|
HH DRSG MEPILEX BORDER 6X8 EA
|
Facility
|
IP
|
$22.47
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300053
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: BCBS Trust/PPO |
$18.34
|
| Rate for Payer: BCN Commercial |
$17.36
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Nomi Health Commercial |
$18.43
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.61
|
| Rate for Payer: Priority Health HMO/PPO |
$19.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.77
|
| Rate for Payer: UHC Core |
$18.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.85
|
|
|
HH DRSG MEPILEX BORDER 6X8 EA
|
Facility
|
OP
|
$22.47
|
|
|
Service Code
|
HCPCS A6213
|
| Hospital Charge Code |
62300053
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$5.34 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Aetna Commercial |
$19.10
|
| Rate for Payer: Aetna Medicare |
$5.84
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$7.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$7.02
|
| Rate for Payer: BCBS Complete |
$8.99
|
| Rate for Payer: BCBS MAPPO |
$5.62
|
| Rate for Payer: BCBS Trust/PPO |
$18.47
|
| Rate for Payer: BCN Commercial |
$17.47
|
| Rate for Payer: BCN Medicare Advantage |
$5.62
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cofinity Commercial |
$19.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.62
|
| Rate for Payer: Healthscope Commercial |
$20.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.90
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.10
|
| Rate for Payer: Nomi Health Commercial |
$18.43
|
| Rate for Payer: PACE Senior Care Partners |
$5.34
|
| Rate for Payer: PACE SWMI |
$5.62
|
| Rate for Payer: PHP Commercial |
$19.10
|
| Rate for Payer: PHP Medicare Advantage |
$5.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.61
|
| Rate for Payer: Priority Health HMO/PPO |
$19.55
|
| Rate for Payer: Priority Health Medicare |
$5.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.05
|
| Rate for Payer: Railroad Medicare Medicare |
$5.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.77
|
| Rate for Payer: UHC Core |
$18.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.62
|
| Rate for Payer: UHC Exchange |
$5.62
|
| Rate for Payer: UHC Medicare Advantage |
$5.62
|
| Rate for Payer: VA VA |
$5.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.85
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM
|
Facility
|
OP
|
$839.87
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
76100035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$199.47 |
| Max. Negotiated Rate |
$755.88 |
| Rate for Payer: Aetna Commercial |
$713.89
|
| Rate for Payer: Aetna Medicare |
$218.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$262.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$262.46
|
| Rate for Payer: BCBS Complete |
$303.32
|
| Rate for Payer: BCBS MAPPO |
$209.97
|
| Rate for Payer: BCBS Trust/PPO |
$690.46
|
| Rate for Payer: BCN Commercial |
$653.00
|
| Rate for Payer: BCN Medicare Advantage |
$209.97
|
| Rate for Payer: Cash Price |
$671.90
|
| Rate for Payer: Cash Price |
$671.90
|
| Rate for Payer: Cofinity Commercial |
$722.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.97
|
| Rate for Payer: Healthscope Commercial |
$755.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.90
|
| Rate for Payer: Mclaren Medicaid |
$288.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.47
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$241.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.89
|
| Rate for Payer: Nomi Health Commercial |
$688.69
|
| Rate for Payer: PACE Senior Care Partners |
$199.47
|
| Rate for Payer: PACE SWMI |
$209.97
|
| Rate for Payer: PHP Commercial |
$713.89
|
| Rate for Payer: PHP Medicare Advantage |
$209.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.92
|
| Rate for Payer: Priority Health HMO/PPO |
$730.69
|
| Rate for Payer: Priority Health Medicare |
$212.07
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$562.71
|
| Rate for Payer: Railroad Medicare Medicare |
$209.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$739.09
|
| Rate for Payer: UHC Core |
$701.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.97
|
| Rate for Payer: UHC Exchange |
$209.97
|
| Rate for Payer: UHC Medicare Advantage |
$209.97
|
| Rate for Payer: UHCCP Medicaid |
$288.86
|
| Rate for Payer: VA VA |
$209.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.90
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL < 50SQ CM
|
Facility
|
IP
|
$839.87
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
76100035
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$545.92 |
| Max. Negotiated Rate |
$755.88 |
| Rate for Payer: Aetna Commercial |
$713.89
|
| Rate for Payer: BCBS Trust/PPO |
$685.59
|
| Rate for Payer: BCN Commercial |
$649.05
|
| Rate for Payer: Cash Price |
$671.90
|
| Rate for Payer: Cofinity Commercial |
$722.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$671.90
|
| Rate for Payer: Healthscope Commercial |
$755.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$629.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.89
|
| Rate for Payer: Nomi Health Commercial |
$688.69
|
| Rate for Payer: PHP Commercial |
$713.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$545.92
|
| Rate for Payer: Priority Health HMO/PPO |
$730.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$562.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$739.09
|
| Rate for Payer: UHC Core |
