|
WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$47.85
|
|
|
Service Code
|
NDC 00338001304
|
| Hospital Charge Code |
28400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.30 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: BCBS Trust/PPO |
$39.52
|
| Rate for Payer: BCN Commercial |
$39.52
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Nomi Health Commercial |
$39.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$39.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
WATER FOR INJECTION, STERILE INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$47.85
|
|
|
Service Code
|
NDC 00338001304
|
| Hospital Charge Code |
28400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: Aetna Medicare |
$12.44
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$14.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$14.95
|
| Rate for Payer: BCBS Complete |
$8.86
|
| Rate for Payer: BCBS MAPPO |
$11.96
|
| Rate for Payer: BCBS Trust/PPO |
$39.34
|
| Rate for Payer: BCN Commercial |
$39.34
|
| Rate for Payer: BCN Medicare Advantage |
$11.96
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.96
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Mclaren Medicaid |
$8.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.56
|
| Rate for Payer: Meridian Medicaid |
$8.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$13.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$40.67
|
| Rate for Payer: Nomi Health Commercial |
$39.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.89
|
| Rate for Payer: PACE Senior Care Partners |
$11.36
|
| Rate for Payer: PACE SWMI |
$11.96
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: PHP Medicare Advantage |
$11.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$41.63
|
| Rate for Payer: Priority Health Medicare |
$12.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$33.30
|
| Rate for Payer: Railroad Medicare Medicare |
$11.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$39.95
|
| Rate for Payer: UHC Exchange |
$11.96
|
| Rate for Payer: UHC Medicaid |
$8.44
|
| Rate for Payer: UHC Medicare Advantage |
$11.96
|
| Rate for Payer: UHCCP Medicaid |
$8.44
|
| Rate for Payer: VA VA |
$11.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
WATER FOR IRRIGATION, STERILE SOLUTION
|
Facility
|
OP
|
$95.70
|
|
|
Service Code
|
NDC 00338000402
|
| Hospital Charge Code |
7485
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$86.13 |
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: Aetna Medicare |
$24.88
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29.91
|
| Rate for Payer: BCBS Complete |
$17.71
|
| Rate for Payer: BCBS MAPPO |
$23.93
|
| Rate for Payer: BCBS Trust/PPO |
$78.67
|
| Rate for Payer: BCN Commercial |
$78.67
|
| Rate for Payer: BCN Medicare Advantage |
$23.93
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cofinity Commercial |
$82.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.93
|
| Rate for Payer: Healthscope Commercial |
$86.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.78
|
| Rate for Payer: Mclaren Medicaid |
$16.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.12
|
| Rate for Payer: Meridian Medicaid |
$17.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.34
|
| Rate for Payer: Nomi Health Commercial |
$78.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.78
|
| Rate for Payer: PACE Senior Care Partners |
$22.73
|
| Rate for Payer: PACE SWMI |
$23.93
|
| Rate for Payer: PHP Commercial |
$81.34
|
| Rate for Payer: PHP Medicare Advantage |
$23.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.26
|
| Rate for Payer: Priority Health Medicare |
$24.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.61
|
| Rate for Payer: Railroad Medicare Medicare |
$23.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.22
|
| Rate for Payer: UHC Core |
$79.91
|
| Rate for Payer: UHC Exchange |
$23.93
|
| Rate for Payer: UHC Medicaid |
$16.87
|
| Rate for Payer: UHC Medicare Advantage |
$23.93
|
| Rate for Payer: UHCCP Medicaid |
$16.87
|
| Rate for Payer: VA VA |
$23.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.78
|
|
|
WATER FOR IRRIGATION, STERILE SOLUTION
|
Facility
|
IP
|
$95.70
|
|
|
Service Code
|
NDC 00338000402
|
| Hospital Charge Code |
7485
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$66.61 |
| Max. Negotiated Rate |
$86.13 |
| Rate for Payer: Aetna Commercial |
$81.34
|
| Rate for Payer: BCBS Trust/PPO |
$79.04
|
| Rate for Payer: BCN Commercial |
$79.04
|
| Rate for Payer: Cash Price |
$76.56
|
| Rate for Payer: Cofinity Commercial |
