|
HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION
|
Facility
|
OP
|
$78.05
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
108970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.22 |
| Max. Negotiated Rate |
$78.05 |
| Rate for Payer: Aetna Commercial |
$70.25
|
| Rate for Payer: Aetna Medicare |
$39.02
|
| Rate for Payer: ASR ASR |
$75.71
|
| Rate for Payer: ASR Commercial |
$75.71
|
| Rate for Payer: BCBS Complete |
$31.22
|
| Rate for Payer: BCBS Trust/PPO |
$63.92
|
| Rate for Payer: BCN Commercial |
$60.51
|
| Rate for Payer: Cash Price |
$62.44
|
| Rate for Payer: Cofinity Commercial |
$73.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.44
|
| Rate for Payer: Healthscope Commercial |
$78.05
|
| Rate for Payer: Healthscope Whirlpool |
$75.71
|
| Rate for Payer: Mclaren Commercial |
$70.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.34
|
| Rate for Payer: Nomi Health Commercial |
$64.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.39
|
| Rate for Payer: Priority Health Narrow Network |
$54.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.68
|
|
|
HYDROCORTISONE SODIUM SUCCINATE 100 MG SOLUTION FOR INJECTION
|
Facility
|
IP
|
$78.05
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
108970
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.73 |
| Max. Negotiated Rate |
$78.05 |
| Rate for Payer: Aetna Commercial |
$70.25
|
| Rate for Payer: ASR ASR |
$75.71
|
| Rate for Payer: ASR Commercial |
$75.71
|
| Rate for Payer: BCBS Trust/PPO |
$63.60
|
| Rate for Payer: BCN Commercial |
$60.51
|
| Rate for Payer: Cash Price |
$62.44
|
| Rate for Payer: Cofinity Commercial |
$73.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$62.44
|
| Rate for Payer: Healthscope Commercial |
$78.05
|
| Rate for Payer: Healthscope Whirlpool |
$75.71
|
| Rate for Payer: Mclaren Commercial |
$70.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.34
|
| Rate for Payer: Nomi Health Commercial |
$64.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$68.68
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 1,000 MG/8 ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$575.42
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119666
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$230.17 |
| Max. Negotiated Rate |
$575.42 |
| Rate for Payer: Aetna Commercial |
$517.88
|
| Rate for Payer: Aetna Medicare |
$287.71
|
| Rate for Payer: ASR ASR |
$558.16
|
| Rate for Payer: ASR Commercial |
$558.16
|
| Rate for Payer: BCBS Complete |
$230.17
|
| Rate for Payer: BCBS Trust/PPO |
$471.21
|
| Rate for Payer: BCN Commercial |
$446.12
|
| Rate for Payer: Cash Price |
$460.34
|
| Rate for Payer: Cofinity Commercial |
$540.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.34
|
| Rate for Payer: Healthscope Commercial |
$575.42
|
| Rate for Payer: Healthscope Whirlpool |
$558.16
|
| Rate for Payer: Mclaren Commercial |
$517.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.11
|
| Rate for Payer: Nomi Health Commercial |
$471.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$504.18
|
| Rate for Payer: Priority Health Narrow Network |
$403.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$506.37
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 1,000 MG/8 ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$575.42
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119666
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$374.02 |
| Max. Negotiated Rate |
$575.42 |
| Rate for Payer: Aetna Commercial |
$517.88
|
| Rate for Payer: ASR ASR |
$558.16
|
| Rate for Payer: ASR Commercial |
$558.16
|
| Rate for Payer: BCBS Trust/PPO |
$468.91
|
| Rate for Payer: BCN Commercial |
$446.12
|
| Rate for Payer: Cash Price |
$460.34
|
| Rate for Payer: Cofinity Commercial |
$540.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$460.34
