|
HYDROXYUREA (BULK) 100 % POWDER
|
Facility
|
IP
|
$226.80
|
|
|
Service Code
|
NDC 38779135404
|
| Hospital Charge Code |
23979
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.79 |
| Max. Negotiated Rate |
$204.12 |
| Rate for Payer: Aetna American Axle |
$147.42
|
| Rate for Payer: Aetna Commercial |
$192.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.42
|
| Rate for Payer: Cash Price |
$181.44
|
| Rate for Payer: Cofinity Advantage |
$158.76
|
| Rate for Payer: Cofinity Commercial |
$195.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.44
|
| Rate for Payer: Healthscope Commercial |
$204.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.10
|
| Rate for Payer: PHP Commercial |
$192.78
|
| Rate for Payer: Priority Health SBD |
$142.88
|
| Rate for Payer: UMR Bronson Commercial |
$99.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.10
|
|
|
HYDROXYUREA (BULK) 100 % POWDER
|
Facility
|
OP
|
$1,272.00
|
|
|
Service Code
|
NDC 51552085104
|
| Hospital Charge Code |
23979
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$470.64 |
| Max. Negotiated Rate |
$1,144.80 |
| Rate for Payer: Aetna American Axle |
$826.80
|
| Rate for Payer: Aetna Commercial |
$1,081.20
|
| Rate for Payer: Aetna Medicare |
$636.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$826.80
|
| Rate for Payer: BCBS Complete |
$508.80
|
| Rate for Payer: Cash Price |
$1,017.60
|
| Rate for Payer: Cofinity Advantage |
$890.40
|
| Rate for Payer: Cofinity Commercial |
$1,093.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,017.60
|
| Rate for Payer: Healthscope Commercial |
$1,144.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$890.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$954.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,017.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,081.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$954.00
|
| Rate for Payer: PHP Commercial |
$1,081.20
|
| Rate for Payer: Priority Health SBD |
$801.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$826.80
|
| Rate for Payer: UHC Core |
$662.71
|
| Rate for Payer: UHC Exchange |
$499.90
|
| Rate for Payer: UMR Bronson Commercial |
$470.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$954.00
|
|
|
HYDROXYUREA (BULK) 100 % POWDER
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
NDC 51552085109
|
| Hospital Charge Code |
23979
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.10 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Aetna American Axle |
$214.50
|
| Rate for Payer: Aetna Commercial |
$280.50
|
| Rate for Payer: Aetna Medicare |
$165.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.50
|
| Rate for Payer: BCBS Complete |
$132.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cofinity Advantage |
$231.00
|
| Rate for Payer: Cofinity Commercial |
$283.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$264.00
|
| Rate for Payer: Healthscope Commercial |
$297.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$231.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$247.50
|
| Rate for Payer: MI Amish Medical Board Commercial |
$264.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$280.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$247.50
|
| Rate for Payer: PHP Commercial |
$280.50
|
| Rate for Payer: Priority Health SBD |
$207.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.50
|
| Rate for Payer: UHC Core |
$171.93
|
| Rate for Payer: UHC Exchange |
$129.69
|
| Rate for Payer: UMR Bronson Commercial |
$122.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$247.50
|
|
|
HYDROXYUREA (BULK) 100 % POWDER
|
Facility
|
OP
|
$226.80
|
|
|
Service Code
|
NDC 38779135404
|
| Hospital Charge Code |
23979
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.92 |
| Max. Negotiated Rate |
$204.12 |
| Rate for Payer: Aetna American Axle |
$147.42
|
| Rate for Payer: Aetna Commercial |
$192.78
|
| Rate for Payer: Aetna Medicare |
$113.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.42
|
| Rate for Payer: BCBS Complete |
$90.72
|
| Rate for Payer: Cash Price |
$181.44
|
| Rate for Payer: Cofinity Advantage |
$158.76
|
| Rate for Payer: Cofinity Commercial |
$195.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$181.44
|
| Rate for Payer: Healthscope Commercial |
$204.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$158.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$170.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$181.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$192.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$170.10
