Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

ZIDOVUDINE 10 MG/ML ORAL SYRUP

Facility

$789.60

Service Code	NDC 65862004824
Hospital Charge Code	11693
Hospital Revenue Code	637
Min. Negotiated Rate	$497.45
Max. Negotiated Rate	$710.64
Rate for Payer: Aetna Commercial	$671.16
Rate for Payer: Aetna New Business (MI Preferred)	$513.24
Rate for Payer: Cash Price	$631.68
Rate for Payer: Cofinity Advantage	$552.72
Rate for Payer: Cofinity Commercial	$679.06
Rate for Payer: Encore Health Key Benefits Commercial	$631.68
Rate for Payer: Healthscope Commercial	$710.64
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$671.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$592.20
Rate for Payer: PHP Commercial	$671.16
Rate for Payer: Priority Health SBD	$497.45

ZIDOVUDINE 10 MG/ML ORAL SYRUP

Facility

$789.60

Service Code	NDC 65862004824
Hospital Charge Code	11693
Hospital Revenue Code	637
Min. Negotiated Rate	$310.31
Max. Negotiated Rate	$710.64
Rate for Payer: Aetna Commercial	$671.16
Rate for Payer: Aetna Medicare	$394.80
Rate for Payer: Aetna New Business (MI Preferred)	$513.24
Rate for Payer: BCBS Complete	$315.84
Rate for Payer: Cash Price	$631.68
Rate for Payer: Cofinity Advantage	$552.72
Rate for Payer: Cofinity Commercial	$679.06
Rate for Payer: Encore Health Key Benefits Commercial	$631.68
Rate for Payer: Healthscope Commercial	$710.64
Rate for Payer: MI Amish Medical Board Commercial	$631.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$671.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$592.20
Rate for Payer: PHP Commercial	$671.16
Rate for Payer: Priority Health SBD	$497.45
Rate for Payer: UHC All Payor (Choice/PPO)	$513.24
Rate for Payer: UHC Core	$411.38
Rate for Payer: UHC Exchange	$310.31

ZINC OXIDE 20 % TOPICAL OINTMENT

Facility

$26.92

Service Code	NDC 75834017001
Hospital Charge Code	8874
Hospital Revenue Code	637
Min. Negotiated Rate	$16.96
Max. Negotiated Rate	$24.23
Rate for Payer: Aetna Commercial	$22.88
Rate for Payer: Aetna New Business (MI Preferred)	$17.50
Rate for Payer: Cash Price	$21.54
Rate for Payer: Cofinity Advantage	$18.84
Rate for Payer: Cofinity Commercial	$23.15
Rate for Payer: Encore Health Key Benefits Commercial	$21.54
Rate for Payer: Healthscope Commercial	$24.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.19
Rate for Payer: PHP Commercial	$22.88
Rate for Payer: Priority Health SBD	$16.96

ZINC OXIDE 20 % TOPICAL OINTMENT

Facility

$26.92

Service Code	NDC 75834017001
Hospital Charge Code	8874
Hospital Revenue Code	637
Min. Negotiated Rate	$10.58
Max. Negotiated Rate	$24.23
Rate for Payer: Aetna Commercial	$22.88
Rate for Payer: Aetna Medicare	$13.46
Rate for Payer: Aetna New Business (MI Preferred)	$17.50
Rate for Payer: BCBS Complete	$10.77
Rate for Payer: Cash Price	$21.54
Rate for Payer: Cofinity Advantage	$18.84
Rate for Payer: Cofinity Commercial	$23.15
Rate for Payer: Encore Health Key Benefits Commercial	$21.54
Rate for Payer: Healthscope Commercial	$24.23
Rate for Payer: MI Amish Medical Board Commercial	$21.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.19
Rate for Payer: PHP Commercial	$22.88
Rate for Payer: Priority Health SBD	$16.96
Rate for Payer: UHC All Payor (Choice/PPO)	$17.50
Rate for Payer: UHC Core	$14.03
Rate for Payer: UHC Exchange	$10.58

ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE

Facility

$83.50

Service Code	NDC 11701005033
Hospital Charge Code	11378
Hospital Revenue Code	637
Min. Negotiated Rate	$32.82
Max. Negotiated Rate	$75.15
Rate for Payer: Aetna Commercial	$70.97
Rate for Payer: Aetna Medicare	$41.75
Rate for Payer: Aetna New Business (MI Preferred)	$54.27
Rate for Payer: BCBS Complete	$33.40
Rate for Payer: Cash Price	$66.80
Rate for Payer: Cofinity Advantage	$58.45
Rate for Payer: Cofinity Commercial	$71.81
Rate for Payer: Encore Health Key Benefits Commercial	$66.80
Rate for Payer: Healthscope Commercial	$75.15
Rate for Payer: MI Amish Medical Board Commercial	$66.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$62.62
Rate for Payer: PHP Commercial	$70.97
Rate for Payer: Priority Health SBD	$52.60
Rate for Payer: UHC All Payor (Choice/PPO)	$54.27
Rate for Payer: UHC Core	$43.50
Rate for Payer: UHC Exchange	$32.82

ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE

Facility

$83.50

Service Code	NDC 11701005033
Hospital Charge Code	11378
Hospital Revenue Code	637
Min. Negotiated Rate	$52.60
Max. Negotiated Rate	$75.15
Rate for Payer: Aetna Commercial	$70.97
Rate for Payer: Aetna New Business (MI Preferred)	$54.27
Rate for Payer: Cash Price	$66.80
Rate for Payer: Cofinity Advantage	$58.45
Rate for Payer: Cofinity Commercial	$71.81
Rate for Payer: Encore Health Key Benefits Commercial	$66.80
Rate for Payer: Healthscope Commercial	$75.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$70.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$62.62
Rate for Payer: PHP Commercial	$70.97
Rate for Payer: Priority Health SBD	$52.60

ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE

Facility

$138.72

Service Code	NDC 11701005032
Hospital Charge Code	11378
Hospital Revenue Code	637
Min. Negotiated Rate	$54.52
Max. Negotiated Rate	$124.85
Rate for Payer: Aetna Commercial	$117.91
Rate for Payer: Aetna Medicare	$69.36
Rate for Payer: Aetna New Business (MI Preferred)	$90.17
Rate for Payer: BCBS Complete	$55.49
Rate for Payer: Cash Price	$110.98
Rate for Payer: Cofinity Advantage	$97.10
Rate for Payer: Cofinity Commercial	$119.30
Rate for Payer: Encore Health Key Benefits Commercial	$110.98
Rate for Payer: Healthscope Commercial	$124.85
Rate for Payer: MI Amish Medical Board Commercial	$110.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$117.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$104.04
Rate for Payer: PHP Commercial	$117.91
Rate for Payer: Priority Health SBD	$87.39
Rate for Payer: UHC All Payor (Choice/PPO)	$90.17
Rate for Payer: UHC Core	$72.27
Rate for Payer: UHC Exchange	$54.52

ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE

Facility

$138.72

Service Code	NDC 11701005032
Hospital Charge Code	11378
Hospital Revenue Code	637
Min. Negotiated Rate	$87.39
Max. Negotiated Rate	$124.85
Rate for Payer: Aetna Commercial	$117.91
Rate for Payer: Aetna New Business (MI Preferred)	$90.17
Rate for Payer: Cash Price	$110.98
Rate for Payer: Cofinity Advantage	$97.10
Rate for Payer: Cofinity Commercial	$119.30
Rate for Payer: Encore Health Key Benefits Commercial	$110.98
Rate for Payer: Healthscope Commercial	$124.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$117.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$104.04
Rate for Payer: PHP Commercial	$117.91
Rate for Payer: Priority Health SBD	$87.39

