|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$166.66
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
76338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.33 |
| Max. Negotiated Rate |
$149.99 |
| Rate for Payer: Aetna American Axle |
$108.33
|
| Rate for Payer: Aetna Commercial |
$141.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.33
|
| Rate for Payer: Cash Price |
$133.33
|
| Rate for Payer: Cofinity Commercial |
$116.66
|
| Rate for Payer: Cofinity Commercial |
$143.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.33
|
| Rate for Payer: Healthscope Commercial |
$149.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.66
|
| Rate for Payer: PHP Commercial |
$141.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.33
|
| Rate for Payer: Priority Health SBD |
$105.00
|
| Rate for Payer: UMR Bronson Commercial |
$73.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.00
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$166.66
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
76338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.66 |
| Max. Negotiated Rate |
$149.99 |
| Rate for Payer: Aetna American Axle |
$108.33
|
| Rate for Payer: Aetna Commercial |
$141.66
|
| Rate for Payer: Aetna Medicare |
$83.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.33
|
| Rate for Payer: BCBS Complete |
$66.66
|
| Rate for Payer: Cash Price |
$133.33
|
| Rate for Payer: Cofinity Commercial |
$116.66
|
| Rate for Payer: Cofinity Commercial |
$143.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.33
|
| Rate for Payer: Healthscope Commercial |
$149.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.66
|
| Rate for Payer: PHP Commercial |
$141.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.33
|
| Rate for Payer: Priority Health SBD |
$105.00
|
| Rate for Payer: UMR Bronson Commercial |
$61.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.00
|
|
|
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 Commercial |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.60
|
| 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: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.35
|
| Rate for Payer: Priority Health SBD |
$141.84
|
| Rate for Payer: UMR Bronson Commercial |
$83.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
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 Commercial |
$157.60
|
| Rate for Payer: Cofinity Commercial |
$193.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$157.60
|
| 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: PHP Commercial |
$191.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.35
|
| Rate for Payer: Priority Health SBD |
$141.84
|
| Rate for Payer: UMR Bronson Commercial |
$99.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$168.86
|
|
|
HYDRALAZINE 100 MG TABLET
|
Facility
|
IP
|
$157.45
|
|
|
Service Code
|
NDC 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 Commercial |
$110.22
|
| Rate for Payer: Cofinity Commercial |
$135.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$110.22
|
| 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: PHP Commercial |
$133.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.34
|
| 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
|
$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 Commercial |
$110.22
|
| Rate for Payer: Cofinity Commercial |
$135.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$110.22
|
| 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: PHP Commercial |
$133.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.34
|
| Rate for Payer: Priority Health SBD |
$99.19
|
| 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
|
$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 Commercial |
$217.14
|
| Rate for Payer: Cofinity Commercial |
$266.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$217.14
|
| 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: PHP Commercial |
$263.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.63
|
| Rate for Payer: Priority Health SBD |
$195.43
|
| 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
|
$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 Commercial |
$317.49
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$317.49
|
| 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: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.81
|
| Rate for Payer: Priority Health SBD |
$285.74
|
| Rate for Payer: UMR Bronson Commercial |
$167.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.16
|
|
|
HYDRALAZINE 100 MG TABLET
|
Facility
|
OP
|
$157.45
|
|
|
Service Code
|
NDC 23155083501
|
| 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 Commercial |
$110.22
|
| Rate for Payer: Cofinity Commercial |
$135.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$110.22
|
| 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: PHP Commercial |
$133.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.34
|
| Rate for Payer: Priority Health SBD |
$99.19
|
| Rate for Payer: UMR Bronson Commercial |
$58.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.09
|
|
|
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 Commercial |
$217.14
|
| Rate for Payer: Cofinity Commercial |
$266.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$217.14
|
| 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: PHP Commercial |
$263.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.63
|
| 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
|
$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 Commercial |
$317.49
|
| Rate for Payer: Cofinity Commercial |
$390.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$317.49
|
| 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: PHP Commercial |
$385.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$294.81
|
| Rate for Payer: Priority Health SBD |
$285.74
|
| Rate for Payer: UMR Bronson Commercial |
$199.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$340.16
|
|
|
HYDRALAZINE 100 MG TABLET
|
Facility
|
IP
|
$157.45
|
|
|
Service Code
|
NDC 23155083501
|
| 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 Commercial |
$110.22
|
| Rate for Payer: Cofinity Commercial |
