|
HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$221.12
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.31 |
| Max. Negotiated Rate |
$221.12 |
| Rate for Payer: Aetna Commercial |
$199.01
|
| Rate for Payer: Aetna Medicare |
$81.81
|
| Rate for Payer: ASR ASR |
$214.49
|
| Rate for Payer: BCBS Complete |
$88.45
|
| Rate for Payer: BCBS Trust/PPO |
$182.31
|
| Rate for Payer: BCN Commercial |
$182.31
|
| Rate for Payer: Cash Price |
$176.90
|
| Rate for Payer: Cash Price |
$176.90
|
| Rate for Payer: Cofinity Commercial |
$207.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.90
|
| Rate for Payer: Healthscope Commercial |
$214.49
|
| Rate for Payer: Healthscope Whirlpool |
$221.12
|
| Rate for Payer: Mclaren Commercial |
$199.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$176.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.95
|
| Rate for Payer: Nomi Health Commercial |
$181.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$22.89
|
| Rate for Payer: Priority Health Narrow Network |
$18.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.59
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE
|
Facility
|
OP
|
$16.47
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
166819
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$16.47 |
| Rate for Payer: Aetna Commercial |
$14.82
|
| Rate for Payer: Aetna Commercial |
$18.16
|
| Rate for Payer: Aetna Commercial |
$19.32
|
| Rate for Payer: Aetna Medicare |
$7.47
|
| Rate for Payer: Aetna Medicare |
$6.09
|
| Rate for Payer: Aetna Medicare |
$7.94
|
| Rate for Payer: ASR ASR |
$20.82
|
| Rate for Payer: ASR ASR |
$15.98
|
| Rate for Payer: ASR ASR |
$19.58
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS Complete |
$8.59
|
| Rate for Payer: BCBS Complete |
$8.07
|
| Rate for Payer: BCBS Trust/PPO |
$13.58
|
| Rate for Payer: BCBS Trust/PPO |
$16.64
|
| Rate for Payer: BCBS Trust/PPO |
$17.70
|
| Rate for Payer: BCN Commercial |
$13.58
|
| Rate for Payer: BCN Commercial |
$16.64
|
| Rate for Payer: BCN Commercial |
$17.70
|
| Rate for Payer: Cash Price |
$16.14
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$16.14
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cofinity Commercial |
$18.97
|
| Rate for Payer: Cofinity Commercial |
$15.48
|
| Rate for Payer: Cofinity Commercial |
$20.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.14
|
| Rate for Payer: Healthscope Commercial |
$20.82
|
| Rate for Payer: Healthscope Commercial |
$15.98
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Healthscope Whirlpool |
$20.18
|
| Rate for Payer: Healthscope Whirlpool |
$16.47
|
| Rate for Payer: Healthscope Whirlpool |
$21.47
|
| Rate for Payer: Mclaren Commercial |
$19.32
|
| Rate for Payer: Mclaren Commercial |
$18.16
|
| Rate for Payer: Mclaren Commercial |
$14.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: Nomi Health Commercial |
$17.60
|
| Rate for Payer: Nomi Health Commercial |
$13.51
|
| Rate for Payer: Nomi Health Commercial |
$16.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.15
|
| Rate for Payer: Priority Health Narrow Network |
$0.12
|
| Rate for Payer: Priority Health Narrow Network |
$0.12
|
| Rate for Payer: Priority Health Narrow Network |
$0.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.49
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE
|
Facility
|
IP
|
$16.47
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
166819
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$16.47 |
| Rate for Payer: Aetna Commercial |
$14.82
|
| Rate for Payer: Aetna Commercial |
$19.32
|
| Rate for Payer: Aetna Commercial |
$18.16
|
| Rate for Payer: ASR ASR |
$20.82
|
| Rate for Payer: ASR ASR |
$15.98
|
| Rate for Payer: ASR ASR |
$19.58
|
| Rate for Payer: BCBS Trust/PPO |
$17.63
|
| Rate for Payer: BCBS Trust/PPO |
$13.53
|
| Rate for Payer: BCBS Trust/PPO |
$16.57
|
| Rate for Payer: BCN Commercial |
$16.57
|
| Rate for Payer: BCN Commercial |
$13.53
|
| Rate for Payer: BCN Commercial |
$17.63
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$16.14
|
| Rate for Payer: Cofinity Commercial |
$15.48
|
| Rate for Payer: Cofinity Commercial |
$18.97
|
| Rate for Payer: Cofinity Commercial |
$20.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.14
|
| Rate for Payer: Healthscope Commercial |
$19.58
|
| Rate for Payer: Healthscope Commercial |
$15.98
|
| Rate for Payer: Healthscope Commercial |
