|
HIV WITH OR WITHOUT OTHER RELATED CONDITION
|
Facility
|
IP
|
$21,601.19
|
|
|
Service Code
|
MS-DRG 977
|
| Min. Negotiated Rate |
$10,853.62 |
| Max. Negotiated Rate |
$21,601.19 |
| Rate for Payer: Aetna Medicare |
$11,881.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14,281.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14,281.08
|
| Rate for Payer: BCBS MAPPO |
$11,424.86
|
| Rate for Payer: BCBS Trust/PPO |
$21,279.24
|
| Rate for Payer: BCN Medicare Advantage |
$11,424.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,424.86
|
| Rate for Payer: Mclaren Medicare |
$11,424.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11,996.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13,138.59
|
| Rate for Payer: PACE Medicare |
$10,853.62
|
| Rate for Payer: PACE SWMI |
$11,424.86
|
| Rate for Payer: PHP Medicare Advantage |
$11,424.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20,320.92
|
| Rate for Payer: Priority Health Medicare |
$11,424.86
|
| Rate for Payer: Priority Health Narrow Network |
$16,256.74
|
| Rate for Payer: Railroad Medicare Medicare |
$11,424.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21,601.19
|
| Rate for Payer: UHC Core |
$17,712.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$11,424.86
|
| Rate for Payer: UHC Exchange |
$14,081.70
|
| Rate for Payer: UHC Medicare Advantage |
$11,767.61
|
| Rate for Payer: VA VA |
$11,424.86
|
|
|
HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT
|
Facility
|
OP
|
$383.33
|
|
|
Service Code
|
CPT G0463
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$64.27 |
| Max. Negotiated Rate |
$383.33 |
| Rate for Payer: Aetna Medicare |
$122.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$146.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$146.88
|
| Rate for Payer: BCBS Complete |
$67.49
|
| Rate for Payer: BCBS MAPPO |
$117.50
|
| Rate for Payer: BCBS Trust/PPO |
$383.33
|
| Rate for Payer: BCN Medicare Advantage |
$117.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.50
|
| Rate for Payer: Mclaren Medicaid |
$64.27
|
| Rate for Payer: Mclaren Medicare |
$117.50
|
| Rate for Payer: Meridian Medicaid |
$67.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$123.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$135.12
|
| Rate for Payer: PACE Medicare |
$111.62
|
| Rate for Payer: PACE SWMI |
$117.50
|
| Rate for Payer: PHP Medicare Advantage |
$117.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$369.91
|
| Rate for Payer: Priority Health Medicare |
$117.50
|
| Rate for Payer: Priority Health Narrow Network |
$295.93
|
| Rate for Payer: Railroad Medicare Medicare |
$117.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.50
|
| Rate for Payer: UHC Medicare Advantage |
$121.02
|
| Rate for Payer: VA VA |
$117.50
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT (PF) 0.5 ML IM SUSPENSION
|
Facility
|
IP
|
$699.36
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
173369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$307.72 |
| Max. Negotiated Rate |
$629.42 |
| Rate for Payer: Aetna American Axle |
$454.58
|
| Rate for Payer: Aetna Commercial |
$594.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.58
|
| Rate for Payer: Cash Price |
$559.49
|
| Rate for Payer: Cofinity Commercial |
$489.55
|
| Rate for Payer: Cofinity Commercial |
$601.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.49
|
| Rate for Payer: Healthscope Commercial |
$629.42
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$489.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$524.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$594.46
|
| Rate for Payer: PHP Commercial |
$594.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$489.55
|
| Rate for Payer: Priority Health SBD |
$440.60
|
| Rate for Payer: UMR Bronson Commercial |
$307.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$524.52
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE
|
Facility
|
IP
|
$911.62
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
173370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$401.11 |
| Max. Negotiated Rate |
$820.46 |
| Rate for Payer: Aetna American Axle |
$592.55
|
| Rate for Payer: Aetna Commercial |
$774.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$592.55
|
| Rate for Payer: Cash Price |
$729.30
|
| Rate for Payer: Cofinity Commercial |
$638.13
|
| Rate for Payer: Cofinity Commercial |
$783.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$729.30
|
| Rate for Payer: Healthscope Commercial |
$820.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$638.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$683.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$774.88
|
| Rate for Payer: PHP Commercial |
$774.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$638.13
