|
WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
IP
|
$40,376.01
|
|
|
Service Code
|
MS-DRG 902
|
| Min. Negotiated Rate |
$13,362.65 |
| Max. Negotiated Rate |
$40,376.01 |
| Rate for Payer: Aetna Medicare |
$14,628.59
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$17,582.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$17,582.44
|
| Rate for Payer: BCBS MAPPO |
$14,065.95
|
| Rate for Payer: BCBS Trust/PPO |
$40,376.01
|
| Rate for Payer: BCN Medicare Advantage |
$14,065.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,065.95
|
| Rate for Payer: Mclaren Medicare |
$14,065.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14,769.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$16,175.84
|
| Rate for Payer: PACE Medicare |
$13,362.65
|
| Rate for Payer: PACE SWMI |
$14,065.95
|
| Rate for Payer: PHP Medicare Advantage |
$14,065.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,045.29
|
| Rate for Payer: Priority Health Medicare |
$14,065.95
|
| Rate for Payer: Priority Health Narrow Network |
$21,636.23
|
| Rate for Payer: Railroad Medicare Medicare |
$14,065.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,749.21
|
| Rate for Payer: UHC Core |
$17,640.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,065.95
|
| Rate for Payer: UHC Exchange |
$18,894.12
|
| Rate for Payer: UHC Medicare Advantage |
$14,487.93
|
| Rate for Payer: VA VA |
$14,065.95
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
IP
|
$66,016.26
|
|
|
Service Code
|
MS-DRG 901
|
| Min. Negotiated Rate |
$30,077.62 |
| Max. Negotiated Rate |
$66,016.26 |
| Rate for Payer: Aetna Medicare |
$32,927.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39,575.81
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39,575.81
|
| Rate for Payer: BCBS MAPPO |
$31,660.65
|
| Rate for Payer: BCBS Trust/PPO |
$62,007.82
|
| Rate for Payer: BCN Medicare Advantage |
$31,660.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,660.65
|
| Rate for Payer: Mclaren Medicare |
$31,660.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$33,243.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36,409.75
|
| Rate for Payer: PACE Medicare |
$30,077.62
|
| Rate for Payer: PACE SWMI |
$31,660.65
|
| Rate for Payer: PHP Medicare Advantage |
$31,660.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62,103.58
|
| Rate for Payer: Priority Health Medicare |
$31,660.65
|
| Rate for Payer: Priority Health Narrow Network |
$49,682.86
|
| Rate for Payer: Railroad Medicare Medicare |
$31,660.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66,016.26
|
| Rate for Payer: UHC Core |
$40,508.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$31,660.65
|
| Rate for Payer: UHC Exchange |
$43,386.20
|
| Rate for Payer: UHC Medicare Advantage |
$32,610.47
|
| Rate for Payer: VA VA |
$31,660.65
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC
|
Facility
IP
|
$22,433.31
|
|
|
Service Code
|
MS-DRG 903
|
| Min. Negotiated Rate |
$8,962.07 |
| Max. Negotiated Rate |
$22,433.31 |
| Rate for Payer: Aetna Medicare |
$9,811.11
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$11,792.20
|
| Rate for Payer: Amish Plain Church Group Commercial |
$11,792.20
|
| Rate for Payer: BCBS MAPPO |
$9,433.76
|
| Rate for Payer: BCBS Trust/PPO |
$22,433.31
|
| Rate for Payer: BCN Medicare Advantage |
$9,433.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9,433.76
|
| Rate for Payer: Mclaren Medicare |
$9,433.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9,905.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$10,848.82
|
| Rate for Payer: PACE Medicare |
$8,962.07
|
| Rate for Payer: PACE SWMI |
$9,433.76
|
| Rate for Payer: PHP Medicare Advantage |
$9,433.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,815.43
|
| Rate for Payer: Priority Health Medicare |
$9,433.76
|
| Rate for Payer: Priority Health Narrow Network |
$14,252.34
|
| Rate for Payer: Railroad Medicare Medicare |
$9,433.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,937.84
|
| Rate for Payer: UHC Core |
$11,620.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$9,433.76
|
| Rate for Payer: UHC Exchange |
$12,446.04
|
| Rate for Payer: UHC Medicare Advantage |
$9,716.77
|
| Rate for Payer: VA VA |
$9,433.76
|
|
|
ZIDOVUDINE 100 MG CAPSULE
|
Facility
IP
|
$676.32
|
|
|
Service Code
|
NDC 65862-107-01
|
| Hospital Charge Code |
11692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$426.08 |
| Max. Negotiated Rate |
$608.69 |
| Rate for Payer: Aetna Commercial |
$574.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.61
