Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

HYDROCORTISONE 10 MG TABLET

Facility

$639.84

Service Code	NDC 0904-7188-61
Hospital Charge Code	3733
Hospital Revenue Code	637
Min. Negotiated Rate	$447.89
Max. Negotiated Rate	$639.84
Rate for Payer: Aetna Commercial	$575.86
Rate for Payer: ASR ASR	$620.64
Rate for Payer: BCBS Trust/PPO	$496.07
Rate for Payer: BCN Commercial	$496.07
Rate for Payer: Cash Price	$511.87
Rate for Payer: Cofinity Commercial	$601.45
Rate for Payer: Encore Health Key Benefits Commercial	$511.87
Rate for Payer: Healthscope Commercial	$639.84
Rate for Payer: Healthscope Whirlpool	$620.64
Rate for Payer: Mclaren Commercial	$575.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$543.86
Rate for Payer: Priority Health Cigna Priority Health	$447.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$563.06

HYDROCORTISONE 1 % TOPICAL CREAM

Facility

$7.73

Service Code	NDC 0904-7623-31
Hospital Charge Code	3726
Hospital Revenue Code	637
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$7.73
Rate for Payer: Aetna Commercial	$6.96
Rate for Payer: ASR ASR	$7.50
Rate for Payer: BCBS Trust/PPO	$5.99
Rate for Payer: BCN Commercial	$5.99
Rate for Payer: Cash Price	$6.18
Rate for Payer: Cofinity Commercial	$7.27
Rate for Payer: Encore Health Key Benefits Commercial	$6.18
Rate for Payer: Healthscope Commercial	$7.73
Rate for Payer: Healthscope Whirlpool	$7.50
Rate for Payer: Mclaren Commercial	$6.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$6.57
Rate for Payer: Priority Health Cigna Priority Health	$5.41
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$6.80

HYDROCORTISONE 1 % TOPICAL CREAM

Facility

$14.62

Service Code	NDC 51672-2069-2
Hospital Charge Code	3726
Hospital Revenue Code	637
Min. Negotiated Rate	$10.23
Max. Negotiated Rate	$14.62
Rate for Payer: Aetna Commercial	$13.16
Rate for Payer: ASR ASR	$14.18
Rate for Payer: BCBS Trust/PPO	$11.33
Rate for Payer: BCN Commercial	$11.33
Rate for Payer: Cash Price	$11.69
Rate for Payer: Cofinity Commercial	$13.74
Rate for Payer: Encore Health Key Benefits Commercial	$11.70
Rate for Payer: Healthscope Commercial	$14.62
Rate for Payer: Healthscope Whirlpool	$14.18
Rate for Payer: Mclaren Commercial	$13.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$12.43
Rate for Payer: Priority Health Cigna Priority Health	$10.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$12.87

HYDROCORTISONE 1 % TOPICAL CREAM

Facility

$9.45

Service Code	NDC 45802-438-03
Hospital Charge Code	3726
Hospital Revenue Code	637
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$9.45
Rate for Payer: Aetna Commercial	$8.50
Rate for Payer: ASR ASR	$9.17
Rate for Payer: BCBS Trust/PPO	$7.33
Rate for Payer: BCN Commercial	$7.33
Rate for Payer: Cash Price	$7.56
Rate for Payer: Cofinity Commercial	$8.88
Rate for Payer: Encore Health Key Benefits Commercial	$7.56
Rate for Payer: Healthscope Commercial	$9.45
Rate for Payer: Healthscope Whirlpool	$9.17
Rate for Payer: Mclaren Commercial	$8.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$8.03
Rate for Payer: Priority Health Cigna Priority Health	$6.62
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$8.32

HYDROCORTISONE 2.5 % TOPICAL CREAM

Facility

$15.82

Service Code	NDC 45802-004-03
Hospital Charge Code	3727
Hospital Revenue Code	637
Min. Negotiated Rate	$11.07
Max. Negotiated Rate	$15.82
Rate for Payer: Aetna Commercial	$14.24
Rate for Payer: ASR ASR	$15.35
Rate for Payer: BCBS Trust/PPO	$12.27
Rate for Payer: BCN Commercial	$12.27
Rate for Payer: Cash Price	$12.66
Rate for Payer: Cofinity Commercial	$14.87
Rate for Payer: Encore Health Key Benefits Commercial	$12.66
Rate for Payer: Healthscope Commercial	$15.82
Rate for Payer: Healthscope Whirlpool	$15.35
Rate for Payer: Mclaren Commercial	$14.24
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.45
Rate for Payer: Priority Health Cigna Priority Health	$11.07
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$13.92

