|
HYDRALAZINE 20 MG/ML INJECTION SOLUTION
|
Facility
|
IP
|
$23.33
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
3697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.16 |
| Max. Negotiated Rate |
$23.33 |
| Rate for Payer: Aetna Commercial |
$21.00
|
| Rate for Payer: Aetna Commercial |
$19.39
|
| Rate for Payer: ASR ASR |
$22.63
|
| Rate for Payer: ASR ASR |
$20.89
|
| Rate for Payer: ASR Commercial |
$20.89
|
| Rate for Payer: ASR Commercial |
$22.63
|
| Rate for Payer: BCBS Trust/PPO |
$17.55
|
| Rate for Payer: BCBS Trust/PPO |
$19.01
|
| Rate for Payer: BCN Commercial |
$18.09
|
| Rate for Payer: BCN Commercial |
$16.70
|
| Rate for Payer: Cash Price |
$18.67
|
| Rate for Payer: Cash Price |
$17.23
|
| Rate for Payer: Cofinity Commercial |
$20.25
|
| Rate for Payer: Cofinity Commercial |
$21.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.66
|
| Rate for Payer: Healthscope Commercial |
$21.54
|
| Rate for Payer: Healthscope Commercial |
$23.33
|
| Rate for Payer: Healthscope Whirlpool |
$20.89
|
| Rate for Payer: Healthscope Whirlpool |
$22.63
|
| Rate for Payer: Mclaren Commercial |
$19.39
|
| Rate for Payer: Mclaren Commercial |
$21.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.83
|
| Rate for Payer: Nomi Health Commercial |
$17.66
|
| Rate for Payer: Nomi Health Commercial |
$19.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.53
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$3.74
|
|
|
Service Code
|
NDC 62584073311
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: Aetna Medicare |
$1.87
|
| Rate for Payer: ASR ASR |
$3.63
|
| Rate for Payer: ASR Commercial |
$3.63
|
| Rate for Payer: BCBS Complete |
$1.50
|
| Rate for Payer: BCBS Trust/PPO |
$3.06
|
| Rate for Payer: BCN Commercial |
$2.90
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Healthscope Whirlpool |
$3.63
|
| Rate for Payer: Mclaren Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: Nomi Health Commercial |
$3.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.28
|
| Rate for Payer: Priority Health Narrow Network |
$2.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.29
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$4.25
|
|
|
Service Code
|
NDC 51079007501
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.82
|
| Rate for Payer: ASR ASR |
$4.12
|
| Rate for Payer: ASR Commercial |
$4.12
|
| Rate for Payer: BCBS Trust/PPO |
$3.46
|
| Rate for Payer: BCN Commercial |
$3.30
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cofinity Commercial |
$4.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Healthscope Commercial |
$4.25
|
| Rate for Payer: Healthscope Whirlpool |
$4.12
|
| Rate for Payer: Mclaren Commercial |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.61
|
| Rate for Payer: Nomi Health Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.74
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$82.25
|
|
|
Service Code
|
NDC 23155083301
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.90 |
| Max. Negotiated Rate |
$82.25 |
| Rate for Payer: Aetna Commercial |
$74.02
|
| Rate for Payer: Aetna Medicare |
$41.12
|
| Rate for Payer: ASR ASR |
$79.78
|
| Rate for Payer: ASR Commercial |
$79.78
|
| Rate for Payer: BCBS Complete |
$32.90
|
| Rate for Payer: BCBS Trust/PPO |
$67.35
|
| Rate for Payer: BCN Commercial |
$63.77
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$77.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$82.25
|
| Rate for Payer: Healthscope Whirlpool |
$79.78
|
| Rate for Payer: Mclaren Commercial |
$74.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Nomi Health Commercial |
$67.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.07
|
| Rate for Payer: Priority Health Narrow Network |
$57.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.38
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$190.95
|
|
|
Service Code
|
NDC 60687082201
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.12 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Aetna Commercial |
$171.86
|
| Rate for Payer: ASR ASR |
$185.22
|
| Rate for Payer: ASR Commercial |
$185.22
|
| Rate for Payer: BCBS Trust/PPO |
$155.61
|
| Rate for Payer: BCN Commercial |
$148.04
|
| Rate for Payer: Cash Price |
$152.76
|
| Rate for Payer: Cofinity Commercial |
$179.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.76
|
| Rate for Payer: Healthscope Commercial |
$190.95
|
| Rate for Payer: Healthscope Whirlpool |
$185.22
|
| Rate for Payer: Mclaren Commercial |
$171.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.31
|
| Rate for Payer: Nomi Health Commercial |
