|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM
|
Facility
|
OP
|
$699.89
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
76100036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$208.85 |
| Max. Negotiated Rate |
$699.89 |
| Rate for Payer: Aetna Commercial |
$629.90
|
| Rate for Payer: Aetna Medicare |
$389.65
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$487.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$487.06
|
| Rate for Payer: ASR ASR |
$678.89
|
| Rate for Payer: ASR Commercial |
$678.89
|
| Rate for Payer: BCBS Complete |
$219.30
|
| Rate for Payer: BCBS MAPPO |
$389.65
|
| Rate for Payer: BCBS Trust/PPO |
$573.14
|
| Rate for Payer: BCN Commercial |
$542.62
|
| Rate for Payer: BCN Medicare Advantage |
$389.65
|
| Rate for Payer: Cash Price |
$559.91
|
| Rate for Payer: Cash Price |
$559.91
|
| Rate for Payer: Cofinity Commercial |
$657.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$389.65
|
| Rate for Payer: Healthscope Commercial |
$699.89
|
| Rate for Payer: Healthscope Whirlpool |
$678.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.65
|
| Rate for Payer: Mclaren Commercial |
$629.90
|
| Rate for Payer: Mclaren Medicaid |
$208.85
|
| Rate for Payer: Mclaren Medicare |
$389.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$409.13
|
| Rate for Payer: Meridian Medicaid |
$219.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$448.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.91
|
| Rate for Payer: Nomi Health Commercial |
$573.91
|
| Rate for Payer: PACE Medicare |
$370.17
|
| Rate for Payer: PACE SWMI |
$389.65
|
| Rate for Payer: PHP Commercial |
$428.62
|
| Rate for Payer: PHP Medicaid |
$208.85
|
| Rate for Payer: PHP Medicare Advantage |
$389.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$613.24
|
| Rate for Payer: Priority Health Medicare |
$389.65
|
| Rate for Payer: Priority Health Narrow Network |
$490.62
|
| Rate for Payer: Railroad Medicare Medicare |
$389.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$615.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.65
|
| Rate for Payer: UHC Exchange |
$603.96
|
| Rate for Payer: UHC Medicare Advantage |
$389.65
|
| Rate for Payer: UHCCP DNSP |
$389.65
|
| Rate for Payer: UHCCP Medicaid |
$208.85
|
| Rate for Payer: VA VA |
$389.65
|
|
|
HH HC NEGATIVE PRESSURE WOUND THERAPY DISPOSAL >50SQ CM
|
Facility
|
IP
|
$699.89
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
76100036
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$454.93 |
| Max. Negotiated Rate |
$699.89 |
| Rate for Payer: Aetna Commercial |
$629.90
|
| Rate for Payer: ASR ASR |
$678.89
|
| Rate for Payer: ASR Commercial |
$678.89
|
| Rate for Payer: BCBS Trust/PPO |
$570.34
|
| Rate for Payer: BCN Commercial |
$542.62
|
| Rate for Payer: Cash Price |
$559.91
|
| Rate for Payer: Cofinity Commercial |
$657.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$559.91
|
| Rate for Payer: Healthscope Commercial |
$699.89
|
| Rate for Payer: Healthscope Whirlpool |
$678.89
|
| Rate for Payer: Mclaren Commercial |
$629.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$594.91
|
| Rate for Payer: Nomi Health Commercial |
$573.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$615.90
|
|
|
HH POUCH 2.5" CTF HOLL8331 EA
|
Facility
|
OP
|
$6.36
|
|
|
Service Code
|
HCPCS A5056
|
| Hospital Charge Code |
27000597
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$6.36 |
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: Aetna Medicare |
$3.18
|
| Rate for Payer: ASR ASR |
$6.17
|
| Rate for Payer: ASR Commercial |
$6.17
|
| Rate for Payer: BCBS Complete |
$2.54
|
| Rate for Payer: BCBS Trust/PPO |
$5.21
|
| Rate for Payer: BCN Commercial |
$4.93
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Commercial |
$5.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$6.36
|
| Rate for Payer: Healthscope Whirlpool |
$6.17
|
| Rate for Payer: Mclaren Commercial |
$5.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.57
|
| Rate for Payer: Priority Health Narrow Network |
