|
HYDRALAZINE 10 MG TABLET
|
Facility
|
IP
|
$227.95
|
|
|
Service Code
|
NDC 00904644061
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.17 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$193.76
|
| Rate for Payer: BCBS Trust/PPO |
$186.08
|
| Rate for Payer: BCN Commercial |
$176.16
|
| 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: PHP Commercial |
$193.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.17
|
| Rate for Payer: Priority Health HMO/PPO |
$198.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.73
|
| 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
|
OP
|
$345.45
|
|
|
Service Code
|
NDC 68084044711
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.04 |
| 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 |
$138.18
|
| Rate for Payer: BCBS MAPPO |
$86.36
|
| Rate for Payer: BCBS Trust/PPO |
$283.99
|
| Rate for Payer: BCN Commercial |
$268.59
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$99.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.63
|
| Rate for Payer: Nomi Health Commercial |
$283.27
|
| 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 Cigna Priority Health |
$224.54
|
| Rate for Payer: Priority Health HMO/PPO |
$300.54
|
| Rate for Payer: Priority Health Medicare |
$87.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$231.45
|
| 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 Dual Complete DSNP |
$86.36
|
| Rate for Payer: UHC Exchange |
$86.36
|
| Rate for Payer: UHC Medicare Advantage |
$86.36
|
| Rate for Payer: VA VA |
$86.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.09
|
|
|
HYDRALAZINE 20 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$23.27
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
3697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$20.94 |
| Rate for Payer: Aetna Commercial |
$19.78
|
| Rate for Payer: BCBS Trust/PPO |
$19.00
|
| Rate for Payer: BCN Commercial |
$17.98
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cofinity Commercial |
$20.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.62
|
| Rate for Payer: Healthscope Commercial |
$20.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.78
|
| Rate for Payer: Nomi Health Commercial |
$19.08
|
| Rate for Payer: PHP Commercial |
$19.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.13
|
| Rate for Payer: Priority Health HMO/PPO |
$20.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.48
|
| Rate for Payer: UHC Core |
$19.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.45
|
|
|
HYDRALAZINE 20 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$23.27
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
3697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$20.94 |
| Rate for Payer: Aetna Commercial |
$19.78
|
| Rate for Payer: Aetna Medicare |
$6.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.27
|
| Rate for Payer: BCBS Complete |
$9.31
|
| Rate for Payer: BCBS MAPPO |
$5.82
|
| Rate for Payer: BCBS Trust/PPO |
$19.13
|
| Rate for Payer: BCN Commercial |
$18.09
|
| Rate for Payer: BCN Medicare Advantage |
$5.82
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cofinity Commercial |
$20.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.82
|
| Rate for Payer: Healthscope Commercial |
$20.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.78
|
| Rate for Payer: Nomi Health Commercial |
$19.08
|
| Rate for Payer: PACE Senior Care Partners |
$5.53
|
| Rate for Payer: PACE SWMI |
$5.82
|
| Rate for Payer: PHP Commercial |
$19.78
|
| Rate for Payer: PHP Medicare Advantage |
$5.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.13
|
| Rate for Payer: Priority Health HMO/PPO |
$20.24
|
| Rate for Payer: Priority Health Medicare |
$5.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.59
|
| Rate for Payer: Railroad Medicare Medicare |
$5.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.48
|
| Rate for Payer: UHC Core |
$19.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.82
|
| Rate for Payer: UHC Exchange |
$5.82
|
| Rate for Payer: UHC Medicare Advantage |
$5.82
|
| Rate for Payer: VA VA |
$5.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.45
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$82.25
|
|
|
Service Code
|
NDC 23155083301
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$74.02 |
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: BCBS Trust/PPO |
$67.14
|
| Rate for Payer: BCN Commercial |
$63.56
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$70.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Nomi Health Commercial |
$67.44
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.46
|
| Rate for Payer: Priority Health HMO/PPO |
$71.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.38
|
| Rate for Payer: UHC Core |
$68.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$82.25
|
|
|
Service Code
