|
HYDRALAZINE 100 MG TABLET
|
Facility
|
IP
|
$310.20
|
|
|
Service Code
|
NDC 31722052201
|
| Hospital Charge Code |
3699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.49 |
| Max. Negotiated Rate |
$279.18 |
| Rate for Payer: Aetna American Axle |
$201.63
|
| Rate for Payer: Aetna Commercial |
$263.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.63
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cofinity Advantage |
$217.14
|
| Rate for Payer: Cofinity Commercial |
$266.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.16
|
| Rate for Payer: Healthscope Commercial |
$279.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.65
|
| Rate for Payer: PHP Commercial |
$263.67
|
| Rate for Payer: Priority Health SBD |
$195.43
|
| Rate for Payer: UMR Bronson Commercial |
$136.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.65
|
|
|
HYDRALAZINE 100 MG TABLET
|
Facility
|
IP
|
$157.45
|
|
|
Service Code
|
NDC 23155000401
|
| Hospital Charge Code |
3699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.28 |
| Max. Negotiated Rate |
$141.71 |
| 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 Advantage |
$110.22
|
| Rate for Payer: Cofinity Commercial |
$135.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.96
|
| Rate for Payer: Healthscope Commercial |
$141.71
|
| 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 Commercial |
$133.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.09
|
| Rate for Payer: PHP Commercial |
$133.83
|
| 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 100 MG TABLET
|
Facility
|
OP
|
$453.55
|
|
|
Service Code
|
NDC 00904644361
|
| Hospital Charge Code |
3699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$167.81 |
| Max. Negotiated Rate |
$408.19 |
| Rate for Payer: Aetna American Axle |
$294.81
|
| Rate for Payer: Aetna Commercial |
$385.52
|
| Rate for Payer: Aetna Medicare |
$226.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$294.81
|
| Rate for Payer: BCBS Complete |
$181.42
|
| Rate for Payer: Cash Price |
$362.84
|
| Rate for Payer: Cofinity Advantage |
$317.49
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Healthscope Commercial |
$408.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$362.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.16
|
| Rate for Payer: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health SBD |
$285.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$294.81
|
| Rate for Payer: UHC Core |
$236.30
|
| Rate for Payer: UHC Exchange |
$178.25
|
| Rate for Payer: UMR Bronson Commercial |
$167.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.16
|
|
|
HYDRALAZINE 100 MG TABLET
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
NDC 23155083501
|
| Hospital Charge Code |
3699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.72 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna American Axle |
$122.20
|
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Advantage |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health SBD |
$118.44
|
| Rate for Payer: UMR Bronson Commercial |
$82.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
HYDRALAZINE 100 MG TABLET
|
Facility
|
IP
|
$225.15
|
|
|
Service Code
|
NDC 64380073606
|
| Hospital Charge Code |
3699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.07 |
| Max. Negotiated Rate |
$202.63 |
| 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 Advantage |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.63
|
| 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 Commercial |
$191.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.86
|
| Rate for Payer: PHP Commercial |
$191.38
|
| 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
|
OP
|
$310.20
|
|
|
Service Code
|
NDC 31722052201
|
| Hospital Charge Code |
3699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$114.77 |
| Max. Negotiated Rate |
$279.18 |
| Rate for Payer: Aetna American Axle |
$201.63
|
| Rate for Payer: Aetna Commercial |
$263.67
|
| Rate for Payer: Aetna Medicare |
$155.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$201.63
|
| Rate for Payer: BCBS Complete |
$124.08
|
| Rate for Payer: Cash Price |
$248.16
|
| Rate for Payer: Cofinity Advantage |
$217.14
|
| Rate for Payer: Cofinity Commercial |
$266.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.16
|
| Rate for Payer: Healthscope Commercial |
$279.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$217.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$248.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.65
|
| Rate for Payer: PHP Commercial |
$263.67
|
| Rate for Payer: Priority Health SBD |
$195.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$201.63
|
| Rate for Payer: UHC Core |
$161.61
|
| Rate for Payer: UHC Exchange |