$82.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$76.56
|
| Rate for Payer: Healthscope Commercial |
$86.13
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$71.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.34
|
| Rate for Payer: Nomi Health Commercial |
$78.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.78
|
| Rate for Payer: PHP Commercial |
$81.34
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$83.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.22
|
| Rate for Payer: UHC Core |
$79.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$71.78
|
|
|
WHITE PETROLATUM 57.7 %-MINERAL OIL 31.9 % EYE OINTMENT
|
Facility
|
OP
|
$27.80
|
|
|
Service Code
|
NDC 63736014308
|
| Hospital Charge Code |
175688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$25.02 |
| Rate for Payer: Aetna Commercial |
$23.63
|
| Rate for Payer: Aetna Medicare |
$7.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.69
|
| Rate for Payer: BCBS Complete |
$5.15
|
| Rate for Payer: BCBS MAPPO |
$6.95
|
| Rate for Payer: BCBS Trust/PPO |
$22.85
|
| Rate for Payer: BCN Commercial |
$22.85
|
| Rate for Payer: BCN Medicare Advantage |
$6.95
|
| Rate for Payer: Cash Price |
$22.24
|
| Rate for Payer: Cofinity Commercial |
$23.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.95
|
| Rate for Payer: Healthscope Commercial |
$25.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.85
|
| Rate for Payer: Mclaren Medicaid |
$4.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.30
|
| Rate for Payer: Meridian Medicaid |
$5.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.63
|
| Rate for Payer: Nomi Health Commercial |
$22.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.85
|
| Rate for Payer: PACE Senior Care Partners |
$6.60
|
| Rate for Payer: PACE SWMI |
$6.95
|
| Rate for Payer: PHP Commercial |
$23.63
|
| Rate for Payer: PHP Medicare Advantage |
$6.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.19
|
| Rate for Payer: Priority Health Medicare |
$7.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.35
|
| Rate for Payer: Railroad Medicare Medicare |
$6.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.46
|
| Rate for Payer: UHC Core |
$23.21
|
| Rate for Payer: UHC Exchange |
$6.95
|
| Rate for Payer: UHC Medicaid |
$4.90
|
| Rate for Payer: UHC Medicare Advantage |
$6.95
|
| Rate for Payer: UHCCP Medicaid |
$4.90
|
| Rate for Payer: VA VA |
$6.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.85
|
|
|
WHITE PETROLATUM 57.7 %-MINERAL OIL 31.9 % EYE OINTMENT
|
Facility
|
IP
|
$27.80
|
|
|
Service Code
|
NDC 63736014308
|
| Hospital Charge Code |
175688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$25.02 |
| Rate for Payer: Aetna Commercial |
$23.63
|
| Rate for Payer: BCBS Trust/PPO |
$22.96
|
| Rate for Payer: BCN Commercial |
$22.96
|
| Rate for Payer: Cash Price |
$22.24
|
| Rate for Payer: Cofinity Commercial |
$23.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.24
|
| Rate for Payer: Healthscope Commercial |
$25.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.63
|
| Rate for Payer: Nomi Health Commercial |
$22.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.85
|
| Rate for Payer: PHP Commercial |
$23.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.46
|
| Rate for Payer: UHC Core |
$23.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.85
|
|
|
WHITE PETROLATUM EYE OINTMENT WRAPPER
|
Facility
|
OP
|
$27.80
|
|
|
Service Code
|
NDC 63736014308
|
| Hospital Charge Code |
301577
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$25.02 |
| Rate for Payer: Aetna Commercial |
$23.63
|
| Rate for Payer: Aetna Medicare |
$7.23
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$8.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$8.69
|
| Rate for Payer: BCBS Complete |
$5.15
|
| Rate for Payer: BCBS MAPPO |
$6.95
|
| Rate for Payer: BCBS Trust/PPO |
$22.85
|
| Rate for Payer: BCN Commercial |
$22.85
|
| Rate for Payer: BCN Medicare Advantage |
$6.95
|
| Rate for Payer: Cash Price |
$22.24
|
| Rate for Payer: Cofinity Commercial |
$23.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.95
|
| Rate for Payer: Healthscope Commercial |
$25.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.85
|
| Rate for Payer: Mclaren Medicaid |
$4.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.30
|
| Rate for Payer: Meridian Medicaid |
$5.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$7.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$7.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.63
|