ZINC OXIDE-WHITE PETROLATUM 15 %-49 % TOPICAL OINTMENT

Facility

$32.04

Service Code	NDC 53329077144
Hospital Charge Code	97710
Hospital Revenue Code	637
Min. Negotiated Rate	$12.59
Max. Negotiated Rate	$28.84
Rate for Payer: Aetna Commercial	$27.23
Rate for Payer: Aetna Medicare	$16.02
Rate for Payer: Aetna New Business (MI Preferred)	$20.83
Rate for Payer: BCBS Complete	$12.82
Rate for Payer: Cash Price	$25.63
Rate for Payer: Cofinity Advantage	$22.43
Rate for Payer: Cofinity Commercial	$27.55
Rate for Payer: Encore Health Key Benefits Commercial	$25.63
Rate for Payer: Healthscope Commercial	$28.84
Rate for Payer: MI Amish Medical Board Commercial	$25.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.03
Rate for Payer: PHP Commercial	$27.23
Rate for Payer: Priority Health SBD	$20.19
Rate for Payer: UHC All Payor (Choice/PPO)	$20.83
Rate for Payer: UHC Core	$16.69
Rate for Payer: UHC Exchange	$12.59

ZINC OXIDE-WHITE PETROLATUM 15 %-49 % TOPICAL OINTMENT

Facility

$32.04

Service Code	NDC 53329077144
Hospital Charge Code	97710
Hospital Revenue Code	637
Min. Negotiated Rate	$20.19
Max. Negotiated Rate	$28.84
Rate for Payer: Aetna Commercial	$27.23
Rate for Payer: Aetna New Business (MI Preferred)	$20.83
Rate for Payer: Cash Price	$25.63
Rate for Payer: Cofinity Advantage	$22.43
Rate for Payer: Cofinity Commercial	$27.55
Rate for Payer: Encore Health Key Benefits Commercial	$25.63
Rate for Payer: Healthscope Commercial	$28.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$27.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.03
Rate for Payer: PHP Commercial	$27.23
Rate for Payer: Priority Health SBD	$20.19

ZINC SULFATE 1 MG/ML INTRAVENOUS SOLUTION

Facility

$25.95

Service Code	NDC 70710187607
Hospital Charge Code	8878
Hospital Revenue Code	250
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$23.36
Rate for Payer: Aetna Commercial	$22.06
Rate for Payer: Aetna Medicare	$12.97
Rate for Payer: Aetna New Business (MI Preferred)	$16.87
Rate for Payer: BCBS Complete	$10.38
Rate for Payer: Cash Price	$20.76
Rate for Payer: Cofinity Advantage	$18.16
Rate for Payer: Cofinity Commercial	$22.32
Rate for Payer: Encore Health Key Benefits Commercial	$20.76
Rate for Payer: Healthscope Commercial	$23.36
Rate for Payer: MI Amish Medical Board Commercial	$20.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$19.46
Rate for Payer: PHP Commercial	$22.06
Rate for Payer: Priority Health SBD	$16.35
Rate for Payer: UHC All Payor (Choice/PPO)	$16.87
Rate for Payer: UHC Core	$13.52
Rate for Payer: UHC Exchange	$10.20

ZINC SULFATE 1 MG/ML INTRAVENOUS SOLUTION

Facility

$25.95

Service Code	NDC 70710187607
Hospital Charge Code	8878
Hospital Revenue Code	250
Min. Negotiated Rate	$16.35
Max. Negotiated Rate	$23.36
Rate for Payer: Aetna Commercial	$22.06
Rate for Payer: Aetna New Business (MI Preferred)	$16.87
Rate for Payer: Cash Price	$20.76
Rate for Payer: Cofinity Advantage	$18.16
Rate for Payer: Cofinity Commercial	$22.32
Rate for Payer: Encore Health Key Benefits Commercial	$20.76
Rate for Payer: Healthscope Commercial	$23.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$22.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$19.46
Rate for Payer: PHP Commercial	$22.06
Rate for Payer: Priority Health SBD	$16.35

ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE

Facility

$178.20

Service Code	NDC 20555004000
Hospital Charge Code	8880
Hospital Revenue Code	637
Min. Negotiated Rate	$112.27
Max. Negotiated Rate	$160.38
Rate for Payer: Aetna Commercial	$151.47
Rate for Payer: Aetna New Business (MI Preferred)	$115.83
Rate for Payer: Cash Price	$142.56
Rate for Payer: Cofinity Advantage	$124.74
Rate for Payer: Cofinity Commercial	$153.25
Rate for Payer: Encore Health Key Benefits Commercial	$142.56
Rate for Payer: Healthscope Commercial	$160.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$151.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$133.65
Rate for Payer: PHP Commercial	$151.47
Rate for Payer: Priority Health SBD	$112.27

ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE

Facility

$178.20

Service Code	NDC 20555004000
Hospital Charge Code	8880
Hospital Revenue Code	637
Min. Negotiated Rate	$70.03
Max. Negotiated Rate	$160.38
Rate for Payer: Aetna Commercial	$151.47
Rate for Payer: Aetna Medicare	$89.10
Rate for Payer: Aetna New Business (MI Preferred)	$115.83
Rate for Payer: BCBS Complete	$71.28
Rate for Payer: Cash Price	$142.56
Rate for Payer: Cofinity Advantage	$124.74
Rate for Payer: Cofinity Commercial	$153.25
Rate for Payer: Encore Health Key Benefits Commercial	$142.56
Rate for Payer: Healthscope Commercial	$160.38
Rate for Payer: MI Amish Medical Board Commercial	$142.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$151.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$133.65
Rate for Payer: PHP Commercial	$151.47
Rate for Payer: Priority Health SBD	$112.27
Rate for Payer: UHC All Payor (Choice/PPO)	$115.83
Rate for Payer: UHC Core	$92.84
Rate for Payer: UHC Exchange	$70.03

ZINC SULFATE 5 MG/ML INTRAVENOUS SOLUTION

Facility

$19.78

Service Code	NDC 00517800525
Hospital Charge Code	8879
Hospital Revenue Code	250
Min. Negotiated Rate	$12.46
Max. Negotiated Rate	$17.80
Rate for Payer: Aetna Commercial	$16.81
Rate for Payer: Aetna New Business (MI Preferred)	$12.86
Rate for Payer: Cash Price	$15.82
Rate for Payer: Cofinity Advantage	$13.85
Rate for Payer: Cofinity Commercial	$17.01
Rate for Payer: Encore Health Key Benefits Commercial	$15.82
Rate for Payer: Healthscope Commercial	$17.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.84
Rate for Payer: PHP Commercial	$16.81
Rate for Payer: Priority Health SBD	$12.46

ZINC SULFATE 5 MG/ML INTRAVENOUS SOLUTION

Facility

$19.78

Service Code	NDC 00517800525
Hospital Charge Code	8879
Hospital Revenue Code	250
Min. Negotiated Rate	$7.77
Max. Negotiated Rate	$17.80
Rate for Payer: Aetna Commercial	$16.81
Rate for Payer: Aetna Medicare	$9.89
Rate for Payer: Aetna New Business (MI Preferred)	$12.86
Rate for Payer: BCBS Complete	$7.91
Rate for Payer: Cash Price	$15.82
Rate for Payer: Cofinity Advantage	$13.85
Rate for Payer: Cofinity Commercial	$17.01
Rate for Payer: Encore Health Key Benefits Commercial	$15.82
Rate for Payer: Healthscope Commercial	$17.80
Rate for Payer: MI Amish Medical Board Commercial	$15.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.84
Rate for Payer: PHP Commercial	$16.81
Rate for Payer: Priority Health SBD	$12.46
Rate for Payer: UHC All Payor (Choice/PPO)	$12.86
Rate for Payer: UHC Core	$10.31
Rate for Payer: UHC Exchange	$7.77

ZINC SULFATE 5 MG/ML INTRAVENOUS SOLUTION

Facility

$19.78

Service Code	NDC 00517800501
Hospital Charge Code	8879
Hospital Revenue Code	250
Min. Negotiated Rate	$7.77
Max. Negotiated Rate	$17.80
Rate for Payer: Aetna Commercial	$16.81
Rate for Payer: Aetna Medicare	$9.89
Rate for Payer: Aetna New Business (MI Preferred)	$12.86
Rate for Payer: BCBS Complete	$7.91
Rate for Payer: Cash Price	$15.82
Rate for Payer: Cofinity Advantage	$13.85
Rate for Payer: Cofinity Commercial	$17.01
Rate for Payer: Encore Health Key Benefits Commercial	$15.82
Rate for Payer: Healthscope Commercial	$17.80
Rate for Payer: MI Amish Medical Board Commercial	$15.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.84
Rate for Payer: PHP Commercial	$16.81
Rate for Payer: Priority Health SBD	$12.46
Rate for Payer: UHC All Payor (Choice/PPO)	$12.86
Rate for Payer: UHC Core	$10.31
Rate for Payer: UHC Exchange	$7.77