$121.91
|
| Rate for Payer: UMR Bronson Commercial |
$114.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.65
|
|
|
HYDRALAZINE 100 MG TABLET
|
Facility
|
OP
|
$157.45
|
|
|
Service Code
|
NDC 23155000401
|
| Hospital Charge Code |
3699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.26 |
| Max. Negotiated Rate |
$141.71 |
| Rate for Payer: Aetna American Axle |
$102.34
|
| Rate for Payer: Aetna Commercial |
$133.83
|
| Rate for Payer: Aetna Medicare |
$78.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.34
|
| Rate for Payer: BCBS Complete |
$62.98
|
| Rate for Payer: Cash Price |
$125.96
|
| Rate for Payer: Cofinity Advantage |
$110.22
|
| Rate for Payer: Cofinity Commercial |
$135.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$125.96
|
| Rate for Payer: Healthscope Commercial |
$141.71
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$125.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$118.09
|
| Rate for Payer: PHP Commercial |
$133.83
|
| Rate for Payer: Priority Health SBD |
$99.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.34
|
| Rate for Payer: UHC Core |
$82.03
|
| Rate for Payer: UHC Exchange |
$61.88
|
| Rate for Payer: UMR Bronson Commercial |
$58.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.09
|
|
|
HYDRALAZINE 100 MG TABLET
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
NDC 23155083501
|
| Hospital Charge Code |
3699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.56 |
| Max. Negotiated Rate |
$169.20 |
| Rate for Payer: Aetna American Axle |
$122.20
|
| Rate for Payer: Aetna Commercial |
$159.80
|
| Rate for Payer: Aetna Medicare |
$94.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.20
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Advantage |
$131.60
|
| Rate for Payer: Cofinity Commercial |
$161.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.40
|
| Rate for Payer: Healthscope Commercial |
$169.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$150.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: PHP Commercial |
$159.80
|
| Rate for Payer: Priority Health SBD |
$118.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.20
|
| Rate for Payer: UHC Core |
$97.95
|
| Rate for Payer: UHC Exchange |
$73.88
|
| Rate for Payer: UMR Bronson Commercial |
$69.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.00
|
|
|
HYDRALAZINE 100 MG TABLET
|
Facility
|
IP
|
$453.55
|
|
|
Service Code
|
NDC 00904644361
|
| Hospital Charge Code |
3699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$199.56 |
| Max. Negotiated Rate |
$408.19 |
| 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 Advantage |
$317.49
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$362.84
|
| Rate for Payer: Healthscope Commercial |
$408.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$317.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$340.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$340.16
|
| Rate for Payer: PHP Commercial |
$385.52
|
| 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
|
OP
|
$225.15
|
|
|
Service Code
|
NDC 64380073606
|
| Hospital Charge Code |
3699
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.31 |
| Max. Negotiated Rate |
$202.63 |
| Rate for Payer: Aetna American Axle |
$146.35
|
| Rate for Payer: Aetna Commercial |
$191.38
|
| Rate for Payer: Aetna Medicare |
$112.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.35
|
| Rate for Payer: BCBS Complete |
$90.06
|
| Rate for Payer: Cash Price |
$180.12
|
| Rate for Payer: Cofinity Advantage |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$180.12
|
| Rate for Payer: Healthscope Commercial |
$202.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$157.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$168.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$180.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$191.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$168.86
|
| Rate for Payer: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health SBD |
$141.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.35
|
| Rate for Payer: UHC Core |
$117.30
|
| Rate for Payer: UHC Exchange |
$88.48
|
| Rate for Payer: UMR Bronson Commercial |
$83.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
OP
|
$4.33
|
|
|
Service Code
|
NDC 60687081111
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna American Axle |
$2.81
|
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Aetna Medicare |
$2.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.81
|
| Rate for Payer: BCBS Complete |
$1.73
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Advantage |
$3.03
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.25
|
| Rate for Payer: PHP Commercial |
$3.68
|