|
| Rate for Payer: PHP Commercial |
$192.78
|
| Rate for Payer: Priority Health SBD |
$142.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.42
|
| Rate for Payer: UHC Core |
$118.16
|
| Rate for Payer: UHC Exchange |
$89.13
|
| Rate for Payer: UMR Bronson Commercial |
$83.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$170.10
|
|
|
HYDROXYUREA (SICKLE CELL) 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$2,741.84
|
|
|
Service Code
|
NDC 62484001504
|
| Hospital Charge Code |
210330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,014.48 |
| Max. Negotiated Rate |
$2,467.66 |
| Rate for Payer: Aetna American Axle |
$1,782.20
|
| Rate for Payer: Aetna Commercial |
$2,330.56
|
| Rate for Payer: Aetna Medicare |
$1,370.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,782.20
|
| Rate for Payer: BCBS Complete |
$1,096.74
|
| Rate for Payer: Cash Price |
$2,193.47
|
| Rate for Payer: Cofinity Advantage |
$1,919.29
|
| Rate for Payer: Cofinity Commercial |
$2,357.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,193.47
|
| Rate for Payer: Healthscope Commercial |
$2,467.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,919.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,056.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,193.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,330.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,056.38
|
| Rate for Payer: PHP Commercial |
$2,330.56
|
| Rate for Payer: Priority Health SBD |
$1,727.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,782.20
|
| Rate for Payer: UHC Core |
$1,428.50
|
| Rate for Payer: UHC Exchange |
$1,077.54
|
| Rate for Payer: UMR Bronson Commercial |
$1,014.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,056.38
|
|
|
HYDROXYUREA (SICKLE CELL) 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$2,741.84
|
|
|
Service Code
|
NDC 62484001504
|
| Hospital Charge Code |
210330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,206.41 |
| Max. Negotiated Rate |
$2,467.66 |
| Rate for Payer: Aetna American Axle |
$1,782.20
|
| Rate for Payer: Aetna Commercial |
$2,330.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,782.20
|
| Rate for Payer: Cash Price |
$2,193.47
|
| Rate for Payer: Cofinity Advantage |
$1,919.29
|
| Rate for Payer: Cofinity Commercial |
$2,357.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,193.47
|
| Rate for Payer: Healthscope Commercial |
$2,467.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,919.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,056.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,330.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,056.38
|
| Rate for Payer: PHP Commercial |
$2,330.56
|
| Rate for Payer: Priority Health SBD |
$1,727.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,206.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,056.38
|
|
|
HYDROXYUREA (SICKLE CELL) 100 MG/ML ORAL SOLUTION
|
Facility
|
IP
|
$2,741.84
|
|
|
Service Code
|
NDC 62484001505
|
| Hospital Charge Code |
210330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,206.41 |
| Max. Negotiated Rate |
$2,467.66 |
| Rate for Payer: Aetna American Axle |
$1,782.20
|
| Rate for Payer: Aetna Commercial |
$2,330.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,782.20
|
| Rate for Payer: Cash Price |
$2,193.47
|
| Rate for Payer: Cofinity Advantage |
$1,919.29
|
| Rate for Payer: Cofinity Commercial |
$2,357.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,193.47
|
| Rate for Payer: Healthscope Commercial |
$2,467.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,919.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,056.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,330.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,056.38
|
| Rate for Payer: PHP Commercial |
$2,330.56
|
| Rate for Payer: Priority Health SBD |
$1,727.36
|
| Rate for Payer: UMR Bronson Commercial |
$1,206.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,056.38
|
|
|
HYDROXYUREA (SICKLE CELL) 100 MG/ML ORAL SOLUTION
|
Facility
|
OP
|
$2,741.84
|
|
|
Service Code
|
NDC 62484001505
|
| Hospital Charge Code |
210330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1,014.48 |
| Max. Negotiated Rate |
$2,467.66 |
| Rate for Payer: Aetna American Axle |
$1,782.20
|
| Rate for Payer: Aetna Commercial |
$2,330.56
|
| Rate for Payer: Aetna Medicare |
$1,370.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,782.20
|
| Rate for Payer: BCBS Complete |
$1,096.74
|
| Rate for Payer: Cash Price |
$2,193.47
|
| Rate for Payer: Cofinity Advantage |