$701.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$629.90
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM
|
Facility
|
OP
|
$699.89
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
76100036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$166.22 |
| Max. Negotiated Rate |
$629.90 |
| Rate for Payer: Aetna Commercial |
$594.91
|
| Rate for Payer: Aetna Medicare |
$181.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$218.72
|
| Rate for Payer: Amish Plain Church Group Commercial |
$218.72
|
| Rate for Payer: BCBS Complete |
$303.32
|
| Rate for Payer: BCBS MAPPO |
$174.97
|
| Rate for Payer: BCBS Trust/PPO |
$575.38
|
| Rate for Payer: BCN Commercial |
$544.16
|
| Rate for Payer: BCN Medicare Advantage |
$174.97
|
| Rate for Payer: Cash Price |
$559.91
|
| Rate for Payer: Cash Price |
$559.91
|
| Rate for Payer: Cofinity Commercial |
$601.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$174.97
|
| Rate for Payer: Healthscope Commercial |
$629.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.92
|
| Rate for Payer: Mclaren Medicaid |
$288.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$183.72
|
| Rate for Payer: Meridian Medicaid |
$303.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$201.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.91
|
| Rate for Payer: Nomi Health Commercial |
$573.91
|
| Rate for Payer: PACE Senior Care Partners |
$166.22
|
| Rate for Payer: PACE SWMI |
$174.97
|
| Rate for Payer: PHP Commercial |
$594.91
|
| Rate for Payer: PHP Medicare Advantage |
$174.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.93
|
| Rate for Payer: Priority Health HMO/PPO |
$608.90
|
| Rate for Payer: Priority Health Medicare |
$176.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$468.93
|
| Rate for Payer: Railroad Medicare Medicare |
$174.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$615.90
|
| Rate for Payer: UHC Core |
$584.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$174.97
|
| Rate for Payer: UHC Exchange |
$174.97
|
| Rate for Payer: UHC Medicare Advantage |
$174.97
|
| Rate for Payer: UHCCP Medicaid |
$288.86
|
| Rate for Payer: VA VA |
$174.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.92
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM
|
Facility
|
IP
|
$699.89
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
76100036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$454.93 |
| Max. Negotiated Rate |
$629.90 |
| Rate for Payer: Aetna Commercial |
$594.91
|
| Rate for Payer: BCBS Trust/PPO |
$571.32
|
| Rate for Payer: BCN Commercial |
$540.87
|
| Rate for Payer: Cash Price |
$559.91
|
| Rate for Payer: Cofinity Commercial |
$601.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.91
|
| Rate for Payer: Healthscope Commercial |
$629.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.91
|
| Rate for Payer: Nomi Health Commercial |
$573.91
|
| Rate for Payer: PHP Commercial |
$594.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.93
|
| Rate for Payer: Priority Health HMO/PPO |
$608.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$468.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$615.90
|
| Rate for Payer: UHC Core |
$584.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.92
|
|
|
HH POUCH 2.5" CTF HOLL8331 EA
|
Facility
|
OP
|
$6.36
|
|
|
Service Code
|
HCPCS A5056
|
| Hospital Charge Code |
27000597
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: Aetna Medicare |
$1.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.99
|
| Rate for Payer: BCBS Complete |
$2.54
|
| Rate for Payer: BCBS MAPPO |
$1.59
|
| Rate for Payer: BCBS Trust/PPO |
$5.23
|
| Rate for Payer: BCN Commercial |
$4.94
|
| Rate for Payer: BCN Medicare Advantage |
$1.59
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.59
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: PACE Senior Care Partners |
$1.51
|
| Rate for Payer: PACE SWMI |
$1.59
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: PHP Medicare Advantage |
$1.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.13
|
| Rate for Payer: Priority Health HMO/PPO |
$5.53
|
| Rate for Payer: Priority Health Medicare |
$1.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.60
|
| Rate for Payer: UHC Core |
$5.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.59
|
| Rate for Payer: UHC Exchange |
$1.59
|
| Rate for Payer: UHC Medicare Advantage |
$1.59
|
| Rate for Payer: VA VA |
$1.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.77
|
|
|
HH POUCH 2.5" CTF HOLL8331 EA
|
Facility
|
IP
|
$6.36
|
|
|
Service Code
|
HCPCS A5056
|
| Hospital Charge Code |
27000597
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$5.72 |
| Rate for Payer: Aetna Commercial |
$5.41
|
| Rate for Payer: BCBS Trust/PPO |
$5.19
|
| Rate for Payer: BCN Commercial |
$4.92
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$5.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$4.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: PHP Commercial |
$5.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.13
|
| Rate for Payer: Priority Health HMO/PPO |
$5.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.60
|
| Rate for Payer: UHC Core |
$5.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$4.77
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE (PCC)-LANS 500 UNIT IV SOLUTION
|
Facility
|
OP
|
$3,753.41
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
204903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$3,378.07 |
| Rate for Payer: Aetna Commercial |
