |
$393.95
|
| Rate for Payer: BCBS MAPPO |
$507.82
|
| Rate for Payer: BCBS MAPPO |
$532.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,669.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,749.67
|
| Rate for Payer: BCN Commercial |
$1,749.67
|
| Rate for Payer: BCN Commercial |
$1,669.91
|
| Rate for Payer: BCN Medicare Advantage |
$532.07
|
| Rate for Payer: BCN Medicare Advantage |
$507.82
|
| Rate for Payer: Cash Price |
$1,625.02
|
| Rate for Payer: Cash Price |
$1,702.63
|
| 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: Health Alliance Plan Medicare Advantage |
$532.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$507.82
|
| Rate for Payer: Healthscope Commercial |
$1,828.14
|
| Rate for Payer: Healthscope Commercial |
$1,915.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,523.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,596.22
|
| Rate for Payer: Mclaren Medicaid |
$375.22
|
| Rate for Payer: Mclaren Medicaid |
$358.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$558.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$533.21
|
| Rate for Payer: Meridian Medicaid |
$375.99
|
| Rate for Payer: Meridian Medicaid |
$393.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$611.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$583.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$585.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$558.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,809.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,726.58
|
| Rate for Payer: Nomi Health Commercial |
$1,745.20
|
| Rate for Payer: Nomi Health Commercial |
$1,665.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,523.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,596.22
|
| Rate for Payer: PACE Senior Care Partners |
$505.47
|
| Rate for Payer: PACE Senior Care Partners |
$482.43
|
| Rate for Payer: PACE SWMI |
$532.07
|
| Rate for Payer: PACE SWMI |
$507.82
|
| Rate for Payer: PHP Commercial |
$1,726.58
|
| Rate for Payer: PHP Commercial |
$1,809.05
|
| Rate for Payer: PHP Medicare Advantage |
$507.82
|
| Rate for Payer: PHP Medicare Advantage |
$532.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$375.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$358.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,851.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1,767.20
|
| Rate for Payer: Priority Health Medicare |
$537.39
|
| Rate for Payer: Priority Health Medicare |
$512.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,413.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1,481.29
|
| Rate for Payer: Railroad Medicare Medicare |
$507.82
|
| Rate for Payer: Railroad Medicare Medicare |
$532.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,787.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,872.90
|
| Rate for Payer: UHC Core |
$1,777.12
|
| Rate for Payer: UHC Core |
$1,696.11
|
| Rate for Payer: UHC Exchange |
$532.07
|
| Rate for Payer: UHC Exchange |
$507.82
|
| Rate for Payer: UHC Medicaid |
$375.22
|
| Rate for Payer: UHC Medicaid |
$358.11
|
| Rate for Payer: UHC Medicare Advantage |
$507.82
|
| Rate for Payer: UHC Medicare Advantage |
$532.07
|
| Rate for Payer: UHCCP Medicaid |
$358.11
|
| Rate for Payer: UHCCP Medicaid |
$375.22
|
| Rate for Payer: VA VA |
$507.82
|
| Rate for Payer: VA VA |
$532.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,596.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,523.45
|
|
|
HYDROXYUREA 500 MG CAPSULE
|
Facility
|
OP
|
$407.04
|
|
|
Service Code
|
NDC 00904693961
|
| Hospital Charge Code |
10236
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.76 |
| Max. Negotiated Rate |
$366.34 |
| Rate for Payer: Aetna Commercial |
$345.98
|
| Rate for Payer: Aetna Medicare |
$105.83
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.20
|
| Rate for Payer: BCBS Complete |
$75.34
|
| Rate for Payer: BCBS MAPPO |
$101.76
|
| Rate for Payer: BCBS Trust/PPO |
$334.63
|
| Rate for Payer: BCN Commercial |
$334.63
|
| Rate for Payer: BCN Medicare Advantage |
$101.76
|
| Rate for Payer: Cash Price |
$325.63
|
| Rate for Payer: Cofinity Commercial |
$350.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.76
|
| Rate for Payer: Healthscope Commercial |
$366.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$305.28
|
| Rate for Payer: Mclaren Medicaid |
$71.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.85
|
| Rate for Payer: Meridian Medicaid |
$75.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.98
|
| Rate for Payer: Nomi Health Commercial |
$333.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$305.28
|
| Rate for Payer: PACE Senior Care Partners |
$96.67
|
| Rate for Payer: PACE SWMI |
$101.76
|
| Rate for Payer: PHP Commercial |
$345.98
|
