|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
NDC 60687067511
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna American Axle |
$1.40
|
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.40
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Advantage |
$1.51
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health SBD |
$1.36
|
| Rate for Payer: UMR Bronson Commercial |
$0.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.62
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
IP
|
$162.15
|
|
|
Service Code
|
NDC 00093506101
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.35 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna American Axle |
$105.40
|
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.40
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Advantage |
$113.50
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.61
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: Priority Health SBD |
$102.15
|
| Rate for Payer: UMR Bronson Commercial |
$71.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.61
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
OP
|
$216.20
|
|
|
Service Code
|
NDC 10702001101
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.99 |
| Max. Negotiated Rate |
$194.58 |
| Rate for Payer: Aetna American Axle |
$140.53
|
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna Medicare |
$108.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.53
|
| Rate for Payer: BCBS Complete |
$86.48
|
| Rate for Payer: Cash Price |
$172.96
|
| Rate for Payer: Cofinity Advantage |
$151.34
|
| Rate for Payer: Cofinity Commercial |
$185.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.96
|
| Rate for Payer: Healthscope Commercial |
$194.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.15
|
| Rate for Payer: PHP Commercial |
$183.77
|
| Rate for Payer: Priority Health SBD |
$136.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.53
|
| Rate for Payer: UHC Core |
$112.64
|
| Rate for Payer: UHC Exchange |
$84.97
|
| Rate for Payer: UMR Bronson Commercial |
$79.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.15
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
IP
|
$216.20
|
|
|
Service Code
|
NDC 10702001101
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.13 |
| Max. Negotiated Rate |
$194.58 |
| Rate for Payer: Aetna American Axle |
$140.53
|
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.53
|
| Rate for Payer: Cash Price |
$172.96
|
| Rate for Payer: Cofinity Advantage |
$151.34
|
| Rate for Payer: Cofinity Commercial |
$185.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.96
|
| Rate for Payer: Healthscope Commercial |
$194.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$151.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$162.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.15
|
| Rate for Payer: PHP Commercial |
$183.77
|
| Rate for Payer: Priority Health SBD |
$136.21
|
| Rate for Payer: UMR Bronson Commercial |
$95.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$162.15
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
IP
|
$215.65
|
|
|
Service Code
|
NDC 60687067501
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.89 |
| Max. Negotiated Rate |
$194.09 |
| Rate for Payer: Aetna American Axle |
$140.17
|
| Rate for Payer: Aetna Commercial |
$183.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.17
|
| 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: 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: UMR Bronson Commercial |
$94.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$161.74
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
OP
|
$162.15
|
|
|
Service Code
|
NDC 16571011401
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna American Axle |
$105.40
|
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Aetna Medicare |
$81.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.40
|
| Rate for Payer: BCBS Complete |
$64.86
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Advantage |
$113.50
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.61
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: Priority Health SBD |
$102.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.40
|
| Rate for Payer: UHC Core |
$84.48
|
| Rate for Payer: UHC Exchange |
$63.72
|
| Rate for Payer: UMR Bronson Commercial |
$60.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.61
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
OP
|
$441.80
|
|
|
Service Code
|
NDC 63739048610
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$163.47 |
| Max. Negotiated Rate |
$397.62 |
| Rate for Payer: Aetna American Axle |
$287.17
|
| Rate for Payer: Aetna Commercial |
$375.53
|
| Rate for Payer: Aetna Medicare |
$220.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.17
|
| Rate for Payer: BCBS Complete |
$176.72
|
| Rate for Payer: Cash Price |
$353.44
|
| Rate for Payer: Cofinity Advantage |
$309.26
|
| Rate for Payer: Cofinity Commercial |
$379.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.44
|
| Rate for Payer: Healthscope Commercial |
$397.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.35
|
| Rate for Payer: MI Amish Medical Board Commercial |
$353.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.35