| Rate for Payer: Nomi Health Commercial |
$22.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.85
|
| Rate for Payer: PACE Senior Care Partners |
$6.60
|
| Rate for Payer: PACE SWMI |
$6.95
|
| Rate for Payer: PHP Commercial |
$23.63
|
| Rate for Payer: PHP Medicare Advantage |
$6.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.90
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.19
|
| Rate for Payer: Priority Health Medicare |
$7.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.35
|
| Rate for Payer: Railroad Medicare Medicare |
$6.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.46
|
| Rate for Payer: UHC Core |
$23.21
|
| Rate for Payer: UHC Exchange |
$6.95
|
| Rate for Payer: UHC Medicaid |
$4.90
|
| Rate for Payer: UHC Medicare Advantage |
$6.95
|
| Rate for Payer: UHCCP Medicaid |
$4.90
|
| Rate for Payer: VA VA |
$6.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.85
|
|
|
WHITE PETROLATUM EYE OINTMENT WRAPPER
|
Facility
|
IP
|
$27.80
|
|
|
Service Code
|
NDC 63736014308
|
| Hospital Charge Code |
301577
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$25.02 |
| Rate for Payer: Aetna Commercial |
$23.63
|
| Rate for Payer: BCBS Trust/PPO |
$22.96
|
| Rate for Payer: BCN Commercial |
$22.96
|
| Rate for Payer: Cash Price |
$22.24
|
| Rate for Payer: Cofinity Commercial |
$23.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.24
|
| Rate for Payer: Healthscope Commercial |
$25.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.63
|
| Rate for Payer: Nomi Health Commercial |
$22.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.85
|
| Rate for Payer: PHP Commercial |
$23.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$24.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.46
|
| Rate for Payer: UHC Core |
$23.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.85
|
|
|
WHITE PETROLATUM-MINERAL OIL 56.8 %-42.5 % EYE OINTMENT
|
Facility
|
OP
|
$31.82
|
|
|
Service Code
|
NDC 00023031204
|
| Hospital Charge Code |
117955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$28.64 |
| Rate for Payer: Aetna Commercial |
$27.05
|
| Rate for Payer: Aetna Medicare |
$8.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.94
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.94
|
| Rate for Payer: BCBS Complete |
$5.89
|
| Rate for Payer: BCBS MAPPO |
$7.96
|
| Rate for Payer: BCBS Trust/PPO |
$26.16
|
| Rate for Payer: BCN Commercial |
$26.16
|
| Rate for Payer: BCN Medicare Advantage |
$7.96
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.96
|
| Rate for Payer: Healthscope Commercial |
$28.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.86
|
| Rate for Payer: Mclaren Medicaid |
$5.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.35
|
| Rate for Payer: Meridian Medicaid |
$5.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$8.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.05
|
| Rate for Payer: Nomi Health Commercial |
$26.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.86
|
| Rate for Payer: PACE Senior Care Partners |
$7.56
|
| Rate for Payer: PACE SWMI |
$7.96
|
| Rate for Payer: PHP Commercial |
$27.05
|
| Rate for Payer: PHP Medicare Advantage |
$7.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.68
|
| Rate for Payer: Priority Health Medicare |
$8.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.15
|
| Rate for Payer: Railroad Medicare Medicare |
$7.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.00
|
| Rate for Payer: UHC Core |
$26.57
|
| Rate for Payer: UHC Exchange |
$7.96
|
| Rate for Payer: UHC Medicaid |
$5.61
|
| Rate for Payer: UHC Medicare Advantage |
$7.96
|
| Rate for Payer: UHCCP Medicaid |
$5.61
|
| Rate for Payer: VA VA |
$7.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.86
|
|
|
WHITE PETROLATUM-MINERAL OIL 56.8 %-42.5 % EYE OINTMENT
|
Facility
|
IP
|
$31.82
|
|
|
Service Code
|
NDC 00023031204
|
| Hospital Charge Code |
117955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.15 |
| Max. Negotiated Rate |
$28.64 |
| Rate for Payer: Aetna Commercial |
$27.05
|
| Rate for Payer: BCBS Trust/PPO |
$26.28
|
| Rate for Payer: BCN Commercial |
$26.28
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$28.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.05
|
| Rate for Payer: Nomi Health Commercial |
$26.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.86
|
| Rate for Payer: PHP Commercial |
$27.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$27.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$22.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.00
|