|
NDC 23155083301
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$74.02 |
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna Medicare |
$21.38
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$25.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$25.70
|
| Rate for Payer: BCBS Complete |
$32.90
|
| Rate for Payer: BCBS MAPPO |
$20.56
|
| Rate for Payer: BCBS Trust/PPO |
$67.62
|
| Rate for Payer: BCN Commercial |
$63.95
|
| Rate for Payer: BCN Medicare Advantage |
$20.56
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$70.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.56
|
| Rate for Payer: Healthscope Commercial |
$74.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Nomi Health Commercial |
$67.44
|
| Rate for Payer: PACE Senior Care Partners |
$19.53
|
| Rate for Payer: PACE SWMI |
$20.56
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: PHP Medicare Advantage |
$20.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.46
|
| Rate for Payer: Priority Health HMO/PPO |
$71.56
|
| Rate for Payer: Priority Health Medicare |
$20.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.11
|
| Rate for Payer: Railroad Medicare Medicare |
$20.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.38
|
| Rate for Payer: UHC Core |
$68.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.56
|
| Rate for Payer: UHC Exchange |
$20.56
|
| Rate for Payer: UHC Medicare Advantage |
$20.56
|
| Rate for Payer: VA VA |
$20.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$258.50
|
|
|
Service Code
|
NDC 00904644161
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.39 |
| 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 |
$103.40
|
| Rate for Payer: BCBS MAPPO |
$64.62
|
| Rate for Payer: BCBS Trust/PPO |
$212.51
|
| Rate for Payer: BCN Commercial |
$200.98
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$67.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.72
|
| Rate for Payer: Nomi Health Commercial |
$211.97
|
| 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 Cigna Priority Health |
$168.02
|
| Rate for Payer: Priority Health HMO/PPO |
$224.90
|
| Rate for Payer: Priority Health Medicare |
$65.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.20
|
| 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 Dual Complete DSNP |
$64.62
|
| Rate for Payer: UHC Exchange |
$64.62
|
| Rate for Payer: UHC Medicare Advantage |
$64.62
|
| Rate for Payer: VA VA |
$64.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.88
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$1.91
|
|
|
Service Code
|
NDC 60687082211
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Aetna Commercial |
$1.62
|
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.60
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.60
|
| Rate for Payer: BCBS Complete |
$0.76
|
| Rate for Payer: BCBS MAPPO |
$0.48
|
| Rate for Payer: BCBS Trust/PPO |
$1.57
|
| Rate for Payer: BCN Commercial |
$1.49
|
| Rate for Payer: BCN Medicare Advantage |
$0.48
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cofinity Commercial |
$1.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.48
|
| Rate for Payer: Healthscope Commercial |
$1.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.62
|
| Rate for Payer: Nomi Health Commercial |
$1.57
|
| Rate for Payer: PACE Senior Care Partners |
$0.45
|
| Rate for Payer: PACE SWMI |
$0.48
|
| Rate for Payer: PHP Commercial |
$1.62
|
| Rate for Payer: PHP Medicare Advantage |
$0.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.24
|
| Rate for Payer: Priority Health HMO/PPO |
$1.66
|
| Rate for Payer: Priority Health Medicare |
$0.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.28
|
| Rate for Payer: Railroad Medicare Medicare |
$0.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.68
|
| Rate for Payer: UHC Core |
$1.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.48
|
| Rate for Payer: UHC Exchange |
$0.48
|
| Rate for Payer: UHC Medicare Advantage |
$0.48
|
| Rate for Payer: VA VA |
$0.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.43
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$260.85
|
|
|
Service Code
|
NDC 63739032710
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.95 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: Aetna Medicare |
$67.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$81.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$81.52
|
| Rate for Payer: BCBS Complete |
$104.34
|
| Rate for Payer: BCBS MAPPO |
$65.21
|
| Rate for Payer: BCBS Trust/PPO |
$214.44
|
| Rate for Payer: BCN Commercial |
$202.81
|
| Rate for Payer: BCN Medicare Advantage |
$65.21
|
| 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: Health Alliance Plan Medicare Advantage |
$65.21
|
| Rate for Payer: Healthscope Commercial |