$3,190.40
|
| Rate for Payer: Aetna Medicare |
$975.89
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,172.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,172.94
|
| Rate for Payer: BCBS Complete |
$1.18
|
| Rate for Payer: BCBS MAPPO |
$938.35
|
| Rate for Payer: BCBS Trust/PPO |
$3,085.68
|
| Rate for Payer: BCN Commercial |
$2,918.28
|
| Rate for Payer: BCN Medicare Advantage |
$938.35
|
| Rate for Payer: Cash Price |
$3,002.73
|
| Rate for Payer: Cash Price |
$3,002.73
|
| Rate for Payer: Cofinity Commercial |
$3,227.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,002.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$938.35
|
| Rate for Payer: Healthscope Commercial |
$3,378.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,815.06
|
| Rate for Payer: Mclaren Medicaid |
$1.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$985.27
|
| Rate for Payer: Meridian Medicaid |
$1.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,079.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,190.40
|
| Rate for Payer: Nomi Health Commercial |
$3,077.80
|
| Rate for Payer: PACE Senior Care Partners |
$891.43
|
| Rate for Payer: PACE SWMI |
$938.35
|
| Rate for Payer: PHP Commercial |
$3,190.40
|
| Rate for Payer: PHP Medicare Advantage |
$938.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,439.72
|
| Rate for Payer: Priority Health HMO/PPO |
$3,265.47
|
| Rate for Payer: Priority Health Medicare |
$947.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,514.78
|
| Rate for Payer: Railroad Medicare Medicare |
$938.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,303.00
|
| Rate for Payer: UHC Core |
$3,134.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$938.35
|
| Rate for Payer: UHC Exchange |
$938.35
|
| Rate for Payer: UHC Medicare Advantage |
$938.35
|
| Rate for Payer: UHCCP Medicaid |
$1.12
|
| Rate for Payer: VA VA |
$938.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,815.06
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE (PCC)-LANS 500 UNIT IV SOLUTION
|
Facility
|
IP
|
$3,753.41
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
204903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,439.72 |
| Max. Negotiated Rate |
$3,378.07 |
| Rate for Payer: Aetna Commercial |
$3,190.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,063.91
|
| Rate for Payer: BCN Commercial |
$2,900.64
|
| Rate for Payer: Cash Price |
$3,002.73
|
| Rate for Payer: Cofinity Commercial |
$3,227.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,002.73
|
| Rate for Payer: Healthscope Commercial |
$3,378.07
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,815.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,190.40
|
| Rate for Payer: Nomi Health Commercial |
$3,077.80
|
| Rate for Payer: PHP Commercial |
$3,190.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,439.72
|
| Rate for Payer: Priority Health HMO/PPO |
$3,265.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2,514.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,303.00
|
| Rate for Payer: UHC Core |
$3,134.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,815.06
|
|
|
HUM PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION
|
Facility
|
OP
|
$4.93
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
170850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna Commercial |
$4.19
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.54
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.54
|
| Rate for Payer: BCBS Complete |
$1.62
|
| Rate for Payer: BCBS MAPPO |
$1.23
|
| Rate for Payer: BCBS Trust/PPO |
$4.05
|
| Rate for Payer: BCN Commercial |
$3.83
|
| Rate for Payer: BCN Medicare Advantage |
$1.23
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.23
|
| Rate for Payer: Healthscope Commercial |
$4.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.70
|
| Rate for Payer: Mclaren Medicaid |
$1.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.29
|
| Rate for Payer: Meridian Medicaid |
$1.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.19
|
| Rate for Payer: Nomi Health Commercial |
$4.04
|
| Rate for Payer: PACE Senior Care Partners |
$1.17
|
| Rate for Payer: PACE SWMI |
$1.23
|
| Rate for Payer: PHP Commercial |
$4.19
|
| Rate for Payer: PHP Medicare Advantage |
$1.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health HMO/PPO |
$4.29
|
| Rate for Payer: Priority Health Medicare |
$1.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.30
|
| Rate for Payer: Railroad Medicare Medicare |
$1.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.34
|
| Rate for Payer: UHC Core |
$4.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.23
|
| Rate for Payer: UHC Exchange |
$1.23
|
| Rate for Payer: UHC Medicare Advantage |
$1.23
|
| Rate for Payer: UHCCP Medicaid |
$1.55
|
| Rate for Payer: VA VA |
$1.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.70
|
|
|
HUM PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION
|
Facility
|
IP
|
$4.93
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
170850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna Commercial |
$4.19
|
| Rate for Payer: BCBS Trust/PPO |
$4.02
|
| Rate for Payer: BCN Commercial |
$3.81
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$4.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.19
|
| Rate for Payer: Nomi Health Commercial |
$4.04
|
| Rate for Payer: PHP Commercial |
$4.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health HMO/PPO |