| Rate for Payer: UHC Core |
$26.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.86
|
|
|
WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM
|
Facility
|
OP
|
$12.88
|
|
|
Service Code
|
NDC 61924017804
|
| Hospital Charge Code |
11371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$11.59 |
| Rate for Payer: Aetna Commercial |
$10.95
|
| Rate for Payer: Aetna Medicare |
$3.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.03
|
| Rate for Payer: BCBS Complete |
$2.38
|
| Rate for Payer: BCBS MAPPO |
$3.22
|
| Rate for Payer: BCBS Trust/PPO |
$10.59
|
| Rate for Payer: BCN Commercial |
$10.59
|
| Rate for Payer: BCN Medicare Advantage |
$3.22
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cofinity Commercial |
$11.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.22
|
| Rate for Payer: Healthscope Commercial |
$11.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.66
|
| Rate for Payer: Mclaren Medicaid |
$2.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.38
|
| Rate for Payer: Meridian Medicaid |
$2.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.95
|
| Rate for Payer: Nomi Health Commercial |
$10.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.66
|
| Rate for Payer: PACE Senior Care Partners |
$3.06
|
| Rate for Payer: PACE SWMI |
$3.22
|
| Rate for Payer: PHP Commercial |
$10.95
|
| Rate for Payer: PHP Medicare Advantage |
$3.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.21
|
| Rate for Payer: Priority Health Medicare |
$3.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.96
|
| Rate for Payer: Railroad Medicare Medicare |
$3.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.33
|
| Rate for Payer: UHC Core |
$10.75
|
| Rate for Payer: UHC Exchange |
$3.22
|
| Rate for Payer: UHC Medicaid |
$2.27
|
| Rate for Payer: UHC Medicare Advantage |
$3.22
|
| Rate for Payer: UHCCP Medicaid |
$2.27
|
| Rate for Payer: VA VA |
$3.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.66
|
|
|
WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM
|
Facility
|
IP
|
$12.88
|
|
|
Service Code
|
NDC 61924017804
|
| Hospital Charge Code |
11371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$11.59 |
| Rate for Payer: Aetna Commercial |
$10.95
|
| Rate for Payer: BCBS Trust/PPO |
$10.64
|
| Rate for Payer: BCN Commercial |
$10.64
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cofinity Commercial |
$11.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.30
|
| Rate for Payer: Healthscope Commercial |
$11.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.95
|
| Rate for Payer: Nomi Health Commercial |
$10.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$9.66
|
| Rate for Payer: PHP Commercial |
$10.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$11.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.33
|
| Rate for Payer: UHC Core |
$10.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.66
|
|
|
WOUND DRESSINGS TOPICAL PASTE
|
Facility
|
IP
|
$49.95
|
|
|
Service Code
|
NDC 11701003133
|
| Hospital Charge Code |
108643
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.77 |
| Max. Negotiated Rate |
$44.95 |
| Rate for Payer: Aetna Commercial |
$42.46
|
| Rate for Payer: BCBS Trust/PPO |
$41.25
|
| Rate for Payer: BCN Commercial |
$41.25
|
| Rate for Payer: Cash Price |
$39.96
|
| Rate for Payer: Cofinity Commercial |
$42.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.96
|
| Rate for Payer: Healthscope Commercial |
$44.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.46
|
| Rate for Payer: Nomi Health Commercial |
$40.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.46
|
| Rate for Payer: PHP Commercial |
$42.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43.46
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.96
|
| Rate for Payer: UHC Core |
$41.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.46
|
|
|
WOUND DRESSINGS TOPICAL PASTE
|
Facility
|
OP
|
$49.95
|
|
|
Service Code
|
NDC 11701003133
|
| Hospital Charge Code |
108643
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$44.95 |
| Rate for Payer: Aetna Commercial |
$42.46
|
| Rate for Payer: Aetna Medicare |
$12.99
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15.61
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15.61
|
| Rate for Payer: BCBS Complete |
$9.25
|
| Rate for Payer: BCBS MAPPO |
$12.49
|
| Rate for Payer: BCBS Trust/PPO |
$41.06
|
| Rate for Payer: BCN Commercial |
$41.06
|
| Rate for Payer: BCN Medicare Advantage |
$12.49
|
| Rate for Payer: Cash Price |
$39.96
|
| Rate for Payer: Cofinity Commercial |