|
| Rate for Payer: Priority Health SBD |
$574.32
|
| Rate for Payer: UMR Bronson Commercial |
$401.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$683.72
|
|
|
HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1,240 UNIT) IV SOLUTION
|
Facility
|
IP
|
$4.93
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
171259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna American Axle |
$3.20
|
| Rate for Payer: Aetna Commercial |
$4.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.20
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$3.45
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$3.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.19
|
| Rate for Payer: PHP Commercial |
$4.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.45
|
| Rate for Payer: Priority Health SBD |
$3.11
|
| Rate for Payer: UMR Bronson Commercial |
$2.17
|
| 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 |
$2.17 |
| Max. Negotiated Rate |
$4.44 |
| Rate for Payer: Aetna American Axle |
$3.20
|
| Rate for Payer: Aetna Commercial |
$4.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.20
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$3.45
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$3.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$4.19
|
| Rate for Payer: PHP Commercial |
$4.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.45
|
| Rate for Payer: Priority Health SBD |
$3.11
|
| Rate for Payer: UMR Bronson Commercial |
$2.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.70
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$165.57
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
76338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$149.01 |
| Rate for Payer: Aetna American Axle |
$107.62
|
| Rate for Payer: Aetna Commercial |
$140.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.62
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cofinity Commercial |
$115.90
|
| Rate for Payer: Cofinity Commercial |
$142.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.46
|
| Rate for Payer: Healthscope Commercial |
$149.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.73
|
| Rate for Payer: PHP Commercial |
$140.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.90
|
| Rate for Payer: Priority Health SBD |
$104.31
|
| Rate for Payer: UMR Bronson Commercial |
$72.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.18
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$165.57
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
76338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.14 |
| Max. Negotiated Rate |
$149.01 |
| Rate for Payer: Aetna American Axle |
$107.62
|
| Rate for Payer: Aetna Commercial |
$140.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.62
|
| Rate for Payer: BCBS Complete |
$66.23
|
| Rate for Payer: BCBS Trust/PPO |
$1.14
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cash Price |
$132.46
|
| Rate for Payer: Cofinity Commercial |
$115.90
|
| Rate for Payer: Cofinity Commercial |
$142.39
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.46
|
| Rate for Payer: Healthscope Commercial |
$149.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$115.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$140.73
|
| Rate for Payer: PHP Commercial |
$140.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.90
|
| Rate for Payer: Priority Health SBD |
$104.31
|
| Rate for Payer: UMR Bronson Commercial |
$61.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.18
|
|
|
HYDRALAZINE 100 MG TABLET
|
Facility
|
IP
|
$453.55
|
|
|
Service Code
|
NDC 0904-6443-61
|
| Hospital Charge Code |
3699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.56 |
| Max. Negotiated Rate |
$408.20 |
| Rate for Payer: Aetna American Axle |
$294.81
|
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.81
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Commercial |
$317.48
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Healthscope Commercial |
$408.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$385.52
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$317.48
|
| Rate for Payer: Priority Health SBD |
$285.74
|
| Rate for Payer: UMR Bronson Commercial |
$199.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.16
|
|
|
HYDRALAZINE 100 MG TABLET
|
Facility
|
IP
|
$313.50
|
|
|
Service Code
|
NDC 31722-522-01
|
| Hospital Charge Code |
3699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$282.15 |
| Rate for Payer: Aetna American Axle |
$203.78
|
| Rate for Payer: Aetna Commercial |
$266.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.78
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cofinity Commercial |
$219.45
|
| Rate for Payer: Cofinity Commercial |
