Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

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 Commercial	$119.30
Rate for Payer: Cofinity Commercial	$97.10
Rate for Payer: Cofinity Medicare Advantage	$97.10
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: PHP Commercial	$117.91
Rate for Payer: Priority Health Cigna Priority Health	$90.17
Rate for Payer: Priority Health SBD	$87.39

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	$55.49
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 Commercial	$119.30
Rate for Payer: Cofinity Commercial	$97.10
Rate for Payer: Cofinity Medicare Advantage	$97.10
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: PHP Commercial	$117.91
Rate for Payer: Priority Health Cigna Priority Health	$90.17
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	$12.82
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 Commercial	$22.43
Rate for Payer: Cofinity Commercial	$27.55
Rate for Payer: Cofinity Medicare Advantage	$22.43
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: PHP Commercial	$27.23
Rate for Payer: Priority Health Cigna Priority Health	$20.83
Rate for Payer: Priority Health SBD	$20.19

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 Commercial	$22.43
Rate for Payer: Cofinity Commercial	$27.55
Rate for Payer: Cofinity Medicare Advantage	$22.43
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: PHP Commercial	$27.23
Rate for Payer: Priority Health Cigna Priority Health	$20.83
Rate for Payer: Priority Health SBD	$20.19

ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE

Facility

$144.10

Service Code	NDC 20555004000
Hospital Charge Code	8880
Hospital Revenue Code	637
Min. Negotiated Rate	$57.64
Max. Negotiated Rate	$129.69
Rate for Payer: Aetna Commercial	$122.48
Rate for Payer: Aetna Medicare	$72.05
Rate for Payer: Aetna New Business (MI Preferred)	$93.66
Rate for Payer: BCBS Complete	$57.64
Rate for Payer: Cash Price	$115.28
Rate for Payer: Cofinity Commercial	$100.87
Rate for Payer: Cofinity Commercial	$123.93
Rate for Payer: Cofinity Medicare Advantage	$100.87
Rate for Payer: Encore Health Key Benefits Commercial	$115.28
Rate for Payer: Healthscope Commercial	$129.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$122.48
Rate for Payer: PHP Commercial	$122.48
Rate for Payer: Priority Health Cigna Priority Health	$93.66
Rate for Payer: Priority Health SBD	$90.78

ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE

Facility

$144.10

Service Code	NDC 20555004000
Hospital Charge Code	8880
Hospital Revenue Code	637
Min. Negotiated Rate	$90.78
Max. Negotiated Rate	$129.69
Rate for Payer: Aetna Commercial	$122.48
Rate for Payer: Aetna New Business (MI Preferred)	$93.66
Rate for Payer: Cash Price	$115.28
Rate for Payer: Cofinity Commercial	$100.87
Rate for Payer: Cofinity Commercial	$123.93
Rate for Payer: Cofinity Medicare Advantage	$100.87
Rate for Payer: Encore Health Key Benefits Commercial	$115.28
Rate for Payer: Healthscope Commercial	$129.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$122.48
Rate for Payer: PHP Commercial	$122.48
Rate for Payer: Priority Health Cigna Priority Health	$93.66
Rate for Payer: Priority Health SBD	$90.78

ZINC SULFATE 5 MG/ML INTRAVENOUS SOLUTION

Facility

$60.38

Service Code	NDC 00517800501
Hospital Charge Code	8879
Hospital Revenue Code	250
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$54.34
Rate for Payer: Aetna Commercial	$51.32
Rate for Payer: Aetna Medicare	$30.19
Rate for Payer: Aetna New Business (MI Preferred)	$39.25
Rate for Payer: BCBS Complete	$24.15
Rate for Payer: Cash Price	$48.30
Rate for Payer: Cofinity Commercial	$42.27
Rate for Payer: Cofinity Commercial	$51.93
Rate for Payer: Cofinity Medicare Advantage	$42.27
Rate for Payer: Encore Health Key Benefits Commercial	$48.30
Rate for Payer: Healthscope Commercial	$54.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.32
Rate for Payer: PHP Commercial	$51.32
Rate for Payer: Priority Health Cigna Priority Health	$39.25
Rate for Payer: Priority Health SBD	$38.04