$4.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.60
|
|
|
HH POUCH 2.5" CTF HOLL8331 EA
|
Facility
|
IP
|
$6.36
|
|
|
Service Code
|
HCPCS A5056
|
| Hospital Charge Code |
27000597
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$6.36 |
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: ASR ASR |
$6.17
|
| Rate for Payer: ASR Commercial |
$6.17
|
| Rate for Payer: BCBS Trust/PPO |
$5.18
|
| Rate for Payer: BCN Commercial |
$4.93
|
| Rate for Payer: Cash Price |
$5.09
|
| Rate for Payer: Cofinity Commercial |
$5.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.09
|
| Rate for Payer: Healthscope Commercial |
$6.36
|
| Rate for Payer: Healthscope Whirlpool |
$6.17
|
| Rate for Payer: Mclaren Commercial |
$5.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.41
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.60
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE (PCC)-LANS 500 UNIT IV SOLUTION
|
Facility
|
IP
|
$3,753.41
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
204903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,439.72 |
| Max. Negotiated Rate |
$3,753.41 |
| Rate for Payer: Aetna Commercial |
$3,378.07
|
| Rate for Payer: ASR ASR |
$3,640.81
|
| Rate for Payer: ASR Commercial |
$3,640.81
|
| Rate for Payer: BCBS Trust/PPO |
$3,058.65
|
| Rate for Payer: BCN Commercial |
$2,910.02
|
| Rate for Payer: Cash Price |
$3,002.73
|
| Rate for Payer: Cofinity Commercial |
$3,528.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,002.73
|
| Rate for Payer: Healthscope Commercial |
$3,753.41
|
| Rate for Payer: Healthscope Whirlpool |
$3,640.81
|
| Rate for Payer: Mclaren Commercial |
$3,378.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,190.40
|
| Rate for Payer: Nomi Health Commercial |
$3,077.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,439.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,303.00
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE (PCC)-LANS 500 UNIT IV SOLUTION
|
Facility
|
OP
|
$3,753.41
|
|
|
Service Code
|
HCPCS J7165
|
| Hospital Charge Code |
204903
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$3,753.41 |
| Rate for Payer: Aetna Commercial |
$3,378.07
|
| Rate for Payer: Aetna Medicare |
$1.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.94
|
| Rate for Payer: ASR ASR |
$3,640.81
|
| Rate for Payer: ASR Commercial |
$3,640.81
|
| Rate for Payer: BCBS Complete |
$0.87
|
| Rate for Payer: BCBS MAPPO |
$1.55
|
| Rate for Payer: BCBS Trust/PPO |
$3,073.67
|
| Rate for Payer: BCN Commercial |
$2,910.02
|
| Rate for Payer: BCN Medicare Advantage |
$1.55
|
| Rate for Payer: Cash Price |
$3,002.73
|
| Rate for Payer: Cash Price |
$3,002.73
|
| Rate for Payer: Cofinity Commercial |
$3,528.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,002.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.55
|
| Rate for Payer: Healthscope Commercial |
$3,753.41
|
| Rate for Payer: Healthscope Whirlpool |
$3,640.81
|
| Rate for Payer: Humana Choice PPO Medicare |
$1.55
|
| Rate for Payer: Mclaren Commercial |
$3,378.07
|
| Rate for Payer: Mclaren Medicaid |
$0.83
|
| Rate for Payer: Mclaren Medicare |
$1.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.63
|
| Rate for Payer: Meridian Medicaid |
$0.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,190.40
|
| Rate for Payer: Nomi Health Commercial |
$3,077.80
|
| Rate for Payer: PACE Medicare |
$1.47
|
| Rate for Payer: PACE SWMI |
$1.55
|
| Rate for Payer: PHP Commercial |
$1.71
|
| Rate for Payer: PHP Medicaid |
$0.83
|
| Rate for Payer: PHP Medicare Advantage |
$1.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,439.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,288.74
|
| Rate for Payer: Priority Health Medicare |
$1.55
|
| Rate for Payer: Priority Health Narrow Network |
$2,631.14
|
| Rate for Payer: Railroad Medicare Medicare |
$1.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,303.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1.55
|
| Rate for Payer: UHC Exchange |
$2.40
|
| Rate for Payer: UHC Medicare Advantage |