|
| Rate for Payer: Healthscope Commercial |
$575.42
|
| Rate for Payer: Healthscope Whirlpool |
$558.16
|
| Rate for Payer: Mclaren Commercial |
$517.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$489.11
|
| Rate for Payer: Nomi Health Commercial |
$471.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$374.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$506.37
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$97.58
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.03 |
| Max. Negotiated Rate |
$97.58 |
| Rate for Payer: Aetna Commercial |
$87.82
|
| Rate for Payer: Aetna Medicare |
$48.79
|
| Rate for Payer: ASR ASR |
$94.65
|
| Rate for Payer: ASR Commercial |
$94.65
|
| Rate for Payer: BCBS Complete |
$39.03
|
| Rate for Payer: BCBS Trust/PPO |
$79.91
|
| Rate for Payer: BCN Commercial |
$75.65
|
| Rate for Payer: Cash Price |
$78.06
|
| Rate for Payer: Cofinity Commercial |
$91.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.06
|
| Rate for Payer: Healthscope Commercial |
$97.58
|
| Rate for Payer: Healthscope Whirlpool |
$94.65
|
| Rate for Payer: Mclaren Commercial |
$87.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.94
|
| Rate for Payer: Nomi Health Commercial |
$80.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.50
|
| Rate for Payer: Priority Health Narrow Network |
$68.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.87
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 100 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$97.58
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119665
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$63.43 |
| Max. Negotiated Rate |
$97.58 |
| Rate for Payer: Aetna Commercial |
$87.82
|
| Rate for Payer: ASR ASR |
$94.65
|
| Rate for Payer: ASR Commercial |
$94.65
|
| Rate for Payer: BCBS Trust/PPO |
$79.52
|
| Rate for Payer: BCN Commercial |
$75.65
|
| Rate for Payer: Cash Price |
$78.06
|
| Rate for Payer: Cofinity Commercial |
$91.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.06
|
| Rate for Payer: Healthscope Commercial |
$97.58
|
| Rate for Payer: Healthscope Whirlpool |
$94.65
|
| Rate for Payer: Mclaren Commercial |
$87.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$82.94
|
| Rate for Payer: Nomi Health Commercial |
$80.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.87
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
IP
|
$182.94
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.91 |
| Max. Negotiated Rate |
$182.94 |
| Rate for Payer: Aetna Commercial |
$164.65
|
| Rate for Payer: ASR ASR |
$177.45
|
| Rate for Payer: ASR Commercial |
$177.45
|
| Rate for Payer: BCBS Trust/PPO |
$149.08
|
| Rate for Payer: BCN Commercial |
$141.83
|
| Rate for Payer: Cash Price |
$146.35
|
| Rate for Payer: Cofinity Commercial |
$171.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.35
|
| Rate for Payer: Healthscope Commercial |
$182.94
|
| Rate for Payer: Healthscope Whirlpool |
$177.45
|
| Rate for Payer: Mclaren Commercial |
$164.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.50
|
| Rate for Payer: Nomi Health Commercial |
$150.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.99
|
|
|
HYDROCORTISONE SOD SUCCINATE (PF) 250 MG/2 ML SOLUTION FOR INJECTION
|
Facility
|
OP
|
$182.94
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
119664
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.18 |
| Max. Negotiated Rate |
$182.94 |
| Rate for Payer: Aetna Commercial |
$164.65
|
| Rate for Payer: Aetna Medicare |
$91.47
|
| Rate for Payer: ASR ASR |
$177.45
|
| Rate for Payer: ASR Commercial |
$177.45
|
| Rate for Payer: BCBS Complete |
$73.18
|
| Rate for Payer: BCBS Trust/PPO |
$149.81
|
| Rate for Payer: BCN Commercial |
$141.83
|
| Rate for Payer: Cash Price |
$146.35
|
| Rate for Payer: Cofinity Commercial |