ZINC SULFATE 5 MG/ML INTRAVENOUS SOLUTION

Facility

$60.38

Service Code	NDC 00517800525
Hospital Charge Code	8879
Hospital Revenue Code	250
Min. Negotiated Rate	$38.04
Max. Negotiated Rate	$54.34
Rate for Payer: Aetna Commercial	$51.32
Rate for Payer: Aetna New Business (MI Preferred)	$39.25
Rate for Payer: Cash Price	$48.30
Rate for Payer: Cofinity Commercial	$42.27
Rate for Payer: Cofinity Commercial	$51.93
Rate for Payer: Cofinity Medicare Advantage	$42.27
Rate for Payer: Encore Health Key Benefits Commercial	$48.30
Rate for Payer: Healthscope Commercial	$54.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.32
Rate for Payer: PHP Commercial	$51.32
Rate for Payer: Priority Health Cigna Priority Health	$39.25
Rate for Payer: Priority Health SBD	$38.04

ZINC SULFATE 5 MG/ML INTRAVENOUS SOLUTION

Facility

$60.38

Service Code	NDC 00517800501
Hospital Charge Code	8879
Hospital Revenue Code	250
Min. Negotiated Rate	$38.04
Max. Negotiated Rate	$54.34
Rate for Payer: Aetna Commercial	$51.32
Rate for Payer: Aetna New Business (MI Preferred)	$39.25
Rate for Payer: Cash Price	$48.30
Rate for Payer: Cofinity Commercial	$42.27
Rate for Payer: Cofinity Commercial	$51.93
Rate for Payer: Cofinity Medicare Advantage	$42.27
Rate for Payer: Encore Health Key Benefits Commercial	$48.30
Rate for Payer: Healthscope Commercial	$54.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.32
Rate for Payer: PHP Commercial	$51.32
Rate for Payer: Priority Health Cigna Priority Health	$39.25
Rate for Payer: Priority Health SBD	$38.04

ZINC SULFATE 5 MG/ML INTRAVENOUS SOLUTION

Facility

$60.38

Service Code	NDC 00517800525
Hospital Charge Code	8879
Hospital Revenue Code	250
Min. Negotiated Rate	$24.15
Max. Negotiated Rate	$54.34
Rate for Payer: Aetna Commercial	$51.32
Rate for Payer: Aetna Medicare	$30.19
Rate for Payer: Aetna New Business (MI Preferred)	$39.25
Rate for Payer: BCBS Complete	$24.15
Rate for Payer: Cash Price	$48.30
Rate for Payer: Cofinity Commercial	$42.27
Rate for Payer: Cofinity Commercial	$51.93
Rate for Payer: Cofinity Medicare Advantage	$42.27
Rate for Payer: Encore Health Key Benefits Commercial	$48.30
Rate for Payer: Healthscope Commercial	$54.34
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$51.32
Rate for Payer: PHP Commercial	$51.32
Rate for Payer: Priority Health Cigna Priority Health	$39.25
Rate for Payer: Priority Health SBD	$38.04

ZIPRASIDONE 20 MG CAPSULE

Facility

$757.47

Service Code	NDC 68084010309
Hospital Charge Code	29778
Hospital Revenue Code	637
Min. Negotiated Rate	$302.99
Max. Negotiated Rate	$681.72
Rate for Payer: Aetna Commercial	$643.85
Rate for Payer: Aetna Medicare	$378.74
Rate for Payer: Aetna New Business (MI Preferred)	$492.36
Rate for Payer: BCBS Complete	$302.99
Rate for Payer: Cash Price	$605.98
Rate for Payer: Cofinity Commercial	$530.23
Rate for Payer: Cofinity Commercial	$651.42
Rate for Payer: Cofinity Medicare Advantage	$530.23
Rate for Payer: Encore Health Key Benefits Commercial	$605.98
Rate for Payer: Healthscope Commercial	$681.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$643.85
Rate for Payer: PHP Commercial	$643.85
Rate for Payer: Priority Health Cigna Priority Health	$492.36
Rate for Payer: Priority Health SBD	$477.21