| Rate for Payer: Priority Health SBD |
$2.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.81
|
| Rate for Payer: UHC Core |
$2.26
|
| Rate for Payer: UHC Exchange |
$1.70
|
| Rate for Payer: UMR Bronson Commercial |
$1.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.25
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
OP
|
$345.45
|
|
|
Service Code
|
NDC 68084044701
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.82 |
| Max. Negotiated Rate |
$310.90 |
| Rate for Payer: Aetna American Axle |
$224.54
|
| Rate for Payer: Aetna Commercial |
$293.63
|
| Rate for Payer: Aetna Medicare |
$172.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.54
|
| Rate for Payer: BCBS Complete |
$138.18
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cofinity Advantage |
$241.81
|
| 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 |
$241.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.09
|
| Rate for Payer: PHP Commercial |
$293.63
|
| Rate for Payer: Priority Health SBD |
$217.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.54
|
| Rate for Payer: UHC Core |
$179.98
|
| Rate for Payer: UHC Exchange |
$135.76
|
| Rate for Payer: UMR Bronson Commercial |
$127.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.09
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
IP
|
$96.35
|
|
|
Service Code
|
NDC 31722051901
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.39 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Aetna American Axle |
$62.63
|
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.63
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Advantage |
$67.44
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Healthscope Commercial |
$86.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.26
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health SBD |
$60.70
|
| Rate for Payer: UMR Bronson Commercial |
$42.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.26
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
IP
|
$345.45
|
|
|
Service Code
|
NDC 68084044711
|
| 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 Advantage |
$241.81
|
| 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 |
$241.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.09
|
| Rate for Payer: PHP Commercial |
$293.63
|
| 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
|
$432.40
|
|
|
Service Code
|
NDC 60687081101
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$190.26 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna American Axle |
$281.06
|
| Rate for Payer: Aetna Commercial |
$367.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.06
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cofinity Advantage |
$302.68
|
| Rate for Payer: Cofinity Commercial |
$371.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Healthscope Commercial |
$389.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.30
|
| Rate for Payer: PHP Commercial |
$367.54
|
| Rate for Payer: Priority Health SBD |
$272.41
|
| Rate for Payer: UMR Bronson Commercial |
$190.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.30
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
OP
|
$96.35
|
|
|
Service Code
|
NDC 31722051901
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.65 |
| Max. Negotiated Rate |
$86.72 |
| Rate for Payer: Aetna American Axle |
$62.63
|
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna Medicare |
$48.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.63
|
| Rate for Payer: BCBS Complete |
$38.54
|
| Rate for Payer: Cash Price |
$77.08
|
| Rate for Payer: Cofinity Advantage |
$67.44
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$77.08
|
| Rate for Payer: Healthscope Commercial |
$86.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$67.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$72.26
|
| Rate for Payer: MI Amish Medical Board Commercial |
$77.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.26
|
| Rate for Payer: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health SBD |
$60.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.63
|
| Rate for Payer: UHC Core |
$50.20
|
| Rate for Payer: UHC Exchange |
$37.87
|
| Rate for Payer: UMR Bronson Commercial |
$35.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.26
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
OP
|
$432.40
|
|
|
Service Code
|
NDC 60687081101
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$159.99 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna American Axle |
$281.06
|
| Rate for Payer: Aetna Commercial |
$367.54
|
| Rate for Payer: Aetna Medicare |
$216.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.06
|
| Rate for Payer: BCBS Complete |
$172.96
|
| Rate for Payer: Cash Price |
$345.92
|
