|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
|
IP
|
$14,637.36
|
|
|
Service Code
|
APR-DRG 8904
|
| Min. Negotiated Rate |
$13,233.92 |
| Max. Negotiated Rate |
$14,637.36 |
| Rate for Payer: BCBS Complete |
$14,637.36
|
| Rate for Payer: Mclaren Medicaid |
$13,940.34
|
| Rate for Payer: Meridian Medicaid |
$14,637.36
|
| Rate for Payer: PHP Medicaid |
$13,233.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$13,940.34
|
| Rate for Payer: UHC Medicaid |
$13,940.34
|
| Rate for Payer: UHCCP Medicaid |
$13,940.34
|
|
|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
|
IP
|
$6,933.94
|
|
|
Service Code
|
APR-DRG 8902
|
| Min. Negotiated Rate |
$6,269.11 |
| Max. Negotiated Rate |
$6,933.94 |
| Rate for Payer: BCBS Complete |
$6,933.94
|
| Rate for Payer: Mclaren Medicaid |
$6,603.76
|
| Rate for Payer: Meridian Medicaid |
$6,933.94
|
| Rate for Payer: PHP Medicaid |
$6,269.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,603.76
|
| Rate for Payer: UHC Medicaid |
$6,603.76
|
| Rate for Payer: UHCCP Medicaid |
$6,603.76
|
|
|
HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS
|
Facility
|
IP
|
$8,945.35
|
|
|
Service Code
|
APR-DRG 8903
|
| Min. Negotiated Rate |
$8,087.67 |
| Max. Negotiated Rate |
$8,945.35 |
| Rate for Payer: BCBS Complete |
$8,945.35
|
| Rate for Payer: Mclaren Medicaid |
$8,519.39
|
| Rate for Payer: Meridian Medicaid |
$8,945.35
|
| Rate for Payer: PHP Medicaid |
$8,087.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$8,519.39
|
| Rate for Payer: UHC Medicaid |
$8,519.39
|
| Rate for Payer: UHCCP Medicaid |
$8,519.39
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$4,237.53
|
|
|
Service Code
|
APR-DRG 8942
|
| Min. Negotiated Rate |
$3,831.24 |
| Max. Negotiated Rate |
$4,237.53 |
| Rate for Payer: BCBS Complete |
$4,237.53
|
| Rate for Payer: Mclaren Medicaid |
$4,035.74
|
| Rate for Payer: Meridian Medicaid |
$4,237.53
|
| Rate for Payer: PHP Medicaid |
$3,831.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,035.74
|
| Rate for Payer: UHC Medicaid |
$4,035.74
|
| Rate for Payer: UHCCP Medicaid |
$4,035.74
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$3,967.24
|
|
|
Service Code
|
APR-DRG 8941
|
| Min. Negotiated Rate |
$3,586.86 |
| Max. Negotiated Rate |
$3,967.24 |
| Rate for Payer: BCBS Complete |
$3,967.24
|
| Rate for Payer: Mclaren Medicaid |
$3,778.32
|
| Rate for Payer: Meridian Medicaid |
$3,967.24
|
| Rate for Payer: PHP Medicaid |
$3,586.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$3,778.32
|
| Rate for Payer: UHC Medicaid |
$3,778.32
|
| Rate for Payer: UHCCP Medicaid |
$3,778.32
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$7,347.56
|
|
|
Service Code
|
APR-DRG 8944
|
| Min. Negotiated Rate |
$6,643.07 |
| Max. Negotiated Rate |
$7,347.56 |
| Rate for Payer: BCBS Complete |
$7,347.56
|
| Rate for Payer: Mclaren Medicaid |
$6,997.68
|
| Rate for Payer: Meridian Medicaid |
$7,347.56
|
| Rate for Payer: PHP Medicaid |
$6,643.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$6,997.68
|
| Rate for Payer: UHC Medicaid |
$6,997.68
|
| Rate for Payer: UHCCP Medicaid |
$6,997.68
|
|
|
HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS
|
Facility
|
IP
|
$4,698.01
|
|
|
Service Code
|
APR-DRG 8943
|
| Min. Negotiated Rate |
$4,247.57 |
| Max. Negotiated Rate |
$4,698.01 |
| Rate for Payer: BCBS Complete |
$4,698.01
|
| Rate for Payer: Mclaren Medicaid |
$4,474.30
|
| Rate for Payer: Meridian Medicaid |
$4,698.01
|
| Rate for Payer: PHP Medicaid |
$4,247.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$4,474.30
|
| Rate for Payer: UHC Medicaid |
$4,474.30
|
| Rate for Payer: UHCCP Medicaid |
$4,474.30
|
|
|
HIV WITH OR WITHOUT OTHER RELATED CONDITION
|
Facility
|
IP
|
$17,828.84
|
|
|
Service Code
|
MSDRG 977
|
| Min. Negotiated Rate |
$10,544.53 |