ZIPRASIDONE 20 MG CAPSULE

Facility

$364.90

Service Code	NDC 60505252806
Hospital Charge Code	29778
Hospital Revenue Code	637
Min. Negotiated Rate	$145.96
Max. Negotiated Rate	$328.41
Rate for Payer: Aetna Commercial	$310.16
Rate for Payer: Aetna Medicare	$182.45
Rate for Payer: Aetna New Business (MI Preferred)	$237.18
Rate for Payer: BCBS Complete	$145.96
Rate for Payer: Cash Price	$291.92
Rate for Payer: Cofinity Commercial	$255.43
Rate for Payer: Cofinity Commercial	$313.81
Rate for Payer: Cofinity Medicare Advantage	$255.43
Rate for Payer: Encore Health Key Benefits Commercial	$291.92
Rate for Payer: Healthscope Commercial	$328.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$310.16
Rate for Payer: PHP Commercial	$310.16
Rate for Payer: Priority Health Cigna Priority Health	$237.18
Rate for Payer: Priority Health SBD	$229.89

ZIPRASIDONE 20 MG CAPSULE

Facility

$225.72

Service Code	NDC 65862070260
Hospital Charge Code	29778
Hospital Revenue Code	637
Min. Negotiated Rate	$90.29
Max. Negotiated Rate	$203.15
Rate for Payer: Aetna Commercial	$191.86
Rate for Payer: Aetna Medicare	$112.86
Rate for Payer: Aetna New Business (MI Preferred)	$146.72
Rate for Payer: BCBS Complete	$90.29
Rate for Payer: Cash Price	$180.58
Rate for Payer: Cofinity Commercial	$158.00
Rate for Payer: Cofinity Commercial	$194.12
Rate for Payer: Cofinity Medicare Advantage	$158.00
Rate for Payer: Encore Health Key Benefits Commercial	$180.58
Rate for Payer: Healthscope Commercial	$203.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$191.86
Rate for Payer: PHP Commercial	$191.86
Rate for Payer: Priority Health Cigna Priority Health	$146.72
Rate for Payer: Priority Health SBD	$142.20

ZIPRASIDONE 20 MG CAPSULE

Facility

$225.72

Service Code	NDC 65862070260
Hospital Charge Code	29778
Hospital Revenue Code	637
Min. Negotiated Rate	$142.20
Max. Negotiated Rate	$203.15
Rate for Payer: Aetna Commercial	$191.86
Rate for Payer: Aetna New Business (MI Preferred)	$146.72
Rate for Payer: Cash Price	$180.58
Rate for Payer: Cofinity Commercial	$158.00
Rate for Payer: Cofinity Commercial	$194.12
Rate for Payer: Cofinity Medicare Advantage	$158.00
Rate for Payer: Encore Health Key Benefits Commercial	$180.58
Rate for Payer: Healthscope Commercial	$203.15
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$191.86
Rate for Payer: PHP Commercial	$191.86
Rate for Payer: Priority Health Cigna Priority Health	$146.72
Rate for Payer: Priority Health SBD	$142.20

ZIPRASIDONE 20 MG CAPSULE

Facility

$161.88

Service Code	NDC 55111025660
Hospital Charge Code	29778
Hospital Revenue Code	637
Min. Negotiated Rate	$64.75
Max. Negotiated Rate	$145.69
Rate for Payer: Aetna Commercial	$137.60
Rate for Payer: Aetna Medicare	$80.94
Rate for Payer: Aetna New Business (MI Preferred)	$105.22
Rate for Payer: BCBS Complete	$64.75
Rate for Payer: Cash Price	$129.50
Rate for Payer: Cofinity Commercial	$113.32
Rate for Payer: Cofinity Commercial	$139.22
Rate for Payer: Cofinity Medicare Advantage	$113.32
Rate for Payer: Encore Health Key Benefits Commercial	$129.50
Rate for Payer: Healthscope Commercial	$145.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$137.60
Rate for Payer: PHP Commercial	$137.60
Rate for Payer: Priority Health Cigna Priority Health	$105.22
Rate for Payer: Priority Health SBD	$101.98