|
| Rate for Payer: Cash Price |
$541.06
|
| Rate for Payer: Cofinity Commercial |
$473.42
|
| Rate for Payer: Cofinity Commercial |
$581.64
|
| Rate for Payer: Healthscope Commercial |
$608.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$574.87
|
| Rate for Payer: PHP Commercial |
$574.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.42
|
| Rate for Payer: Priority Health SBD |
$426.08
|
|
|
ZIDOVUDINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$126.65
|
|
|
Service Code
|
HCPCS J3485
|
| Hospital Charge Code |
11691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.79 |
| Max. Negotiated Rate |
$113.98 |
| Rate for Payer: Aetna Commercial |
$107.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.32
|
| Rate for Payer: Cash Price |
$101.32
|
| Rate for Payer: Cofinity Commercial |
$108.92
|
| Rate for Payer: Cofinity Commercial |
$88.66
|
| Rate for Payer: Healthscope Commercial |
$113.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.65
|
| Rate for Payer: PHP Commercial |
$107.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.66
|
| Rate for Payer: Priority Health SBD |
$79.79
|
|
|
ZIDOVUDINE 10 MG/ML ORAL SYRUP
|
Facility
IP
|
$789.60
|
|
|
Service Code
|
NDC 65862-048-24
|
| 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 Commercial |
$679.06
|
| Rate for Payer: Cofinity Commercial |
$552.72
|
| Rate for Payer: Healthscope Commercial |
$710.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$671.16
|
| Rate for Payer: PHP Commercial |
$671.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$552.72
|
| Rate for Payer: Priority Health SBD |
$497.45
|
|
|
ZINC OXIDE 20 % TOPICAL OINTMENT
|
Facility
IP
|
$11.16
|
|
|
Service Code
|
NDC 0536-5700-28
|
| Hospital Charge Code |
8874
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$10.04 |
| Rate for Payer: Aetna Commercial |
$9.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.25
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Cofinity Commercial |
$7.81
|
| Rate for Payer: Cofinity Commercial |
$9.60
|
| Rate for Payer: Healthscope Commercial |
$10.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.49
|
| Rate for Payer: PHP Commercial |
$9.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.81
|
| Rate for Payer: Priority Health SBD |
$7.03
|
|
|
ZINC OXIDE 20 % TOPICAL OINTMENT
|
Facility
IP
|
$23.32
|
|
|
Service Code
|
NDC 75834-170-01
|
| Hospital Charge Code |
8874
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.69 |
| Max. Negotiated Rate |
$20.99 |
| Rate for Payer: Aetna Commercial |
$19.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.16
|
| Rate for Payer: Cash Price |
$18.66
|
| Rate for Payer: Cofinity Commercial |
$16.32
|
| Rate for Payer: Cofinity Commercial |
$20.06
|
| Rate for Payer: Healthscope Commercial |
$20.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.82
|
| Rate for Payer: PHP Commercial |
$19.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.32
|
| Rate for Payer: Priority Health SBD |
$14.69
|
|
|
ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE
|
Facility
IP
|
$134.64
|
|
|
Service Code
|
NDC 11701-050-32
|
| Hospital Charge Code |
11378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.82 |
| Max. Negotiated Rate |
$121.18 |
| Rate for Payer: Aetna Commercial |
$114.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.52
|
| Rate for Payer: Cash Price |
$107.71
|
| Rate for Payer: Cofinity Commercial |
$115.79
|
| Rate for Payer: Cofinity Commercial |
$94.25
|
| Rate for Payer: Healthscope Commercial |
$121.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.44
|
| Rate for Payer: PHP Commercial |
$114.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health SBD |
$84.82
|
|
|
ZINC OXIDE-WHITE PETROLATUM 15 %-49 % TOPICAL OINTMENT
|
Facility
IP
|
$32.04
|
|
|
Service Code
|
NDC 53329-771-44
|
| 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 |
$27.55
|
| Rate for Payer: Cofinity Commercial |
$22.43
|
| Rate for Payer: Healthscope Commercial |
$28.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.23
|
| Rate for Payer: PHP Commercial |
$27.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.43
|
| Rate for Payer: Priority Health SBD |
$20.19
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
IP
|
$158.40
|
|
|
Service Code
|
NDC 2055504000
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.79 |
| Max. Negotiated Rate |
$142.56 |
| Rate for Payer: Aetna Commercial |
$134.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.96
|
| Rate for Payer: Cash Price |