$269.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$250.80
|
| Rate for Payer: Healthscope Commercial |
$282.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$219.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$235.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$266.48
|
| Rate for Payer: PHP Commercial |
$266.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.45
|
| Rate for Payer: Priority Health SBD |
$197.50
|
| Rate for Payer: UMR Bronson Commercial |
$137.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$235.12
|
|
|
HYDRALAZINE 100 MG TABLET
|
Facility
|
IP
|
$225.15
|
|
|
Service Code
|
NDC 64380-736-06
|
| Hospital Charge Code |
3699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.07 |
| Max. Negotiated Rate |
$202.64 |
| Rate for Payer: Aetna American Axle |
$146.35
|
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.35
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Commercial |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.38
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.60
|
| Rate for Payer: Priority Health SBD |
$141.84
|
| Rate for Payer: UMR Bronson Commercial |
$99.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
HYDRALAZINE 100 MG TABLET
|
Facility
|
IP
|
$157.45
|
|
|
Service Code
|
NDC 23155-004-01
|
| Hospital Charge Code |
3699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.28 |
| Max. Negotiated Rate |
$141.70 |
| Rate for Payer: Aetna American Axle |
$102.34
|
| Rate for Payer: Aetna Commercial |
$133.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.34
|
| Rate for Payer: Cash Price |
$125.96
|
| Rate for Payer: Cofinity Commercial |
$110.22
|
| Rate for Payer: Cofinity Commercial |
$135.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.96
|
| Rate for Payer: Healthscope Commercial |
$141.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.83
|
| Rate for Payer: PHP Commercial |
$133.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.22
|
| Rate for Payer: Priority Health SBD |
$99.19
|
| Rate for Payer: UMR Bronson Commercial |
$69.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.09
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
IP
|
$345.45
|
|
|
Service Code
|
NDC 68084-447-11
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.00 |
| Max. Negotiated Rate |
$310.90 |
| Rate for Payer: Aetna American Axle |
$224.54
|
| Rate for Payer: Aetna Commercial |
$293.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.54
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$241.82
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$241.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$293.63
|
| Rate for Payer: PHP Commercial |
$293.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.82
|
| Rate for Payer: Priority Health SBD |
$217.63
|
| Rate for Payer: UMR Bronson Commercial |
$152.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.09
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
IP
|
$3.86
|
|
|
Service Code
|
NDC 51079-074-01
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$3.47 |
| Rate for Payer: Aetna American Axle |
$2.51
|
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.51
|
| Rate for Payer: Cash Price |
$3.09
|
| Rate for Payer: Cofinity Commercial |
$2.70
|
| Rate for Payer: Cofinity Commercial |
$3.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.09
|
| Rate for Payer: Healthscope Commercial |
$3.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.28
|
| Rate for Payer: PHP Commercial |
$3.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.70
|
| Rate for Payer: Priority Health SBD |
$2.43
|
| Rate for Payer: UMR Bronson Commercial |
$1.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.90
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
IP
|
$345.45
|
|
|
Service Code
|
NDC 68084-447-01
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$152.00 |
| Max. Negotiated Rate |
$310.90 |
| Rate for Payer: Aetna American Axle |
$224.54
|
| Rate for Payer: Aetna Commercial |
$293.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.54
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$241.82
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$241.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$293.63
|
| Rate for Payer: PHP Commercial |
$293.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.82
|
| Rate for Payer: Priority Health SBD |
$217.63
|
| Rate for Payer: UMR Bronson Commercial |
$152.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.09
|
|
|
HYDRALAZINE 20 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$37.18
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
3697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.36 |
| Max. Negotiated Rate |
$33.46 |
| Rate for Payer: Aetna American Axle |
$24.17
|