ZINC SULFATE 5 MG/ML INTRAVENOUS SOLUTION

Facility

$19.78

Service Code	NDC 00517800501
Hospital Charge Code	8879
Hospital Revenue Code	250
Min. Negotiated Rate	$12.46
Max. Negotiated Rate	$17.80
Rate for Payer: Aetna Commercial	$16.81
Rate for Payer: Aetna New Business (MI Preferred)	$12.86
Rate for Payer: Cash Price	$15.82
Rate for Payer: Cofinity Advantage	$13.85
Rate for Payer: Cofinity Commercial	$17.01
Rate for Payer: Encore Health Key Benefits Commercial	$15.82
Rate for Payer: Healthscope Commercial	$17.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$16.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.84
Rate for Payer: PHP Commercial	$16.81
Rate for Payer: Priority Health SBD	$12.46

ZIPRASIDONE 20 MG CAPSULE

Facility

$713.07

Service Code	NDC 00904626945
Hospital Charge Code	29778
Hospital Revenue Code	637
Min. Negotiated Rate	$280.24
Max. Negotiated Rate	$641.76
Rate for Payer: Aetna Commercial	$606.11
Rate for Payer: Aetna Medicare	$356.54
Rate for Payer: Aetna New Business (MI Preferred)	$463.50
Rate for Payer: BCBS Complete	$285.23
Rate for Payer: Cash Price	$570.46
Rate for Payer: Cofinity Advantage	$499.15
Rate for Payer: Cofinity Commercial	$613.24
Rate for Payer: Encore Health Key Benefits Commercial	$570.46
Rate for Payer: Healthscope Commercial	$641.76
Rate for Payer: MI Amish Medical Board Commercial	$570.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$606.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$534.80
Rate for Payer: PHP Commercial	$606.11
Rate for Payer: Priority Health SBD	$449.23
Rate for Payer: UHC All Payor (Choice/PPO)	$463.50
Rate for Payer: UHC Core	$371.51
Rate for Payer: UHC Exchange	$280.24

ZIPRASIDONE 20 MG CAPSULE

Facility

$357.12

Service Code	NDC 60505252806
Hospital Charge Code	29778
Hospital Revenue Code	637
Min. Negotiated Rate	$140.35
Max. Negotiated Rate	$321.41
Rate for Payer: Aetna Commercial	$303.55
Rate for Payer: Aetna Medicare	$178.56
Rate for Payer: Aetna New Business (MI Preferred)	$232.13
Rate for Payer: BCBS Complete	$142.85
Rate for Payer: Cash Price	$285.70
Rate for Payer: Cofinity Advantage	$249.98
Rate for Payer: Cofinity Commercial	$307.12
Rate for Payer: Encore Health Key Benefits Commercial	$285.70
Rate for Payer: Healthscope Commercial	$321.41
Rate for Payer: MI Amish Medical Board Commercial	$285.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$303.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$267.84
Rate for Payer: PHP Commercial	$303.55
Rate for Payer: Priority Health SBD	$224.99
Rate for Payer: UHC All Payor (Choice/PPO)	$232.13
Rate for Payer: UHC Core	$186.06
Rate for Payer: UHC Exchange	$140.35

ZIPRASIDONE 20 MG CAPSULE

Facility

$713.07

Service Code	NDC 00904626945
Hospital Charge Code	29778
Hospital Revenue Code	637
Min. Negotiated Rate	$449.23
Max. Negotiated Rate	$641.76
Rate for Payer: Aetna Commercial	$606.11
Rate for Payer: Aetna New Business (MI Preferred)	$463.50
Rate for Payer: Cash Price	$570.46
Rate for Payer: Cofinity Advantage	$499.15
Rate for Payer: Cofinity Commercial	$613.24
Rate for Payer: Encore Health Key Benefits Commercial	$570.46
Rate for Payer: Healthscope Commercial	$641.76
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$606.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$534.80
Rate for Payer: PHP Commercial	$606.11
Rate for Payer: Priority Health SBD	$449.23