$234.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$74.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.72
|
| Rate for Payer: Nomi Health Commercial |
$213.90
|
| Rate for Payer: PACE Senior Care Partners |
$61.95
|
| Rate for Payer: PACE SWMI |
$65.21
|
| Rate for Payer: PHP Commercial |
$221.72
|
| Rate for Payer: PHP Medicare Advantage |
$65.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.55
|
| Rate for Payer: Priority Health HMO/PPO |
$226.94
|
| Rate for Payer: Priority Health Medicare |
$65.86
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.77
|
| Rate for Payer: Railroad Medicare Medicare |
$65.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$229.55
|
| Rate for Payer: UHC Core |
$217.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$65.21
|
| Rate for Payer: UHC Exchange |
$65.21
|
| Rate for Payer: UHC Medicare Advantage |
$65.21
|
| Rate for Payer: VA VA |
$65.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.64
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$190.95
|
|
|
Service Code
|
NDC 60687082201
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$171.86 |
| Rate for Payer: Aetna Commercial |
$162.31
|
| Rate for Payer: Aetna Medicare |
$49.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$59.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$59.67
|
| Rate for Payer: BCBS Complete |
$76.38
|
| Rate for Payer: BCBS MAPPO |
$47.74
|
| Rate for Payer: BCBS Trust/PPO |
$156.98
|
| Rate for Payer: BCN Commercial |
$148.46
|
| Rate for Payer: BCN Medicare Advantage |
$47.74
|
| Rate for Payer: Cash Price |
$152.76
|
| Rate for Payer: Cofinity Commercial |
$164.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.74
|
| Rate for Payer: Healthscope Commercial |
$171.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$54.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.31
|
| Rate for Payer: Nomi Health Commercial |
$156.58
|
| Rate for Payer: PACE Senior Care Partners |
$45.35
|
| Rate for Payer: PACE SWMI |
$47.74
|
| Rate for Payer: PHP Commercial |
$162.31
|
| Rate for Payer: PHP Medicare Advantage |
$47.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.12
|
| Rate for Payer: Priority Health HMO/PPO |
$166.13
|
| Rate for Payer: Priority Health Medicare |
$48.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.94
|
| Rate for Payer: Railroad Medicare Medicare |
$47.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.04
|
| Rate for Payer: UHC Core |
$159.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.74
|
| Rate for Payer: UHC Exchange |
$47.74
|
| Rate for Payer: UHC Medicare Advantage |
$47.74
|
| Rate for Payer: VA VA |
$47.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.21
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$190.95
|
|
|
Service Code
|
NDC 60687082201
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.12 |
| Max. Negotiated Rate |
$171.86 |
| Rate for Payer: Aetna Commercial |
$162.31
|
| Rate for Payer: BCBS Trust/PPO |
$155.87
|
| Rate for Payer: BCN Commercial |
$147.57
|
| Rate for Payer: Cash Price |
$152.76
|
| Rate for Payer: Cofinity Commercial |
$164.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.76
|
| Rate for Payer: Healthscope Commercial |
$171.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.31
|
| Rate for Payer: Nomi Health Commercial |
$156.58
|
| Rate for Payer: PHP Commercial |
$162.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.12
|
| Rate for Payer: Priority Health HMO/PPO |
$166.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$127.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$168.04
|
| Rate for Payer: UHC Core |
$159.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.21
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$258.50
|
|
|
Service Code
|
NDC 00904644161
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.02 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: Aetna Commercial |
$219.72
|
| Rate for Payer: BCBS Trust/PPO |
$211.01
|
| Rate for Payer: BCN Commercial |
$199.77
|
| 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: Healthscope Commercial |
$232.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.72
|
| Rate for Payer: Nomi Health Commercial |
$211.97
|
| Rate for Payer: PHP Commercial |
$219.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.02
|
| Rate for Payer: Priority Health HMO/PPO |
$224.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$227.48
|
| Rate for Payer: UHC Core |
$215.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.88
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$1.91
|
|
|
Service Code
|
NDC 60687082211
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Aetna Commercial |
$1.62
|
| Rate for Payer: BCBS Trust/PPO |
$1.56
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cofinity Commercial |
$1.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.53
|