HYDROCORTISONE 2.5 % TOPICAL CREAM

Facility

$12.38

Service Code	NDC 51672-3003-2
Hospital Charge Code	3727
Hospital Revenue Code	637
Min. Negotiated Rate	$8.67
Max. Negotiated Rate	$12.38
Rate for Payer: Aetna Commercial	$11.14
Rate for Payer: ASR ASR	$12.01
Rate for Payer: BCBS Trust/PPO	$9.60
Rate for Payer: BCN Commercial	$9.60
Rate for Payer: Cash Price	$9.90
Rate for Payer: Cofinity Commercial	$11.64
Rate for Payer: Encore Health Key Benefits Commercial	$9.90
Rate for Payer: Healthscope Commercial	$12.38
Rate for Payer: Healthscope Whirlpool	$12.01
Rate for Payer: Mclaren Commercial	$11.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$10.52
Rate for Payer: Priority Health Cigna Priority Health	$8.67
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$10.89

HYDROCORTISONE 2.5 % TOPICAL CREAM

Facility

$9.18

Service Code	NDC 0168-0080-31
Hospital Charge Code	3727
Hospital Revenue Code	637
Min. Negotiated Rate	$6.43
Max. Negotiated Rate	$9.18
Rate for Payer: Aetna Commercial	$8.26
Rate for Payer: ASR ASR	$8.90
Rate for Payer: BCBS Trust/PPO	$7.12
Rate for Payer: BCN Commercial	$7.12
Rate for Payer: Cash Price	$7.34
Rate for Payer: Cofinity Commercial	$8.63
Rate for Payer: Encore Health Key Benefits Commercial	$7.34
Rate for Payer: Healthscope Commercial	$9.18
Rate for Payer: Healthscope Whirlpool	$8.90
Rate for Payer: Mclaren Commercial	$8.26
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$7.80
Rate for Payer: Priority Health Cigna Priority Health	$6.43
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$8.08

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY

Facility

$512.33

Service Code	NDC 0574-7090-12
Hospital Charge Code	3738
Hospital Revenue Code	637
Min. Negotiated Rate	$358.63
Max. Negotiated Rate	$512.33
Rate for Payer: Aetna Commercial	$461.10
Rate for Payer: ASR ASR	$496.96
Rate for Payer: BCBS Trust/PPO	$397.21
Rate for Payer: BCN Commercial	$397.21
Rate for Payer: Cash Price	$409.87
Rate for Payer: Cofinity Commercial	$481.59
Rate for Payer: Encore Health Key Benefits Commercial	$409.86
Rate for Payer: Healthscope Commercial	$512.33
Rate for Payer: Healthscope Whirlpool	$496.96
Rate for Payer: Mclaren Commercial	$461.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$435.48
Rate for Payer: Priority Health Cigna Priority Health	$358.63
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$450.85

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY

Facility

$474.81

Service Code	NDC 0713-0503-12
Hospital Charge Code	3738
Hospital Revenue Code	637
Min. Negotiated Rate	$332.37
Max. Negotiated Rate	$474.81
Rate for Payer: Aetna Commercial	$427.33
Rate for Payer: ASR ASR	$460.57
Rate for Payer: BCBS Trust/PPO	$368.12
Rate for Payer: BCN Commercial	$368.12
Rate for Payer: Cash Price	$379.85
Rate for Payer: Cofinity Commercial	$446.32
Rate for Payer: Encore Health Key Benefits Commercial	$379.85
Rate for Payer: Healthscope Commercial	$474.81
Rate for Payer: Healthscope Whirlpool	$460.57
Rate for Payer: Mclaren Commercial	$427.33
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$403.59
Rate for Payer: Priority Health Cigna Priority Health	$332.37
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$417.83