$126.72
|
| Rate for Payer: Cofinity Commercial |
$110.88
|
| Rate for Payer: Cofinity Commercial |
$136.22
|
| Rate for Payer: Healthscope Commercial |
$142.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.64
|
| Rate for Payer: PHP Commercial |
$134.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.88
|
| Rate for Payer: Priority Health SBD |
$99.79
|
|
|
ZINC SULFATE 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$60.38
|
|
|
Service Code
|
NDC 0517-8005-01
|
| 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: Healthscope Commercial |
$54.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.32
|
| Rate for Payer: PHP Commercial |
$51.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.27
|
| Rate for Payer: Priority Health SBD |
$38.04
|
|
|
ZINC SULFATE 5 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$60.38
|
|
|
Service Code
|
NDC 0517-8005-25
|
| 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: Healthscope Commercial |
$54.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$51.32
|
| Rate for Payer: PHP Commercial |
$51.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.27
|
| Rate for Payer: Priority Health SBD |
$38.04
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
IP
|
$603.84
|
|
|
Service Code
|
NDC 0904-6269-45
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$380.42 |
| Max. Negotiated Rate |
$543.46 |
| Rate for Payer: Aetna Commercial |
$513.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$392.50
|
| Rate for Payer: Cash Price |
$483.07
|
| Rate for Payer: Cofinity Commercial |
$422.69
|
| Rate for Payer: Cofinity Commercial |
$519.30
|
| Rate for Payer: Healthscope Commercial |
$543.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$513.26
|
| Rate for Payer: PHP Commercial |
$513.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$422.69
|
| Rate for Payer: Priority Health SBD |
$380.42
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
IP
|
$265.05
|
|
|
Service Code
|
NDC 0781-2164-60
|
| 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: Healthscope Commercial |
$238.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$225.29
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.54
|
| Rate for Payer: Priority Health SBD |
$166.98
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
IP
|
$225.72
|
|
|
Service Code
|
NDC 65862-702-60
|
| 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: Healthscope Commercial |
$203.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$191.86
|
| Rate for Payer: PHP Commercial |
$191.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.00
|
| Rate for Payer: Priority Health SBD |
$142.20
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
IP
|
$755.10
|
|
|
Service Code
|
NDC 68084-103-09
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$475.71 |
| Max. Negotiated Rate |
$679.59 |
| Rate for Payer: Aetna Commercial |
$641.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$490.82
|
| Rate for Payer: Cash Price |
$604.08
|
| Rate for Payer: Cofinity Commercial |
$528.57
|
| Rate for Payer: Cofinity Commercial |
$649.39
|
| Rate for Payer: Healthscope Commercial |
$679.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$641.84
|
| Rate for Payer: PHP Commercial |
$641.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$528.57
|
| Rate for Payer: Priority Health SBD |
$475.71
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
IP
|
$245.34
|
|
|
Service Code
|
NDC 55111-256-60
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.56 |
| Max. Negotiated Rate |
$220.81 |
| Rate for Payer: Aetna Commercial |
$208.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.47
|
| Rate for Payer: Cash Price |
$196.27
|
| Rate for Payer: Cofinity Commercial |
$171.74
|
| Rate for Payer: Cofinity Commercial |
$210.99
|
| Rate for Payer: Healthscope Commercial |
$220.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.54
|
| Rate for Payer: PHP Commercial |
$208.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.74
|
| Rate for Payer: Priority Health SBD |
$154.56
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
IP
|
$364.90
|
|
|
Service Code
|
NDC 60505-2528-6
|
| 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: Healthscope Commercial |
$328.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$310.16
|
| Rate for Payer: PHP Commercial |
$310.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$255.43
|
| Rate for Payer: Priority Health SBD |
$229.89
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
IP
|
$267.56
|
|
|
Service Code