$20.82
|
| Rate for Payer: Healthscope Whirlpool |
$20.18
|
| Rate for Payer: Healthscope Whirlpool |
$21.47
|
| Rate for Payer: Healthscope Whirlpool |
$16.47
|
| Rate for Payer: Mclaren Commercial |
$18.16
|
| Rate for Payer: Mclaren Commercial |
$14.82
|
| Rate for Payer: Mclaren Commercial |
$19.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: Nomi Health Commercial |
$16.55
|
| Rate for Payer: Nomi Health Commercial |
$13.51
|
| Rate for Payer: Nomi Health Commercial |
$17.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$12.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.49
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$21.93
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
112193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.45 |
| Max. Negotiated Rate |
$21.93 |
| Rate for Payer: Aetna Commercial |
$19.74
|
| Rate for Payer: Aetna Commercial |
$16.81
|
| Rate for Payer: Aetna Commercial |
$28.77
|
| Rate for Payer: ASR ASR |
$18.12
|
| Rate for Payer: ASR ASR |
$31.01
|
| Rate for Payer: ASR ASR |
$21.27
|
| Rate for Payer: BCBS Trust/PPO |
$15.34
|
| Rate for Payer: BCBS Trust/PPO |
$26.25
|
| Rate for Payer: BCBS Trust/PPO |
$18.01
|
| Rate for Payer: BCN Commercial |
$18.01
|
| Rate for Payer: BCN Commercial |
$15.34
|
| Rate for Payer: BCN Commercial |
$26.25
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Cash Price |
$17.54
|
| Rate for Payer: Cash Price |
$25.57
|
| Rate for Payer: Cofinity Commercial |
$30.05
|
| Rate for Payer: Cofinity Commercial |
$17.56
|
| Rate for Payer: Cofinity Commercial |
$20.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.54
|
| Rate for Payer: Healthscope Commercial |
$31.01
|
| Rate for Payer: Healthscope Commercial |
$21.27
|
| Rate for Payer: Healthscope Commercial |
$18.12
|
| Rate for Payer: Healthscope Whirlpool |
$31.97
|
| Rate for Payer: Healthscope Whirlpool |
$18.68
|
| Rate for Payer: Healthscope Whirlpool |
$21.93
|
| Rate for Payer: Mclaren Commercial |
$19.74
|
| Rate for Payer: Mclaren Commercial |
$28.77
|
| Rate for Payer: Mclaren Commercial |
$16.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.64
|
| Rate for Payer: Nomi Health Commercial |
$15.32
|
| Rate for Payer: Nomi Health Commercial |
$17.98
|
| Rate for Payer: Nomi Health Commercial |
$26.21
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.13
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$18.68
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
112193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$18.68 |
| Rate for Payer: Aetna Commercial |
$16.81
|
| Rate for Payer: Aetna Commercial |
$19.74
|
| Rate for Payer: Aetna Commercial |
$28.77
|
| Rate for Payer: Aetna Medicare |
$8.11
|
| Rate for Payer: Aetna Medicare |
$6.91
|
| Rate for Payer: Aetna Medicare |
$11.83
|
| Rate for Payer: ASR ASR |
$31.01
|
| Rate for Payer: ASR ASR |
$18.12
|
| Rate for Payer: ASR ASR |
$21.27
|
| Rate for Payer: BCBS Complete |
$7.47
|
| Rate for Payer: BCBS Complete |
$12.79
|
| Rate for Payer: BCBS Complete |
$8.77
|
| Rate for Payer: BCBS Trust/PPO |
$15.40
|
| Rate for Payer: BCBS Trust/PPO |
$18.08
|
| Rate for Payer: BCBS Trust/PPO |
$26.36
|
| Rate for Payer: BCN Commercial |
$15.40
|
| Rate for Payer: BCN Commercial |
$18.08
|
| Rate for Payer: BCN Commercial |
$26.36
|
| Rate for Payer: Cash Price |
$17.54
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Cash Price |
$17.54
|
| Rate for Payer: Cash Price |
$25.57
|
| Rate for Payer: Cash Price |
$25.57
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Cofinity Commercial |
$20.62
|
| Rate for Payer: Cofinity Commercial |
$17.56
|
| Rate for Payer: Cofinity Commercial |
$30.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$14.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.54
|
| Rate for Payer: Healthscope Commercial |
$31.01
|
| Rate for Payer: Healthscope Commercial |
$18.12
|
| Rate for Payer: Healthscope Commercial |
$21.27
|
| Rate for Payer: Healthscope Whirlpool |
$21.93
|
| Rate for Payer: Healthscope Whirlpool |
$18.68
|
| Rate for Payer: Healthscope Whirlpool |
$31.97
|
| Rate for Payer: Mclaren Commercial |
$28.77
|
| Rate for Payer: Mclaren Commercial |
$19.74
|
| Rate for Payer: Mclaren Commercial |
$16.81
|
| Rate for Payer: MI Amish Medical Board Commercial |
$25.57
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$15.88
|