| Rate for Payer: PHP Medicare Advantage |
$101.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$71.76
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$354.12
|
| Rate for Payer: Priority Health Medicare |
$102.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$283.30
|
| Rate for Payer: Railroad Medicare Medicare |
$101.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$358.20
|
| Rate for Payer: UHC Core |
$339.88
|
| Rate for Payer: UHC Exchange |
$101.76
|
| Rate for Payer: UHC Medicaid |
$71.76
|
| Rate for Payer: UHC Medicare Advantage |
$101.76
|
| Rate for Payer: UHCCP Medicaid |
$71.76
|
| Rate for Payer: VA VA |
$101.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$305.28
|
|
|
HYDROXYUREA 500 MG CAPSULE
|
Facility
|
IP
|
$353.40
|
|
|
Service Code
|
NDC 49884072401
|
| Hospital Charge Code |
10236
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.97 |
| Max. Negotiated Rate |
$318.06 |
| Rate for Payer: Aetna Commercial |
$300.39
|
| Rate for Payer: BCBS Trust/PPO |
$291.87
|
| Rate for Payer: BCN Commercial |
$291.87
|
| Rate for Payer: Cash Price |
$282.72
|
| Rate for Payer: Cofinity Commercial |
$303.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.72
|
| Rate for Payer: Healthscope Commercial |
$318.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.39
|
| Rate for Payer: Nomi Health Commercial |
$289.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.05
|
| Rate for Payer: PHP Commercial |
$300.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$307.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.99
|
| Rate for Payer: UHC Core |
$295.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.05
|
|
|
HYDROXYUREA 500 MG CAPSULE
|
Facility
|
OP
|
$353.40
|
|
|
Service Code
|
NDC 49884072401
|
| Hospital Charge Code |
10236
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$318.06 |
| Rate for Payer: Aetna Commercial |
$300.39
|
| Rate for Payer: Aetna Medicare |
$91.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$110.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$110.44
|
| Rate for Payer: BCBS Complete |
$65.41
|
| Rate for Payer: BCBS MAPPO |
$88.35
|
| Rate for Payer: BCBS Trust/PPO |
$290.53
|
| Rate for Payer: BCN Commercial |
$290.53
|
| Rate for Payer: BCN Medicare Advantage |
$88.35
|
| Rate for Payer: Cash Price |
$282.72
|
| Rate for Payer: Cofinity Commercial |
$303.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.35
|
| Rate for Payer: Healthscope Commercial |
$318.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$265.05
|
| Rate for Payer: Mclaren Medicaid |
$62.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.77
|
| Rate for Payer: Meridian Medicaid |
$65.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$97.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$300.39
|
| Rate for Payer: Nomi Health Commercial |
$289.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$265.05
|
| Rate for Payer: PACE Senior Care Partners |
$83.93
|
| Rate for Payer: PACE SWMI |
$88.35
|
| Rate for Payer: PHP Commercial |
$300.39
|
| Rate for Payer: PHP Medicare Advantage |
$88.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$307.46
|
| Rate for Payer: Priority Health Medicare |
$89.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.97
|
| Rate for Payer: Railroad Medicare Medicare |
$88.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.99
|
| Rate for Payer: UHC Core |
$295.09
|
| Rate for Payer: UHC Exchange |
$88.35
|
| Rate for Payer: UHC Medicaid |
$62.30
|
| Rate for Payer: UHC Medicare Advantage |
$88.35
|
| Rate for Payer: UHCCP Medicaid |
$62.30
|
| Rate for Payer: VA VA |
$88.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$265.05
|
|
|
HYDROXYUREA 500 MG CAPSULE
|
Facility
|
IP
|
$407.04
|
|
|
Service Code
|
NDC 00904693961
|
| Hospital Charge Code |
10236
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$283.30 |
| Max. Negotiated Rate |
$366.34 |
| Rate for Payer: Aetna Commercial |
$345.98
|
| Rate for Payer: BCBS Trust/PPO |
$336.17
|
| Rate for Payer: BCN Commercial |
$336.17
|
| Rate for Payer: Cash Price |
$325.63
|
| Rate for Payer: Cofinity Commercial |
$350.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$325.63
|
| Rate for Payer: Healthscope Commercial |
$366.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$305.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$345.98
|
| Rate for Payer: Nomi Health Commercial |
$333.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$305.28
|
| Rate for Payer: PHP Commercial |
$345.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$354.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$283.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$358.20
|
| Rate for Payer: UHC Core |
$339.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$305.28