$1,919.29
|
| Rate for Payer: Cofinity Commercial |
$2,357.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,193.47
|
| Rate for Payer: Healthscope Commercial |
$2,467.66
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,919.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2,056.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2,193.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,330.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,056.38
|
| Rate for Payer: PHP Commercial |
$2,330.56
|
| Rate for Payer: Priority Health SBD |
$1,727.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,782.20
|
| Rate for Payer: UHC Core |
$1,428.50
|
| Rate for Payer: UHC Exchange |
$1,077.54
|
| Rate for Payer: UMR Bronson Commercial |
$1,014.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2,056.38
|
|
|
HYDROXYZINE HCL 10 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$277.89
|
|
|
Service Code
|
NDC 60432015016
|
| Hospital Charge Code |
3771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$122.27 |
| Max. Negotiated Rate |
$250.10 |
| Rate for Payer: Aetna American Axle |
$180.63
|
| Rate for Payer: Aetna Commercial |
$236.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.63
|
| Rate for Payer: Cash Price |
$222.31
|
| Rate for Payer: Cofinity Advantage |
$194.52
|
| Rate for Payer: Cofinity Commercial |
$238.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.31
|
| Rate for Payer: Healthscope Commercial |
$250.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.42
|
| Rate for Payer: PHP Commercial |
$236.21
|
| Rate for Payer: Priority Health SBD |
$175.07
|
| Rate for Payer: UMR Bronson Commercial |
$122.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.42
|
|
|
HYDROXYZINE HCL 10 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$277.89
|
|
|
Service Code
|
NDC 60432015016
|
| Hospital Charge Code |
3771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$102.82 |
| Max. Negotiated Rate |
$250.10 |
| Rate for Payer: Aetna American Axle |
$180.63
|
| Rate for Payer: Aetna Commercial |
$236.21
|
| Rate for Payer: Aetna Medicare |
$138.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.63
|
| Rate for Payer: BCBS Complete |
$111.16
|
| Rate for Payer: Cash Price |
$222.31
|
| Rate for Payer: Cofinity Advantage |
$194.52
|
| Rate for Payer: Cofinity Commercial |
$238.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$222.31
|
| Rate for Payer: Healthscope Commercial |
$250.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$194.52
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$208.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$222.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$236.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$208.42
|
| Rate for Payer: PHP Commercial |
$236.21
|
| Rate for Payer: Priority Health SBD |
$175.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.63
|
| Rate for Payer: UHC Core |
$144.78
|
| Rate for Payer: UHC Exchange |
$109.21
|
| Rate for Payer: UMR Bronson Commercial |
$102.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$208.42
|
|
|
HYDROXYZINE HCL 10 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$1,767.37
|
|
|
Service Code
|
NDC 54838050280
|
| Hospital Charge Code |
3771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$653.93 |
| Max. Negotiated Rate |
$1,590.63 |
| Rate for Payer: Aetna American Axle |
$1,148.79
|
| Rate for Payer: Aetna Commercial |
$1,502.26
|
| Rate for Payer: Aetna Medicare |
$883.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,148.79
|
| Rate for Payer: BCBS Complete |
$706.95
|
| Rate for Payer: Cash Price |
$1,413.90
|
| Rate for Payer: Cofinity Advantage |
$1,237.16
|
| Rate for Payer: Cofinity Commercial |
$1,519.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,413.90
|
| Rate for Payer: Healthscope Commercial |
$1,590.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,237.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,325.53
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,413.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,502.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,325.53
|
| Rate for Payer: PHP Commercial |
$1,502.26
|
| Rate for Payer: Priority Health SBD |
$1,113.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,148.79
|
| Rate for Payer: UHC Core |
$920.80
|
| Rate for Payer: UHC Exchange |
$694.58
|
| Rate for Payer: UMR Bronson Commercial |
$653.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,325.53
|
|
|
HYDROXYZINE HCL 10 MG/5 ML ORAL SOLUTION
|
Facility
|
OP
|
$236.88