$171.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.35
|
| Rate for Payer: Healthscope Commercial |
$182.94
|
| Rate for Payer: Healthscope Whirlpool |
$177.45
|
| Rate for Payer: Mclaren Commercial |
$164.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.50
|
| Rate for Payer: Nomi Health Commercial |
$150.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.29
|
| Rate for Payer: Priority Health Narrow Network |
$128.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.99
|
|
|
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 |
$10.71 |
| Max. Negotiated Rate |
$16.47 |
| Rate for Payer: Aetna Commercial |
$14.82
|
| Rate for Payer: Aetna Commercial |
$14.06
|
| Rate for Payer: Aetna Commercial |
$19.32
|
| Rate for Payer: ASR ASR |
$15.15
|
| Rate for Payer: ASR ASR |
$15.98
|
| Rate for Payer: ASR ASR |
$20.83
|
| Rate for Payer: ASR Commercial |
$15.98
|
| Rate for Payer: ASR Commercial |
$15.15
|
| Rate for Payer: ASR Commercial |
$20.83
|
| Rate for Payer: BCBS Trust/PPO |
$17.50
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCBS Trust/PPO |
$13.42
|
| Rate for Payer: BCN Commercial |
$12.11
|
| Rate for Payer: BCN Commercial |
$16.65
|
| Rate for Payer: BCN Commercial |
$12.77
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Commercial |
$20.18
|
| Rate for Payer: Cofinity Commercial |
$14.68
|
| Rate for Payer: Cofinity Commercial |
$15.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$15.62
|
| Rate for Payer: Healthscope Commercial |
$16.47
|
| Rate for Payer: Healthscope Commercial |
$21.47
|
| Rate for Payer: Healthscope Whirlpool |
$15.98
|
| Rate for Payer: Healthscope Whirlpool |
$15.15
|
| Rate for Payer: Healthscope Whirlpool |
$20.83
|
| Rate for Payer: Mclaren Commercial |
$14.82
|
| Rate for Payer: Mclaren Commercial |
$14.06
|
| Rate for Payer: Mclaren Commercial |
$19.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.28
|
| Rate for Payer: Nomi Health Commercial |
$13.51
|
| Rate for Payer: Nomi Health Commercial |
$12.81
|
| Rate for Payer: Nomi Health Commercial |
$17.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.75
|
|
|
HYDROMORPHONE 0.5 MG/0.5 ML INJECTION SYRINGE
|
Facility
|
OP
|
$15.62
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
166819
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$15.62 |
| Rate for Payer: Aetna Commercial |
$14.06
|
| Rate for Payer: Aetna Commercial |
$14.82
|
| Rate for Payer: Aetna Commercial |
$19.32
|
| Rate for Payer: Aetna Medicare |
$8.23
|
| Rate for Payer: Aetna Medicare |
$10.73
|
| Rate for Payer: Aetna Medicare |
$7.81
|
| Rate for Payer: ASR ASR |
$15.98
|
| Rate for Payer: ASR ASR |
$15.15
|
| Rate for Payer: ASR ASR |
$20.83
|
| Rate for Payer: ASR Commercial |
$20.83
|
| Rate for Payer: ASR Commercial |
$15.98
|
| Rate for Payer: ASR Commercial |
$15.15
|
| Rate for Payer: BCBS Complete |
$6.25
|
| Rate for Payer: BCBS Complete |
$6.59
|
| Rate for Payer: BCBS Complete |
$8.59
|
| Rate for Payer: BCBS Trust/PPO |
$12.79
|
| Rate for Payer: BCBS Trust/PPO |
$13.49
|
| Rate for Payer: BCBS Trust/PPO |
$17.58
|
| Rate for Payer: BCN Commercial |
$16.65
|
| Rate for Payer: BCN Commercial |
$12.11
|
| Rate for Payer: BCN Commercial |
$12.77
|
| Rate for Payer: Cash Price |
$13.18
|
| Rate for Payer: Cash Price |
$12.50
|
| Rate for Payer: Cash Price |
$17.18
|
| Rate for Payer: Cofinity Commercial |
$20.18
|
| Rate for Payer: Cofinity Commercial |
$14.68
|
| Rate for Payer: Cofinity Commercial |
$15.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.18
|
| Rate for Payer: Healthscope Commercial |
$15.62
|
| Rate for Payer: Healthscope Commercial |
$16.47
|
| Rate for Payer: Healthscope Commercial |
$21.47
|
| Rate for Payer: Healthscope Whirlpool |
$15.98
|
| Rate for Payer: Healthscope Whirlpool |
$15.15
|