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY

Facility

$39.57

Service Code	NDC 0713-0503-06
Hospital Charge Code	3738
Hospital Revenue Code	637
Min. Negotiated Rate	$27.70
Max. Negotiated Rate	$39.57
Rate for Payer: Aetna Commercial	$35.61
Rate for Payer: ASR ASR	$38.38
Rate for Payer: BCBS Trust/PPO	$30.68
Rate for Payer: BCN Commercial	$30.68
Rate for Payer: Cash Price	$31.65
Rate for Payer: Cofinity Commercial	$37.20
Rate for Payer: Encore Health Key Benefits Commercial	$31.66
Rate for Payer: Healthscope Commercial	$39.57
Rate for Payer: Healthscope Whirlpool	$38.38
Rate for Payer: Mclaren Commercial	$35.61
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$33.63
Rate for Payer: Priority Health Cigna Priority Health	$27.70
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$34.82

HYDROCORTISONE ACETATE 25 MG RECTAL SUPPOSITORY

Facility

$116.73

Service Code	NDC 59741-301-12
Hospital Charge Code	3738
Hospital Revenue Code	637
Min. Negotiated Rate	$81.71
Max. Negotiated Rate	$116.73
Rate for Payer: Aetna Commercial	$105.06
Rate for Payer: ASR ASR	$113.23
Rate for Payer: BCBS Trust/PPO	$90.50
Rate for Payer: BCN Commercial	$90.50
Rate for Payer: Cash Price	$93.38
Rate for Payer: Cofinity Commercial	$109.73
Rate for Payer: Encore Health Key Benefits Commercial	$93.38
Rate for Payer: Healthscope Commercial	$116.73
Rate for Payer: Healthscope Whirlpool	$113.23
Rate for Payer: Mclaren Commercial	$105.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$99.22
Rate for Payer: Priority Health Cigna Priority Health	$81.71
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$102.72

HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION

Facility

$61.45

Service Code	HCPCS J1720
Hospital Charge Code	108970
Hospital Revenue Code	636
Min. Negotiated Rate	$43.02
Max. Negotiated Rate	$61.45
Rate for Payer: Aetna Commercial	$55.30
Rate for Payer: ASR ASR	$59.61
Rate for Payer: BCBS Trust/PPO	$47.64
Rate for Payer: BCN Commercial	$47.64
Rate for Payer: Cash Price	$49.16
Rate for Payer: Cofinity Commercial	$57.76
Rate for Payer: Encore Health Key Benefits Commercial	$49.16
Rate for Payer: Healthscope Commercial	$61.45
Rate for Payer: Healthscope Whirlpool	$59.61
Rate for Payer: Mclaren Commercial	$55.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$52.23
Rate for Payer: Priority Health Cigna Priority Health	$43.02
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$54.08

HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION

Facility

$84.42

Service Code	HCPCS J1720
Hospital Charge Code	119665
Hospital Revenue Code	636
Min. Negotiated Rate	$59.09
Max. Negotiated Rate	$84.42
Rate for Payer: Aetna Commercial	$75.98
Rate for Payer: ASR ASR	$81.89
Rate for Payer: BCBS Trust/PPO	$65.45
Rate for Payer: BCN Commercial	$65.45
Rate for Payer: Cash Price	$67.53
Rate for Payer: Cofinity Commercial	$79.35
Rate for Payer: Encore Health Key Benefits Commercial	$67.54
Rate for Payer: Healthscope Commercial	$84.42
Rate for Payer: Healthscope Whirlpool	$81.89
Rate for Payer: Mclaren Commercial	$75.98
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$71.76
Rate for Payer: Priority Health Cigna Priority Health	$59.09
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$74.29

HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION

Facility

$155.22

Service Code	HCPCS J1720
Hospital Charge Code	119664
Hospital Revenue Code	636
Min. Negotiated Rate	$108.65
Max. Negotiated Rate	$155.22
Rate for Payer: Aetna Commercial	$139.70
Rate for Payer: ASR ASR	$150.56
Rate for Payer: BCBS Trust/PPO	$120.34
Rate for Payer: BCN Commercial	$120.34
Rate for Payer: Cash Price	$124.17
Rate for Payer: Cofinity Commercial	$145.91
Rate for Payer: Encore Health Key Benefits Commercial	$124.18
Rate for Payer: Healthscope Commercial	$155.22
Rate for Payer: Healthscope Whirlpool	$150.56
Rate for Payer: Mclaren Commercial	$139.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$131.94
Rate for Payer: Priority Health Cigna Priority Health	$108.65
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$136.59

HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE

Facility

$16.47

Service Code	HCPCS J1170
Hospital Charge Code	166819
Hospital Revenue Code	636
Min. Negotiated Rate	$11.53
Max. Negotiated Rate	$16.47
Rate for Payer: Aetna Commercial	$14.82
Rate for Payer: Aetna Commercial	$19.32
Rate for Payer: ASR ASR	$20.83
Rate for Payer: ASR ASR	$15.98
Rate for Payer: BCBS Trust/PPO	$12.77
Rate for Payer: BCBS Trust/PPO	$16.65
Rate for Payer: BCN Commercial	$16.65
Rate for Payer: BCN Commercial	$12.77
Rate for Payer: Cash Price	$17.18
Rate for Payer: Cash Price	$13.18
Rate for Payer: Cofinity Commercial	$20.18
Rate for Payer: Cofinity Commercial	$15.48
Rate for Payer: Encore Health Key Benefits Commercial	$13.18
Rate for Payer: Encore Health Key Benefits Commercial	$17.18
Rate for Payer: Healthscope Commercial	$16.47
Rate for Payer: Healthscope Commercial	$21.47
Rate for Payer: Healthscope Whirlpool	$20.83
Rate for Payer: Healthscope Whirlpool	$15.98
Rate for Payer: Mclaren Commercial	$19.32
Rate for Payer: Mclaren Commercial	$14.82
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$14.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.25
Rate for Payer: Priority Health Cigna Priority Health	$15.03
Rate for Payer: Priority Health Cigna Priority Health	$11.53
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$14.49
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$18.89

HYDROMORPHONE 1 MG/ML INJECTION SYRINGE

Facility

$21.93

Service Code	HCPCS J1170
Hospital Charge Code	112193
Hospital Revenue Code	636
Min. Negotiated Rate	$15.35
Max. Negotiated Rate	$21.93
Rate for Payer: Aetna Commercial	$19.74
Rate for Payer: Aetna Commercial	$26.64
Rate for Payer: Aetna Commercial	$14.42
Rate for Payer: ASR ASR	$21.27
Rate for Payer: ASR ASR	$15.54
Rate for Payer: ASR ASR	$28.71
Rate for Payer: BCBS Trust/PPO	$17.00
Rate for Payer: BCBS Trust/PPO	$12.42
Rate for Payer: BCBS Trust/PPO	$22.95
Rate for Payer: BCN Commercial	$17.00
Rate for Payer: BCN Commercial	$12.42
Rate for Payer: BCN Commercial	$22.95
Rate for Payer: Cash Price	$23.68
Rate for Payer: Cash Price	$12.81
Rate for Payer: Cash Price	$17.54
Rate for Payer: Cofinity Commercial	$27.82
Rate for Payer: Cofinity Commercial	$15.06
Rate for Payer: Cofinity Commercial	$20.61
Rate for Payer: Encore Health Key Benefits Commercial	$23.68
Rate for Payer: Encore Health Key Benefits Commercial	$17.54
Rate for Payer: Encore Health Key Benefits Commercial	$12.82
Rate for Payer: Healthscope Commercial	$29.60
Rate for Payer: Healthscope Commercial	$16.02
Rate for Payer: Healthscope Commercial	$21.93
Rate for Payer: Healthscope Whirlpool	$28.71
Rate for Payer: Healthscope Whirlpool	$21.27
Rate for Payer: Healthscope Whirlpool	$15.54
Rate for Payer: Mclaren Commercial	$14.42
Rate for Payer: Mclaren Commercial	$26.64
Rate for Payer: Mclaren Commercial	$19.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$25.16
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$18.64
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$13.62
Rate for Payer: Priority Health Cigna Priority Health	$11.21
Rate for Payer: Priority Health Cigna Priority Health	$15.35
Rate for Payer: Priority Health Cigna Priority Health	$20.72
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$26.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$19.30
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$14.10

HYDROMORPHONE VARIABLE DOSE

Facility

$14.07

Service Code	HCPCS J1170
Hospital Charge Code	150712
Hospital Revenue Code	636
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$14.07
Rate for Payer: Aetna Commercial	$12.66
Rate for Payer: ASR ASR	$13.65
Rate for Payer: BCBS Trust/PPO	$10.91
Rate for Payer: BCN Commercial	$10.91
Rate for Payer: Cash Price	$11.26
Rate for Payer: Cofinity Commercial	$13.23
Rate for Payer: Encore Health Key Benefits Commercial	$11.26
Rate for Payer: Healthscope Commercial	$14.07
Rate for Payer: Healthscope Whirlpool	$13.65
Rate for Payer: Mclaren Commercial	$12.66
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$11.96
Rate for Payer: Priority Health Cigna Priority Health	$9.85
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$12.38

HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION

Facility

$2,650.82

Service Code	NDC 11704-370-01
Hospital Charge Code	155400
Hospital Revenue Code	250
Min. Negotiated Rate	$1,855.57
Max. Negotiated Rate	$2,650.82
Rate for Payer: Aetna Commercial	$2,385.74
Rate for Payer: ASR ASR	$2,571.30
Rate for Payer: BCBS Trust/PPO	$2,055.18
Rate for Payer: BCN Commercial	$2,055.18
Rate for Payer: Cash Price	$2,120.65
Rate for Payer: Cofinity Commercial	$2,491.77
Rate for Payer: Encore Health Key Benefits Commercial	$2,120.66
Rate for Payer: Healthscope Commercial	$2,650.82
Rate for Payer: Healthscope Whirlpool	$2,571.30
Rate for Payer: Mclaren Commercial	$2,385.74
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,253.20
Rate for Payer: Priority Health Cigna Priority Health	$1,855.57
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,332.72

HYDROXYCHLOROQUINE 200 MG TABLET

Facility

$193.20

Service Code	NDC 0904-7046-06
Hospital Charge Code	10235
Hospital Revenue Code	637
Min. Negotiated Rate	$135.24
Max. Negotiated Rate	$193.20
Rate for Payer: Aetna Commercial	$173.88
Rate for Payer: ASR ASR	$187.40
Rate for Payer: BCBS Trust/PPO	$149.79
Rate for Payer: BCN Commercial	$149.79
Rate for Payer: Cash Price	$154.56
Rate for Payer: Cofinity Commercial	$181.61
Rate for Payer: Encore Health Key Benefits Commercial	$154.56
Rate for Payer: Healthscope Commercial	$193.20
Rate for Payer: Healthscope Whirlpool	$187.40
Rate for Payer: Mclaren Commercial	$173.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$164.22
Rate for Payer: Priority Health Cigna Priority Health	$135.24
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$170.02

HYDROXYCHLOROQUINE 200 MG TABLET

Facility

$267.90

Service Code	NDC 43598-721-01
Hospital Charge Code	10235
Hospital Revenue Code	637
Min. Negotiated Rate	$187.53
Max. Negotiated Rate	$267.90
Rate for Payer: Aetna Commercial	$241.11
Rate for Payer: ASR ASR	$259.86
Rate for Payer: BCBS Trust/PPO	$207.70
Rate for Payer: BCN Commercial	$207.70
Rate for Payer: Cash Price	$214.32
Rate for Payer: Cofinity Commercial	$251.83
Rate for Payer: Encore Health Key Benefits Commercial	$214.32
Rate for Payer: Healthscope Commercial	$267.90
Rate for Payer: Healthscope Whirlpool	$259.86
Rate for Payer: Mclaren Commercial	$241.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$227.72
Rate for Payer: Priority Health Cigna Priority Health	$187.53
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$235.75

HYDROXYCHLOROQUINE 200 MG TABLET

Facility

$291.65

Service Code	NDC 69238-1544-1
Hospital Charge Code	10235
Hospital Revenue Code	637
Min. Negotiated Rate	$204.16
Max. Negotiated Rate	$291.65
Rate for Payer: Aetna Commercial	$262.48
Rate for Payer: ASR ASR	$282.90
Rate for Payer: BCBS Trust/PPO	$226.12
Rate for Payer: BCN Commercial	$226.12
Rate for Payer: Cash Price	$233.32
Rate for Payer: Cofinity Commercial	$274.15
Rate for Payer: Encore Health Key Benefits Commercial	$233.32
Rate for Payer: Healthscope Commercial	$291.65
Rate for Payer: Healthscope Whirlpool	$282.90
Rate for Payer: Mclaren Commercial	$262.48
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$247.90
Rate for Payer: Priority Health Cigna Priority Health	$204.16
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$256.65