$1.55
|
| Rate for Payer: UHCCP DNSP |
$1.55
|
| Rate for Payer: UHCCP Medicaid |
$0.83
|
| Rate for Payer: VA VA |
$1.55
|
|
|
HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1,240 UNIT) IV SOLUTION
|
Facility
|
IP
|
$4.93
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
171259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$4.93 |
| Rate for Payer: Aetna Commercial |
$4.44
|
| Rate for Payer: ASR ASR |
$4.78
|
| Rate for Payer: ASR Commercial |
$4.78
|
| Rate for Payer: BCBS Trust/PPO |
$4.02
|
| Rate for Payer: BCN Commercial |
$3.82
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$4.93
|
| Rate for Payer: Healthscope Whirlpool |
$4.78
|
| Rate for Payer: Mclaren Commercial |
$4.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.19
|
| Rate for Payer: Nomi Health Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.34
|
|
|
HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1,240 UNIT) IV SOLUTION
|
Facility
|
OP
|
$4.93
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
171259
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$4.93 |
| Rate for Payer: Aetna Commercial |
$4.44
|
| Rate for Payer: Aetna Medicare |
$2.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.67
|
| Rate for Payer: ASR ASR |
$4.78
|
| Rate for Payer: ASR Commercial |
$4.78
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCBS MAPPO |
$2.14
|
| Rate for Payer: BCBS Trust/PPO |
$4.04
|
| Rate for Payer: BCN Commercial |
$3.82
|
| Rate for Payer: BCN Medicare Advantage |
$2.14
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$4.93
|
| Rate for Payer: Healthscope Whirlpool |
$4.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.14
|
| Rate for Payer: Mclaren Commercial |
$4.44
|
| Rate for Payer: Mclaren Medicaid |
$1.15
|
| Rate for Payer: Mclaren Medicare |
$2.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.25
|
| Rate for Payer: Meridian Medicaid |
$1.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.19
|
| Rate for Payer: Nomi Health Commercial |
$4.04
|
| Rate for Payer: PACE Medicare |
$2.03
|
| Rate for Payer: PACE SWMI |
$2.14
|
| Rate for Payer: PHP Commercial |
$2.35
|
| Rate for Payer: PHP Medicaid |
$1.15
|
| Rate for Payer: PHP Medicare Advantage |
$2.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.32
|
| Rate for Payer: Priority Health Medicare |
$2.14
|
| Rate for Payer: Priority Health Narrow Network |
$3.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.14
|
| Rate for Payer: UHC Exchange |
$3.32
|
| Rate for Payer: UHC Medicare Advantage |
$2.14
|
| Rate for Payer: UHCCP DNSP |
$2.14
|
| Rate for Payer: UHCCP Medicaid |
$1.15
|
| Rate for Payer: VA VA |
$2.14
|
|
|
HUM PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION
|
Facility
|
OP
|
$4.93
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
170850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$4.93 |
| Rate for Payer: Aetna Commercial |
$4.44
|
| Rate for Payer: Aetna Medicare |
$2.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$2.67
|
| Rate for Payer: Amish Plain Church Group Commercial |
$2.67
|
| Rate for Payer: ASR ASR |
$4.78
|
| Rate for Payer: ASR Commercial |
$4.78
|
| Rate for Payer: BCBS Complete |
$1.20
|
| Rate for Payer: BCBS MAPPO |
$2.14
|
| Rate for Payer: BCBS Trust/PPO |
$4.04
|
| Rate for Payer: BCN Commercial |
$3.82
|
| Rate for Payer: BCN Medicare Advantage |
$2.14
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.14
|
| Rate for Payer: Healthscope Commercial |
$4.93
|
| Rate for Payer: Healthscope Whirlpool |
$4.78
|
| Rate for Payer: Humana Choice PPO Medicare |
$2.14
|
| Rate for Payer: Mclaren Commercial |
$4.44
|
| Rate for Payer: Mclaren Medicaid |
$1.15
|
| Rate for Payer: Mclaren Medicare |
$2.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.25
|
| Rate for Payer: Meridian Medicaid |
$1.20
|
| Rate for Payer: MI Amish Medical Board Commercial |
$2.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.19
|
| Rate for Payer: Nomi Health Commercial |
$4.04
|
| Rate for Payer: PACE Medicare |
$2.03
|