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
IP
|
$2.36
|
|
|
Service Code
|
NDC 60687066411
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna Commercial |
$2.01
|
| Rate for Payer: BCBS Trust/PPO |
$1.95
|
| Rate for Payer: BCN Commercial |
$1.95
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cofinity Commercial |
$2.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.89
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.01
|
| Rate for Payer: Nomi Health Commercial |
$1.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.77
|
| Rate for Payer: PHP Commercial |
$2.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.08
|
| Rate for Payer: UHC Core |
$1.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.77
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 10702001001
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.03 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: BCBS Trust/PPO |
$143.62
|
| Rate for Payer: BCN Commercial |
$143.62
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Nomi Health Commercial |
$142.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.43
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$151.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.03
|
| Rate for Payer: UHC Core |
$145.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.43
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
IP
|
$235.60
|
|
|
Service Code
|
NDC 60687066401
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.98 |
| Max. Negotiated Rate |
$212.04 |
| Rate for Payer: Aetna Commercial |
$200.26
|
| Rate for Payer: BCBS Trust/PPO |
$194.58
|
| Rate for Payer: BCN Commercial |
$194.58
|
| Rate for Payer: Cash Price |
$188.48
|
| Rate for Payer: Cofinity Commercial |
$202.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.48
|
| Rate for Payer: Healthscope Commercial |
$212.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.26
|
| Rate for Payer: Nomi Health Commercial |
$193.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.70
|
| Rate for Payer: PHP Commercial |
$200.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$204.97
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.33
|
| Rate for Payer: UHC Core |
$196.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.70
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
OP
|
$352.50
|
|
|
Service Code
|
NDC 63739048310
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.15 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Aetna Commercial |
$299.62
|
| Rate for Payer: Aetna Medicare |
$91.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$110.16
|
| Rate for Payer: Amish Plain Church Group Commercial |
$110.16
|
| Rate for Payer: BCBS Complete |
$65.25
|
| Rate for Payer: BCBS MAPPO |
$88.12
|
| Rate for Payer: BCBS Trust/PPO |
$289.79
|
| Rate for Payer: BCN Commercial |
$289.79
|
| Rate for Payer: BCN Medicare Advantage |
$88.12
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.12
|
| Rate for Payer: Healthscope Commercial |
$317.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.38
|
| Rate for Payer: Mclaren Medicaid |
$62.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.53
|
| Rate for Payer: Meridian Medicaid |
$65.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$101.34
|
| Rate for Payer: Molina Medicare/Medicaid |
$96.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.62
|
| Rate for Payer: Nomi Health Commercial |
$289.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$264.38
|
| Rate for Payer: PACE Senior Care Partners |
$83.72
|
| Rate for Payer: PACE SWMI |
$88.12
|
| Rate for Payer: PHP Commercial |
$299.62
|
| Rate for Payer: PHP Medicare Advantage |
$88.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$306.68
|
| Rate for Payer: Priority Health Medicare |
$89.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.34
|
| Rate for Payer: Railroad Medicare Medicare |
$88.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.20
|
| Rate for Payer: UHC Core |
$294.34
|
| Rate for Payer: UHC Exchange |
$88.12
|
| Rate for Payer: UHC Medicaid |
$62.15
|
| Rate for Payer: UHC Medicare Advantage |
$88.12
|
| Rate for Payer: UHCCP Medicaid |
$62.15
|
| Rate for Payer: VA VA |
$88.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.38
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
OP
|
$235.60
|
|
|
Service Code
|
NDC 60687066401
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.54 |
| Max. Negotiated Rate |
$212.04 |
| Rate for Payer: Aetna Commercial |
$200.26
|
| Rate for Payer: Aetna Medicare |
$61.26
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$73.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$73.62
|
| Rate for Payer: BCBS Complete |
$43.61
|
| Rate for Payer: BCBS MAPPO |
$58.90
|
| Rate for Payer: BCBS Trust/PPO |