$156.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$168.04
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$1.91
|
|
|
Service Code
|
NDC 60687082211
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.72
|
| Rate for Payer: ASR ASR |
$1.85
|
| Rate for Payer: ASR Commercial |
$1.85
|
| Rate for Payer: BCBS Trust/PPO |
$1.56
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.53
|
| Rate for Payer: Healthscope Commercial |
$1.91
|
| Rate for Payer: Healthscope Whirlpool |
$1.85
|
| Rate for Payer: Mclaren Commercial |
$1.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.62
|
| Rate for Payer: Nomi Health Commercial |
$1.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.68
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$425.35
|
|
|
Service Code
|
NDC 51079007520
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$170.14 |
| Max. Negotiated Rate |
$425.35 |
| Rate for Payer: Aetna Commercial |
$382.82
|
| Rate for Payer: Aetna Medicare |
$212.68
|
| Rate for Payer: ASR ASR |
$412.59
|
| Rate for Payer: ASR Commercial |
$412.59
|
| Rate for Payer: BCBS Complete |
$170.14
|
| Rate for Payer: BCBS Trust/PPO |
$348.32
|
| Rate for Payer: BCN Commercial |
$329.77
|
| Rate for Payer: Cash Price |
$340.28
|
| Rate for Payer: Cofinity Commercial |
$399.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.28
|
| Rate for Payer: Healthscope Commercial |
$425.35
|
| Rate for Payer: Healthscope Whirlpool |
$412.59
|
| Rate for Payer: Mclaren Commercial |
$382.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.55
|
| Rate for Payer: Nomi Health Commercial |
$348.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$372.69
|
| Rate for Payer: Priority Health Narrow Network |
$298.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$374.31
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$190.95
|
|
|
Service Code
|
NDC 60687082201
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.38 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Aetna Commercial |
$171.86
|
| Rate for Payer: Aetna Medicare |
$95.48
|
| Rate for Payer: ASR ASR |
$185.22
|
| Rate for Payer: ASR Commercial |
$185.22
|
| Rate for Payer: BCBS Complete |
$76.38
|
| Rate for Payer: BCBS Trust/PPO |
$156.37
|
| Rate for Payer: BCN Commercial |
$148.04
|
| Rate for Payer: Cash Price |
$152.76
|
| Rate for Payer: Cofinity Commercial |
$179.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.76
|
| Rate for Payer: Healthscope Commercial |
$190.95
|
| Rate for Payer: Healthscope Whirlpool |
$185.22
|
| Rate for Payer: Mclaren Commercial |
$171.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.31
|
| Rate for Payer: Nomi Health Commercial |
$156.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.31
|
| Rate for Payer: Priority Health Narrow Network |
$133.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$168.04
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$82.25
|
|
|
Service Code
|
NDC 23155083301
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$82.25 |
| Rate for Payer: Aetna Commercial |
$74.02
|
| Rate for Payer: ASR ASR |
$79.78
|
| Rate for Payer: ASR Commercial |
$79.78
|
| Rate for Payer: BCBS Trust/PPO |
$67.03
|
| Rate for Payer: BCN Commercial |
$63.77
|
| Rate for Payer: Cash Price |
$65.80
|
| Rate for Payer: Cofinity Commercial |
$77.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.80
|
| Rate for Payer: Healthscope Commercial |
$82.25
|
| Rate for Payer: Healthscope Whirlpool |
$79.78
|
| Rate for Payer: Mclaren Commercial |
$74.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.91
|
| Rate for Payer: Nomi Health Commercial |
$67.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.38
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$258.50
|
|
|
Service Code
|
NDC 00904644161
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Aetna Commercial |
$232.65
|
| Rate for Payer: Aetna Medicare |
$129.25
|
| Rate for Payer: ASR ASR |
$250.74
|
| Rate for Payer: ASR Commercial |
$250.74
|
| Rate for Payer: BCBS Complete |
$103.40
|
| Rate for Payer: BCBS Trust/PPO |
$211.69
|
| Rate for Payer: BCN Commercial |
$200.42
|
| 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 |
$258.50
|
| Rate for Payer: Healthscope Whirlpool |
$250.74
|
| Rate for Payer: Mclaren Commercial |
$232.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.72
|
| Rate for Payer: Nomi Health Commercial |
$211.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.02
|
| Rate for Payer: 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
|
OP
|
$260.85
|
|
|
Service Code
|
NDC 63739032710
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.34 |