|
| Rate for Payer: PHP Commercial |
$375.53
|
| Rate for Payer: Priority Health SBD |
$278.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$287.17
|
| Rate for Payer: UHC Core |
$230.18
|
| Rate for Payer: UHC Exchange |
$173.63
|
| Rate for Payer: UMR Bronson Commercial |
$163.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.35
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
IP
|
$162.15
|
|
|
Service Code
|
NDC 16571011401
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.35 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna American Axle |
$105.40
|
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.40
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Advantage |
$113.50
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.61
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: Priority Health SBD |
$102.15
|
| Rate for Payer: UMR Bronson Commercial |
$71.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.61
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
OP
|
$453.55
|
|
|
Service Code
|
NDC 00904661761
|
| Hospital Charge Code |
3774
|
|
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
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
OP
|
$162.15
|
|
|
Service Code
|
NDC 00093506101
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$145.94 |
| Rate for Payer: Aetna American Axle |
$105.40
|
| Rate for Payer: Aetna Commercial |
$137.83
|
| Rate for Payer: Aetna Medicare |
$81.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.40
|
| Rate for Payer: BCBS Complete |
$64.86
|
| Rate for Payer: Cash Price |
$129.72
|
| Rate for Payer: Cofinity Advantage |
$113.50
|
| Rate for Payer: Cofinity Commercial |
$139.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.72
|
| Rate for Payer: Healthscope Commercial |
$145.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.61
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.61
|
| Rate for Payer: PHP Commercial |
$137.83
|
| Rate for Payer: Priority Health SBD |
$102.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$105.40
|
| Rate for Payer: UHC Core |
$84.48
|
| Rate for Payer: UHC Exchange |
$63.72
|
| Rate for Payer: UMR Bronson Commercial |
$60.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.61
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
IP
|
$453.55
|
|
|
Service Code
|
NDC 00904661761
|
| Hospital Charge Code |
3774
|
|
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
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
OP
|
$2.16
|
|
|
Service Code
|
NDC 60687067511
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Aetna American Axle |
$1.40
|
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna Medicare |
$1.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.40
|
| Rate for Payer: BCBS Complete |
$0.86
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Advantage |
$1.51
|
| Rate for Payer: Cofinity Commercial |
$1.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$1.94
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.51
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: PHP Commercial |
$1.84
|
| Rate for Payer: Priority Health SBD |
$1.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.40
|
| Rate for Payer: UHC Core |
$1.13
|
| Rate for Payer: UHC Exchange |
$0.85
|
| Rate for Payer: UMR Bronson Commercial |
$0.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.62
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
IP
|
$441.80
|
|
|
Service Code
|
NDC 63739048610
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.39 |
| Max. Negotiated Rate |
$397.62 |
| Rate for Payer: Aetna American Axle |
$287.17
|
| Rate for Payer: Aetna Commercial |
$375.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.17
|
| Rate for Payer: Cash Price |
$353.44
|
| Rate for Payer: Cofinity Advantage |
$309.26
|
| Rate for Payer: Cofinity Commercial |
$379.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.44
|
| Rate for Payer: Healthscope Commercial |
$397.62
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$309.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$331.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.35
|
| Rate for Payer: PHP Commercial |
$375.53
|
| Rate for Payer: Priority Health SBD |
$278.33
|
| Rate for Payer: UMR Bronson Commercial |
$194.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$331.35
|
|
|
HYOSCYAMINE 0.125 MG/ML ORAL DROPS
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
NDC 54838050615
|
| Hospital Charge Code |
3782
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna American Axle |
$46.80
|
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.80
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cofinity Advantage |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$61.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.60
|
| Rate for Payer: Healthscope Commercial |
$64.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.00
|
| Rate for Payer: PHP Commercial |
$61.20
|
| Rate for Payer: Priority Health SBD |
$45.36
|
| Rate for Payer: UMR Bronson Commercial |
$31.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.00
|
|
|
HYOSCYAMINE 0.125 MG/ML ORAL DROPS
|
Facility
|
IP
|
$88.92
|
|
|
Service Code
|