| Rate for Payer: Healthscope Whirlpool |
$20.83
|
| Rate for Payer: Mclaren Commercial |
$14.06
|
| Rate for Payer: Mclaren Commercial |
$14.82
|
| Rate for Payer: Mclaren Commercial |
$19.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.25
|
| Rate for Payer: Nomi Health Commercial |
$12.81
|
| Rate for Payer: Nomi Health Commercial |
$13.51
|
| Rate for Payer: Nomi Health Commercial |
$17.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.81
|
| Rate for Payer: Priority Health Narrow Network |
$15.05
|
| Rate for Payer: Priority Health Narrow Network |
$10.95
|
| Rate for Payer: Priority Health Narrow Network |
$11.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$13.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$18.89
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
OP
|
$17.12
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
112193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.85 |
| Max. Negotiated Rate |
$17.12 |
| Rate for Payer: Aetna Commercial |
$15.41
|
| Rate for Payer: Aetna Commercial |
$19.74
|
| Rate for Payer: Aetna Commercial |
$28.77
|
| Rate for Payer: Aetna Medicare |
$10.96
|
| Rate for Payer: Aetna Medicare |
$15.98
|
| Rate for Payer: Aetna Medicare |
$8.56
|
| Rate for Payer: ASR ASR |
$21.27
|
| Rate for Payer: ASR ASR |
$16.61
|
| Rate for Payer: ASR ASR |
$31.01
|
| Rate for Payer: ASR Commercial |
$31.01
|
| Rate for Payer: ASR Commercial |
$21.27
|
| Rate for Payer: ASR Commercial |
$16.61
|
| Rate for Payer: BCBS Complete |
$6.85
|
| Rate for Payer: BCBS Complete |
$8.77
|
| Rate for Payer: BCBS Complete |
$12.79
|
| Rate for Payer: BCBS Trust/PPO |
$14.02
|
| Rate for Payer: BCBS Trust/PPO |
$17.96
|
| Rate for Payer: BCBS Trust/PPO |
$26.18
|
| Rate for Payer: BCN Commercial |
$24.79
|
| Rate for Payer: BCN Commercial |
$13.27
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$17.54
|
| Rate for Payer: Cash Price |
$13.70
|
| Rate for Payer: Cash Price |
$25.57
|
| Rate for Payer: Cofinity Commercial |
$30.05
|
| Rate for Payer: Cofinity Commercial |
$16.09
|
| Rate for Payer: Cofinity Commercial |
$20.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.58
|
| Rate for Payer: Healthscope Commercial |
$17.12
|
| Rate for Payer: Healthscope Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$31.97
|
| Rate for Payer: Healthscope Whirlpool |
$21.27
|
| Rate for Payer: Healthscope Whirlpool |
$16.61
|
| Rate for Payer: Healthscope Whirlpool |
$31.01
|
| Rate for Payer: Mclaren Commercial |
$15.41
|
| Rate for Payer: Mclaren Commercial |
$19.74
|
| Rate for Payer: Mclaren Commercial |
$28.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: Nomi Health Commercial |
$14.04
|
| Rate for Payer: Nomi Health Commercial |
$17.98
|
| Rate for Payer: Nomi Health Commercial |
$26.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$28.01
|
| Rate for Payer: Priority Health Narrow Network |
$22.41
|
| Rate for Payer: Priority Health Narrow Network |
$12.00
|
| Rate for Payer: Priority Health Narrow Network |
$15.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.13
|
|
|
HYDROMORPHONE 1 MG/ML INJECTION SYRINGE
|
Facility
|
IP
|
$31.97
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
112193
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.78 |
| Max. Negotiated Rate |
$31.97 |
| Rate for Payer: Aetna Commercial |
$28.77
|
| Rate for Payer: Aetna Commercial |
$15.41
|
| Rate for Payer: Aetna Commercial |
$19.74
|
| Rate for Payer: ASR ASR |
$16.61
|
| Rate for Payer: ASR ASR |
$31.01
|
| Rate for Payer: ASR ASR |
$21.27
|
| Rate for Payer: ASR Commercial |
$21.27
|
| Rate for Payer: ASR Commercial |
$16.61
|
| Rate for Payer: ASR Commercial |
$31.01
|
| Rate for Payer: BCBS Trust/PPO |
$13.95
|
| Rate for Payer: BCBS Trust/PPO |
$17.87
|
| Rate for Payer: BCBS Trust/PPO |
$26.05
|
| Rate for Payer: BCN Commercial |