$42.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$39.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.49
|
| Rate for Payer: Healthscope Commercial |
$44.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$37.46
|
| Rate for Payer: Mclaren Medicaid |
$8.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.11
|
| Rate for Payer: Meridian Medicaid |
$9.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$13.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.46
|
| Rate for Payer: Nomi Health Commercial |
$40.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.46
|
| Rate for Payer: PACE Senior Care Partners |
$11.86
|
| Rate for Payer: PACE SWMI |
$12.49
|
| Rate for Payer: PHP Commercial |
$42.46
|
| Rate for Payer: PHP Medicare Advantage |
$12.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43.46
|
| Rate for Payer: Priority Health Medicare |
$12.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$34.77
|
| Rate for Payer: Railroad Medicare Medicare |
$12.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.96
|
| Rate for Payer: UHC Core |
$41.71
|
| Rate for Payer: UHC Exchange |
$12.49
|
| Rate for Payer: UHC Medicaid |
$8.81
|
| Rate for Payer: UHC Medicare Advantage |
$12.49
|
| Rate for Payer: UHCCP Medicaid |
$8.81
|
| Rate for Payer: VA VA |
$12.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$37.46
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
OP
|
$315.58
|
|
|
Service Code
|
NDC 68084005921
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.64 |
| Max. Negotiated Rate |
$284.02 |
| Rate for Payer: Aetna Commercial |
$268.24
|
| Rate for Payer: Aetna Medicare |
$82.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.62
|
| Rate for Payer: BCBS Complete |
$58.41
|
| Rate for Payer: BCBS MAPPO |
$78.89
|
| Rate for Payer: BCBS Trust/PPO |
$259.44
|
| Rate for Payer: BCN Commercial |
$259.44
|
| Rate for Payer: BCN Medicare Advantage |
$78.89
|
| Rate for Payer: Cash Price |
$252.46
|
| Rate for Payer: Cofinity Commercial |
$271.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.89
|
| Rate for Payer: Healthscope Commercial |
$284.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.69
|
| Rate for Payer: Mclaren Medicaid |
$55.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.84
|
| Rate for Payer: Meridian Medicaid |
$58.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$86.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.24
|
| Rate for Payer: Nomi Health Commercial |
$258.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.69
|
| Rate for Payer: PACE Senior Care Partners |
$74.95
|
| Rate for Payer: PACE SWMI |
$78.89
|
| Rate for Payer: PHP Commercial |
$268.24
|
| Rate for Payer: PHP Medicare Advantage |
$78.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$274.55
|
| Rate for Payer: Priority Health Medicare |
$79.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.64
|
| Rate for Payer: Railroad Medicare Medicare |
$78.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.71
|
| Rate for Payer: UHC Core |
$263.51
|
| Rate for Payer: UHC Exchange |
$78.89
|
| Rate for Payer: UHC Medicaid |
$55.64
|
| Rate for Payer: UHC Medicare Advantage |
$78.89
|
| Rate for Payer: UHCCP Medicaid |
$55.64
|
| Rate for Payer: VA VA |
$78.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.69
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$315.58
|
|
|
Service Code
|
NDC 68084005921
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$219.64 |
| Max. Negotiated Rate |
$284.02 |
| Rate for Payer: Aetna Commercial |
$268.24
|
| Rate for Payer: BCBS Trust/PPO |
$260.64
|
| Rate for Payer: BCN Commercial |
$260.64
|
| Rate for Payer: Cash Price |
$252.46
|
| Rate for Payer: Cofinity Commercial |
$271.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.46
|
| Rate for Payer: Healthscope Commercial |
$284.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.24
|
| Rate for Payer: Nomi Health Commercial |
$258.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$236.69
|
| Rate for Payer: PHP Commercial |
$268.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$274.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.71
|
| Rate for Payer: UHC Core |
$263.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.69
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
OP
|
$10.52
|
|
|
Service Code
|
NDC 68084005911
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$9.47 |
| Rate for Payer: Aetna Commercial |
$8.94
|
| Rate for Payer: Aetna Medicare |
$2.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3.29
|