|
|
|
Service Code
|
NDC 60432015004
|
| Hospital Charge Code |
3771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.65 |
| Max. Negotiated Rate |
$213.19 |
| Rate for Payer: Aetna American Axle |
$153.97
|
| Rate for Payer: Aetna Commercial |
$201.35
|
| Rate for Payer: Aetna Medicare |
$118.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.97
|
| Rate for Payer: BCBS Complete |
$94.75
|
| Rate for Payer: Cash Price |
$189.50
|
| Rate for Payer: Cofinity Advantage |
$165.82
|
| Rate for Payer: Cofinity Commercial |
$203.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.50
|
| Rate for Payer: Healthscope Commercial |
$213.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$189.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.66
|
| Rate for Payer: PHP Commercial |
$201.35
|
| Rate for Payer: Priority Health SBD |
$149.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.97
|
| Rate for Payer: UHC Core |
$123.41
|
| Rate for Payer: UHC Exchange |
$93.09
|
| Rate for Payer: UMR Bronson Commercial |
$87.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.66
|
|
|
HYDROXYZINE HCL 10 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$1,767.37
|
|
|
Service Code
|
NDC 54838050280
|
| Hospital Charge Code |
3771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$777.64 |
| Max. Negotiated Rate |
$1,590.63 |
| Rate for Payer: Aetna American Axle |
$1,148.79
|
| Rate for Payer: Aetna Commercial |
$1,502.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,148.79
|
| Rate for Payer: Cash Price |
$1,413.90
|
| Rate for Payer: Cofinity Advantage |
$1,237.16
|
| Rate for Payer: Cofinity Commercial |
$1,519.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,413.90
|
| Rate for Payer: Healthscope Commercial |
$1,590.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,237.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,325.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,502.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,325.53
|
| Rate for Payer: PHP Commercial |
$1,502.26
|
| Rate for Payer: Priority Health SBD |
$1,113.44
|
| Rate for Payer: UMR Bronson Commercial |
$777.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,325.53
|
|
|
HYDROXYZINE HCL 10 MG/5 ML ORAL SOLUTION
|
Facility
|
IP
|
$236.88
|
|
|
Service Code
|
NDC 60432015004
|
| Hospital Charge Code |
3771
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.23 |
| Max. Negotiated Rate |
$213.19 |
| Rate for Payer: Aetna American Axle |
$153.97
|
| Rate for Payer: Aetna Commercial |
$201.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.97
|
| Rate for Payer: Cash Price |
$189.50
|
| Rate for Payer: Cofinity Advantage |
$165.82
|
| Rate for Payer: Cofinity Commercial |
$203.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.50
|
| Rate for Payer: Healthscope Commercial |
$213.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$201.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$177.66
|
| Rate for Payer: PHP Commercial |
$201.35
|
| Rate for Payer: Priority Health SBD |
$149.23
|
| Rate for Payer: UMR Bronson Commercial |
$104.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.66
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
IP
|
$2.36
|
|
|
Service Code
|
NDC 60687066411
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna American Axle |
$1.53
|
| Rate for Payer: Aetna Commercial |
$2.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.53
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cofinity Advantage |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$2.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.89
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.77
|
| Rate for Payer: PHP Commercial |
$2.01
|
| Rate for Payer: Priority Health SBD |
$1.49
|
| Rate for Payer: UMR Bronson Commercial |
$1.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.77
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
OP
|
$2.36
|
|
|
Service Code
|
NDC 60687066411
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Aetna American Axle |
$1.53
|
| Rate for Payer: Aetna Commercial |
$2.01
|
| Rate for Payer: Aetna Medicare |
$1.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.53
|
| Rate for Payer: BCBS Complete |
$0.94
|
| Rate for Payer: Cash Price |
$1.89
|
| Rate for Payer: Cofinity Advantage |
$1.65
|
| Rate for Payer: Cofinity Commercial |
$2.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.89
|
| Rate for Payer: Healthscope Commercial |
$2.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.77
|
| Rate for Payer: PHP Commercial |
$2.01
|