$24.79
|
| Rate for Payer: BCN Commercial |
$13.27
|
| Rate for Payer: BCN Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$13.70
|
| Rate for Payer: Cash Price |
$25.57
|
| Rate for Payer: Cash Price |
$17.54
|
| Rate for Payer: Cofinity Commercial |
$20.61
|
| Rate for Payer: Cofinity Commercial |
$16.09
|
| Rate for Payer: Cofinity Commercial |
$30.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$13.70
|
| Rate for Payer: Healthscope Commercial |
$17.12
|
| Rate for Payer: Healthscope Commercial |
$21.93
|
| Rate for Payer: Healthscope Commercial |
$31.97
|
| Rate for Payer: Healthscope Whirlpool |
$31.01
|
| Rate for Payer: Healthscope Whirlpool |
$21.27
|
| Rate for Payer: Healthscope Whirlpool |
$16.61
|
| Rate for Payer: Mclaren Commercial |
$19.74
|
| Rate for Payer: Mclaren Commercial |
$15.41
|
| Rate for Payer: Mclaren Commercial |
$28.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.64
|
| Rate for Payer: Nomi Health Commercial |
$26.22
|
| Rate for Payer: Nomi Health Commercial |
$17.98
|
| Rate for Payer: Nomi Health Commercial |
$14.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$28.13
|
|
|
HYDROMORPHONE VARIABLE DOSE
|
Facility
|
IP
|
$14.07
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
150712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$14.07 |
| Rate for Payer: Aetna Commercial |
$12.66
|
| Rate for Payer: ASR ASR |
$13.65
|
| Rate for Payer: ASR Commercial |
$13.65
|
| Rate for Payer: BCBS Trust/PPO |
$11.47
|
| Rate for Payer: BCN Commercial |
$10.91
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cofinity Commercial |
$13.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$14.07
|
| Rate for Payer: Healthscope Whirlpool |
$13.65
|
| Rate for Payer: Mclaren Commercial |
$12.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.96
|
| Rate for Payer: Nomi Health Commercial |
$11.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.38
|
|
|
HYDROMORPHONE VARIABLE DOSE
|
Facility
|
OP
|
$14.07
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
150712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.63 |
| Max. Negotiated Rate |
$14.07 |
| Rate for Payer: Aetna Commercial |
$12.66
|
| Rate for Payer: Aetna Medicare |
$7.04
|
| Rate for Payer: ASR ASR |
$13.65
|
| Rate for Payer: ASR Commercial |
$13.65
|
| Rate for Payer: BCBS Complete |
$5.63
|
| Rate for Payer: BCBS Trust/PPO |
$11.52
|
| Rate for Payer: BCN Commercial |
$10.91
|
| Rate for Payer: Cash Price |
$11.26
|
| Rate for Payer: Cofinity Commercial |
$13.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.26
|
| Rate for Payer: Healthscope Commercial |
$14.07
|
| Rate for Payer: Healthscope Whirlpool |
$13.65
|
| Rate for Payer: Mclaren Commercial |
$12.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.96
|
| Rate for Payer: Nomi Health Commercial |
$11.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.33
|
| Rate for Payer: Priority Health Narrow Network |
$9.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.38
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$275.50
|
|
|
Service Code
|
NDC 43598072101
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Aetna Commercial |
$247.95
|
| Rate for Payer: Aetna Medicare |
$137.75
|
| Rate for Payer: ASR ASR |
$267.24
|
| Rate for Payer: ASR Commercial |
$267.24
|
| Rate for Payer: BCBS Complete |
$110.20
|
| Rate for Payer: BCBS Trust/PPO |
$225.61
|
| Rate for Payer: BCN Commercial |
$213.60
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cofinity Commercial |
$258.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.40
|
| Rate for Payer: Healthscope Commercial |
$275.50
|
| Rate for Payer: Healthscope Whirlpool |
$267.24
|
| Rate for Payer: Mclaren Commercial |
$247.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.18
|
| Rate for Payer: Nomi Health Commercial |