| Rate for Payer: BCBS Complete |
$1.95
|
| Rate for Payer: BCBS MAPPO |
$2.63
|
| Rate for Payer: BCBS Trust/PPO |
$8.65
|
| Rate for Payer: BCN Commercial |
$8.65
|
| Rate for Payer: BCN Medicare Advantage |
$2.63
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cofinity Commercial |
$9.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.63
|
| Rate for Payer: Healthscope Commercial |
$9.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.89
|
| Rate for Payer: Mclaren Medicaid |
$1.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.76
|
| Rate for Payer: Meridian Medicaid |
$1.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$2.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.94
|
| Rate for Payer: Nomi Health Commercial |
$8.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.89
|
| Rate for Payer: PACE Senior Care Partners |
$2.50
|
| Rate for Payer: PACE SWMI |
$2.63
|
| Rate for Payer: PHP Commercial |
$8.94
|
| Rate for Payer: PHP Medicare Advantage |
$2.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$1.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.15
|
| Rate for Payer: Priority Health Medicare |
$2.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.32
|
| Rate for Payer: Railroad Medicare Medicare |
$2.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.26
|
| Rate for Payer: UHC Core |
$8.78
|
| Rate for Payer: UHC Exchange |
$2.63
|
| Rate for Payer: UHC Medicaid |
$1.85
|
| Rate for Payer: UHC Medicare Advantage |
$2.63
|
| Rate for Payer: UHCCP Medicaid |
$1.85
|
| Rate for Payer: VA VA |
$2.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.89
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$10.52
|
|
|
Service Code
|
NDC 68084005911
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$9.47 |
| Rate for Payer: Aetna Commercial |
$8.94
|
| Rate for Payer: BCBS Trust/PPO |
$8.69
|
| Rate for Payer: BCN Commercial |
$8.69
|
| Rate for Payer: Cash Price |
$8.42
|
| Rate for Payer: Cofinity Commercial |
$9.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.42
|
| Rate for Payer: Healthscope Commercial |
$9.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.94
|
| Rate for Payer: Nomi Health Commercial |
$8.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.89
|
| Rate for Payer: PHP Commercial |
$8.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$9.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.26
|
| Rate for Payer: UHC Core |
$8.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.89
|
|
|
ZALEPLON 5 MG CAPSULE
|
Facility
|
IP
|
$419.90
|
|
|
Service Code
|
NDC 29300013101
|
| Hospital Charge Code |
25997
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$292.25 |
| Max. Negotiated Rate |
$377.91 |
| Rate for Payer: Aetna Commercial |
$356.92
|
| Rate for Payer: BCBS Trust/PPO |
$346.80
|
| Rate for Payer: BCN Commercial |
$346.80
|
| Rate for Payer: Cash Price |
$335.92
|
| Rate for Payer: Cofinity Commercial |
$361.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.92
|
| Rate for Payer: Healthscope Commercial |
$377.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.92
|
| Rate for Payer: Nomi Health Commercial |
$344.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$314.93
|
| Rate for Payer: PHP Commercial |
$356.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$365.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$369.51
|
| Rate for Payer: UHC Core |
$350.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.93
|
|
|
ZALEPLON 5 MG CAPSULE
|
Facility
|
OP
|
$419.90
|
|
|
Service Code
|
NDC 29300013101
|
| Hospital Charge Code |
25997
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.03 |
| Max. Negotiated Rate |
$377.91 |
| Rate for Payer: Aetna Commercial |
$356.92
|
| Rate for Payer: Aetna Medicare |
$109.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$131.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$131.22
|
| Rate for Payer: BCBS Complete |
$77.72
|
| Rate for Payer: BCBS MAPPO |
$104.97
|
| Rate for Payer: BCBS Trust/PPO |
$345.20
|
| Rate for Payer: BCN Commercial |
$345.20
|
| Rate for Payer: BCN Medicare Advantage |
$104.97
|
| Rate for Payer: Cash Price |
$335.92
|
| Rate for Payer: Cofinity Commercial |
$361.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$335.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.97
|
| Rate for Payer: Healthscope Commercial |
$377.91
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$314.93
|
| Rate for Payer: Mclaren Medicaid |
$74.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.22
|
| Rate for Payer: Meridian Medicaid |