| Rate for Payer: Healthscope Commercial |
$1.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.62
|
| Rate for Payer: Nomi Health Commercial |
$1.57
|
| Rate for Payer: PHP Commercial |
$1.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.24
|
| Rate for Payer: Priority Health HMO/PPO |
$1.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.68
|
| Rate for Payer: UHC Core |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.43
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$260.85
|
|
|
Service Code
|
NDC 63739032710
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.55 |
| Max. Negotiated Rate |
$234.76 |
| Rate for Payer: Aetna Commercial |
$221.72
|
| Rate for Payer: BCBS Trust/PPO |
$212.93
|
| Rate for Payer: BCN Commercial |
$201.58
|
| 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: PHP Commercial |
$221.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.55
|
| Rate for Payer: Priority Health HMO/PPO |
$226.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.77
|
| 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
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
OP
|
$307.85
|
|
|
Service Code
|
NDC 51079077620
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.11 |
| Max. Negotiated Rate |
$277.06 |
| Rate for Payer: Aetna Commercial |
$261.67
|
| Rate for Payer: Aetna Medicare |
$80.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.20
|
| Rate for Payer: BCBS Complete |
$123.14
|
| Rate for Payer: BCBS MAPPO |
$76.96
|
| Rate for Payer: BCBS Trust/PPO |
$253.08
|
| Rate for Payer: BCN Commercial |
$239.35
|
| Rate for Payer: BCN Medicare Advantage |
$76.96
|
| Rate for Payer: Cash Price |
$246.28
|
| Rate for Payer: Cofinity Commercial |
$264.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.96
|
| Rate for Payer: Healthscope Commercial |
$277.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.67
|
| Rate for Payer: Nomi Health Commercial |
$252.44
|
| Rate for Payer: PACE Senior Care Partners |
$73.11
|
| Rate for Payer: PACE SWMI |
$76.96
|
| Rate for Payer: PHP Commercial |
$261.67
|
| Rate for Payer: PHP Medicare Advantage |
$76.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.10
|
| Rate for Payer: Priority Health HMO/PPO |
$267.83
|
| Rate for Payer: Priority Health Medicare |
$77.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.26
|
| Rate for Payer: Railroad Medicare Medicare |
$76.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.91
|
| Rate for Payer: UHC Core |
$257.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.96
|
| Rate for Payer: UHC Exchange |
$76.96
|
| Rate for Payer: UHC Medicare Advantage |
$76.96
|
| Rate for Payer: VA VA |
$76.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.89
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
IP
|
$61.10
|
|
|
Service Code
|
NDC 50228014601
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.72 |
| Max. Negotiated Rate |
$54.99 |
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: BCBS Trust/PPO |
$49.88
|
| Rate for Payer: BCN Commercial |
$47.22
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Healthscope Commercial |
$54.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.94
|
| Rate for Payer: Nomi Health Commercial |
$50.10
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.72
|
| Rate for Payer: Priority Health HMO/PPO |
$53.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.77
|
| Rate for Payer: UHC Core |
$51.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.82
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
OP
|
$3.08
|
|
|
Service Code
|
NDC 51079077601
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna Commercial |
$2.62
|
| Rate for Payer: Aetna Medicare |
$0.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.96
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.96
|
| Rate for Payer: BCBS Complete |
$1.23
|
| Rate for Payer: BCBS MAPPO |
$0.77
|
| Rate for Payer: BCBS Trust/PPO |
$2.53
|
| Rate for Payer: BCN Commercial |
$2.39
|
| Rate for Payer: BCN Medicare Advantage |
$0.77
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.77
|
| Rate for Payer: Healthscope Commercial |
$2.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.62
|
| Rate for Payer: Nomi Health Commercial |
$2.53
|
| Rate for Payer: PACE Senior Care Partners |
$0.73
|
| Rate for Payer: PACE SWMI |
$0.77
|
| Rate for Payer: PHP Commercial |
$2.62
|
| Rate for Payer: PHP Medicare Advantage |
$0.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.00
|
| Rate for Payer: Priority Health HMO/PPO |
$2.68
|
| Rate for Payer: Priority Health Medicare |
$0.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.06
|
| Rate for Payer: Railroad Medicare Medicare |
$0.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.71
|
| Rate for Payer: UHC Core |
$2.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.77
