3000194 — Hydroxyzine Pam (vistaril) 25 Mg Capsule
Cite this view
HANK Price Transparency. (n.d.). HYDROXYZINE PAM (VISTARIL) 25 MG CAPSULE (CDM 3000194) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/3000194?code_type=CDM
“HYDROXYZINE PAM (VISTARIL) 25 MG CAPSULE (CDM 3000194) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/3000194?code_type=CDM. Accessed .
“HYDROXYZINE PAM (VISTARIL) 25 MG CAPSULE (CDM 3000194) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/3000194?code_type=CDM.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $1–$6 (25th–75th percentile) across 5 hospitals · 27 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CDM 3000194 — the consumer-grade median across the country. It covers the facility charge only; the surgeon’s and anesthesiologist’s fees are billed separately.
Per-month price trends are temporarily unavailable while we rebuild them on quality-filtered rates. The medians, percentiles, and per-hospital rates on this page are the quality-filtered figures.
Hospital rates (per row)
Showing consumer-grade rates only. Flagged / outlier filings (excluded from the medians above) are hidden — tick “Show flagged / outlier rates” to include them.
| Hospital | Payer | Plan | Negotiated rate | Gross | Cash | Observed | Source |
|---|---|---|---|---|---|---|---|
| LEVI HOSPITAL OutpatientFacility | NovaSys Health Inc | NovaSys Exchange | $0.34 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | NovaSys Health Inc | Network Access | $0.34 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | NovaSys Health Inc | NovaSys All Payor | $0.34 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | Aetna Behavioral Health Medicare Advantage | Medicare Advantage | $0.55 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | BCBS HMO | HMO | $0.96 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | True Blue PPO | True Blue PPO | $0.96 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | BCBS PPO | PPO | $0.96 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | BCBS Preferred | Preferred | $0.96 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | Access Health SVCS ADV Medicare Advantage-Superior Select | Medicare Advantage | $1.01 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | Cigna Medicare Advantage | Medicare Advantage | $1.01 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | BCBS MCR ADV | Health Advantage HMO | $1.01 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | Caresource Medicare | Medicare Advantage | $1.01 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | Amerigroup Medicare Advantage | Medicare Advantage | $1.01 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | Humana Medicare | Medicare Advantage | $1.01 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | Caresouce MarketPlace BH | All Products | $1.01 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | Caresource Medicare Behavioral | Medicare Behavorial | $1.01 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | Supple,emental | Medicare Advantage | $1.01 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | NovaSys Health Inc | Medicaid Passe | $1.04 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | AllWell | Medicare Advantage | $1.04 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | NovaSys Health Inc | Medicare Advantage | $1.04 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL BothFacility | Velocity National Provider Network | Auto Liability | $1.32 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | Velocity National Provider Network | Workers Comp | $1.32 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | Velocity National Provider Network | Medicare Advantage | $1.32 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | Velocity National Provider Network | Group Health | $1.32 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | United Behavorial Health | All Products | $1.44 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | Provider Network of America PNOA | All Products | $1.51 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | Mercy Behavorial Health | All Products | $1.68 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL BothFacility | Velocity National Provider Network | All Other | $1.68 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | Multi Plan | All Products | $1.68 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | Bardavon | All Products | $1.68 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| LEVI HOSPITAL OutpatientFacility | Municipal Health Benefits MHB | All Products | $1.68 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| FRANKLIN COUNTY MEMORIAL HOSPITAL Both | United Healthcare | PPO | $2.00 | $3.00 | $3.00 | 2026-03-10 | MRF ↗ |
| FRANKLIN COUNTY MEMORIAL HOSPITAL Both | United Healthcare | Commercial | $2.00 | $3.00 | $3.00 | 2026-03-10 | MRF ↗ |
| FRANKLIN COUNTY MEMORIAL HOSPITAL Both | United Healthcare | HMO | $2.00 | $3.00 | $3.00 | 2026-03-10 | MRF ↗ |
| LEVI HOSPITAL BothFacility | Corvel | All Products | $2.04 | $2.40 | $0.89 | 2024-12-26 | MRF ↗ |
| FRANKLIN COUNTY MEMORIAL HOSPITAL Both | Blue Cross Blue Shield of Nebraska | PPO | $3.00 | $3.00 | $3.00 | 2026-03-10 | MRF ↗ |
| FRANKLIN COUNTY MEMORIAL HOSPITAL Both | Aetna | Medicare Advantage | $3.00 | $3.00 | $3.00 | 2026-03-10 | MRF ↗ |
| FRANKLIN COUNTY MEMORIAL HOSPITAL Both | Aetna | Commercial | $3.00 | $3.00 | $3.00 | 2026-03-10 | MRF ↗ |
| KNOX COUNTY HOSPITAL Both | Superior Health Plan | Commercial | $6.00 | $10.00 | $10.00 | 2025-11-06 | MRF ↗ |
| KNOX COUNTY HOSPITAL Both | WellMed | Commercial | $6.00 | $10.00 | $10.00 | 2025-11-06 | MRF ↗ |
| KNOX COUNTY HOSPITAL Both | MultiPlan | Commercial | $6.00 | $10.00 | $10.00 | 2025-11-06 | MRF ↗ |
| KNOX COUNTY HOSPITAL Both | Humana | Commercial | $6.00 | $10.00 | $10.00 | 2025-11-06 | MRF ↗ |
| KNOX COUNTY HOSPITAL Both | Blue Cross Blue Shield of Texas | PPO | $7.00 | $10.00 | $10.00 | 2025-11-06 | MRF ↗ |
| KNOX COUNTY HOSPITAL Both | Blue Cross Blue Shield of Texas | Blue Essentials | $7.00 | $10.00 | $10.00 | 2025-11-06 | MRF ↗ |
| KNOX COUNTY HOSPITAL Both | Aetna | Commercial | $8.00 | $10.00 | $10.00 | 2025-11-06 | MRF ↗ |
| KNOX COUNTY HOSPITAL Both | FirstCare | Commercial | $9.00 | $10.00 | $10.00 | 2025-11-06 | MRF ↗ |
| FOREST HEALTH MEDICAL CENTER Both | — | — | — | $123.85 | — | 2026-02-26 | MRF ↗ |
| PARKVIEW HOSPITAL Both | FirstCare | PPO | $351.00 | $2,922.00 | $2,484.00 | 2026-08-20 | MRF ↗ |
| PARKVIEW HOSPITAL Both | Blue Cross Blue Shield | HMO | $1,753.00 | $2,922.00 | $2,484.00 | 2026-08-20 | MRF ↗ |
| PARKVIEW HOSPITAL Both | Aetna | Commercial | $2,484.00 | $2,922.00 | $2,484.00 | 2026-08-20 | MRF ↗ |
| PARKVIEW HOSPITAL Both | United Healthcare | Commercial | $2,492.00 | $2,922.00 | $2,484.00 | 2026-08-20 | MRF ↗ |
| PARKVIEW HOSPITAL Both | Blue Cross Blue Shield | PPO | $2,630.00 | $2,922.00 | $2,484.00 | 2026-08-20 | MRF ↗ |
| PARKVIEW HOSPITAL Both | Blue Cross Blue Shield | Medicare Advantage | $2,688.00 | $2,922.00 | $2,484.00 | 2026-08-20 | MRF ↗ |
| PARKVIEW HOSPITAL Both | Humana | Medicare Advantage | $2,688.00 | $2,922.00 | $2,484.00 | 2026-08-20 | MRF ↗ |
| PARKVIEW HOSPITAL Both | Superior HealthPlan | Medicare Advantage | $2,688.00 | $2,922.00 | $2,484.00 | 2026-08-20 | MRF ↗ |
| PARKVIEW HOSPITAL Both | FirstCare | HMO | $2,776.00 | $2,922.00 | $2,484.00 | 2026-08-20 | MRF ↗ |