$77.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$120.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$115.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$356.92
|
| Rate for Payer: Nomi Health Commercial |
$344.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$314.93
|
| Rate for Payer: PACE Senior Care Partners |
$99.73
|
| Rate for Payer: PACE SWMI |
$104.97
|
| Rate for Payer: PHP Commercial |
$356.92
|
| Rate for Payer: PHP Medicare Advantage |
$104.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$365.31
|
| Rate for Payer: Priority Health Medicare |
$106.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$292.25
|
| Rate for Payer: Railroad Medicare Medicare |
$104.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$369.51
|
| Rate for Payer: UHC Core |
$350.62
|
| Rate for Payer: UHC Exchange |
$104.97
|
| Rate for Payer: UHC Medicaid |
$74.03
|
| Rate for Payer: UHC Medicare Advantage |
$104.97
|
| Rate for Payer: UHCCP Medicaid |
$74.03
|
| Rate for Payer: VA VA |
$104.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$314.93
|
|
|
ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE
|
Facility
|
OP
|
$138.72
|
|
|
Service Code
|
NDC 11701005032
|
| Hospital Charge Code |
11378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$124.85 |
| Rate for Payer: Aetna Commercial |
$117.91
|
| Rate for Payer: Aetna Medicare |
$36.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.35
|
| Rate for Payer: BCBS Complete |
$25.68
|
| Rate for Payer: BCBS MAPPO |
$34.68
|
| Rate for Payer: BCBS Trust/PPO |
$114.04
|
| Rate for Payer: BCN Commercial |
$114.04
|
| Rate for Payer: BCN Medicare Advantage |
$34.68
|
| Rate for Payer: Cash Price |
$110.98
|
| Rate for Payer: Cofinity Commercial |
$119.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.68
|
| Rate for Payer: Healthscope Commercial |
$124.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.04
|
| Rate for Payer: Mclaren Medicaid |
$24.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.41
|
| Rate for Payer: Meridian Medicaid |
$25.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$38.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.91
|
| Rate for Payer: Nomi Health Commercial |
$113.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.04
|
| Rate for Payer: PACE Senior Care Partners |
$32.95
|
| Rate for Payer: PACE SWMI |
$34.68
|
| Rate for Payer: PHP Commercial |
$117.91
|
| Rate for Payer: PHP Medicare Advantage |
$34.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$120.69
|
| Rate for Payer: Priority Health Medicare |
$35.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.55
|
| Rate for Payer: Railroad Medicare Medicare |
$34.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.07
|
| Rate for Payer: UHC Core |
$115.83
|
| Rate for Payer: UHC Exchange |
$34.68
|
| Rate for Payer: UHC Medicaid |
$24.46
|
| Rate for Payer: UHC Medicare Advantage |
$34.68
|
| Rate for Payer: UHCCP Medicaid |
$24.46
|
| Rate for Payer: VA VA |
$34.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.04
|
|
|
ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE
|
Facility
|
IP
|
$138.72
|
|
|
Service Code
|
NDC 11701005032
|
| Hospital Charge Code |
11378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.55 |
| Max. Negotiated Rate |
$124.85 |
| Rate for Payer: Aetna Commercial |
$117.91
|
| Rate for Payer: BCBS Trust/PPO |
$114.57
|
| Rate for Payer: BCN Commercial |
$114.57
|
| Rate for Payer: Cash Price |
$110.98
|
| 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: Lakeland Regional Health Systems Commercial |
$104.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.91
|
| Rate for Payer: Nomi Health Commercial |
$113.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.04
|
| Rate for Payer: PHP Commercial |
$117.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$120.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.07
|
| Rate for Payer: UHC Core |
$115.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.04
|
|
|
ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE
|
Facility
|
IP
|
$83.50
|
|
|
Service Code
|
NDC 11701005033
|
| Hospital Charge Code |
11378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$58.12 |
| Max. Negotiated Rate |
$75.15 |
| Rate for Payer: Aetna Commercial |
$70.97
|
| Rate for Payer: BCBS Trust/PPO |
$68.96
|
| Rate for Payer: BCN Commercial |
$68.96
|
| Rate for Payer: Cash Price |
$66.80
|
| 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: Lakeland Regional Health Systems Commercial |
$62.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.97