|
| Rate for Payer: UHC Exchange |
$0.77
|
| Rate for Payer: UHC Medicare Advantage |
$0.77
|
| Rate for Payer: VA VA |
$0.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.31
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
OP
|
$61.10
|
|
|
Service Code
|
NDC 50228014601
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.51 |
| Max. Negotiated Rate |
$54.99 |
| Rate for Payer: Aetna Commercial |
$51.94
|
| Rate for Payer: Aetna Medicare |
$15.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19.09
|
| Rate for Payer: BCBS Complete |
$24.44
|
| Rate for Payer: BCBS MAPPO |
$15.28
|
| Rate for Payer: BCBS Trust/PPO |
$50.23
|
| Rate for Payer: BCN Commercial |
$47.51
|
| Rate for Payer: BCN Medicare Advantage |
$15.28
|
| Rate for Payer: Cash Price |
$48.88
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$48.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15.28
|
| Rate for Payer: Healthscope Commercial |
$54.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$45.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$51.94
|
| Rate for Payer: Nomi Health Commercial |
$50.10
|
| Rate for Payer: PACE Senior Care Partners |
$14.51
|
| Rate for Payer: PACE SWMI |
$15.28
|
| Rate for Payer: PHP Commercial |
$51.94
|
| Rate for Payer: PHP Medicare Advantage |
$15.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.72
|
| Rate for Payer: Priority Health HMO/PPO |
$53.16
|
| Rate for Payer: Priority Health Medicare |
$15.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.94
|
| Rate for Payer: Railroad Medicare Medicare |
$15.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.77
|
| Rate for Payer: UHC Core |
$51.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$15.28
|
| Rate for Payer: UHC Exchange |
$15.28
|
| Rate for Payer: UHC Medicare Advantage |
$15.28
|
| Rate for Payer: VA VA |
$15.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$45.82
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
IP
|
$3.08
|
|
|
Service Code
|
NDC 51079077601
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$2.77 |
| Rate for Payer: Aetna Commercial |
$2.62
|
| Rate for Payer: BCBS Trust/PPO |
$2.51
|
| Rate for Payer: BCN Commercial |
$2.38
|
| Rate for Payer: Cash Price |
$2.46
|
| Rate for Payer: Cofinity Commercial |
$2.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.46
|
| Rate for Payer: Healthscope Commercial |
$2.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.62
|
| Rate for Payer: Nomi Health Commercial |
$2.53
|
| Rate for Payer: PHP Commercial |
$2.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.00
|
| Rate for Payer: Priority Health HMO/PPO |
$2.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.71
|
| Rate for Payer: UHC Core |
$2.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.31
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG CAPSULE
|
Facility
|
IP
|
$307.85
|
|
|
Service Code
|
NDC 51079077620
|
| Hospital Charge Code |
19146
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.10 |
| Max. Negotiated Rate |
$277.06 |
| Rate for Payer: Aetna Commercial |
$261.67
|
| Rate for Payer: BCBS Trust/PPO |
$251.30
|
| Rate for Payer: BCN Commercial |
$237.91
|
| Rate for Payer: Cash Price |
$246.28
|
| Rate for Payer: Cofinity Commercial |
$264.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.28
|
| Rate for Payer: Healthscope Commercial |
$277.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$230.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.67
|
| Rate for Payer: Nomi Health Commercial |
$252.44
|
| Rate for Payer: PHP Commercial |
$261.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.10
|
| Rate for Payer: Priority Health HMO/PPO |
$267.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$270.91
|
| Rate for Payer: UHC Core |
$257.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$230.89
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 60687059301
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.81 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: Aetna Medicare |
$113.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$136.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$136.59
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: BCBS MAPPO |
$109.28
|
| Rate for Payer: BCBS Trust/PPO |
$359.34
|
| Rate for Payer: BCN Commercial |
$339.85
|
| Rate for Payer: BCN Medicare Advantage |
$109.28
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.28
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Nomi Health Commercial |
$358.42
|
| Rate for Payer: PACE Senior Care Partners |
$103.81
|
| Rate for Payer: PACE SWMI |
$109.28
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: PHP Medicare Advantage |
$109.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health HMO/PPO |
$380.28
|
| Rate for Payer: Priority Health Medicare |