$135.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$110.22
|
| 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: PHP Commercial |
$133.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.34
|
| Rate for Payer: Priority Health SBD |
$99.19
|
| Rate for Payer: UMR Bronson Commercial |
$69.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.09
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
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 Commercial |
$241.81
|
| Rate for Payer: Cofinity Commercial |
$297.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$241.81
|
| 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: PHP Commercial |
$293.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.54
|
| Rate for Payer: Priority Health SBD |
$217.63
|
| 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 Commercial |
$67.44
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.44
|
| 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: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.63
|
| 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 Commercial |
$241.81
|
| Rate for Payer: Cofinity Commercial |
$297.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$241.81
|
| 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: PHP Commercial |
$293.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.54
|
| 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
|
$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 Commercial |
$241.81
|
| Rate for Payer: Cofinity Commercial |
$297.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$241.81
|
| 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: PHP Commercial |
$293.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.54
|
| 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
|
OP
|
$3.93
|
|
|
Service Code
|
NDC 51079007401
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$3.54 |
| Rate for Payer: Aetna American Axle |
$2.55
|
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Aetna Medicare |
$1.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.55
|
| Rate for Payer: BCBS Complete |
$1.57
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cofinity Commercial |
$2.75
|
| Rate for Payer: Cofinity Commercial |
$3.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.14
|
| Rate for Payer: Healthscope Commercial |
$3.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.34
|
| Rate for Payer: PHP Commercial |
$3.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.55
|
| Rate for Payer: Priority Health SBD |
$2.48
|
| Rate for Payer: UMR Bronson Commercial |
$1.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.95
|
|
|
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 Commercial |
$241.81
|
| Rate for Payer: Cofinity Commercial |
$297.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$241.81
|
| 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: PHP Commercial |
$293.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.54
|
| Rate for Payer: Priority Health SBD |
$217.63
|
| 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
|
$3.93
|
|
|
Service Code
|
NDC 51079007401
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$3.54 |
| Rate for Payer: Aetna American Axle |
$2.55
|
| Rate for Payer: Aetna Commercial |
$3.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.55
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cofinity Commercial |
$2.75
|
| Rate for Payer: Cofinity Commercial |
$3.38
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.14
|
| Rate for Payer: Healthscope Commercial |
$3.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.34
|
| Rate for Payer: PHP Commercial |
$3.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.55
|
| Rate for Payer: Priority Health SBD |
$2.48
|
| Rate for Payer: UMR Bronson Commercial |
$1.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.95
|
|
|
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 Commercial |
$67.44
|
| Rate for Payer: Cofinity Commercial |
$82.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$67.44
|
| 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: PHP Commercial |
$81.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.63
|
| Rate for Payer: Priority Health SBD |
$60.70
|
| Rate for Payer: UMR Bronson Commercial |
$35.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$72.26
|
|
|
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 |
$7.95 |
| Max. Negotiated Rate |
$19.33 |
| Rate for Payer: Aetna American Axle |
$13.96
|
| Rate for Payer: Aetna American Axle |
$24.17
|
| Rate for Payer: Aetna American Axle |
$114.02
|
| Rate for Payer: Aetna American Axle |
$15.13
|
| Rate for Payer: Aetna Commercial |
$31.60
|
| 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 |
$11.63
|
| Rate for Payer: Aetna Medicare |
$87.70
|
| Rate for Payer: Aetna Medicare |
$18.59
|
| Rate for Payer: Aetna Medicare |
$10.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.02
|
| Rate for Payer: BCBS Complete |
$70.16
|
| Rate for Payer: BCBS Complete |
$14.87
|
| Rate for Payer: BCBS Complete |
$9.31
|
| Rate for Payer: BCBS Complete |
$8.59
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cash Price |
$140.33
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Cofinity Commercial |
$18.47
|
| Rate for Payer: Cofinity Commercial |
$31.97
|
| Rate for Payer: Cofinity Commercial |
$122.79
|
| Rate for Payer: Cofinity Commercial |
$20.01
|
| Rate for Payer: Cofinity Commercial |
$16.29
|
| Rate for Payer: Cofinity Commercial |
$26.03
|
| Rate for Payer: Cofinity Commercial |
$150.85
|
| Rate for Payer: Cofinity Commercial |
$15.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$122.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$20.94
|
| Rate for Payer: Healthscope Commercial |
$157.87
|
| Rate for Payer: Healthscope Commercial |
$19.33
|
| Rate for Payer: Healthscope Commercial |
$33.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.03
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$122.79
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$27.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.78
|
| Rate for Payer: PHP Commercial |