| Max. Negotiated Rate |
$17,828.84 |
| Rate for Payer: Aetna Medicare |
$11,099.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$13,874.39
|
| Rate for Payer: Amish Plain Church Group Commercial |
$13,874.39
|
| Rate for Payer: BCBS MAPPO |
$11,099.51
|
| Rate for Payer: BCN Medicare Advantage |
$11,099.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11,099.51
|
| Rate for Payer: Humana Choice PPO Medicare |
$11,099.51
|
| Rate for Payer: Mclaren Medicare |
$11,099.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11,654.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$12,764.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$12,209.46
|
| Rate for Payer: PACE Medicare |
$10,544.53
|
| Rate for Payer: PACE SWMI |
$11,099.51
|
| Rate for Payer: PHP Commercial |
$12,209.46
|
| Rate for Payer: PHP Medicare Advantage |
$11,099.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$17,828.84
|
| Rate for Payer: Priority Health Medicare |
$11,099.51
|
| Rate for Payer: Priority Health Narrow Network |
$14,263.07
|
| Rate for Payer: Railroad Medicare Medicare |
$11,099.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$11,099.51
|
| Rate for Payer: UHC Exchange |
$17,204.24
|
| Rate for Payer: UHCCP DNSP |
$11,099.51
|
| Rate for Payer: VA VA |
$11,099.51
|
|
|
HOSPICE AND PALLIATIVE CARE
|
Facility
|
IP
|
$1,074.10
|
|
|
Service Code
|
APR-DRG 8644
|
| Min. Negotiated Rate |
$971.11 |
| Max. Negotiated Rate |
$1,074.10 |
| Rate for Payer: BCBS Complete |
$1,074.10
|
| Rate for Payer: Mclaren Medicaid |
$1,022.95
|
| Rate for Payer: Meridian Medicaid |
$1,074.10
|
| Rate for Payer: PHP Medicaid |
$971.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,022.95
|
| Rate for Payer: UHC Medicaid |
$1,022.95
|
| Rate for Payer: UHCCP Medicaid |
$1,022.95
|
|
|
HOSPICE AND PALLIATIVE CARE
|
Facility
|
IP
|
$1,022.87
|
|
|
Service Code
|
APR-DRG 8643
|
| Min. Negotiated Rate |
$924.80 |
| Max. Negotiated Rate |
$1,022.87 |
| Rate for Payer: BCBS Complete |
$1,022.87
|
| Rate for Payer: Mclaren Medicaid |
$974.16
|
| Rate for Payer: Meridian Medicaid |
$1,022.87
|
| Rate for Payer: PHP Medicaid |
$924.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$974.16
|
| Rate for Payer: UHC Medicaid |
$974.16
|
| Rate for Payer: UHCCP Medicaid |
$974.16
|
|
|
HOSPICE AND PALLIATIVE CARE
|
Facility
|
IP
|
$921.51
|
|
|
Service Code
|
APR-DRG 8642
|
| Min. Negotiated Rate |
$833.16 |
| Max. Negotiated Rate |
$921.51 |
| Rate for Payer: BCBS Complete |
$921.51
|
| Rate for Payer: Mclaren Medicaid |
$877.63
|
| Rate for Payer: Meridian Medicaid |
$921.51
|
| Rate for Payer: PHP Medicaid |
$833.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$877.63
|
| Rate for Payer: UHC Medicaid |
$877.63
|
| Rate for Payer: UHCCP Medicaid |
$877.63
|
|
|
HOSPICE AND PALLIATIVE CARE
|
Facility
|
IP
|
$894.81
|
|
|
Service Code
|
APR-DRG 8641
|
| Min. Negotiated Rate |
$809.01 |
| Max. Negotiated Rate |
$894.81 |
| Rate for Payer: BCBS Complete |
$894.81
|
| Rate for Payer: Mclaren Medicaid |
$852.20
|
| Rate for Payer: Meridian Medicaid |
$894.81
|
| Rate for Payer: PHP Medicaid |
$809.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$852.20
|
| Rate for Payer: UHC Medicaid |
$852.20
|
| Rate for Payer: UHCCP Medicaid |
$852.20
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE-LANS 500 UNIT IV SOLUTION
|
Facility
|
IP
|
$5.82
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
204903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$5.82 |
| Rate for Payer: Aetna Commercial |
$5.24
|
| Rate for Payer: ASR ASR |
$5.64
|
| Rate for Payer: BCBS Trust/PPO |
$4.78
|
| Rate for Payer: BCN Commercial |
$4.78
|
| Rate for Payer: Cash Price |
$4.65
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.65
|
| Rate for Payer: Healthscope Commercial |
$5.64
|