| Rate for Payer: Aetna American Axle |
$114.02
|
| Rate for Payer: Aetna American Axle |
$15.13
|
| Rate for Payer: Aetna American Axle |
$13.96
|
| Rate for Payer: Aetna Commercial |
$18.26
|
| Rate for Payer: Aetna Commercial |
$149.10
|
| Rate for Payer: Aetna Commercial |
$31.60
|
| Rate for Payer: Aetna Commercial |
$19.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.17
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Cash Price |
$140.33
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cofinity Commercial |
$122.79
|
| Rate for Payer: Cofinity Commercial |
$150.85
|
| Rate for Payer: Cofinity Commercial |
$16.29
|
| Rate for Payer: Cofinity Commercial |
$26.03
|
| Rate for Payer: Cofinity Commercial |
$15.04
|
| Rate for Payer: Cofinity Commercial |
$18.47
|
| Rate for Payer: Cofinity Commercial |
$31.97
|
| Rate for Payer: Cofinity Commercial |
$20.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.33
|
| Rate for Payer: Healthscope Commercial |
$33.46
|
| Rate for Payer: Healthscope Commercial |
$19.33
|
| Rate for Payer: Healthscope Commercial |
$157.87
|
| Rate for Payer: Healthscope Commercial |
$20.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$31.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.26
|
| Rate for Payer: PHP Commercial |
$149.10
|
| Rate for Payer: PHP Commercial |
$18.26
|
| Rate for Payer: PHP Commercial |
$19.78
|
| Rate for Payer: PHP Commercial |
$31.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.79
|
| Rate for Payer: Priority Health SBD |
$110.51
|
| Rate for Payer: Priority Health SBD |
$23.42
|
| Rate for Payer: Priority Health SBD |
$13.53
|
| Rate for Payer: Priority Health SBD |
$14.66
|
| Rate for Payer: UMR Bronson Commercial |
$77.18
|
| Rate for Payer: UMR Bronson Commercial |
$10.24
|
| Rate for Payer: UMR Bronson Commercial |
$9.45
|
| Rate for Payer: UMR Bronson Commercial |
$16.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.88
|
|
|
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 |
$8.61 |
| Max. Negotiated Rate |
$20.94 |
| Rate for Payer: Aetna American Axle |
$15.13
|
| Rate for Payer: Aetna Commercial |
$19.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.13
|
| Rate for Payer: BCBS Complete |
$9.31
|
| Rate for Payer: BCBS Trust/PPO |
$18.05
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cofinity Commercial |
$20.01
|
| Rate for Payer: Cofinity Commercial |
$16.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.62
|
| Rate for Payer: Healthscope Commercial |
$20.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.78
|
| Rate for Payer: PHP Commercial |
$19.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.29
|
| Rate for Payer: Priority Health SBD |
$14.66
|
| Rate for Payer: UMR Bronson Commercial |
$8.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.45
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$258.50
|
|
|
Service Code
|
NDC 0904-6441-61
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.74 |
| Max. Negotiated Rate |
$232.65 |
| Rate for Payer: Aetna American Axle |
$168.02
|
| Rate for Payer: Aetna Commercial |
$219.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.02
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cofinity Commercial |
$180.95
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$180.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$193.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$219.72
|
| Rate for Payer: PHP Commercial |
$219.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.95
|
| Rate for Payer: Priority Health SBD |
$162.86
|
| Rate for Payer: UMR Bronson Commercial |
$113.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$193.88
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$420.65
|
|
|
Service Code
|
NDC 51079-075-20
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$185.09 |
| Max. Negotiated Rate |
$378.58 |
| Rate for Payer: Aetna American Axle |
$273.42
|
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.42
|
| Rate for Payer: Cash Price |
$336.52
|
| Rate for Payer: Cofinity Commercial |
$294.46
|
| Rate for Payer: Cofinity Commercial |
$361.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$336.52
|
| Rate for Payer: Healthscope Commercial |
$378.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$294.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$315.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$357.55
|
| Rate for Payer: PHP Commercial |
$357.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.46
|
| Rate for Payer: Priority Health SBD |
$265.01
|
| Rate for Payer: UMR Bronson Commercial |
$185.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$315.49
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$4.21
|
|
|
Service Code
|
NDC 51079-075-01