$19.78
|
| Rate for Payer: PHP Commercial |
$18.26
|
| Rate for Payer: PHP Commercial |
$31.60
|
| Rate for Payer: PHP Commercial |
$149.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.02
|
| Rate for Payer: Priority Health SBD |
$14.66
|
| Rate for Payer: Priority Health SBD |
$23.42
|
| Rate for Payer: Priority Health SBD |
$13.53
|
| Rate for Payer: Priority Health SBD |
$110.51
|
| Rate for Payer: UMR Bronson Commercial |
$8.61
|
| Rate for Payer: UMR Bronson Commercial |
$7.95
|
| Rate for Payer: UMR Bronson Commercial |
$13.76
|
| Rate for Payer: UMR Bronson Commercial |
$64.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.11
|
|
|
HYDRALAZINE 20 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$23.27
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
3697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$20.94 |
| Rate for Payer: Aetna American Axle |
$15.13
|
| Rate for Payer: Aetna American Axle |
$13.96
|
| Rate for Payer: Aetna American Axle |
$114.02
|
| Rate for Payer: Aetna American Axle |
$24.17
|
| Rate for Payer: Aetna Commercial |
$19.78
|
| Rate for Payer: Aetna Commercial |
$31.60
|
| Rate for Payer: Aetna Commercial |
$18.26
|
| Rate for Payer: Aetna Commercial |
$149.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.13
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cash Price |
$18.62
|
| Rate for Payer: Cash Price |
$140.33
|
| Rate for Payer: Cash Price |
$29.74
|
| Rate for Payer: Cofinity Commercial |
$122.79
|
| Rate for Payer: Cofinity Commercial |
$31.97
|
| Rate for Payer: Cofinity Commercial |
$26.03
|
| Rate for Payer: Cofinity Commercial |
$16.29
|
| Rate for Payer: Cofinity Commercial |
$15.04
|
| Rate for Payer: Cofinity Commercial |
$18.47
|
| Rate for Payer: Cofinity Commercial |
$20.01
|
| Rate for Payer: Cofinity Commercial |
$150.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$16.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$26.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$122.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$29.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$20.94
|
| Rate for Payer: Healthscope Commercial |
$157.87
|
| Rate for Payer: Healthscope Commercial |
$19.33
|
| Rate for Payer: Healthscope Commercial |
$33.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.79
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$26.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$16.29
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.11
|
| 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 |
$27.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.60
|
| 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: PHP Commercial |
$19.78
|
| Rate for Payer: PHP Commercial |
$31.60
|
| Rate for Payer: PHP Commercial |
$149.10
|
| Rate for Payer: PHP Commercial |
$18.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.02
|
| Rate for Payer: Priority Health SBD |
$23.42
|
| 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 |
$10.24
|
| Rate for Payer: UMR Bronson Commercial |
$16.36
|
| Rate for Payer: UMR Bronson Commercial |
$9.45
|
| Rate for Payer: UMR Bronson Commercial |
$77.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$27.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.45
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$82.25
|
|
|
Service Code
|
NDC 23155083301
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.19 |
| Max. Negotiated Rate |
$74.03 |
| Rate for Payer: Aetna American Axle |
$53.46
|
| Rate for Payer: Aetna Commercial |
$69.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.46
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$57.58
|
| Rate for Payer: Cofinity Commercial |
$70.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$57.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$74.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: PHP Commercial |
$69.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.46
|
| Rate for Payer: Priority Health SBD |
$51.82
|
| Rate for Payer: UMR Bronson Commercial |
$36.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.69
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$133.95
|
|
|
Service Code
|
NDC 31722052001
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.56 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna American Axle |
$87.07
|
| Rate for Payer: Aetna Commercial |
$113.86
|
| Rate for Payer: Aetna Medicare |
$66.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.07
|
| Rate for Payer: BCBS Complete |
$53.58
|
| Rate for Payer: Cash Price |
$107.16
|
| Rate for Payer: Cofinity Commercial |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$93.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$93.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.16
|
| Rate for Payer: Healthscope Commercial |
$120.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$93.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.86
|
| Rate for Payer: PHP Commercial |
$113.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.07
|
| Rate for Payer: Priority Health SBD |
$84.39
|
| Rate for Payer: UMR Bronson Commercial |
$49.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.46
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$190.95
|
|
|
Service Code
|
NDC 60687082201
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.02 |
| Max. Negotiated Rate |
$171.85 |
| Rate for Payer: Aetna American Axle |
$124.12
|
| Rate for Payer: Aetna Commercial |
$162.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.12
|
| Rate for Payer: Cash Price |
$152.76
|
| Rate for Payer: Cofinity Commercial |
$133.66
|
| Rate for Payer: Cofinity Commercial |
$164.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$133.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.76
|
| Rate for Payer: Healthscope Commercial |
$171.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.31
|
| Rate for Payer: PHP Commercial |
$162.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.12
|
| Rate for Payer: Priority Health SBD |
$120.30
|
| Rate for Payer: UMR Bronson Commercial |
$84.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.21
|
|