$225.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.07
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.39
|
| Rate for Payer: Priority Health Narrow Network |
$193.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.44
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$275.50
|
|
|
Service Code
|
NDC 43598072101
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$179.07 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Aetna Commercial |
$247.95
|
| Rate for Payer: ASR ASR |
$267.24
|
| Rate for Payer: ASR Commercial |
$267.24
|
| Rate for Payer: BCBS Trust/PPO |
$224.50
|
| Rate for Payer: BCN Commercial |
$213.60
|
| Rate for Payer: Cash Price |
$220.40
|
| Rate for Payer: Cofinity Commercial |
$258.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$220.40
|
| Rate for Payer: Healthscope Commercial |
$275.50
|
| Rate for Payer: Healthscope Whirlpool |
$267.24
|
| Rate for Payer: Mclaren Commercial |
$247.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$234.18
|
| Rate for Payer: Nomi Health Commercial |
$225.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$242.44
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$195.12
|
|
|
Service Code
|
NDC 00904704606
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.05 |
| Max. Negotiated Rate |
$195.12 |
| Rate for Payer: Aetna Commercial |
$175.61
|
| Rate for Payer: Aetna Medicare |
$97.56
|
| Rate for Payer: ASR ASR |
$189.27
|
| Rate for Payer: ASR Commercial |
$189.27
|
| Rate for Payer: BCBS Complete |
$78.05
|
| Rate for Payer: BCBS Trust/PPO |
$159.78
|
| Rate for Payer: BCN Commercial |
$151.28
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: Cofinity Commercial |
$183.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.10
|
| Rate for Payer: Healthscope Commercial |
$195.12
|
| Rate for Payer: Healthscope Whirlpool |
$189.27
|
| Rate for Payer: Mclaren Commercial |
$175.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.85
|
| Rate for Payer: Nomi Health Commercial |
$160.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$170.96
|
| Rate for Payer: Priority Health Narrow Network |
$136.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.71
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
OP
|
$291.65
|
|
|
Service Code
|
NDC 69238154401
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.66 |
| Max. Negotiated Rate |
$291.65 |
| Rate for Payer: Aetna Commercial |
$262.49
|
| Rate for Payer: Aetna Medicare |
$145.82
|
| Rate for Payer: ASR ASR |
$282.90
|
| Rate for Payer: ASR Commercial |
$282.90
|
| Rate for Payer: BCBS Complete |
$116.66
|
| Rate for Payer: BCBS Trust/PPO |
$238.83
|
| Rate for Payer: BCN Commercial |
$226.12
|
| Rate for Payer: Cash Price |
$233.32
|
| Rate for Payer: Cofinity Commercial |
$274.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.32
|
| Rate for Payer: Healthscope Commercial |
$291.65
|
| Rate for Payer: Healthscope Whirlpool |
$282.90
|
| Rate for Payer: Mclaren Commercial |
$262.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.90
|
| Rate for Payer: Nomi Health Commercial |
$239.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.57
|
| Rate for Payer: 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 |
$189.57 |
| Max. Negotiated Rate |
$291.65 |
| Rate for Payer: Aetna Commercial |
$262.49
|
| Rate for Payer: ASR ASR |
$282.90
|
| Rate for Payer: ASR Commercial |
$282.90
|
| Rate for Payer: BCBS Trust/PPO |
$237.67
|
| Rate for Payer: BCN Commercial |
$226.12
|
| Rate for Payer: Cash Price |
$233.32
|
| Rate for Payer: Cofinity Commercial |
$274.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$233.32
|
| Rate for Payer: Healthscope Commercial |
$291.65
|
| Rate for Payer: Healthscope Whirlpool |
$282.90
|
| Rate for Payer: Mclaren Commercial |
$262.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$247.90