| Rate for Payer: Healthscope Whirlpool |
$5.82
|
| Rate for Payer: Mclaren Commercial |
$5.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.95
|
| Rate for Payer: Nomi Health Commercial |
$4.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.12
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE-LANS 500 UNIT IV SOLUTION
|
Facility
|
OP
|
$5.82
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
204903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$5.82 |
| Rate for Payer: Aetna Commercial |
$5.24
|
| Rate for Payer: Aetna Medicare |
$1.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.15
|
| Rate for Payer: ASR ASR |
$5.64
|
| Rate for Payer: BCBS Complete |
$0.94
|
| Rate for Payer: BCBS MAPPO |
$1.72
|
| Rate for Payer: BCBS Trust/PPO |
$4.80
|
| Rate for Payer: BCN Commercial |
$4.80
|
| Rate for Payer: BCN Medicare Advantage |
$1.72
|
| Rate for Payer: Cash Price |
$4.65
|
| Rate for Payer: Cash Price |
$4.65
|
| Rate for Payer: Cofinity Commercial |
$5.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.72
|
| Rate for Payer: Healthscope Commercial |
$5.64
|
| Rate for Payer: Healthscope Whirlpool |
$5.82
|
| Rate for Payer: Humana Choice PPO Medicare |
$1.72
|
| Rate for Payer: Mclaren Commercial |
$5.24
|
| Rate for Payer: Mclaren Medicaid |
$1.72
|
| Rate for Payer: Mclaren Medicare |
$1.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.81
|
| Rate for Payer: Meridian Medicaid |
$0.94
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.95
|
| Rate for Payer: Nomi Health Commercial |
$4.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4.36
|
| Rate for Payer: PACE Medicare |
$1.63
|
| Rate for Payer: PACE SWMI |
$1.72
|
| Rate for Payer: PHP Commercial |
$1.89
|
| Rate for Payer: PHP Medicaid |
$0.92
|
| Rate for Payer: PHP Medicare Advantage |
$1.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$3.21
|
| Rate for Payer: Priority Health Medicare |
$1.72
|
| Rate for Payer: Priority Health Narrow Network |
$2.57
|
| Rate for Payer: Railroad Medicare Medicare |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.72
|
| Rate for Payer: UHC Exchange |
$2.67
|
| Rate for Payer: UHC Medicaid |
$0.90
|
| Rate for Payer: UHCCP DNSP |
$1.72
|
| Rate for Payer: UHCCP Medicaid |
$0.90
|
| Rate for Payer: VA VA |
$1.72
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION
|
Facility
|
IP
|
$212.46
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
76338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$159.34 |
| Max. Negotiated Rate |
$212.46 |
| Rate for Payer: Aetna Commercial |
$191.21
|
| Rate for Payer: ASR ASR |
$206.08
|
| Rate for Payer: BCBS Trust/PPO |
$174.47
|
| Rate for Payer: BCN Commercial |
$174.47
|
| Rate for Payer: Cash Price |
$169.97
|
| Rate for Payer: Cofinity Commercial |
$199.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.97
|
| Rate for Payer: Healthscope Commercial |
$206.08
|
| Rate for Payer: Healthscope Whirlpool |
$212.46
|
| Rate for Payer: Mclaren Commercial |
$191.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.59
|
| Rate for Payer: Nomi Health Commercial |
$174.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.96
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION
|
Facility
|
OP
|
$212.46
|
|
|
Service Code
|
HCPCS J3473
|
| Hospital Charge Code |
76338
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$212.46 |
| Rate for Payer: Aetna Commercial |
$191.21
|
| Rate for Payer: Aetna Medicare |
$78.61
|
| Rate for Payer: ASR ASR |
$206.08
|
| Rate for Payer: BCBS Complete |
$84.98
|
| Rate for Payer: BCBS Trust/PPO |
$175.17
|
| Rate for Payer: BCN Commercial |
$175.17
|
| Rate for Payer: Cash Price |
$169.97
|
| Rate for Payer: Cash Price |
$169.97
|
| Rate for Payer: Cofinity Commercial |
$199.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.97
|