NDC 39328004715
|
| Hospital Charge Code |
3782
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.12 |
| Max. Negotiated Rate |
$80.03 |
| Rate for Payer: Aetna American Axle |
$57.80
|
| Rate for Payer: Aetna Commercial |
$75.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.80
|
| Rate for Payer: Cash Price |
$71.14
|
| Rate for Payer: Cofinity Advantage |
$62.24
|
| Rate for Payer: Cofinity Commercial |
$76.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.14
|
| Rate for Payer: Healthscope Commercial |
$80.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.69
|
| Rate for Payer: PHP Commercial |
$75.58
|
| Rate for Payer: Priority Health SBD |
$56.02
|
| Rate for Payer: UMR Bronson Commercial |
$39.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.69
|
|
|
HYOSCYAMINE 0.125 MG/ML ORAL DROPS
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
NDC 54838050615
|
| Hospital Charge Code |
3782
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$26.64 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Aetna American Axle |
$46.80
|
| Rate for Payer: Aetna Commercial |
$61.20
|
| Rate for Payer: Aetna Medicare |
$36.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.80
|
| Rate for Payer: BCBS Complete |
$28.80
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cofinity Advantage |
$50.40
|
| Rate for Payer: Cofinity Commercial |
$61.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.60
|
| Rate for Payer: Healthscope Commercial |
$64.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$50.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$54.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$57.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$61.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.00
|
| Rate for Payer: PHP Commercial |
$61.20
|
| Rate for Payer: Priority Health SBD |
$45.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.80
|
| Rate for Payer: UHC Core |
$37.51
|
| Rate for Payer: UHC Exchange |
$28.30
|
| Rate for Payer: UMR Bronson Commercial |
$26.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$54.00
|
|
|
HYOSCYAMINE 0.125 MG/ML ORAL DROPS
|
Facility
|
OP
|
$88.92
|
|
|
Service Code
|
NDC 39328004715
|
| Hospital Charge Code |
3782
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$80.03 |
| Rate for Payer: Aetna American Axle |
$57.80
|
| Rate for Payer: Aetna Commercial |
$75.58
|
| Rate for Payer: Aetna Medicare |
$44.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.80
|
| Rate for Payer: BCBS Complete |
$35.57
|
| Rate for Payer: Cash Price |
$71.14
|
| Rate for Payer: Cofinity Advantage |
$62.24
|
| Rate for Payer: Cofinity Commercial |
$76.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.14
|
| Rate for Payer: Healthscope Commercial |
$80.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$62.24
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$66.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$71.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$66.69
|
| Rate for Payer: PHP Commercial |
$75.58
|
| Rate for Payer: Priority Health SBD |
$56.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.80
|
| Rate for Payer: UHC Core |
$46.33
|
| Rate for Payer: UHC Exchange |
$34.95
|
| Rate for Payer: UMR Bronson Commercial |
$32.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$66.69
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$398.05
|
|
|
Service Code
|
NDC 42192033901
|
| Hospital Charge Code |
17023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$175.14 |
| Max. Negotiated Rate |
$358.25 |
| Rate for Payer: Aetna American Axle |
$258.73
|
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.73
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Advantage |
$278.63
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.54
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health SBD |
$250.77
|
| Rate for Payer: UMR Bronson Commercial |
$175.14
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$368.95
|
|
|
Service Code
|
NDC 62559042401
|
| Hospital Charge Code |
17023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$162.34 |
| Max. Negotiated Rate |
$332.06 |
| Rate for Payer: Aetna American Axle |
$239.82
|
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.82
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Advantage |
$258.26
|
| Rate for Payer: Cofinity Commercial |
$317.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$258.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.71
|
| Rate for Payer: PHP Commercial |
$313.61
|
| Rate for Payer: Priority Health SBD |
$232.44
|
| Rate for Payer: UMR Bronson Commercial |
$162.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.71
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$398.05
|
|
|
Service Code
|
NDC 42192033901
|
| Hospital Charge Code |
17023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.28 |
| Max. Negotiated Rate |
$358.25 |
| Rate for Payer: Aetna American Axle |
$258.73
|
| Rate for Payer: Aetna Commercial |
$338.34
|
| Rate for Payer: Aetna Medicare |
$199.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.73
|
| Rate for Payer: BCBS Complete |
$159.22
|
| Rate for Payer: Cash Price |
$318.44
|
| Rate for Payer: Cofinity Advantage |
$278.63
|