| Max. Negotiated Rate |
$260.85 |
| Rate for Payer: Aetna Commercial |
$234.76
|
| Rate for Payer: Aetna Medicare |
$130.42
|
| Rate for Payer: ASR ASR |
$253.02
|
| Rate for Payer: ASR Commercial |
$253.02
|
| Rate for Payer: BCBS Complete |
$104.34
|
| Rate for Payer: BCBS Trust/PPO |
$213.61
|
| Rate for Payer: BCN Commercial |
$202.24
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$245.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$260.85
|
| Rate for Payer: Healthscope Whirlpool |
$253.02
|
| Rate for Payer: Mclaren Commercial |
$234.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.72
|
| Rate for Payer: Nomi Health Commercial |
$213.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.56
|
| Rate for Payer: Priority Health Narrow Network |
$182.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$229.55
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$3.74
|
|
|
Service Code
|
NDC 62584073311
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.43 |
| Max. Negotiated Rate |
$3.74 |
| Rate for Payer: Aetna Commercial |
$3.37
|
| Rate for Payer: ASR ASR |
$3.63
|
| Rate for Payer: ASR Commercial |
$3.63
|
| Rate for Payer: BCBS Trust/PPO |
$3.05
|
| Rate for Payer: BCN Commercial |
$2.90
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cofinity Commercial |
$3.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.99
|
| Rate for Payer: Healthscope Commercial |
$3.74
|
| Rate for Payer: Healthscope Whirlpool |
$3.63
|
| Rate for Payer: Mclaren Commercial |
$3.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.18
|
| Rate for Payer: Nomi Health Commercial |
$3.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.29
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$260.85
|
|
|
Service Code
|
NDC 63739032710
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.55 |
| Max. Negotiated Rate |
$260.85 |
| Rate for Payer: Aetna Commercial |
$234.76
|
| Rate for Payer: ASR ASR |
$253.02
|
| Rate for Payer: ASR Commercial |
$253.02
|
| Rate for Payer: BCBS Trust/PPO |
$212.57
|
| Rate for Payer: BCN Commercial |
$202.24
|
| Rate for Payer: Cash Price |
$208.68
|
| Rate for Payer: Cofinity Commercial |
$245.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.68
|
| Rate for Payer: Healthscope Commercial |
$260.85
|
| Rate for Payer: Healthscope Whirlpool |
$253.02
|
| Rate for Payer: Mclaren Commercial |
$234.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.72
|
| Rate for Payer: Nomi Health Commercial |
$213.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$229.55
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$4.25
|
|
|
Service Code
|
NDC 51079007501
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Aetna Commercial |
$3.82
|
| Rate for Payer: Aetna Medicare |
$2.12
|
| Rate for Payer: ASR ASR |
$4.12
|
| Rate for Payer: ASR Commercial |
$4.12
|
| Rate for Payer: BCBS Complete |
$1.70
|
| Rate for Payer: BCBS Trust/PPO |
$3.48
|
| Rate for Payer: BCN Commercial |
$3.30
|
| Rate for Payer: Cash Price |
$3.40
|
| Rate for Payer: Cofinity Commercial |
$4.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.40
|
| Rate for Payer: Healthscope Commercial |
$4.25
|
| Rate for Payer: Healthscope Whirlpool |
$4.12
|
| Rate for Payer: Mclaren Commercial |
$3.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.61
|
| Rate for Payer: Nomi Health Commercial |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.72
|
| Rate for Payer: Priority Health Narrow Network |
$2.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.74
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$425.35
|
|
|
Service Code
|
NDC 51079007520
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$276.48 |
| Max. Negotiated Rate |
$425.35 |
| Rate for Payer: Aetna Commercial |
$382.82
|
| Rate for Payer: ASR ASR |
$412.59
|
| Rate for Payer: ASR Commercial |
$412.59
|
| Rate for Payer: BCBS Trust/PPO |
$346.62
|
| Rate for Payer: BCN Commercial |
$329.77
|
| Rate for Payer: Cash Price |
$340.28
|
| Rate for Payer: Cofinity Commercial |
$399.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.28
|
| Rate for Payer: Healthscope Commercial |
$425.35
|
| Rate for Payer: Healthscope Whirlpool |
$412.59
|
| Rate for Payer: Mclaren Commercial |
$382.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.55
|
| Rate for Payer: Nomi Health Commercial |
$348.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$374.31
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
OP
|
$1.91
|
|
|
Service Code
|
NDC 60687082211
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.72
|
| Rate for Payer: Aetna Medicare |