$110.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.86
|
| Rate for Payer: Railroad Medicare Medicare |
$109.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$384.65
|
| Rate for Payer: UHC Core |
$364.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.28
|
| Rate for Payer: UHC Exchange |
$109.28
|
| Rate for Payer: UHC Medicare Advantage |
$109.28
|
| Rate for Payer: VA VA |
$109.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$23.50
|
|
|
Service Code
|
NDC 16729018301
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: BCBS Trust/PPO |
$19.18
|
| Rate for Payer: BCN Commercial |
$18.16
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Nomi Health Commercial |
$19.27
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health HMO/PPO |
$20.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.68
|
| Rate for Payer: UHC Core |
$19.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 60687059301
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.12 |
| Max. Negotiated Rate |
$393.39 |
| Rate for Payer: Aetna Commercial |
$371.54
|
| Rate for Payer: BCBS Trust/PPO |
$356.80
|
| Rate for Payer: BCN Commercial |
$337.79
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$375.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$393.39
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$327.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Nomi Health Commercial |
$358.42
|
| Rate for Payer: PHP Commercial |
$371.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health HMO/PPO |
$380.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$384.65
|
| Rate for Payer: UHC Core |
$364.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$327.82
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$23.50
|
|
|
Service Code
|
NDC 16729018301
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$21.15 |
| Rate for Payer: Aetna Commercial |
$19.98
|
| Rate for Payer: Aetna Medicare |
$6.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.34
|
| Rate for Payer: BCBS Complete |
$9.40
|
| Rate for Payer: BCBS MAPPO |
$5.88
|
| Rate for Payer: BCBS Trust/PPO |
$19.32
|
| Rate for Payer: BCN Commercial |
$18.27
|
| Rate for Payer: BCN Medicare Advantage |
$5.88
|
| Rate for Payer: Cash Price |
$18.80
|
| Rate for Payer: Cofinity Commercial |
$20.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.88
|
| Rate for Payer: Healthscope Commercial |
$21.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.98
|
| Rate for Payer: Nomi Health Commercial |
$19.27
|
| Rate for Payer: PACE Senior Care Partners |
$5.58
|
| Rate for Payer: PACE SWMI |
$5.88
|
| Rate for Payer: PHP Commercial |
$19.98
|
| Rate for Payer: PHP Medicare Advantage |
$5.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.28
|
| Rate for Payer: Priority Health HMO/PPO |
$20.44
|
| Rate for Payer: Priority Health Medicare |
$5.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.74
|
| Rate for Payer: Railroad Medicare Medicare |
$5.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.68
|
| Rate for Payer: UHC Core |
$19.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.88
|
| Rate for Payer: UHC Exchange |
$5.88
|
| Rate for Payer: UHC Medicare Advantage |
$5.88
|
| Rate for Payer: VA VA |
$5.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.62
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$4.38
|
|
|
Service Code
|
NDC 60687059311
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$3.94 |
| Rate for Payer: Aetna Commercial |
$3.72
|
| Rate for Payer: Aetna Medicare |
$1.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.37
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: BCBS MAPPO |
$1.10
|
| Rate for Payer: BCBS Trust/PPO |
$3.60
|
| Rate for Payer: BCN Commercial |
$3.41
|
| Rate for Payer: BCN Medicare Advantage |
$1.10
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$3.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.10
|
| Rate for Payer: Healthscope Commercial |
$3.94
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.72
|
| Rate for Payer: Nomi Health Commercial |
$3.59
|
| Rate for Payer: PACE Senior Care Partners |
$1.04
|
| Rate for Payer: PACE SWMI |
$1.10
|
| Rate for Payer: PHP Commercial |
$3.72
|
| Rate for Payer: PHP Medicare Advantage |
$1.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.85
|
| Rate for Payer: Priority Health HMO/PPO |
$3.81
|
| Rate for Payer: Priority Health Medicare |
$1.11
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.93
|
| Rate for Payer: Railroad Medicare Medicare |
$1.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.85
|
| Rate for Payer: UHC Core |
$3.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.10
|
| Rate for Payer: UHC Exchange |
$1.10
|
| Rate for Payer: UHC Medicare Advantage |
$1.10
|
| Rate for Payer: VA VA |
$1.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.28
|
|