| Rate for Payer: Cofinity Advantage |
$302.68
|
| Rate for Payer: Cofinity Commercial |
$371.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$345.92
|
| Rate for Payer: Healthscope Commercial |
$389.16
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$302.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$324.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$345.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$367.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$324.30
|
| Rate for Payer: PHP Commercial |
$367.54
|
| Rate for Payer: Priority Health SBD |
$272.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$281.06
|
| Rate for Payer: UHC Core |
$225.28
|
| Rate for Payer: UHC Exchange |
$169.93
|
| Rate for Payer: UMR Bronson Commercial |
$159.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$324.30
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
OP
|
$4.33
|
|
|
Service Code
|
NDC 51079007401
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna American Axle |
$2.81
|
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Aetna Medicare |
$2.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.81
|
| Rate for Payer: BCBS Complete |
$1.73
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Advantage |
$3.03
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.25
|
| Rate for Payer: PHP Commercial |
$3.68
|
| Rate for Payer: Priority Health SBD |
$2.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.81
|
| Rate for Payer: UHC Core |
$2.26
|
| Rate for Payer: UHC Exchange |
$1.70
|
| Rate for Payer: UMR Bronson Commercial |
$1.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.25
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
IP
|
$4.33
|
|
|
Service Code
|
NDC 51079007401
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna American Axle |
$2.81
|
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.81
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Advantage |
$3.03
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.25
|
| Rate for Payer: PHP Commercial |
$3.68
|
| Rate for Payer: Priority Health SBD |
$2.73
|
| Rate for Payer: UMR Bronson Commercial |
$1.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.25
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
IP
|
$4.33
|
|
|
Service Code
|
NDC 60687081111
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Aetna American Axle |
$2.81
|
| Rate for Payer: Aetna Commercial |
$3.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.81
|
| Rate for Payer: Cash Price |
$3.46
|
| Rate for Payer: Cofinity Advantage |
$3.03
|
| Rate for Payer: Cofinity Commercial |
$3.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.46
|
| Rate for Payer: Healthscope Commercial |
$3.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.03
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.68
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.25
|
| Rate for Payer: PHP Commercial |
$3.68
|
| Rate for Payer: Priority Health SBD |
$2.73
|
| Rate for Payer: UMR Bronson Commercial |
$1.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.25
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
OP
|
$345.45
|
|
|
Service Code
|
NDC 68084044711
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.82 |
| Max. Negotiated Rate |
$310.90 |
| Rate for Payer: Aetna American Axle |
$224.54
|
| Rate for Payer: Aetna Commercial |
$293.63
|
| Rate for Payer: Aetna Medicare |
$172.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.54
|
| Rate for Payer: BCBS Complete |
$138.18
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cofinity Advantage |
$241.81
|
| 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 |
$241.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$276.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.09
|
| Rate for Payer: PHP Commercial |
$293.63
|
| Rate for Payer: Priority Health SBD |
$217.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$224.54
|
| Rate for Payer: UHC Core |
$179.98
|
| Rate for Payer: UHC Exchange |
$135.76
|
| Rate for Payer: UMR Bronson Commercial |
$127.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$259.09
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
IP
|
$345.45
|
|
|
Service Code
|
NDC 68084044701
|
| 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 Advantage |
$241.81
|
| 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 |
$241.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$259.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$293.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$259.09
|
| Rate for Payer: PHP Commercial |
$293.63
|
| 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
|
$175.41
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