$193.69
|
| Rate for Payer: BCN Commercial |
$193.69
|
| Rate for Payer: BCN Medicare Advantage |
$58.90
|
| Rate for Payer: Cash Price |
$188.48
|
| Rate for Payer: Cofinity Commercial |
$202.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.90
|
| Rate for Payer: Healthscope Commercial |
$212.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.70
|
| Rate for Payer: Mclaren Medicaid |
$41.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.84
|
| Rate for Payer: Meridian Medicaid |
$43.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$67.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$64.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.26
|
| Rate for Payer: Nomi Health Commercial |
$193.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.70
|
| Rate for Payer: PACE Senior Care Partners |
$55.95
|
| Rate for Payer: PACE SWMI |
$58.90
|
| Rate for Payer: PHP Commercial |
$200.26
|
| Rate for Payer: PHP Medicare Advantage |
$58.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$204.97
|
| Rate for Payer: Priority Health Medicare |
$59.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$163.98
|
| Rate for Payer: Railroad Medicare Medicare |
$58.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.33
|
| Rate for Payer: UHC Core |
$196.73
|
| Rate for Payer: UHC Exchange |
$58.90
|
| Rate for Payer: UHC Medicaid |
$41.54
|
| Rate for Payer: UHC Medicare Advantage |
$58.90
|
| Rate for Payer: UHCCP Medicaid |
$41.54
|
| Rate for Payer: VA VA |
$58.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.70
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
OP
|
$173.90
|
|
|
Service Code
|
NDC 10702001001
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.66 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna Medicare |
$45.21
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$54.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$54.34
|
| Rate for Payer: BCBS Complete |
$32.19
|
| Rate for Payer: BCBS MAPPO |
$43.48
|
| Rate for Payer: BCBS Trust/PPO |
$142.96
|
| Rate for Payer: BCN Commercial |
$142.96
|
| Rate for Payer: BCN Medicare Advantage |
$43.48
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.48
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.43
|
| Rate for Payer: Mclaren Medicaid |
$30.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.65
|
| Rate for Payer: Meridian Medicaid |
$32.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.00
|
| Rate for Payer: Molina Medicare/Medicaid |
$47.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Nomi Health Commercial |
$142.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.43
|
| Rate for Payer: PACE Senior Care Partners |
$41.30
|
| Rate for Payer: PACE SWMI |
$43.48
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: PHP Medicare Advantage |
$43.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$151.29
|
| Rate for Payer: Priority Health Medicare |
$43.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.03
|
| Rate for Payer: Railroad Medicare Medicare |
$43.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.03
|
| Rate for Payer: UHC Core |
$145.21
|
| Rate for Payer: UHC Exchange |
$43.48
|
| Rate for Payer: UHC Medicaid |
$30.66
|
| Rate for Payer: UHC Medicare Advantage |
$43.48
|
| Rate for Payer: UHCCP Medicaid |
$30.66
|
| Rate for Payer: VA VA |
$43.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.43
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
IP
|
$352.50
|
|
|
Service Code
|
NDC 63739048310
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$245.34 |
| Max. Negotiated Rate |
$317.25 |
| Rate for Payer: Aetna Commercial |
$299.62
|
| Rate for Payer: BCBS Trust/PPO |
$291.13
|
| Rate for Payer: BCN Commercial |
$291.13
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cofinity Commercial |
$303.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.00
|
| Rate for Payer: Healthscope Commercial |
$317.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$264.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.62
|
| Rate for Payer: Nomi Health Commercial |
$289.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$264.38
|
| Rate for Payer: PHP Commercial |
$299.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$306.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$245.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.20
|
| Rate for Payer: UHC Core |
$294.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$264.38
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
OP
|
$2.36
|
|
|
Service Code
|
NDC 60687066411
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.42 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna Commercial |
$2.01
|
| Rate for Payer: Aetna Medicare |
$0.61
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.74
|