| Rate for Payer: Cofinity Commercial |
$342.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$318.44
|
| Rate for Payer: Healthscope Commercial |
$358.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$278.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$298.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$318.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$338.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$298.54
|
| Rate for Payer: PHP Commercial |
$338.34
|
| Rate for Payer: Priority Health SBD |
$250.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.73
|
| Rate for Payer: UHC Core |
$207.38
|
| Rate for Payer: UHC Exchange |
$156.43
|
| Rate for Payer: UMR Bronson Commercial |
$147.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$298.54
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$303.36
|
|
|
Service Code
|
NDC 47781001101
|
| Hospital Charge Code |
17023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.24 |
| Max. Negotiated Rate |
$273.02 |
| Rate for Payer: Aetna American Axle |
$197.18
|
| Rate for Payer: Aetna Commercial |
$257.86
|
| Rate for Payer: Aetna Medicare |
$151.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.18
|
| Rate for Payer: BCBS Complete |
$121.34
|
| Rate for Payer: Cash Price |
$242.69
|
| Rate for Payer: Cofinity Advantage |
$212.35
|
| Rate for Payer: Cofinity Commercial |
$260.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.69
|
| Rate for Payer: Healthscope Commercial |
$273.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$242.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.52
|
| Rate for Payer: PHP Commercial |
$257.86
|
| Rate for Payer: Priority Health SBD |
$191.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.18
|
| Rate for Payer: UHC Core |
$158.05
|
| Rate for Payer: UHC Exchange |
$119.22
|
| Rate for Payer: UMR Bronson Commercial |
$112.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.52
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET
|
Facility
|
IP
|
$303.36
|
|
|
Service Code
|
NDC 47781001101
|
| Hospital Charge Code |
17023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$133.48 |
| Max. Negotiated Rate |
$273.02 |
| Rate for Payer: Aetna American Axle |
$197.18
|
| Rate for Payer: Aetna Commercial |
$257.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.18
|
| Rate for Payer: Cash Price |
$242.69
|
| Rate for Payer: Cofinity Advantage |
$212.35
|
| Rate for Payer: Cofinity Commercial |
$260.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$242.69
|
| Rate for Payer: Healthscope Commercial |
$273.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$212.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$227.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$257.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$227.52
|
| Rate for Payer: PHP Commercial |
$257.86
|
| Rate for Payer: Priority Health SBD |
$191.12
|
| Rate for Payer: UMR Bronson Commercial |
$133.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$227.52
|
|
|
HYOSCYAMINE 0.125 MG SUBLINGUAL TABLET
|
Facility
|
OP
|
$368.95
|
|
|
Service Code
|
NDC 62559042401
|
| Hospital Charge Code |
17023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$136.51 |
| Max. Negotiated Rate |
$332.06 |
| Rate for Payer: Aetna American Axle |
$239.82
|
| Rate for Payer: Aetna Commercial |
$313.61
|
| Rate for Payer: Aetna Medicare |
$184.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$239.82
|
| Rate for Payer: BCBS Complete |
$147.58
|
| Rate for Payer: Cash Price |
$295.16
|
| Rate for Payer: Cofinity Advantage |
$258.26
|
| Rate for Payer: Cofinity Commercial |
$317.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$295.16
|
| Rate for Payer: Healthscope Commercial |
$332.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$258.26
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$276.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$295.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.71
|
| Rate for Payer: PHP Commercial |
$313.61
|
| Rate for Payer: Priority Health SBD |
$232.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.82
|
| Rate for Payer: UHC Core |
$192.22
|
| Rate for Payer: UHC Exchange |
$145.00
|
| Rate for Payer: UMR Bronson Commercial |
$136.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$276.71
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$6,164.63
|
|
|
Service Code
|
APR-DRG 1993
|
| Min. Negotiated Rate |
$5,871.08 |
| Max. Negotiated Rate |
$6,164.63 |
| Rate for Payer: BCBS Complete |
$6,164.63
|
| Rate for Payer: Mclaren Medicaid |
$5,871.08
|
| Rate for Payer: Meridian Medicaid |
$6,164.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$5,871.08
|
| Rate for Payer: UHC Medicaid |
$5,871.08
|
| Rate for Payer: UHCCP Medicaid |
$5,871.08
|
|
|
HYPERTENSION
|
Facility
|
IP
|
$4,549.62
|
|
|
Service Code
|
APR-DRG 1991
|
| Min. Negotiated Rate |
$4,332.97 |
| Max. Negotiated Rate |
$4,549.62 |
| Rate for Payer: BCBS Complete |
$4,549.62
|
| Rate for Payer: Mclaren Medicaid |
$4,332.97
|
| Rate for Payer: Meridian Medicaid |
$4,549.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,332.97
|
| Rate for Payer: UHC Medicaid |
$4,332.97
|
| Rate for Payer: UHCCP Medicaid |
$4,332.97
|
|