| Rate for Payer: Nomi Health Commercial |
$26.21
|
| Rate for Payer: Nomi Health Commercial |
$15.32
|
| Rate for Payer: Nomi Health Commercial |
$17.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.15
|
| Rate for Payer: Priority Health Narrow Network |
$0.12
|
| Rate for Payer: Priority Health Narrow Network |
$0.12
|
| Rate for Payer: Priority Health Narrow Network |
$0.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$16.44
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
NDC 406324301
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Aetna Medicare |
$113.96
|
| Rate for Payer: ASR ASR |
$298.76
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: BCBS Trust/PPO |
$253.95
|
| Rate for Payer: BCN Commercial |
$253.95
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$289.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.40
|
| Rate for Payer: Healthscope Commercial |
$298.76
|
| Rate for Payer: Healthscope Whirlpool |
$308.00
|
| Rate for Payer: Mclaren Commercial |
$277.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$246.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.80
|
| Rate for Payer: Nomi Health Commercial |
$252.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$269.87
|
| Rate for Payer: Priority Health Narrow Network |
$215.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.04
|
|
|
HYDROMORPHONE 2 MG TABLET
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
NDC 406324301
|
| Hospital Charge Code |
3760
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: ASR ASR |
$298.76
|
| Rate for Payer: BCBS Trust/PPO |
$252.93
|
| Rate for Payer: BCN Commercial |
$252.93
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$289.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.40
|
| Rate for Payer: Healthscope Commercial |
$298.76
|
| Rate for Payer: Healthscope Whirlpool |
$308.00
|
| Rate for Payer: Mclaren Commercial |
$277.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.80
|
| Rate for Payer: Nomi Health Commercial |
$252.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.04
|
|
|
HYDROMORPHONE VARIABLE DOSE
|
Facility
|
OP
|
$14.07
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
150712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$14.07 |
| Rate for Payer: Aetna Commercial |
$12.66
|
| Rate for Payer: Aetna Medicare |
$5.21
|
| Rate for Payer: ASR ASR |
$13.65
|
| Rate for Payer: BCBS Complete |
$5.63
|
| Rate for Payer: BCBS Trust/PPO |
$11.60
|
| Rate for Payer: BCN Commercial |
$11.60
|
| Rate for Payer: Cash Price |
$11.26
|
| 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 |
$13.65
|
| Rate for Payer: Healthscope Whirlpool |
$14.07
|
| Rate for Payer: Mclaren Commercial |
$12.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.96
|
| Rate for Payer: Nomi Health Commercial |
$11.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$0.15
|
| Rate for Payer: Priority Health Narrow Network |
$0.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.38
|
|
|
HYDROMORPHONE VARIABLE DOSE
|
Facility
|
IP
|
$14.07
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
150712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.55 |
| 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 |
$11.55
|
| Rate for Payer: BCN Commercial |
$11.55
|
| 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 |
$13.65
|
| Rate for Payer: Healthscope Whirlpool |
$14.07
|
| Rate for Payer: Mclaren Commercial |
$12.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.96
|
| Rate for Payer: Nomi Health Commercial |
$11.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.38
|
|
|
HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,118.85
|
|
|
Service Code
|
HCPCS J3424
|
| Hospital Charge Code |
155400
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,339.14 |
| Max. Negotiated Rate |
$3,118.85 |
| Rate for Payer: Aetna Commercial |
$2,806.96
|
| Rate for Payer: ASR ASR |
$3,025.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,561.20
|
| Rate for Payer: BCN Commercial |
$2,561.20
|
| Rate for Payer: Cash Price |
$2,495.08
|
| Rate for Payer: Cofinity Commercial |
$2,931.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,495.08
|
| Rate for Payer: Healthscope Commercial |
$3,025.28
|
| Rate for Payer: Healthscope Whirlpool |
$3,118.85
|
| Rate for Payer: Mclaren Commercial |
$2,806.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,651.02
|