HYDROXYPROGESTERONE (PF)(PREGNANCY PRESERVING) 250 MG/ML (1 ML) IM OIL

Facility

$2,031.26

Service Code	HCPCS J1726
Hospital Charge Code	178180
Hospital Revenue Code	636
Min. Negotiated Rate	$1,421.88
Max. Negotiated Rate	$2,031.26
Rate for Payer: Aetna Commercial	$1,828.13
Rate for Payer: Aetna Commercial	$1,915.46
Rate for Payer: ASR ASR	$2,064.44
Rate for Payer: ASR ASR	$1,970.32
Rate for Payer: BCBS Trust/PPO	$1,650.06
Rate for Payer: BCBS Trust/PPO	$1,574.84
Rate for Payer: BCN Commercial	$1,650.06
Rate for Payer: BCN Commercial	$1,574.84
Rate for Payer: Cash Price	$1,625.01
Rate for Payer: Cash Price	$1,702.63
Rate for Payer: Cofinity Commercial	$2,000.59
Rate for Payer: Cofinity Commercial	$1,909.38
Rate for Payer: Encore Health Key Benefits Commercial	$1,702.63
Rate for Payer: Encore Health Key Benefits Commercial	$1,625.01
Rate for Payer: Healthscope Commercial	$2,128.29
Rate for Payer: Healthscope Commercial	$2,031.26
Rate for Payer: Healthscope Whirlpool	$2,064.44
Rate for Payer: Healthscope Whirlpool	$1,970.32
Rate for Payer: Mclaren Commercial	$1,915.46
Rate for Payer: Mclaren Commercial	$1,828.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,809.05
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,726.57
Rate for Payer: Priority Health Cigna Priority Health	$1,421.88
Rate for Payer: Priority Health Cigna Priority Health	$1,489.80
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,787.51
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,872.90

HYDROXYZINE HCL 10 MG TABLET

Facility

$427.70

Service Code	NDC 68084-253-11
Hospital Charge Code	3772
Hospital Revenue Code	637
Min. Negotiated Rate	$299.39
Max. Negotiated Rate	$427.70
Rate for Payer: Aetna Commercial	$384.93
Rate for Payer: ASR ASR	$414.87
Rate for Payer: BCBS Trust/PPO	$331.60
Rate for Payer: BCN Commercial	$331.60
Rate for Payer: Cash Price	$342.16
Rate for Payer: Cofinity Commercial	$402.04
Rate for Payer: Encore Health Key Benefits Commercial	$342.16
Rate for Payer: Healthscope Commercial	$427.70
Rate for Payer: Healthscope Whirlpool	$414.87
Rate for Payer: Mclaren Commercial	$384.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$363.54
Rate for Payer: Priority Health Cigna Priority Health	$299.39
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$376.38

HYDROXYZINE HCL 10 MG TABLET

Facility

$427.70

Service Code	NDC 68084-253-01
Hospital Charge Code	3772
Hospital Revenue Code	637
Min. Negotiated Rate	$299.39
Max. Negotiated Rate	$427.70
Rate for Payer: Aetna Commercial	$384.93
Rate for Payer: ASR ASR	$414.87
Rate for Payer: BCBS Trust/PPO	$331.60
Rate for Payer: BCN Commercial	$331.60
Rate for Payer: Cash Price	$342.16
Rate for Payer: Cofinity Commercial	$402.04
Rate for Payer: Encore Health Key Benefits Commercial	$342.16
Rate for Payer: Healthscope Commercial	$427.70
Rate for Payer: Healthscope Whirlpool	$414.87
Rate for Payer: Mclaren Commercial	$384.93
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$363.54
Rate for Payer: Priority Health Cigna Priority Health	$299.39
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$376.38

HYDROXYZINE HCL 25 MG TABLET

Facility

$281.20

Service Code	NDC 68084-254-01
Hospital Charge Code	3774
Hospital Revenue Code	637
Min. Negotiated Rate	$196.84
Max. Negotiated Rate	$281.20
Rate for Payer: Aetna Commercial	$253.08
Rate for Payer: ASR ASR	$272.76
Rate for Payer: BCBS Trust/PPO	$218.01
Rate for Payer: BCN Commercial	$218.01
Rate for Payer: Cash Price	$224.96
Rate for Payer: Cofinity Commercial	$264.33
Rate for Payer: Encore Health Key Benefits Commercial	$224.96
Rate for Payer: Healthscope Commercial	$281.20
Rate for Payer: Healthscope Whirlpool	$272.76
Rate for Payer: Mclaren Commercial	$253.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$239.02
Rate for Payer: Priority Health Cigna Priority Health	$196.84
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$247.46

Know your out-of-pocket cost for care.

All Charges