| Rate for Payer: Priority Health SBD |
$1.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.53
|
| Rate for Payer: UHC Core |
$1.23
|
| Rate for Payer: UHC Exchange |
$0.93
|
| Rate for Payer: UMR Bronson Commercial |
$0.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.77
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
OP
|
$91.65
|
|
|
Service Code
|
NDC 23155050001
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.91 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna American Axle |
$59.57
|
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Medicare |
$45.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.57
|
| Rate for Payer: BCBS Complete |
$36.66
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Advantage |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.74
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health SBD |
$57.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.57
|
| Rate for Payer: UHC Core |
$47.75
|
| Rate for Payer: UHC Exchange |
$36.02
|
| Rate for Payer: UMR Bronson Commercial |
$33.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
OP
|
$173.90
|
|
|
Service Code
|
NDC 10702001001
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$64.34 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna American Axle |
$113.03
|
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna Medicare |
$86.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| Rate for Payer: BCBS Complete |
$69.56
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Advantage |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.43
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health SBD |
$109.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.03
|
| Rate for Payer: UHC Core |
$90.60
|
| Rate for Payer: UHC Exchange |
$68.34
|
| Rate for Payer: UMR Bronson Commercial |
$64.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.43
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
IP
|
$173.90
|
|
|
Service Code
|
NDC 10702001001
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.52 |
| Max. Negotiated Rate |
$156.51 |
| Rate for Payer: Aetna American Axle |
$113.03
|
| Rate for Payer: Aetna Commercial |
$147.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.03
|
| Rate for Payer: Cash Price |
$139.12
|
| Rate for Payer: Cofinity Advantage |
$121.73
|
| Rate for Payer: Cofinity Commercial |
$149.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.12
|
| Rate for Payer: Healthscope Commercial |
$156.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$121.73
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$130.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$147.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$130.43
|
| Rate for Payer: PHP Commercial |
$147.81
|
| Rate for Payer: Priority Health SBD |
$109.56
|
| Rate for Payer: UMR Bronson Commercial |
$76.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$130.43
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
IP
|
$91.65
|
|
|
Service Code
|
NDC 23155050001
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.33 |
| Max. Negotiated Rate |
$82.48 |
| Rate for Payer: Aetna American Axle |
$59.57
|
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.57
|
| Rate for Payer: Cash Price |
$73.32
|
| Rate for Payer: Cofinity Advantage |
$64.16
|
| Rate for Payer: Cofinity Commercial |
$78.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$73.32
|
| Rate for Payer: Healthscope Commercial |
$82.48
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$64.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$68.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$77.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.74
|
| Rate for Payer: PHP Commercial |
$77.90
|
| Rate for Payer: Priority Health SBD |
$57.74
|
| Rate for Payer: UMR Bronson Commercial |
$40.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$68.74
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
OP
|
$235.60
|
|
|
Service Code
|
NDC 60687066401
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.17 |
| Max. Negotiated Rate |
$212.04 |
| Rate for Payer: Aetna American Axle |
$153.14
|
| Rate for Payer: Aetna Commercial |
$200.26
|
| Rate for Payer: Aetna Medicare |
$117.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.14
|
| Rate for Payer: BCBS Complete |
$94.24
|
| Rate for Payer: Cash Price |
$188.48
|
| Rate for Payer: Cofinity Advantage |
$164.92
|
| Rate for Payer: Cofinity Commercial |
$202.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.48
|
| Rate for Payer: Healthscope Commercial |