|
| Rate for Payer: Nomi Health Commercial |
$239.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$256.65
|
|
|
HYDROXYCHLOROQUINE 200 MG TABLET
|
Facility
|
IP
|
$195.12
|
|
|
Service Code
|
NDC 00904704606
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.83 |
| Max. Negotiated Rate |
$195.12 |
| Rate for Payer: Aetna Commercial |
$175.61
|
| Rate for Payer: ASR ASR |
$189.27
|
| Rate for Payer: ASR Commercial |
$189.27
|
| Rate for Payer: BCBS Trust/PPO |
$159.00
|
| Rate for Payer: BCN Commercial |
$151.28
|
| Rate for Payer: Cash Price |
$156.10
|
| Rate for Payer: Cofinity Commercial |
$183.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.10
|
| Rate for Payer: Healthscope Commercial |
$195.12
|
| Rate for Payer: Healthscope Whirlpool |
$189.27
|
| Rate for Payer: Mclaren Commercial |
$175.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.85
|
| Rate for Payer: Nomi Health Commercial |
$160.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.71
|
|
|
HYDROXYPROGESTERONE (PF)(PREGNANCY PRESERVING) 250 MG/ML (1 ML) IM OIL
|
Facility
|
OP
|
$2,043.07
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
178180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$817.23 |
| 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: Aetna Medicare |
$1,021.53
|
| Rate for Payer: Aetna Medicare |
$1,064.14
|
| Rate for Payer: ASR ASR |
$1,981.78
|
| Rate for Payer: ASR ASR |
$2,064.44
|
| Rate for Payer: ASR Commercial |
$2,064.44
|
| Rate for Payer: ASR Commercial |
$1,981.78
|
| Rate for Payer: BCBS Complete |
$817.23
|
| Rate for Payer: BCBS Complete |
$851.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,673.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,742.86
|
| Rate for Payer: BCN Commercial |
$1,650.06
|
| Rate for Payer: BCN Commercial |
$1,583.99
|
| Rate for Payer: Cash Price |
$1,634.46
|
| Rate for Payer: Cash Price |
$1,702.63
|
| Rate for Payer: Cofinity Commercial |
$1,920.49
|
| Rate for Payer: Cofinity Commercial |
$2,000.59
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,634.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.63
|
| Rate for Payer: Healthscope Commercial |
$2,043.07
|
| Rate for Payer: Healthscope Commercial |
$2,128.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,981.78
|
| Rate for Payer: Healthscope Whirlpool |
$2,064.44
|
| Rate for Payer: Mclaren Commercial |
$1,838.76
|
| Rate for Payer: Mclaren Commercial |
$1,915.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,809.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,736.61
|
| Rate for Payer: Nomi Health Commercial |
$1,675.32
|
| Rate for Payer: Nomi Health Commercial |
$1,745.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,383.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,328.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,790.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,864.81
|
| Rate for Payer: Priority Health Narrow Network |
$1,491.93
|
| Rate for Payer: Priority Health Narrow Network |
$1,432.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,872.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,797.90
|
|
|
HYDROXYPROGESTERONE (PF)(PREGNANCY PRESERVING) 250 MG/ML (1 ML) IM OIL
|
Facility
|
IP
|
$2,128.29
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
178180
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,383.39 |
| 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: ASR ASR |
$1,981.78
|
| Rate for Payer: ASR ASR |
$2,064.44
|
| Rate for Payer: ASR Commercial |
$1,981.78
|
| Rate for Payer: ASR Commercial |
$2,064.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,664.90
|
| Rate for Payer: BCBS Trust/PPO |
$1,734.34
|
| Rate for Payer: BCN Commercial |
$1,650.06
|
| Rate for Payer: BCN Commercial |
$1,583.99
|