ZIPRASIDONE 20 MG CAPSULE

Facility

$265.05

Service Code	NDC 00781216460
Hospital Charge Code	29778
Hospital Revenue Code	637
Min. Negotiated Rate	$106.02
Max. Negotiated Rate	$238.54
Rate for Payer: Aetna Commercial	$225.29
Rate for Payer: Aetna Medicare	$132.52
Rate for Payer: Aetna New Business (MI Preferred)	$172.28
Rate for Payer: BCBS Complete	$106.02
Rate for Payer: Cash Price	$212.04
Rate for Payer: Cofinity Commercial	$185.54
Rate for Payer: Cofinity Commercial	$227.94
Rate for Payer: Cofinity Medicare Advantage	$185.54
Rate for Payer: Encore Health Key Benefits Commercial	$212.04
Rate for Payer: Healthscope Commercial	$238.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$225.29
Rate for Payer: PHP Commercial	$225.29
Rate for Payer: Priority Health Cigna Priority Health	$172.28
Rate for Payer: Priority Health SBD	$166.98

ZIPRASIDONE 20 MG CAPSULE

Facility

$615.98

Service Code	NDC 00904626945
Hospital Charge Code	29778
Hospital Revenue Code	637
Min. Negotiated Rate	$246.39
Max. Negotiated Rate	$554.38
Rate for Payer: Aetna Commercial	$523.58
Rate for Payer: Aetna Medicare	$307.99
Rate for Payer: Aetna New Business (MI Preferred)	$400.39
Rate for Payer: BCBS Complete	$246.39
Rate for Payer: Cash Price	$492.78
Rate for Payer: Cofinity Commercial	$431.19
Rate for Payer: Cofinity Commercial	$529.74
Rate for Payer: Cofinity Medicare Advantage	$431.19
Rate for Payer: Encore Health Key Benefits Commercial	$492.78
Rate for Payer: Healthscope Commercial	$554.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$523.58
Rate for Payer: PHP Commercial	$523.58
Rate for Payer: Priority Health Cigna Priority Health	$400.39
Rate for Payer: Priority Health SBD	$388.07

ZIPRASIDONE 20 MG CAPSULE

Facility

$161.88

Service Code	NDC 55111025660
Hospital Charge Code	29778
Hospital Revenue Code	637
Min. Negotiated Rate	$101.98
Max. Negotiated Rate	$145.69
Rate for Payer: Aetna Commercial	$137.60
Rate for Payer: Aetna New Business (MI Preferred)	$105.22
Rate for Payer: Cash Price	$129.50
Rate for Payer: Cofinity Commercial	$113.32
Rate for Payer: Cofinity Commercial	$139.22
Rate for Payer: Cofinity Medicare Advantage	$113.32
Rate for Payer: Encore Health Key Benefits Commercial	$129.50
Rate for Payer: Healthscope Commercial	$145.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$137.60
Rate for Payer: PHP Commercial	$137.60
Rate for Payer: Priority Health Cigna Priority Health	$105.22
Rate for Payer: Priority Health SBD	$101.98

ZIPRASIDONE 20 MG CAPSULE

Facility

$265.05

Service Code	NDC 00781216460
Hospital Charge Code	29778
Hospital Revenue Code	637
Min. Negotiated Rate	$166.98
Max. Negotiated Rate	$238.54
Rate for Payer: Aetna Commercial	$225.29
Rate for Payer: Aetna New Business (MI Preferred)	$172.28
Rate for Payer: Cash Price	$212.04
Rate for Payer: Cofinity Commercial	$185.54
Rate for Payer: Cofinity Commercial	$227.94
Rate for Payer: Cofinity Medicare Advantage	$185.54
Rate for Payer: Encore Health Key Benefits Commercial	$212.04
Rate for Payer: Healthscope Commercial	$238.54
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$225.29
Rate for Payer: PHP Commercial	$225.29
Rate for Payer: Priority Health Cigna Priority Health	$172.28
Rate for Payer: Priority Health SBD	$166.98