ZIPRASIDONE 20 MG CAPSULE

Facility

$181.83

Service Code	NDC 55111025660
Hospital Charge Code	29778
Hospital Revenue Code	637
Min. Negotiated Rate	$71.46
Max. Negotiated Rate	$163.65
Rate for Payer: Aetna Commercial	$154.56
Rate for Payer: Aetna Medicare	$90.92
Rate for Payer: Aetna New Business (MI Preferred)	$118.19
Rate for Payer: BCBS Complete	$72.73
Rate for Payer: Cash Price	$145.46
Rate for Payer: Cofinity Advantage	$127.28
Rate for Payer: Cofinity Commercial	$156.37
Rate for Payer: Encore Health Key Benefits Commercial	$145.46
Rate for Payer: Healthscope Commercial	$163.65
Rate for Payer: MI Amish Medical Board Commercial	$145.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$154.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$136.37
Rate for Payer: PHP Commercial	$154.56
Rate for Payer: Priority Health SBD	$114.55
Rate for Payer: UHC All Payor (Choice/PPO)	$118.19
Rate for Payer: UHC Core	$94.73
Rate for Payer: UHC Exchange	$71.46

ZIPRASIDONE 20 MG CAPSULE

Facility

$221.16

Service Code	NDC 65862070260
Hospital Charge Code	29778
Hospital Revenue Code	637
Min. Negotiated Rate	$86.92
Max. Negotiated Rate	$199.04
Rate for Payer: Aetna Commercial	$187.99
Rate for Payer: Aetna Medicare	$110.58
Rate for Payer: Aetna New Business (MI Preferred)	$143.75
Rate for Payer: BCBS Complete	$88.46
Rate for Payer: Cash Price	$176.93
Rate for Payer: Cofinity Advantage	$154.81
Rate for Payer: Cofinity Commercial	$190.20
Rate for Payer: Encore Health Key Benefits Commercial	$176.93
Rate for Payer: Healthscope Commercial	$199.04
Rate for Payer: MI Amish Medical Board Commercial	$176.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$187.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$165.87
Rate for Payer: PHP Commercial	$187.99
Rate for Payer: Priority Health SBD	$139.33
Rate for Payer: UHC All Payor (Choice/PPO)	$143.75
Rate for Payer: UHC Core	$115.22
Rate for Payer: UHC Exchange	$86.92

ZIPRASIDONE 20 MG CAPSULE

Facility

$181.83

Service Code	NDC 55111025660
Hospital Charge Code	29778
Hospital Revenue Code	637
Min. Negotiated Rate	$114.55
Max. Negotiated Rate	$163.65
Rate for Payer: Aetna Commercial	$154.56
Rate for Payer: Aetna New Business (MI Preferred)	$118.19
Rate for Payer: Cash Price	$145.46
Rate for Payer: Cofinity Advantage	$127.28
Rate for Payer: Cofinity Commercial	$156.37
Rate for Payer: Encore Health Key Benefits Commercial	$145.46
Rate for Payer: Healthscope Commercial	$163.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$154.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$136.37
Rate for Payer: PHP Commercial	$154.56
Rate for Payer: Priority Health SBD	$114.55

ZIPRASIDONE 20 MG CAPSULE

Facility

$357.12

Service Code	NDC 60505252806
Hospital Charge Code	29778
Hospital Revenue Code	637
Min. Negotiated Rate	$224.99
Max. Negotiated Rate	$321.41
Rate for Payer: Aetna Commercial	$303.55
Rate for Payer: Aetna New Business (MI Preferred)	$232.13
Rate for Payer: Cash Price	$285.70
Rate for Payer: Cofinity Advantage	$249.98
Rate for Payer: Cofinity Commercial	$307.12
Rate for Payer: Encore Health Key Benefits Commercial	$285.70
Rate for Payer: Healthscope Commercial	$321.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$303.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$267.84
Rate for Payer: PHP Commercial	$303.55
Rate for Payer: Priority Health SBD	$224.99

Know your out-of-pocket cost for care.

All Charges