| Rate for Payer: Nomi Health Commercial |
$2,557.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,339.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,744.59
|
|
|
HYDROXOCOBALAMIN 5 GRAM INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,118.85
|
|
|
Service Code
|
HCPCS J3424
|
| Hospital Charge Code |
155400
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$3,118.85 |
| Rate for Payer: Aetna Commercial |
$2,806.96
|
| Rate for Payer: Aetna Medicare |
$5.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$6.80
|
| Rate for Payer: Amish Plain Church Group Commercial |
$6.80
|
| Rate for Payer: ASR ASR |
$3,025.28
|
| Rate for Payer: BCBS Complete |
$2.99
|
| Rate for Payer: BCBS MAPPO |
$5.44
|
| Rate for Payer: BCBS Trust/PPO |
$2,571.49
|
| Rate for Payer: BCN Commercial |
$2,571.49
|
| Rate for Payer: BCN Medicare Advantage |
$5.44
|
| Rate for Payer: Cash Price |
$2,495.08
|
| Rate for Payer: Cash Price |
$2,495.08
|
| Rate for Payer: Cofinity Commercial |
$2,931.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,495.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.44
|
| Rate for Payer: Healthscope Commercial |
$3,025.28
|
| Rate for Payer: Healthscope Whirlpool |
$3,118.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$5.44
|
| Rate for Payer: Mclaren Commercial |
$2,806.96
|
| Rate for Payer: Mclaren Medicaid |
$5.44
|
| Rate for Payer: Mclaren Medicare |
$5.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.71
|
| Rate for Payer: Meridian Medicaid |
$2.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$6.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,651.02
|
| Rate for Payer: Nomi Health Commercial |
$2,557.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,339.14
|
| Rate for Payer: PACE Medicare |
$5.17
|
| Rate for Payer: PACE SWMI |
$5.44
|
| Rate for Payer: PHP Commercial |
$5.98
|
| Rate for Payer: PHP Medicaid |
$2.92
|
| Rate for Payer: PHP Medicare Advantage |
$5.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.35
|
| Rate for Payer: Priority Health Medicare |
$5.44
|
| Rate for Payer: Priority Health Narrow Network |
$4.28
|
| Rate for Payer: Railroad Medicare Medicare |
$5.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,744.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.44
|
| Rate for Payer: UHC Exchange |
$8.43
|
| Rate for Payer: UHC Medicaid |
$2.85
|
| Rate for Payer: UHCCP DNSP |
$5.44
|
| Rate for Payer: UHCCP Medicaid |
$2.85
|
| Rate for Payer: VA VA |
$5.44
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$190.08
|
|
|
Service Code
|
NDC 904704606
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.33 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: Aetna Commercial |
$171.07
|
| Rate for Payer: Aetna Medicare |
$70.33
|
| Rate for Payer: ASR ASR |
$184.38
|
| Rate for Payer: BCBS Complete |
$76.03
|
| Rate for Payer: BCBS Trust/PPO |
$156.72
|
| Rate for Payer: BCN Commercial |
$156.72
|
| Rate for Payer: Cash Price |
$152.06
|
| Rate for Payer: Cofinity Commercial |
$178.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.06
|
| Rate for Payer: Healthscope Commercial |
$184.38
|
| Rate for Payer: Healthscope Whirlpool |
$190.08
|
| Rate for Payer: Mclaren Commercial |
$171.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.57
|
| Rate for Payer: Nomi Health Commercial |
$155.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$166.55
|
| Rate for Payer: Priority Health Narrow Network |
$133.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.27
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$266.95
|
|
|
Service Code
|
NDC 43598072101
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.77 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$240.25
|
| Rate for Payer: Aetna Medicare |
$98.77
|
| Rate for Payer: ASR ASR |
$258.94
|
| Rate for Payer: BCBS Complete |
$106.78
|
| Rate for Payer: BCBS Trust/PPO |
$220.10
|
| Rate for Payer: BCN Commercial |
$220.10
|
| Rate for Payer: Cash Price |
$213.56
|
| Rate for Payer: Cofinity Commercial |
$250.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.56
|
| Rate for Payer: Healthscope Commercial |
$258.94
|
| Rate for Payer: Healthscope Whirlpool |
$266.95
|
| Rate for Payer: Mclaren Commercial |
$240.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$213.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.91
|
| Rate for Payer: Nomi Health Commercial |