$0.96
|
| Rate for Payer: ASR ASR |
$1.85
|
| Rate for Payer: ASR Commercial |
$1.85
|
| Rate for Payer: BCBS Complete |
$0.76
|
| Rate for Payer: BCBS Trust/PPO |
$1.56
|
| Rate for Payer: BCN Commercial |
$1.48
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cofinity Commercial |
$1.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.53
|
| Rate for Payer: Healthscope Commercial |
$1.91
|
| Rate for Payer: Healthscope Whirlpool |
$1.85
|
| Rate for Payer: Mclaren Commercial |
$1.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.62
|
| Rate for Payer: Nomi Health Commercial |
$1.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.24
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.67
|
| Rate for Payer: Priority Health Narrow Network |
$1.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.68
|
|
|
HYDRALAZINE 25 MG TABLET
|
Facility
|
IP
|
$258.50
|
|
|
Service Code
|
NDC 00904644161
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.02 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Aetna Commercial |
$232.65
|
| Rate for Payer: ASR ASR |
$250.74
|
| Rate for Payer: ASR Commercial |
$250.74
|
| Rate for Payer: BCBS Trust/PPO |
$210.65
|
| Rate for Payer: BCN Commercial |
$200.42
|
| 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 |
$258.50
|
| Rate for Payer: Healthscope Whirlpool |
$250.74
|
| Rate for Payer: Mclaren Commercial |
$232.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.72
|
| Rate for Payer: Nomi Health Commercial |
$211.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.48
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$4.37
|
|
|
Service Code
|
NDC 60687059311
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Aetna Commercial |
$3.93
|
| Rate for Payer: Aetna Medicare |
$2.18
|
| Rate for Payer: ASR ASR |
$4.24
|
| Rate for Payer: ASR Commercial |
$4.24
|
| Rate for Payer: BCBS Complete |
$1.75
|
| Rate for Payer: BCBS Trust/PPO |
$3.58
|
| Rate for Payer: BCN Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$4.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$4.37
|
| Rate for Payer: Healthscope Whirlpool |
$4.24
|
| Rate for Payer: Mclaren Commercial |
$3.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.71
|
| Rate for Payer: Nomi Health Commercial |
$3.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.83
|
| Rate for Payer: Priority Health Narrow Network |
$3.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.85
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
OP
|
$437.10
|
|
|
Service Code
|
NDC 60687059301
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$174.84 |
| Max. Negotiated Rate |
$437.10 |
| Rate for Payer: Aetna Commercial |
$393.39
|
| Rate for Payer: Aetna Medicare |
$218.55
|
| Rate for Payer: ASR ASR |
$423.99
|
| Rate for Payer: ASR Commercial |
$423.99
|
| Rate for Payer: BCBS Complete |
$174.84
|
| Rate for Payer: BCBS Trust/PPO |
$357.94
|
| Rate for Payer: BCN Commercial |
$338.88
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$410.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$437.10
|
| Rate for Payer: Healthscope Whirlpool |
$423.99
|
| Rate for Payer: Mclaren Commercial |
$393.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Nomi Health Commercial |
$358.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$382.99
|
| Rate for Payer: Priority Health Narrow Network |
$306.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.65
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$4.37
|
|
|
Service Code
|
NDC 60687059311
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$4.37 |
| Rate for Payer: Aetna Commercial |
$3.93
|
| Rate for Payer: ASR ASR |
$4.24
|
| Rate for Payer: ASR Commercial |
$4.24
|
| Rate for Payer: BCBS Trust/PPO |
$3.56
|
| Rate for Payer: BCN Commercial |
$3.39
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cofinity Commercial |
$4.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.50
|
| Rate for Payer: Healthscope Commercial |
$4.37
|
| Rate for Payer: Healthscope Whirlpool |
$4.24
|
| Rate for Payer: Mclaren Commercial |
$3.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.71
|
| Rate for Payer: Nomi Health Commercial |
$3.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.85
|
|
|
HYDROCHLOROTHIAZIDE 25 MG TABLET
|
Facility
|
IP
|
$437.10
|
|
|
Service Code
|
NDC 60687059301
|
| Hospital Charge Code |
3720
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$284.12 |
| Max. Negotiated Rate |
$437.10 |
| Rate for Payer: Aetna Commercial |
$393.39
|
| Rate for Payer: ASR ASR |
$423.99
|
| Rate for Payer: ASR Commercial |
$423.99
|