| Rate for Payer: PACE SWMI |
$2.14
|
| Rate for Payer: PHP Commercial |
$2.35
|
| Rate for Payer: PHP Medicaid |
$1.15
|
| Rate for Payer: PHP Medicare Advantage |
$2.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.32
|
| Rate for Payer: Priority Health Medicare |
$2.14
|
| Rate for Payer: Priority Health Narrow Network |
$3.46
|
| Rate for Payer: Railroad Medicare Medicare |
$2.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.14
|
| Rate for Payer: UHC Exchange |
$3.32
|
| Rate for Payer: UHC Medicare Advantage |
$2.14
|
| Rate for Payer: UHCCP DNSP |
$2.14
|
| Rate for Payer: UHCCP Medicaid |
$1.15
|
| Rate for Payer: VA VA |
$2.14
|
|
|
HUM PROTHROMBIN CPLX (PCC) 4FACTOR 500 UNIT (400-620 UNIT) IV SOLUTION
|
Facility
|
IP
|
$4.93
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
170850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$4.93 |
| Rate for Payer: Aetna Commercial |
$4.44
|
| Rate for Payer: ASR ASR |
$4.78
|
| Rate for Payer: ASR Commercial |
$4.78
|
| Rate for Payer: BCBS Trust/PPO |
$4.02
|
| Rate for Payer: BCN Commercial |
$3.82
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Cofinity Commercial |
$4.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.94
|
| Rate for Payer: Healthscope Commercial |
$4.93
|
| Rate for Payer: Healthscope Whirlpool |
$4.78
|
| Rate for Payer: Mclaren Commercial |
$4.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.19
|
| Rate for Payer: Nomi Health Commercial |
$4.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.34
|
|
|
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 |
$138.10 |
| Max. Negotiated Rate |
$212.46 |
| Rate for Payer: Aetna Commercial |
$191.21
|
| Rate for Payer: ASR ASR |
$206.09
|
| Rate for Payer: ASR Commercial |
$206.09
|
| Rate for Payer: BCBS Trust/PPO |
$173.13
|
| Rate for Payer: BCN Commercial |
$164.72
|
| 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 |
$212.46
|
| Rate for Payer: Healthscope Whirlpool |
$206.09
|
| Rate for Payer: Mclaren Commercial |
$191.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.59
|
| Rate for Payer: Nomi Health Commercial |
$174.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.10
|
| 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 |
$84.98 |
| Max. Negotiated Rate |
$212.46 |
| Rate for Payer: Aetna Commercial |
$191.21
|
| Rate for Payer: Aetna Medicare |
$106.23
|
| Rate for Payer: ASR ASR |
$206.09
|
| Rate for Payer: ASR Commercial |
$206.09
|
| Rate for Payer: BCBS Complete |
$84.98
|
| Rate for Payer: BCBS Trust/PPO |
$173.98
|
| Rate for Payer: BCN Commercial |
$164.72
|
| 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 |
$212.46
|
| Rate for Payer: Healthscope Whirlpool |
$206.09
|
| Rate for Payer: Mclaren Commercial |
$191.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.59
|
| Rate for Payer: Nomi Health Commercial |
$174.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$186.16
|
| Rate for Payer: Priority Health Narrow Network |
$148.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.96
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
OP
|
$63.45
|
|
|
Service Code
|
NDC 23155000101
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.38 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Medicare |
$31.73
|
| Rate for Payer: ASR ASR |
$61.55
|
| Rate for Payer: ASR Commercial |
$61.55
|
| Rate for Payer: BCBS Complete |
$25.38
|
| Rate for Payer: BCBS Trust/PPO |
$51.96
|
| Rate for Payer: BCN Commercial |
$49.19
|
| 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 |
$63.45
|
| Rate for Payer: Healthscope Whirlpool |
$61.55
|
| 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: Priority Health Cigna Priority Health |
$41.24
|
| Rate for Payer: 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
|
$63.45
|
|
|
Service Code
|
NDC 23155000101
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.24 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: ASR ASR |
$61.55
|
| Rate for Payer: ASR Commercial |
$61.55
|
| Rate for Payer: BCBS Trust/PPO |
$51.71
|