| Rate for Payer: Healthscope Commercial |
$206.08
|
| Rate for Payer: Healthscope Whirlpool |
$212.46
|
| Rate for Payer: Mclaren Commercial |
$191.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$169.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.59
|
| Rate for Payer: Nomi Health Commercial |
$174.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.38
|
| Rate for Payer: Priority Health Narrow Network |
$0.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.96
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
OP
|
$86.95
|
|
|
Service Code
|
NDC 23155083201
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.17 |
| Max. Negotiated Rate |
$86.95 |
| Rate for Payer: Aetna Commercial |
$78.25
|
| Rate for Payer: Aetna Medicare |
$32.17
|
| Rate for Payer: ASR ASR |
$84.34
|
| Rate for Payer: BCBS Complete |
$34.78
|
| Rate for Payer: BCBS Trust/PPO |
$71.69
|
| Rate for Payer: BCN Commercial |
$71.69
|
| Rate for Payer: Cash Price |
$69.56
|
| Rate for Payer: Cofinity Commercial |
$81.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.56
|
| Rate for Payer: Healthscope Commercial |
$84.34
|
| Rate for Payer: Healthscope Whirlpool |
$86.95
|
| Rate for Payer: Mclaren Commercial |
$78.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.91
|
| Rate for Payer: Nomi Health Commercial |
$71.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$76.19
|
| Rate for Payer: Priority Health Narrow Network |
$60.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.52
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
IP
|
$63.45
|
|
|
Service Code
|
NDC 23155000101
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$47.59 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: ASR ASR |
$61.55
|
| Rate for Payer: BCBS Trust/PPO |
$52.11
|
| Rate for Payer: BCN Commercial |
$52.11
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cofinity Commercial |
$59.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Healthscope Commercial |
$61.55
|
| Rate for Payer: Healthscope Whirlpool |
$63.45
|
| Rate for Payer: Mclaren Commercial |
$57.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: Nomi Health Commercial |
$52.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
OP
|
$63.45
|
|
|
Service Code
|
NDC 23155000101
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Medicare |
$23.48
|
| Rate for Payer: ASR ASR |
$61.55
|
| Rate for Payer: BCBS Complete |
$25.38
|
| Rate for Payer: BCBS Trust/PPO |
$52.31
|
| Rate for Payer: BCN Commercial |
$52.31
|
| Rate for Payer: Cash Price |
$50.76
|
| Rate for Payer: Cofinity Commercial |
$59.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$50.76
|
| Rate for Payer: Healthscope Commercial |
$61.55
|
| Rate for Payer: Healthscope Whirlpool |
$63.45
|
| Rate for Payer: Mclaren Commercial |
$57.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.93
|
| Rate for Payer: Nomi Health Commercial |
$52.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$47.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$55.59
|
| Rate for Payer: Priority Health Narrow Network |
$44.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
IP
|
$86.95
|
|
|
Service Code
|
NDC 23155083201
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.21 |
| Max. Negotiated Rate |
$86.95 |
| Rate for Payer: Aetna Commercial |
$78.25
|
| Rate for Payer: ASR ASR |
$84.34
|
| Rate for Payer: BCBS Trust/PPO |
$71.40
|
| Rate for Payer: BCN Commercial |
$71.40
|
| Rate for Payer: Cash Price |
$69.56
|
| Rate for Payer: Cofinity Commercial |
$81.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$69.56
|
| Rate for Payer: Healthscope Commercial |
$84.34
|
| Rate for Payer: Healthscope Whirlpool |
$86.95
|
| Rate for Payer: Mclaren Commercial |
$78.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$73.91
|
| Rate for Payer: Nomi Health Commercial |