ZIPRASIDONE 20 MG CAPSULE

Facility

$615.98

Service Code	NDC 00904626945
Hospital Charge Code	29778
Hospital Revenue Code	637
Min. Negotiated Rate	$388.07
Max. Negotiated Rate	$554.38
Rate for Payer: Aetna Commercial	$523.58
Rate for Payer: Aetna New Business (MI Preferred)	$400.39
Rate for Payer: Cash Price	$492.78
Rate for Payer: Cofinity Commercial	$431.19
Rate for Payer: Cofinity Commercial	$529.74
Rate for Payer: Cofinity Medicare Advantage	$431.19
Rate for Payer: Encore Health Key Benefits Commercial	$492.78
Rate for Payer: Healthscope Commercial	$554.38
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$523.58
Rate for Payer: PHP Commercial	$523.58
Rate for Payer: Priority Health Cigna Priority Health	$400.39
Rate for Payer: Priority Health SBD	$388.07

ZIPRASIDONE 20 MG CAPSULE

Facility

$757.47

Service Code	NDC 68084010309
Hospital Charge Code	29778
Hospital Revenue Code	637
Min. Negotiated Rate	$477.21
Max. Negotiated Rate	$681.72
Rate for Payer: Aetna Commercial	$643.85
Rate for Payer: Aetna New Business (MI Preferred)	$492.36
Rate for Payer: Cash Price	$605.98
Rate for Payer: Cofinity Commercial	$530.23
Rate for Payer: Cofinity Commercial	$651.42
Rate for Payer: Cofinity Medicare Advantage	$530.23
Rate for Payer: Encore Health Key Benefits Commercial	$605.98
Rate for Payer: Healthscope Commercial	$681.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$643.85
Rate for Payer: PHP Commercial	$643.85
Rate for Payer: Priority Health Cigna Priority Health	$492.36
Rate for Payer: Priority Health SBD	$477.21

ZIPRASIDONE 20 MG CAPSULE

Facility

$364.90

Service Code	NDC 60505252806
Hospital Charge Code	29778
Hospital Revenue Code	637
Min. Negotiated Rate	$229.89
Max. Negotiated Rate	$328.41
Rate for Payer: Aetna Commercial	$310.16
Rate for Payer: Aetna New Business (MI Preferred)	$237.18
Rate for Payer: Cash Price	$291.92
Rate for Payer: Cofinity Commercial	$255.43
Rate for Payer: Cofinity Commercial	$313.81
Rate for Payer: Cofinity Medicare Advantage	$255.43
Rate for Payer: Encore Health Key Benefits Commercial	$291.92
Rate for Payer: Healthscope Commercial	$328.41
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$310.16
Rate for Payer: PHP Commercial	$310.16
Rate for Payer: Priority Health Cigna Priority Health	$237.18
Rate for Payer: Priority Health SBD	$229.89

ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION

Facility

$213.13

Service Code	HCPCS J3486
Hospital Charge Code	33175
Hospital Revenue Code	636
Min. Negotiated Rate	$134.27
Max. Negotiated Rate	$191.82
Rate for Payer: Aetna Commercial	$181.16
Rate for Payer: Aetna Commercial	$42.81
Rate for Payer: Aetna New Business (MI Preferred)	$138.53
Rate for Payer: Aetna New Business (MI Preferred)	$32.74
Rate for Payer: Cash Price	$170.50
Rate for Payer: Cash Price	$40.30
Rate for Payer: Cofinity Commercial	$149.19
Rate for Payer: Cofinity Commercial	$35.26
Rate for Payer: Cofinity Commercial	$43.32
Rate for Payer: Cofinity Commercial	$183.29
Rate for Payer: Cofinity Medicare Advantage	$35.26
Rate for Payer: Cofinity Medicare Advantage	$149.19
Rate for Payer: Encore Health Key Benefits Commercial	$170.50
Rate for Payer: Encore Health Key Benefits Commercial	$40.30
Rate for Payer: Healthscope Commercial	$191.82
Rate for Payer: Healthscope Commercial	$45.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$181.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$42.81
Rate for Payer: PHP Commercial	$181.16
Rate for Payer: PHP Commercial	$42.81
Rate for Payer: Priority Health Cigna Priority Health	$32.74
Rate for Payer: Priority Health Cigna Priority Health	$138.53
Rate for Payer: Priority Health SBD	$31.73
Rate for Payer: Priority Health SBD	$134.27

ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION

Facility

$213.13

Service Code	HCPCS J3486
Hospital Charge Code	33175
Hospital Revenue Code	636
Min. Negotiated Rate	$20.99
Max. Negotiated Rate	$191.82
Rate for Payer: Aetna Commercial	$181.16
Rate for Payer: Aetna Commercial	$42.81
Rate for Payer: Aetna Medicare	$25.18
Rate for Payer: Aetna Medicare	$106.56
Rate for Payer: Aetna New Business (MI Preferred)	$138.53
Rate for Payer: Aetna New Business (MI Preferred)	$32.74
Rate for Payer: BCBS Complete	$20.15
Rate for Payer: BCBS Complete	$85.25
Rate for Payer: BCBS Trust/PPO	$20.99
Rate for Payer: BCBS Trust/PPO	$20.99
Rate for Payer: BCN Commercial	$20.99
Rate for Payer: BCN Commercial	$20.99
Rate for Payer: Cash Price	$40.30
Rate for Payer: Cash Price	$40.30
Rate for Payer: Cash Price	$170.50
Rate for Payer: Cash Price	$170.50
Rate for Payer: Cofinity Commercial	$149.19
Rate for Payer: Cofinity Commercial	$43.32
Rate for Payer: Cofinity Commercial	$35.26
Rate for Payer: Cofinity Commercial	$183.29
Rate for Payer: Cofinity Medicare Advantage	$35.26
Rate for Payer: Cofinity Medicare Advantage	$149.19
Rate for Payer: Encore Health Key Benefits Commercial	$170.50
Rate for Payer: Encore Health Key Benefits Commercial	$40.30
Rate for Payer: Healthscope Commercial	$191.82
Rate for Payer: Healthscope Commercial	$45.33
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$42.81
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$181.16
Rate for Payer: PHP Commercial	$42.81
Rate for Payer: PHP Commercial	$181.16
Rate for Payer: Priority Health Cigna Priority Health	$138.53
Rate for Payer: Priority Health Cigna Priority Health	$32.74
Rate for Payer: Priority Health SBD	$31.73
Rate for Payer: Priority Health SBD	$134.27

ZIPRASIDONE 40 MG CAPSULE

Facility

$188.10

Service Code	NDC 55111025760
Hospital Charge Code	29779
Hospital Revenue Code	637
Min. Negotiated Rate	$75.24
Max. Negotiated Rate	$169.29
Rate for Payer: Aetna Commercial	$159.88
Rate for Payer: Aetna Medicare	$94.05
Rate for Payer: Aetna New Business (MI Preferred)	$122.26
Rate for Payer: BCBS Complete	$75.24
Rate for Payer: Cash Price	$150.48
Rate for Payer: Cofinity Commercial	$131.67
Rate for Payer: Cofinity Commercial	$161.77
Rate for Payer: Cofinity Medicare Advantage	$131.67
Rate for Payer: Encore Health Key Benefits Commercial	$150.48
Rate for Payer: Healthscope Commercial	$169.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$159.88
Rate for Payer: PHP Commercial	$159.88
Rate for Payer: Priority Health Cigna Priority Health	$122.26
Rate for Payer: Priority Health SBD	$118.50

Know your out-of-pocket cost for care.

All Charges