| Rate for Payer: BCBS Trust/PPO |
$356.19
|
| Rate for Payer: BCN Commercial |
$338.88
|
| Rate for Payer: Cash Price |
$349.68
|
| Rate for Payer: Cofinity Commercial |
$410.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$349.68
|
| Rate for Payer: Healthscope Commercial |
$437.10
|
| Rate for Payer: Healthscope Whirlpool |
$423.99
|
| Rate for Payer: Mclaren Commercial |
$393.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$371.54
|
| Rate for Payer: Nomi Health Commercial |
$358.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.65
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$271.25
|
|
|
Service Code
|
NDC 50268040215
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$108.50 |
| Max. Negotiated Rate |
$271.25 |
| Rate for Payer: Aetna Commercial |
$244.12
|
| Rate for Payer: Aetna Medicare |
$135.62
|
| Rate for Payer: ASR ASR |
$263.11
|
| Rate for Payer: ASR Commercial |
$263.11
|
| Rate for Payer: BCBS Complete |
$108.50
|
| Rate for Payer: BCBS Trust/PPO |
$222.13
|
| Rate for Payer: BCN Commercial |
$210.30
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cofinity Commercial |
$254.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$217.00
|
| Rate for Payer: Healthscope Commercial |
$271.25
|
| Rate for Payer: Healthscope Whirlpool |
$263.11
|
| Rate for Payer: Mclaren Commercial |
$244.12
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$230.56
|
| Rate for Payer: Nomi Health Commercial |
$222.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.31
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$237.67
|
| Rate for Payer: Priority Health Narrow Network |
$190.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.70
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$5.42
|
|
|
Service Code
|
NDC 50268040211
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$5.42 |
| Rate for Payer: Aetna Commercial |
$4.88
|
| Rate for Payer: Aetna Medicare |
$2.71
|
| Rate for Payer: ASR ASR |
$5.26
|
| Rate for Payer: ASR Commercial |
$5.26
|
| Rate for Payer: BCBS Complete |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$4.44
|
| Rate for Payer: BCN Commercial |
$4.20
|
| Rate for Payer: Cash Price |
$4.34
|
| Rate for Payer: Cofinity Commercial |
$5.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.34
|
| Rate for Payer: Healthscope Commercial |
$5.42
|
| Rate for Payer: Healthscope Whirlpool |
$5.26
|
| Rate for Payer: Mclaren Commercial |
$4.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.61
|
| Rate for Payer: Nomi Health Commercial |
$4.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.75
|
| Rate for Payer: Priority Health Narrow Network |
$3.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.77
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
IP
|
$80.33
|
|
|
Service Code
|
NDC 00406012562
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$52.21 |
| Max. Negotiated Rate |
$80.33 |
| Rate for Payer: Aetna Commercial |
$72.30
|
| Rate for Payer: ASR ASR |
$77.92
|
| Rate for Payer: ASR Commercial |
$77.92
|
| Rate for Payer: BCBS Trust/PPO |
$65.46
|
| Rate for Payer: BCN Commercial |
$62.28
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$75.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.26
|
| Rate for Payer: Healthscope Commercial |
$80.33
|
| Rate for Payer: Healthscope Whirlpool |
$77.92
|
| Rate for Payer: Mclaren Commercial |
$72.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.28
|
| Rate for Payer: Nomi Health Commercial |
$65.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.69
|
|
|
HYDROCODONE 10 MG-ACETAMINOPHEN 325 MG TABLET
|
Facility
|
OP
|
$80.33
|
|
|
Service Code
|
NDC 00406012562
|
| Hospital Charge Code |
28384
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$80.33 |
| Rate for Payer: Aetna Commercial |
$72.30
|
| Rate for Payer: Aetna Medicare |
$40.16
|
| Rate for Payer: ASR ASR |
$77.92
|
| Rate for Payer: ASR Commercial |
$77.92
|
| Rate for Payer: BCBS Complete |
$32.13
|
| Rate for Payer: BCBS Trust/PPO |
$65.78
|
| Rate for Payer: BCN Commercial |
$62.28
|
| Rate for Payer: Cash Price |
$64.26
|
| Rate for Payer: Cofinity Commercial |
$75.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.26
|
| Rate for Payer: Healthscope Commercial |
$80.33
|
| Rate for Payer: Healthscope Whirlpool |
$77.92
|
| Rate for Payer: Mclaren Commercial |
$72.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.28
|
| Rate for Payer: Nomi Health Commercial |
$65.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.39
|
| Rate for Payer: Priority Health Narrow Network |
$56.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$70.69
|
|