3697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.18 |
| Max. Negotiated Rate |
$157.87 |
| 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 |
$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: Cash Price |
$17.18
|
| Rate for Payer: Cash Price |
$140.33
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cofinity Advantage |
$16.29
|
| Rate for Payer: Cofinity Advantage |
$122.79
|
| Rate for Payer: Cofinity Advantage |
$15.04
|
| Rate for Payer: Cofinity Commercial |
$20.01
|
| Rate for Payer: Cofinity Commercial |
$150.85
|
| Rate for Payer: Cofinity Commercial |
$18.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.62
|
| Rate for Payer: Healthscope Commercial |
$19.33
|
| Rate for Payer: Healthscope Commercial |
$20.94
|
| Rate for Payer: Healthscope Commercial |
$157.87
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.45
|
| 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 Commercial |
$149.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.45
|
| Rate for Payer: PHP Commercial |
$18.26
|
| Rate for Payer: PHP Commercial |
$149.10
|
| Rate for Payer: PHP Commercial |
$19.78
|
| Rate for Payer: Priority Health SBD |
$110.51
|
| 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: 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 |
$17.45
|
|
|
HYDRALAZINE 20 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$21.48
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
3697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.24 |
| Max. Negotiated Rate |
$19.33 |
| Rate for Payer: Aetna American Axle |
$13.96
|
| Rate for Payer: Aetna American Axle |
$114.02
|
| Rate for Payer: Aetna American Axle |
$15.13
|
| Rate for Payer: Aetna Commercial |
$18.26
|
| Rate for Payer: Aetna Commercial |
$19.78
|
| Rate for Payer: Aetna Commercial |
$149.10
|
| Rate for Payer: Aetna Medicare |
$10.74
|
| Rate for Payer: Aetna Medicare |
$87.70
|
| Rate for Payer: Aetna Medicare |
$11.63
|
| 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) |
$15.13
|
| Rate for Payer: BCBS Complete |
$70.16
|
| Rate for Payer: BCBS Complete |
$8.59
|
| Rate for Payer: BCBS Complete |
$9.31
|
| Rate for Payer: BCBS Trust/PPO |
$14.23
|
| Rate for Payer: BCBS Trust/PPO |
$14.23
|
| Rate for Payer: BCBS Trust/PPO |
$14.23
|
| Rate for Payer: BCN Commercial |
$14.23
|
| Rate for Payer: BCN Commercial |
$14.23
|
| Rate for Payer: BCN Commercial |
$14.23
|
| Rate for Payer: Cash Price |
$140.33
|
| Rate for Payer: Cash Price |
$140.33
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Advantage |
$16.29
|
| Rate for Payer: Cofinity Advantage |
$15.04
|
| Rate for Payer: Cofinity Advantage |
$122.79
|
| Rate for Payer: Cofinity Commercial |
$150.85
|
| Rate for Payer: Cofinity Commercial |
$18.47
|
| Rate for Payer: Cofinity Commercial |
$20.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$157.87
|
| Rate for Payer: Healthscope Commercial |
$19.33
|
| Rate for Payer: Healthscope Commercial |
$20.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.04
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$140.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.45
|
| Rate for Payer: PHP Commercial |
$18.26
|
| Rate for Payer: PHP Commercial |
$149.10
|
| Rate for Payer: PHP Commercial |
$19.78
|
| Rate for Payer: Priority Health SBD |
$110.51
|
| Rate for Payer: Priority Health SBD |
$14.66
|
| Rate for Payer: Priority Health SBD |
$13.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.24
|
| Rate for Payer: UHC Core |
$7.24
|
| Rate for Payer: UHC Core |
$7.24
|
| Rate for Payer: UHC Core |
$7.24
|
| Rate for Payer: UHC Exchange |
$7.24
|
| Rate for Payer: UHC Exchange |
$7.24
|
| Rate for Payer: UHC Exchange |
$7.24
|
| Rate for Payer: UMR Bronson Commercial |
$8.61
|
| Rate for Payer: UMR Bronson Commercial |
$64.90
|
| Rate for Payer: UMR Bronson Commercial |
$7.95
|
| 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 |
$17.45
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$185.65
|
|
|
Service Code
|
NDC 64380073406
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.69 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna American Axle |
$120.67
|
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna Medicare |
$92.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.67
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Advantage |
$129.96
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$167.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.24
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health SBD |
$116.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.67
|
| Rate for Payer: UHC Core |
$96.72
|
| Rate for Payer: UHC Exchange |
$72.96
|
| Rate for Payer: UMR Bronson Commercial |
$68.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