$4.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.34
|
| Rate for Payer: UHC Core |
$4.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.70
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$166.66
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
76338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.33 |
| Max. Negotiated Rate |
$149.99 |
| Rate for Payer: Aetna Commercial |
$141.66
|
| Rate for Payer: BCBS Trust/PPO |
$136.04
|
| Rate for Payer: BCN Commercial |
$128.79
|
| Rate for Payer: Cash Price |
$133.33
|
| Rate for Payer: Cofinity Commercial |
$143.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.33
|
| Rate for Payer: Healthscope Commercial |
$149.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.66
|
| Rate for Payer: Nomi Health Commercial |
$136.66
|
| Rate for Payer: PHP Commercial |
$141.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.33
|
| Rate for Payer: Priority Health HMO/PPO |
$144.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.66
|
| Rate for Payer: UHC Core |
$139.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.00
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$166.66
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
76338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.58 |
| Max. Negotiated Rate |
$149.99 |
| Rate for Payer: Aetna Commercial |
$141.66
|
| Rate for Payer: Aetna Medicare |
$43.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.08
|
| Rate for Payer: BCBS Complete |
$66.66
|
| Rate for Payer: BCBS MAPPO |
$41.66
|
| Rate for Payer: BCBS Trust/PPO |
$137.01
|
| Rate for Payer: BCN Commercial |
$129.58
|
| Rate for Payer: BCN Medicare Advantage |
$41.66
|
| Rate for Payer: Cash Price |
$133.33
|
| Rate for Payer: Cofinity Commercial |
$143.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.66
|
| Rate for Payer: Healthscope Commercial |
$149.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.66
|
| Rate for Payer: Nomi Health Commercial |
$136.66
|
| Rate for Payer: PACE Senior Care Partners |
$39.58
|
| Rate for Payer: PACE SWMI |
$41.66
|
| Rate for Payer: PHP Commercial |
$141.66
|
| Rate for Payer: PHP Medicare Advantage |
$41.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.33
|
| Rate for Payer: Priority Health HMO/PPO |
$144.99
|
| Rate for Payer: Priority Health Medicare |
$42.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.66
|
| Rate for Payer: Railroad Medicare Medicare |
$41.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.66
|
| Rate for Payer: UHC Core |
$139.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.66
|
| Rate for Payer: UHC Exchange |
$41.66
|
| Rate for Payer: UHC Medicare Advantage |
$41.66
|
| Rate for Payer: VA VA |
$41.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.00
|
|
|
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 10 MG TABLET
|
Facility
|
IP
|
$345.45
|
|
|
Service Code
|
NDC 68084044711
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$224.54 |
| Max. Negotiated Rate |
$310.90 |
| Rate for Payer: Aetna Commercial |
$293.63
|
| Rate for Payer: BCBS Trust/PPO |
$281.99
|
| Rate for Payer: BCN Commercial |
$266.96
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$297.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.36
|
| Rate for Payer: Healthscope Commercial |
$310.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.63
|
| Rate for Payer: Nomi Health Commercial |
$283.27
|
| Rate for Payer: PHP Commercial |
$293.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.54
|
| Rate for Payer: Priority Health HMO/PPO |
$300.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$231.45
|
| 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
|
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
|
$227.95
|
|
|
Service Code
|
NDC 00904644061
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.14 |
| 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 |
$91.18
|
| Rate for Payer: BCBS MAPPO |
$56.99
|
| Rate for Payer: BCBS Trust/PPO |
$187.40
|
| Rate for Payer: BCN Commercial |
$177.23
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$65.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$193.76
|
| Rate for Payer: Nomi Health Commercial |
$186.92
|
| 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 Cigna Priority Health |
$148.17
|
| Rate for Payer: Priority Health HMO/PPO |
$198.32
|
| Rate for Payer: Priority Health Medicare |
$57.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$152.73
|
| 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 Dual Complete DSNP |
$56.99
|
| Rate for Payer: UHC Exchange |
$56.99
|
| Rate for Payer: UHC Medicare Advantage |
$56.99
|
| Rate for Payer: VA VA |
$56.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.96
|
|
|
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
|
$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
|
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
|
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
|
|
|
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 |
$171.85 |
| 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 |
$171.85
|
| 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
|
$258.50
|
|
|
Service Code
|
NDC 00904644161
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.03 |
| 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 |
$168.03
|
| Rate for Payer: Priority Health HMO/PPO |
$224.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$173.19
|
| 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
|
|