| Rate for Payer: BCN Commercial |
$49.19
|
| 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 |
$63.45
|
| Rate for Payer: Healthscope Whirlpool |
$61.55
|
| 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: Priority Health Cigna Priority Health |
$41.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$55.84
|
|
|
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 |
$20.89
|
| Rate for Payer: ASR ASR |
$22.63
|
| 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 |
$22.63
|
| Rate for Payer: Healthscope Whirlpool |
$20.89
|
| Rate for Payer: Mclaren Commercial |
$19.39
|
| Rate for Payer: Mclaren Commercial |
$21.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$19.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.31
|
| Rate for Payer: Nomi Health Commercial |
$19.13
|
| Rate for Payer: Nomi Health Commercial |
$17.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.53
|
|
|
HYDRALAZINE 20 MG/ML INJECTION SOLUTION
|
Facility
|
OP
|
$21.54
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
3697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$21.54 |
| Rate for Payer: Aetna Commercial |
$19.39
|
| Rate for Payer: Aetna Commercial |
$21.00
|
| Rate for Payer: Aetna Medicare |
$10.77
|
| Rate for Payer: Aetna Medicare |
$11.66
|
| Rate for Payer: ASR ASR |
$20.89
|
| Rate for Payer: ASR ASR |
$22.63
|
| Rate for Payer: ASR Commercial |
$22.63
|
| Rate for Payer: ASR Commercial |
$20.89
|
| Rate for Payer: BCBS Complete |
$8.62
|
| Rate for Payer: BCBS Complete |
$9.33
|
| Rate for Payer: BCBS Trust/PPO |
$17.64
|
| Rate for Payer: BCBS Trust/PPO |
$19.10
|
| Rate for Payer: BCN Commercial |
$18.09
|
| Rate for Payer: BCN Commercial |
$16.70
|
| Rate for Payer: Cash Price |
$17.23
|
| Rate for Payer: Cash Price |
$18.67
|
| 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 |
$19.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.31
|
| 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: Priority Health HMO/PPO/Tiered Network |
$18.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.44
|
| Rate for Payer: Priority Health Narrow Network |
$16.35
|
| Rate for Payer: Priority Health Narrow Network |
$15.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.96
|
|
|
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
|
$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
|
IP
|
$258.50
|
|
|
Service Code
|
NDC 00904644161
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.03 |
| Max. Negotiated Rate |
$258.50 |
| Rate for Payer: Aetna Commercial |
$232.65
|
| Rate for Payer: ASR ASR |
$250.75
|
| Rate for Payer: ASR Commercial |
$250.75
|
| 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 |
$250.75
|
| 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 |
$168.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.48
|
|
|
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
|
$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 |
$250.75
|
| Rate for Payer: ASR Commercial |
$250.75
|
| 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 |
$250.75
|
| 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 |
$168.03
|
| 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
|
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 |
$3.83
|
| 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 |
$3.83
|
| 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
|
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 |
$171.85
|
| 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 |
$171.85
|
| 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
|
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 |
$74.03
|
| 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 |
$77.31
|
| 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 |
$74.03
|
| 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
|
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 |
$171.85
|
| Rate for Payer: Aetna Medicare |
$95.47
|
| 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 |
$171.85
|
| 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
|
|