$212.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$188.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.70
|
| Rate for Payer: PHP Commercial |
$200.26
|
| Rate for Payer: Priority Health SBD |
$148.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.14
|
| Rate for Payer: UHC Core |
$122.75
|
| Rate for Payer: UHC Exchange |
$92.59
|
| Rate for Payer: UMR Bronson Commercial |
$87.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.70
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
IP
|
$235.60
|
|
|
Service Code
|
NDC 60687066401
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.66 |
| Max. Negotiated Rate |
$212.04 |
| Rate for Payer: Aetna American Axle |
$153.14
|
| Rate for Payer: Aetna Commercial |
$200.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.14
|
| Rate for Payer: Cash Price |
$188.48
|
| Rate for Payer: Cofinity Advantage |
$164.92
|
| Rate for Payer: Cofinity Commercial |
$202.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$188.48
|
| Rate for Payer: Healthscope Commercial |
$212.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$164.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$176.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$176.70
|
| Rate for Payer: PHP Commercial |
$200.26
|
| Rate for Payer: Priority Health SBD |
$148.43
|
| Rate for Payer: UMR Bronson Commercial |
$103.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$176.70
|
|
|
HYDROXYZINE HCL 25 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$75.95
|
|
|
Service Code
|
HCPCS J3410
|
| Hospital Charge Code |
3769
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.45 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Aetna American Axle |
$49.37
|
| Rate for Payer: Aetna Commercial |
$64.56
|
| Rate for Payer: Aetna Medicare |
$37.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.37
|
| Rate for Payer: BCBS Complete |
$30.38
|
| Rate for Payer: BCBS Trust/PPO |
$42.14
|
| Rate for Payer: BCN Commercial |
$42.14
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Advantage |
$53.16
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Healthscope Commercial |
$68.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.96
|
| Rate for Payer: PHP Commercial |
$64.56
|
| Rate for Payer: Priority Health SBD |
$47.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.45
|
| Rate for Payer: UHC Core |
$21.45
|
| Rate for Payer: UHC Exchange |
$21.45
|
| Rate for Payer: UMR Bronson Commercial |
$28.10
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.96
|
|
|
HYDROXYZINE HCL 25 MG/ML INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$75.95
|
|
|
Service Code
|
HCPCS J3410
|
| Hospital Charge Code |
3769
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.42 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Aetna American Axle |
$49.37
|
| Rate for Payer: Aetna Commercial |
$64.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.37
|
| Rate for Payer: Cash Price |
$60.76
|
| Rate for Payer: Cofinity Advantage |
$53.16
|
| Rate for Payer: Cofinity Commercial |
$65.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.76
|
| Rate for Payer: Healthscope Commercial |
$68.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$64.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.96
|
| Rate for Payer: PHP Commercial |
$64.56
|
| Rate for Payer: Priority Health SBD |
$47.85
|
| Rate for Payer: UMR Bronson Commercial |
$33.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.96
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
OP
|
$215.65
|
|
|
Service Code
|
NDC 60687067501
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.79 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna American Axle |
$140.17
|
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna Medicare |
$107.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| Rate for Payer: BCBS Complete |
$86.26
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Advantage |
$150.96
|
| Rate for Payer: Cofinity Commercial |
$185.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$194.09
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$150.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$161.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.74
|
| Rate for Payer: PHP Commercial |
$183.30
|
| Rate for Payer: Priority Health SBD |
$135.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.17
|
| Rate for Payer: UHC Core |
$112.35
|
| Rate for Payer: UHC Exchange |
$84.75
|
| Rate for Payer: UMR Bronson Commercial |
$79.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