$71.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.52
|
|
|
HYDRALAZINE 20 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$21.54
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
3697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.16 |
| Max. Negotiated Rate |
$21.54 |
| Rate for Payer: Aetna Commercial |
$19.39
|
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Commercial |
$21.00
|
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: ASR ASR |
$22.63
|
| Rate for Payer: ASR ASR |
$20.90
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: ASR ASR |
$18.69
|
| Rate for Payer: BCBS Trust/PPO |
$17.69
|
| Rate for Payer: BCBS Trust/PPO |
$15.82
|
| Rate for Payer: BCBS Trust/PPO |
$16.99
|
| Rate for Payer: BCBS Trust/PPO |
$19.16
|
| Rate for Payer: BCN Commercial |
$15.82
|
| Rate for Payer: BCN Commercial |
$19.16
|
| Rate for Payer: BCN Commercial |
$16.99
|
| Rate for Payer: BCN Commercial |
$17.69
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cash Price |
$17.23
|
| Rate for Payer: Cash Price |
$15.42
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$18.11
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.42
|
| Rate for Payer: Healthscope Commercial |
$20.90
|
| Rate for Payer: Healthscope Commercial |
$18.69
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Healthscope Commercial |
$22.63
|
| Rate for Payer: Healthscope Whirlpool |
$21.54
|
| Rate for Payer: Healthscope Whirlpool |
$23.33
|
| Rate for Payer: Healthscope Whirlpool |
$19.27
|
| Rate for Payer: Healthscope Whirlpool |
$20.69
|
| Rate for Payer: Mclaren Commercial |
$17.34
|
| Rate for Payer: Mclaren Commercial |
$21.00
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: Mclaren Commercial |
$19.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.38
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Nomi Health Commercial |
$19.13
|
| Rate for Payer: Nomi Health Commercial |
$17.66
|
| Rate for Payer: Nomi Health Commercial |
$15.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.53
|
|
|
HYDRALAZINE 20 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$23.33
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
3697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$23.33 |
| Rate for Payer: Aetna Commercial |
$21.00
|
| Rate for Payer: Aetna Commercial |
$18.62
|
| Rate for Payer: Aetna Commercial |
$19.39
|
| Rate for Payer: Aetna Commercial |
$17.34
|
| Rate for Payer: Aetna Medicare |
$7.13
|
| Rate for Payer: Aetna Medicare |
$8.63
|
| Rate for Payer: Aetna Medicare |
$7.97
|
| Rate for Payer: Aetna Medicare |
$7.66
|
| Rate for Payer: ASR ASR |
$20.90
|
| Rate for Payer: ASR ASR |
$20.07
|
| Rate for Payer: ASR ASR |
$18.69
|
| Rate for Payer: ASR ASR |
$22.63
|
| Rate for Payer: BCBS Complete |
$8.62
|
| Rate for Payer: BCBS Complete |
$7.71
|
| Rate for Payer: BCBS Complete |
$9.33
|
| Rate for Payer: BCBS Complete |
$8.28
|
| Rate for Payer: BCBS Trust/PPO |
$17.06
|
| Rate for Payer: BCBS Trust/PPO |
$19.24
|
| Rate for Payer: BCBS Trust/PPO |
$17.76
|
| Rate for Payer: BCBS Trust/PPO |
$15.89
|
| Rate for Payer: BCN Commercial |
$19.24
|
| Rate for Payer: BCN Commercial |
$17.76
|
| Rate for Payer: BCN Commercial |
$15.89
|
| Rate for Payer: BCN Commercial |
$17.06
|
| Rate for Payer: Cash Price |
$15.42
|
| Rate for Payer: Cash Price |
$17.23
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cash Price |
$16.55
|
| Rate for Payer: Cash Price |
$15.42
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cash Price |
$17.23
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Cofinity Commercial |
$18.11
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$19.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.23
|
| Rate for Payer: Healthscope Commercial |
$22.63
|
| Rate for Payer: Healthscope Commercial |