$218.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$233.90
|
| Rate for Payer: Priority Health Narrow Network |
$187.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$234.92
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$291.65
|
|
|
Service Code
|
NDC 69238154401
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.91 |
| Max. Negotiated Rate |
$291.65 |
| Rate for Payer: Aetna Commercial |
$262.49
|
| Rate for Payer: Aetna Medicare |
$107.91
|
| Rate for Payer: ASR ASR |
$282.90
|
| Rate for Payer: BCBS Complete |
$116.66
|
| Rate for Payer: BCBS Trust/PPO |
$240.47
|
| Rate for Payer: BCN Commercial |
$240.47
|
| 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 |
$282.90
|
| Rate for Payer: Healthscope Whirlpool |
$291.65
|
| Rate for Payer: Mclaren Commercial |
$262.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$233.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.90
|
| Rate for Payer: Nomi Health Commercial |
$239.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$255.54
|
| Rate for Payer: Priority Health Narrow Network |
$204.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.65
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$291.65
|
|
|
Service Code
|
NDC 69238154401
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$218.74 |
| Max. Negotiated Rate |
$291.65 |
| Rate for Payer: Aetna Commercial |
$262.49
|
| Rate for Payer: ASR ASR |
$282.90
|
| Rate for Payer: BCBS Trust/PPO |
$239.50
|
| Rate for Payer: BCN Commercial |
$239.50
|
| 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 |
$282.90
|
| Rate for Payer: Healthscope Whirlpool |
$291.65
|
| Rate for Payer: Mclaren Commercial |
$262.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.90
|
| Rate for Payer: Nomi Health Commercial |
$239.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$218.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.65
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$266.95
|
|
|
Service Code
|
NDC 43598072101
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$200.21 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$240.25
|
| Rate for Payer: ASR ASR |
$258.94
|
| Rate for Payer: BCBS Trust/PPO |
$219.22
|
| Rate for Payer: BCN Commercial |
$219.22
|
| Rate for Payer: Cash Price |
$213.56
|
| Rate for Payer: Cofinity Commercial |
$250.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$213.56
|
| Rate for Payer: Healthscope Commercial |
$258.94
|
| Rate for Payer: Healthscope Whirlpool |
$266.95
|
| Rate for Payer: Mclaren Commercial |
$240.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$226.91
|
| Rate for Payer: Nomi Health Commercial |
$218.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$234.92
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$190.08
|
|
|
Service Code
|
NDC 904704606
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.56 |
| Max. Negotiated Rate |
$190.08 |
| Rate for Payer: Aetna Commercial |
$171.07
|
| Rate for Payer: ASR ASR |
$184.38
|
| Rate for Payer: BCBS Trust/PPO |
$156.09
|
| Rate for Payer: BCN Commercial |
$156.09
|
| Rate for Payer: Cash Price |
$152.06
|
| Rate for Payer: Cofinity Commercial |
$178.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.06
|
| Rate for Payer: Healthscope Commercial |
$184.38
|
| Rate for Payer: Healthscope Whirlpool |
$190.08
|
| Rate for Payer: Mclaren Commercial |
$171.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.57
|
| Rate for Payer: Nomi Health Commercial |
$155.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$167.27
|
|
|
HYDROXYPROGESTERONE (PF)(PREGNANCY PRESERVING) 250 MG/ML (1 ML) IM OIL
|
Facility
|
IP
|
$2,043.07
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
178180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,532.30 |
| Max. Negotiated Rate |
$2,043.07 |
| Rate for Payer: Aetna Commercial |
$1,838.76
|
| Rate for Payer: Aetna Commercial |
$1,915.46
|
| Rate for Payer: ASR ASR |
$2,064.44
|
| Rate for Payer: ASR ASR |
$1,981.78
|
| Rate for Payer: BCBS Trust/PPO |
$1,747.75
|
| Rate for Payer: BCBS Trust/PPO |
$1,677.77
|
| Rate for Payer: BCN Commercial |
$1,747.75
|
| Rate for Payer: BCN Commercial |
$1,677.77
|
| Rate for Payer: Cash Price |
$1,702.63
|
| Rate for Payer: Cash Price |
$1,634.46
|
| Rate for Payer: Cofinity Commercial |
$1,920.49
|
| Rate for Payer: Cofinity Commercial |
$2,000.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,634.46