|
| Rate for Payer: Nomi Health Commercial |
$68.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.62
|
| Rate for Payer: PHP Commercial |
$70.97
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$72.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.48
|
| Rate for Payer: UHC Core |
$69.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.62
|
|
|
ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE
|
Facility
|
OP
|
$83.50
|
|
|
Service Code
|
NDC 11701005033
|
| Hospital Charge Code |
11378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.72 |
| Max. Negotiated Rate |
$75.15 |
| Rate for Payer: Aetna Commercial |
$70.97
|
| Rate for Payer: Aetna Medicare |
$21.71
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$26.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$26.09
|
| Rate for Payer: BCBS Complete |
$15.46
|
| Rate for Payer: BCBS MAPPO |
$20.88
|
| Rate for Payer: BCBS Trust/PPO |
$68.65
|
| Rate for Payer: BCN Commercial |
$68.65
|
| Rate for Payer: BCN Medicare Advantage |
$20.88
|
| Rate for Payer: Cash Price |
$66.80
|
| Rate for Payer: Cofinity Commercial |
$71.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.88
|
| Rate for Payer: Healthscope Commercial |
$75.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.62
|
| Rate for Payer: Mclaren Medicaid |
$14.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.92
|
| Rate for Payer: Meridian Medicaid |
$15.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$24.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$22.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.97
|
| Rate for Payer: Nomi Health Commercial |
$68.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.62
|
| Rate for Payer: PACE Senior Care Partners |
$19.83
|
| Rate for Payer: PACE SWMI |
$20.88
|
| Rate for Payer: PHP Commercial |
$70.97
|
| Rate for Payer: PHP Medicare Advantage |
$20.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$72.64
|
| Rate for Payer: Priority Health Medicare |
$21.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.12
|
| Rate for Payer: Railroad Medicare Medicare |
$20.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.48
|
| Rate for Payer: UHC Core |
$69.72
|
| Rate for Payer: UHC Exchange |
$20.88
|
| Rate for Payer: UHC Medicaid |
$14.72
|
| Rate for Payer: UHC Medicare Advantage |
$20.88
|
| Rate for Payer: UHCCP Medicaid |
$14.72
|
| Rate for Payer: VA VA |
$20.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.62
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
OP
|
$178.20
|
|
|
Service Code
|
NDC 20555004000
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.42 |
| Max. Negotiated Rate |
$160.38 |
| Rate for Payer: Aetna Commercial |
$151.47
|
| Rate for Payer: Aetna Medicare |
$46.33
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55.69
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55.69
|
| Rate for Payer: BCBS Complete |
$32.98
|
| Rate for Payer: BCBS MAPPO |
$44.55
|
| Rate for Payer: BCBS Trust/PPO |
$146.50
|
| Rate for Payer: BCN Commercial |
$146.50
|
| Rate for Payer: BCN Medicare Advantage |
$44.55
|
| Rate for Payer: Cash Price |
$142.56
|
| Rate for Payer: Cofinity Commercial |
$153.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.55
|
| Rate for Payer: Healthscope Commercial |
$160.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.65
|
| Rate for Payer: Mclaren Medicaid |
$31.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.78
|
| Rate for Payer: Meridian Medicaid |
$32.98
|
| Rate for Payer: MI Amish Medical Board Commercial |
$51.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$49.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.47
|
| Rate for Payer: Nomi Health Commercial |
$146.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.65
|
| Rate for Payer: PACE Senior Care Partners |
$42.32
|
| Rate for Payer: PACE SWMI |
$44.55
|
| Rate for Payer: PHP Commercial |
$151.47
|
| Rate for Payer: PHP Medicare Advantage |
$44.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$155.03
|
| Rate for Payer: Priority Health Medicare |
$45.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.03
|
| Rate for Payer: Railroad Medicare Medicare |
$44.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.82
|
| Rate for Payer: UHC Core |
$148.80
|
| Rate for Payer: UHC Exchange |
$44.55
|
| Rate for Payer: UHC Medicaid |
$31.42
|
| Rate for Payer: UHC Medicare Advantage |
$44.55
|
| Rate for Payer: UHCCP Medicaid |
$31.42
|
| Rate for Payer: VA VA |
$44.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.65
|
|