|
NDC 59762-2001-1
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$168.56 |
| Max. Negotiated Rate |
$240.80 |
| Rate for Payer: Aetna Commercial |
$227.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.91
|
| Rate for Payer: Cash Price |
$214.05
|
| Rate for Payer: Cofinity Commercial |
$187.29
|
| Rate for Payer: Cofinity Commercial |
$230.10
|
| Rate for Payer: Healthscope Commercial |
$240.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$227.43
|
| Rate for Payer: PHP Commercial |
$227.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.29
|
| Rate for Payer: Priority Health SBD |
$168.56
|
|
|
ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION
|
Facility
IP
|
$50.37
|
|
|
Service Code
|
HCPCS J3486
|
| Hospital Charge Code |
33175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.73 |
| Max. Negotiated Rate |
$45.33 |
| Rate for Payer: Aetna Commercial |
$42.81
|
| Rate for Payer: Aetna Commercial |
$172.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.68
|
| Rate for Payer: Cash Price |
$40.30
|
| Rate for Payer: Cash Price |
$162.07
|
| Rate for Payer: Cofinity Commercial |
$174.23
|
| Rate for Payer: Cofinity Commercial |
$43.32
|
| Rate for Payer: Cofinity Commercial |
$35.26
|
| Rate for Payer: Cofinity Commercial |
$141.81
|
| Rate for Payer: Healthscope Commercial |
$45.33
|
| Rate for Payer: Healthscope Commercial |
$182.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$42.81
|
| Rate for Payer: PHP Commercial |
$172.20
|
| Rate for Payer: PHP Commercial |
$42.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.81
|
| Rate for Payer: Priority Health SBD |
$127.63
|
| Rate for Payer: Priority Health SBD |
$31.73
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
IP
|
$236.16
|
|
|
Service Code
|
NDC 63739-005-32
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$148.78 |
| Max. Negotiated Rate |
$212.54 |
| Rate for Payer: Aetna Commercial |
$200.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.50
|
| Rate for Payer: Cash Price |
$188.93
|
| Rate for Payer: Cofinity Commercial |
$165.31
|
| Rate for Payer: Cofinity Commercial |
$203.10
|
| Rate for Payer: Healthscope Commercial |
$212.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$200.74
|
| Rate for Payer: PHP Commercial |
$200.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.31
|
| Rate for Payer: Priority Health SBD |
$148.78
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
IP
|
$157.32
|
|
|
Service Code
|
NDC 55111-257-60
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$99.11 |
| Max. Negotiated Rate |
$141.59 |
| Rate for Payer: Aetna Commercial |
$133.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.26
|
| Rate for Payer: Cash Price |
$125.86
|
| Rate for Payer: Cofinity Commercial |
$110.12
|
| Rate for Payer: Cofinity Commercial |
$135.30
|
| Rate for Payer: Healthscope Commercial |
$141.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$133.72
|
| Rate for Payer: PHP Commercial |
$133.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.12
|
| Rate for Payer: Priority Health SBD |
$99.11
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
IP
|
$182.60
|
|
|
Service Code
|
NDC 0904-6270-08
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$115.04 |
| Max. Negotiated Rate |
$164.34 |
| Rate for Payer: Aetna Commercial |
$155.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.69
|
| Rate for Payer: Cash Price |
$146.08
|
| Rate for Payer: Cofinity Commercial |
$127.82
|
| Rate for Payer: Cofinity Commercial |
$157.04
|
| Rate for Payer: Healthscope Commercial |
$164.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$155.21
|
| Rate for Payer: PHP Commercial |
$155.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.82
|
| Rate for Payer: Priority Health SBD |
$115.04
|
|
|
ZOLEDRONIC ACID 4 MG/100 ML-MANNITOL-0.9 % NACL INTRAVENOUS PIGGYBACK
|
Facility
IP
|
$172.66
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
167580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.78 |
| Max. Negotiated Rate |
$155.39 |
| Rate for Payer: Aetna Commercial |
$146.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.23
|
| Rate for Payer: Cash Price |
$138.13
|
| Rate for Payer: Cofinity Commercial |
$120.86
|
| Rate for Payer: Cofinity Commercial |
$148.49
|
| Rate for Payer: Healthscope Commercial |
$155.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$146.76
|
| Rate for Payer: PHP Commercial |
$146.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.86
|
| Rate for Payer: Priority Health SBD |
$108.78
|
|