|
| Rate for Payer: Healthscope Commercial |
$1,981.78
|
| Rate for Payer: Healthscope Commercial |
$2,064.44
|
| Rate for Payer: Healthscope Whirlpool |
$2,128.29
|
| Rate for Payer: Healthscope Whirlpool |
$2,043.07
|
| Rate for Payer: Mclaren Commercial |
$1,915.46
|
| Rate for Payer: Mclaren Commercial |
$1,838.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,809.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,736.61
|
| Rate for Payer: Nomi Health Commercial |
$1,745.20
|
| Rate for Payer: Nomi Health Commercial |
$1,675.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,532.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,596.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,797.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,872.89
|
|
|
HYDROXYPROGESTERONE (PF)(PREGNANCY PRESERVING) 250 MG/ML (1 ML) IM OIL
|
Facility
|
OP
|
$2,128.29
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
178180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$2,128.29 |
| Rate for Payer: Aetna Commercial |
$1,915.46
|
| Rate for Payer: Aetna Commercial |
$1,838.76
|
| Rate for Payer: Aetna Medicare |
$755.94
|
| Rate for Payer: Aetna Medicare |
$787.47
|
| Rate for Payer: ASR ASR |
$2,064.44
|
| Rate for Payer: ASR ASR |
$1,981.78
|
| Rate for Payer: BCBS Complete |
$817.23
|
| Rate for Payer: BCBS Complete |
$851.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,754.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,684.51
|
| Rate for Payer: BCN Commercial |
$1,684.51
|
| Rate for Payer: BCN Commercial |
$1,754.77
|
| Rate for Payer: Cash Price |
$1,702.63
|
| Rate for Payer: Cash Price |
$1,634.46
|
| Rate for Payer: Cash Price |
$1,702.63
|
| Rate for Payer: Cash Price |
$1,634.46
|
| Rate for Payer: Cofinity Commercial |
$1,920.49
|
| Rate for Payer: Cofinity Commercial |
$2,000.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,634.46
|
| Rate for Payer: Healthscope Commercial |
$2,064.44
|
| Rate for Payer: Healthscope Commercial |
$1,981.78
|
| Rate for Payer: Healthscope Whirlpool |
$2,128.29
|
| Rate for Payer: Healthscope Whirlpool |
$2,043.07
|
| Rate for Payer: Mclaren Commercial |
$1,915.46
|
| Rate for Payer: Mclaren Commercial |
$1,838.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,702.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,634.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,736.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,809.04
|
| Rate for Payer: Nomi Health Commercial |
$1,675.32
|
| Rate for Payer: Nomi Health Commercial |
$1,745.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,532.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,596.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.62
|
| Rate for Payer: Priority Health Narrow Network |
$16.50
|
| Rate for Payer: Priority Health Narrow Network |
$16.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,797.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,872.89
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
IP
|
$441.80
|
|
|
Service Code
|
NDC 63739048610
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$331.35 |
| Max. Negotiated Rate |
$441.80 |
| Rate for Payer: Aetna Commercial |
$397.62
|
| Rate for Payer: ASR ASR |
$428.55
|
| Rate for Payer: BCBS Trust/PPO |
$362.81
|
| Rate for Payer: BCN Commercial |
$362.81
|
| Rate for Payer: Cash Price |
$353.44
|
| Rate for Payer: Cofinity Commercial |
$415.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.44
|
| Rate for Payer: Healthscope Commercial |
$428.55
|
| Rate for Payer: Healthscope Whirlpool |
$441.80
|
| Rate for Payer: Mclaren Commercial |
$397.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.53
|
| Rate for Payer: Nomi Health Commercial |
$362.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$388.78
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
OP
|
$352.50
|
|
|
Service Code
|
NDC 904661761
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.43 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Aetna Commercial |
$317.25
|
| Rate for Payer: Aetna Medicare |
$130.43
|
| Rate for Payer: ASR ASR |
$341.93
|
| Rate for Payer: BCBS Complete |
$141.00
|
| Rate for Payer: BCBS Trust/PPO |
$290.64
|
| Rate for Payer: BCN Commercial |
$290.64
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cofinity Commercial |
$331.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.00