| Rate for Payer: BCBS Complete |
$0.44
|
| Rate for Payer: BCBS MAPPO |
$0.59
|
| Rate for Payer: BCBS Trust/PPO |
$1.94
|
| Rate for Payer: BCN Commercial |
$1.94
|
| Rate for Payer: BCN Medicare Advantage |
$0.59
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cofinity Commercial |
$2.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.59
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.77
|
| Rate for Payer: Mclaren Medicaid |
$0.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.62
|
| Rate for Payer: Meridian Medicaid |
$0.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.01
|
| Rate for Payer: Nomi Health Commercial |
$1.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.77
|
| Rate for Payer: PACE Senior Care Partners |
$0.56
|
| Rate for Payer: PACE SWMI |
$0.59
|
| Rate for Payer: PHP Commercial |
$2.01
|
| Rate for Payer: PHP Medicare Advantage |
$0.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$2.05
|
| Rate for Payer: Priority Health Medicare |
$0.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.64
|
| Rate for Payer: Railroad Medicare Medicare |
$0.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.08
|
| Rate for Payer: UHC Core |
$1.97
|
| Rate for Payer: UHC Exchange |
$0.59
|
| Rate for Payer: UHC Medicaid |
$0.42
|
| Rate for Payer: UHC Medicare Advantage |
$0.59
|
| Rate for Payer: UHCCP Medicaid |
$0.42
|
| Rate for Payer: VA VA |
$0.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.77
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 60687067501
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$150.09 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: BCBS Trust/PPO |
$178.11
|
| Rate for Payer: BCN Commercial |
$178.11
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Nomi Health Commercial |
$176.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.74
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$187.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$150.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.77
|
| Rate for Payer: UHC Core |
$180.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
IP
|
$453.55
|
|
|
Service Code
|
NDC 00904661761
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$315.67 |
| Max. Negotiated Rate |
$408.19 |
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: BCBS Trust/PPO |
$374.59
|
| Rate for Payer: BCN Commercial |
$374.59
|
| 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 |
$408.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.52
|
| Rate for Payer: Nomi Health Commercial |
$371.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.16
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$394.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$315.67
|
| 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
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
OP
|
$2.16
|
|
|
Service Code
|
NDC 60687067511
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna Medicare |
$0.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.68
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.68
|
| Rate for Payer: BCBS Complete |
$0.40
|
| Rate for Payer: BCBS MAPPO |
$0.54
|
| Rate for Payer: BCBS Trust/PPO |
$1.78
|
| Rate for Payer: BCN Commercial |
$1.78
|
| Rate for Payer: BCN Medicare Advantage |
$0.54
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.54
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.62
|
| Rate for Payer: Mclaren Medicaid |
$0.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.57
|
| Rate for Payer: Meridian Medicaid |
$0.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$1.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: PACE Senior Care Partners |
$0.51
|
| Rate for Payer: PACE SWMI |
$0.54
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: PHP Medicare Advantage |
$0.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.88
|
| Rate for Payer: Priority Health Medicare |
$0.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.50
|
| Rate for Payer: Railroad Medicare Medicare |
$0.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.90
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: UHC Exchange |
$0.54
|
| Rate for Payer: UHC Medicaid |
$0.38
|
| Rate for Payer: UHC Medicare Advantage |
$0.54
|
| Rate for Payer: UHCCP Medicaid |
$0.38
|
| Rate for Payer: VA VA |
$0.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.62
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
NDC 60687067511
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$1.78
|
| Rate for Payer: BCN Commercial |
$1.78
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Nomi Health Commercial |
$1.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.90
|
| Rate for Payer: UHC Core |
$1.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.62
|
|