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Aetna American Axle |
$2.74
|
| Rate for Payer: Aetna Commercial |
$3.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.74
|
| Rate for Payer: Cash Price |
$3.37
|
| Rate for Payer: Cofinity Commercial |
$2.95
|
| Rate for Payer: Cofinity Commercial |
$3.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.37
|
| Rate for Payer: Healthscope Commercial |
$3.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.58
|
| Rate for Payer: PHP Commercial |
$3.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.95
|
| Rate for Payer: Priority Health SBD |
$2.65
|
| Rate for Payer: UMR Bronson Commercial |
$1.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.16
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$3.74
|
|
|
Service Code
|
NDC 62584-733-11
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna American Axle |
$2.43
|
| Rate for Payer: Aetna Commercial |
$3.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.43
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$2.62
|
| Rate for Payer: Cofinity Commercial |
$3.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.18
|
| Rate for Payer: PHP Commercial |
$3.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.62
|
| Rate for Payer: Priority Health SBD |
$2.36
|
| Rate for Payer: UMR Bronson Commercial |
$1.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.80
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$84.60
|
|
|
Service Code
|
NDC 23155-833-01
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.22 |
| Max. Negotiated Rate |
$76.14 |
| Rate for Payer: Aetna American Axle |
$54.99
|
| Rate for Payer: Aetna Commercial |
$71.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.99
|
| Rate for Payer: Cash Price |
$67.68
|
| Rate for Payer: Cofinity Commercial |
$59.22
|
| Rate for Payer: Cofinity Commercial |
$72.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$67.68
|
| Rate for Payer: Healthscope Commercial |
$76.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$59.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$63.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$71.91
|
| Rate for Payer: PHP Commercial |
$71.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.22
|
| Rate for Payer: Priority Health SBD |
$53.30
|
| Rate for Payer: UMR Bronson Commercial |
$37.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$63.45
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$82.25
|
|
|
Service Code
|
NDC 23155-002-01
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.19 |
| Max. Negotiated Rate |
$74.02 |
| Rate for Payer: Aetna American Axle |
$53.46
|
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$57.58
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$57.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.91
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.58
|
| Rate for Payer: Priority Health SBD |
$51.82
|
| Rate for Payer: UMR Bronson Commercial |
$36.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
|
HYDROCHLORIC ACID 0.1 N LOCK SOLUTION
|
Facility
|
OP
|
$2.25
|
|
|
Service Code
|
NDC 9900-0011-27
|
| Hospital Charge Code |
300175
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Aetna American Axle |
$1.46
|
| Rate for Payer: Aetna Commercial |
$1.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.46
|
| Rate for Payer: BCBS Complete |
$0.90
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cofinity Commercial |
$1.58
|
| Rate for Payer: Cofinity Commercial |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.80
|
| Rate for Payer: Healthscope Commercial |
$2.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.91
|
| Rate for Payer: PHP Commercial |
$1.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.58
|
| Rate for Payer: Priority Health SBD |
$1.42
|
| Rate for Payer: UMR Bronson Commercial |
$0.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.69
|
|
|
HYDROCHLORIC ACID 0.1 N LOCK SOLUTION
|
Facility
|
IP
|
$2.25
|
|
|
Service Code
|
NDC 9900-0011-27
|
| Hospital Charge Code |
300175
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.02 |
| Rate for Payer: Aetna American Axle |
$1.46
|
| Rate for Payer: Aetna Commercial |
$1.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.46
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cofinity Commercial |
$1.58
|
| Rate for Payer: Cofinity Commercial |
$1.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.80
|
| Rate for Payer: Healthscope Commercial |
$2.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.91
|
| Rate for Payer: PHP Commercial |
$1.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.58
|
| Rate for Payer: Priority Health SBD |
$1.42
|
| Rate for Payer: UMR Bronson Commercial |
$0.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.69
|
|