|
| Rate for Payer: Healthscope Commercial |
$341.93
|
| Rate for Payer: Healthscope Whirlpool |
$352.50
|
| Rate for Payer: Mclaren Commercial |
$317.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$282.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.62
|
| Rate for Payer: Nomi Health Commercial |
$289.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$264.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$308.86
|
| Rate for Payer: Priority Health Narrow Network |
$247.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$310.20
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
IP
|
$2.16
|
|
|
Service Code
|
NDC 60687067511
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$2.16 |
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: ASR ASR |
$2.09
|
| Rate for Payer: BCBS Trust/PPO |
$1.77
|
| Rate for Payer: BCN Commercial |
$1.77
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cofinity Commercial |
$2.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.73
|
| Rate for Payer: Healthscope Commercial |
$2.09
|
| Rate for Payer: Healthscope Whirlpool |
$2.16
|
| Rate for Payer: Mclaren Commercial |
$1.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.83
|
| Rate for Payer: Nomi Health Commercial |
$1.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.90
|
|
|
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 |
$441.80 |
| Rate for Payer: Aetna Commercial |
$397.62
|
| Rate for Payer: Aetna Medicare |
$163.47
|
| Rate for Payer: ASR ASR |
$428.55
|
| Rate for Payer: BCBS Complete |
$176.72
|
| Rate for Payer: BCBS Trust/PPO |
$364.26
|
| Rate for Payer: BCN Commercial |
$364.26
|
| Rate for Payer: Cash Price |
$353.44
|
| Rate for Payer: Cofinity Commercial |
$415.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$353.44
|
| Rate for Payer: Healthscope Commercial |
$428.55
|
| Rate for Payer: Healthscope Whirlpool |
$441.80
|
| Rate for Payer: Mclaren Commercial |
$397.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$353.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$375.53
|
| Rate for Payer: Nomi Health Commercial |
$362.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$331.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$387.11
|
| Rate for Payer: Priority Health Narrow Network |
$309.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$388.78
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
OP
|
$215.65
|
|
|
Service Code
|
NDC 60687067501
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$79.79 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Aetna Commercial |
$194.09
|
| Rate for Payer: Aetna Medicare |
$79.79
|
| Rate for Payer: ASR ASR |
$209.18
|
| Rate for Payer: BCBS Complete |
$86.26
|
| Rate for Payer: BCBS Trust/PPO |
$177.80
|
| Rate for Payer: BCN Commercial |
$177.80
|
| Rate for Payer: Cash Price |
$172.52
|
| Rate for Payer: Cofinity Commercial |
$202.71
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$172.52
|
| Rate for Payer: Healthscope Commercial |
$209.18
|
| Rate for Payer: Healthscope Whirlpool |
$215.65
|
| Rate for Payer: Mclaren Commercial |
$194.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$172.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Nomi Health Commercial |
$176.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$161.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$188.95
|
| Rate for Payer: Priority Health Narrow Network |
$151.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.77
|
|
|
HYDROXYZINE HCL 25 MG TABLET
|
Facility
|
IP
|
$352.50
|
|
|
Service Code
|
NDC 904661761
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$264.38 |
| Max. Negotiated Rate |
$352.50 |
| Rate for Payer: Aetna Commercial |
$317.25
|
| Rate for Payer: ASR ASR |
$341.93
|
| Rate for Payer: BCBS Trust/PPO |
$289.47
|
| Rate for Payer: BCN Commercial |
$289.47
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cofinity Commercial |
$331.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$282.00
|
| Rate for Payer: Healthscope Commercial |
$341.93
|
| Rate for Payer: Healthscope Whirlpool |
$352.50
|
| Rate for Payer: Mclaren Commercial |
$317.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.62
|
| Rate for Payer: Nomi Health Commercial |
$289.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$264.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$310.20
|
|