$18.69
|
| Rate for Payer: Healthscope Commercial |
$20.07
|
| Rate for Payer: Healthscope Commercial |
$20.90
|
| Rate for Payer: Healthscope Whirlpool |
$19.27
|
| Rate for Payer: Healthscope Whirlpool |
$21.54
|
| Rate for Payer: Healthscope Whirlpool |
$23.33
|
| Rate for Payer: Healthscope Whirlpool |
$20.69
|
| Rate for Payer: Mclaren Commercial |
$19.39
|
| Rate for Payer: Mclaren Commercial |
$18.62
|
| Rate for Payer: Mclaren Commercial |
$17.34
|
| Rate for Payer: Mclaren Commercial |
$21.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15.42
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.83
|
| Rate for Payer: Nomi Health Commercial |
$15.80
|
| Rate for Payer: Nomi Health Commercial |
$17.66
|
| Rate for Payer: Nomi Health Commercial |
$19.13
|
| Rate for Payer: Nomi Health Commercial |
$16.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.16
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.55
|
| Rate for Payer: Priority Health Narrow Network |
$3.64
|
| Rate for Payer: Priority Health Narrow Network |
$3.64
|
| Rate for Payer: Priority Health Narrow Network |
$3.64
|
| Rate for Payer: Priority Health Narrow Network |
$3.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.21
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$458.25
|
|
|
Service Code
|
NDC 60687082201
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$343.69 |
| Max. Negotiated Rate |
$458.25 |
| Rate for Payer: Aetna Commercial |
$412.43
|
| Rate for Payer: ASR ASR |
$444.50
|
| Rate for Payer: BCBS Trust/PPO |
$376.31
|
| Rate for Payer: BCN Commercial |
$376.31
|
| Rate for Payer: Cash Price |
$366.60
|
| Rate for Payer: Cofinity Commercial |
$430.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$366.60
|
| Rate for Payer: Healthscope Commercial |
$444.50
|
| Rate for Payer: Healthscope Whirlpool |
$458.25
|
| Rate for Payer: Mclaren Commercial |
$412.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$389.51
|
| Rate for Payer: Nomi Health Commercial |
$375.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$343.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$403.26
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$258.50
|
|
|
Service Code
|
NDC 904644161
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$95.64 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Aetna Commercial |
$232.65
|
| Rate for Payer: Aetna Medicare |
$95.64
|
| Rate for Payer: ASR ASR |
$250.75
|
| Rate for Payer: BCBS Complete |
$103.40
|
| Rate for Payer: BCBS Trust/PPO |
$213.13
|
| Rate for Payer: BCN Commercial |
$213.13
|
| Rate for Payer: Cash Price |
$206.80
|
| Rate for Payer: Cofinity Commercial |
$242.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$206.80
|
| Rate for Payer: Healthscope Commercial |
$250.75
|
| Rate for Payer: Healthscope Whirlpool |
$258.50
|
| Rate for Payer: Mclaren Commercial |
$232.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$206.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.72
|
| Rate for Payer: Nomi Health Commercial |
$211.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$193.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$226.50
|
| Rate for Payer: Priority Health Narrow Network |
$181.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.48
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$3.74
|
|
|
Service Code
|
NDC 62584073311
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: ASR ASR |
$3.62
|
| Rate for Payer: BCBS Trust/PPO |
$3.07
|
| Rate for Payer: BCN Commercial |
$3.07
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.62
|
| Rate for Payer: Healthscope Whirlpool |
$3.74
|
| Rate for Payer: Mclaren Commercial |
$3.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: Nomi Health Commercial |
$3.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.29
|
|