| 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 |
$1,634.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,702.63
|
| Rate for Payer: Healthscope Commercial |
$2,043.07
|
| Rate for Payer: Healthscope Commercial |
$2,128.29
|
| Rate for Payer: Healthscope Whirlpool |
$2,064.44
|
| Rate for Payer: Healthscope Whirlpool |
$1,981.78
|
| Rate for Payer: Mclaren Commercial |
$1,838.76
|
| Rate for Payer: Mclaren Commercial |
$1,915.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,809.05
|
| 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: Priority Health Cigna Priority Health |
$1,328.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,383.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,797.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,872.90
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
IP
|
$427.70
|
|
|
Service Code
|
NDC 68084025301
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$278.00 |
| Max. Negotiated Rate |
$427.70 |
| Rate for Payer: Aetna Commercial |
$384.93
|
| Rate for Payer: ASR ASR |
$414.87
|
| Rate for Payer: ASR Commercial |
$414.87
|
| Rate for Payer: BCBS Trust/PPO |
$348.53
|
| Rate for Payer: BCN Commercial |
$331.60
|
| Rate for Payer: Cash Price |
$342.16
|
| Rate for Payer: Cofinity Commercial |
$402.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.16
|
| Rate for Payer: Healthscope Commercial |
$427.70
|
| Rate for Payer: Healthscope Whirlpool |
$414.87
|
| Rate for Payer: Mclaren Commercial |
$384.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.55
|
| Rate for Payer: Nomi Health Commercial |
$350.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.38
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
OP
|
$427.70
|
|
|
Service Code
|
NDC 68084025311
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.08 |
| Max. Negotiated Rate |
$427.70 |
| Rate for Payer: Aetna Commercial |
$384.93
|
| Rate for Payer: Aetna Medicare |
$213.85
|
| Rate for Payer: ASR ASR |
$414.87
|
| Rate for Payer: ASR Commercial |
$414.87
|
| Rate for Payer: BCBS Complete |
$171.08
|
| Rate for Payer: BCBS Trust/PPO |
$350.24
|
| Rate for Payer: BCN Commercial |
$331.60
|
| Rate for Payer: Cash Price |
$342.16
|
| Rate for Payer: Cofinity Commercial |
$402.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.16
|
| Rate for Payer: Healthscope Commercial |
$427.70
|
| Rate for Payer: Healthscope Whirlpool |
$414.87
|
| Rate for Payer: Mclaren Commercial |
$384.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.55
|
| Rate for Payer: Nomi Health Commercial |
$350.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$374.75
|
| Rate for Payer: Priority Health Narrow Network |
$299.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.38
|
|
|
HYDROXYZINE HCL 10 MG TABLET
|
Facility
|
OP
|
$427.70
|
|
|
Service Code
|
NDC 68084025301
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$171.08 |
| Max. Negotiated Rate |
$427.70 |
| Rate for Payer: Aetna Commercial |
$384.93
|
| Rate for Payer: Aetna Medicare |
$213.85
|
| Rate for Payer: ASR ASR |
$414.87
|
| Rate for Payer: ASR Commercial |
$414.87
|
| Rate for Payer: BCBS Complete |
$171.08
|
| Rate for Payer: BCBS Trust/PPO |
$350.24
|
| Rate for Payer: BCN Commercial |
$331.60
|
| Rate for Payer: Cash Price |
$342.16
|
| Rate for Payer: Cofinity Commercial |
$402.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$342.16
|
| Rate for Payer: Healthscope Commercial |
$427.70
|
| Rate for Payer: Healthscope Whirlpool |
$414.87
|
| Rate for Payer: Mclaren Commercial |
$384.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$363.55
|
| Rate for Payer: Nomi Health Commercial |
$350.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$374.75
|
| Rate for Payer: Priority Health Narrow Network |
$299.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$376.38
|
|
