|
ZINC SULFATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$74.10
|
|
|
Service Code
|
NDC 0517-6101-01
|
| Hospital Charge Code |
8878
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$66.69 |
| Rate for Payer: Aetna American Axle |
$48.16
|
| Rate for Payer: Aetna Commercial |
$62.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.16
|
| Rate for Payer: Cash Price |
$59.28
|
| Rate for Payer: Cofinity Commercial |
$51.87
|
| Rate for Payer: Cofinity Commercial |
$63.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.28
|
| Rate for Payer: Healthscope Commercial |
$66.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$62.98
|
| Rate for Payer: PHP Commercial |
$62.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.87
|
| Rate for Payer: Priority Health SBD |
$46.68
|
| Rate for Payer: UMR Bronson Commercial |
$32.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.58
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
IP
|
$144.90
|
|
|
Service Code
|
NDC 8068113500
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.76 |
| Max. Negotiated Rate |
$130.41 |
| Rate for Payer: Aetna American Axle |
$94.18
|
| Rate for Payer: Aetna Commercial |
$123.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.18
|
| Rate for Payer: Cash Price |
$115.92
|
| Rate for Payer: Cofinity Commercial |
$101.43
|
| Rate for Payer: Cofinity Commercial |
$124.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.92
|
| Rate for Payer: Healthscope Commercial |
$130.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$123.16
|
| Rate for Payer: PHP Commercial |
$123.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.43
|
| Rate for Payer: Priority Health SBD |
$91.29
|
| Rate for Payer: UMR Bronson Commercial |
$63.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.68
|
|
|
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 |
$69.70 |
| Max. Negotiated Rate |
$142.56 |
| Rate for Payer: Aetna American Axle |
$102.96
|
| 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: Encore Health Key Benefits Commercial |
$126.72
|
| Rate for Payer: Healthscope Commercial |
$142.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.80
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$69.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.80
|
|
|
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 |
$107.95 |
| Max. Negotiated Rate |
$220.81 |
| Rate for Payer: Aetna American Axle |
$159.47
|
| 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: Encore Health Key Benefits Commercial |
$196.27
|
| Rate for Payer: Healthscope Commercial |
$220.81
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$171.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.00
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$107.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.00
|
|
|
ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION
|
Facility
IP
|
$59.26
|
|
|
Service Code
|
HCPCS J3486
|
| Hospital Charge Code |
33175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$53.33 |
| Rate for Payer: Aetna American Axle |
$38.52
|
| Rate for Payer: Aetna Commercial |
$50.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.52
|
| Rate for Payer: Cash Price |
$47.41
|
| Rate for Payer: Cofinity Commercial |
$41.48
|
| Rate for Payer: Cofinity Commercial |
$50.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$47.41
|
| Rate for Payer: Healthscope Commercial |
$53.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$41.48
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$44.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$50.37
|
| Rate for Payer: PHP Commercial |
$50.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.48
|
| Rate for Payer: Priority Health SBD |
$37.33
|
| Rate for Payer: UMR Bronson Commercial |
$26.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.44
|
|
|
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 |
$80.34 |
| Max. Negotiated Rate |
$164.34 |
| Rate for Payer: Aetna American Axle |
$118.69
|
| 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: Encore Health Key Benefits Commercial |
$146.08
|
| Rate for Payer: Healthscope Commercial |
$164.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.95
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$80.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.95
|
|
|
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 |
$69.22 |
| Max. Negotiated Rate |
$141.59 |
| Rate for Payer: Aetna American Axle |
$102.26
|
| 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: Encore Health Key Benefits Commercial |
$125.86
|
| Rate for Payer: Healthscope Commercial |
$141.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$110.12
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$117.99
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$69.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$117.99
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
IP
|
$221.16
|
|
|
Service Code
|
NDC 65862-703-60
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.31 |
| Max. Negotiated Rate |
$199.04 |
| Rate for Payer: Aetna American Axle |
$143.75
|
| Rate for Payer: Aetna Commercial |
$187.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.75
|
| Rate for Payer: Cash Price |
$176.93
|
| Rate for Payer: Cofinity Commercial |
$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: Kalamazoo County Sherrif's Dept Commercial |
$154.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.99
|
| Rate for Payer: PHP Commercial |
$187.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.81
|
| Rate for Payer: Priority Health SBD |
$139.33
|
| Rate for Payer: UMR Bronson Commercial |
$97.31
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.87
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
IP
|
$265.05
|
|
|
Service Code
|
NDC 0781-2166-60
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| 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: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$116.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
ZIV-AFLIBERCEPT 25MG/ML INJECTION
|
Facility
OP
|
$7,184.00
|
|
|
Service Code
|
HCPCS J9400
|
| Hospital Charge Code |
161499
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$6,465.60 |
| Rate for Payer: Aetna American Axle |
$4,669.60
|
| Rate for Payer: Aetna Commercial |
$6,106.40
|
| Rate for Payer: Aetna Medicare |
$7.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,669.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.10
|
| Rate for Payer: BCBS Complete |
$4.18
|
| Rate for Payer: BCBS MAPPO |
$7.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.50
|
| Rate for Payer: BCN Medicare Advantage |
$7.28
|
| Rate for Payer: Cash Price |
$5,747.20
|
| Rate for Payer: Cash Price |
$5,747.20
|
| Rate for Payer: Cofinity Commercial |
$5,028.80
|
| Rate for Payer: Cofinity Commercial |
$6,178.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,747.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.28
|
| Rate for Payer: Healthscope Commercial |
$6,465.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,028.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,388.00
|
| Rate for Payer: Mclaren Medicaid |
$3.98
|
| Rate for Payer: Mclaren Medicare |
$7.28
|
| Rate for Payer: Meridian Medicaid |
$4.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,106.40
|
| Rate for Payer: PACE Medicare |
$6.92
|
| Rate for Payer: PACE SWMI |
$7.28
|
| Rate for Payer: PHP Commercial |
$6,106.40
|
| Rate for Payer: PHP Medicare Advantage |
$7.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$3.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,028.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.92
|
| Rate for Payer: Priority Health Medicare |
$7.28
|
| Rate for Payer: Priority Health Narrow Network |
$18.34
|
| Rate for Payer: Priority Health SBD |
$4,525.92
|
| Rate for Payer: Railroad Medicare Medicare |
$7.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.28
|
| Rate for Payer: UHC Medicare Advantage |
$7.50
|
| Rate for Payer: UMR Bronson Commercial |
$2,658.08
|
| Rate for Payer: VA VA |
$7.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,388.00
|
|
|
ZIV-AFLIBERCEPT 25MG/ML INJECTION
|
Facility
IP
|
$7,184.00
|
|
|
Service Code
|
HCPCS J9400
|
| Hospital Charge Code |
161499
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,160.96 |
| Max. Negotiated Rate |
$6,465.60 |
| Rate for Payer: Aetna American Axle |
$4,669.60
|
| Rate for Payer: Aetna Commercial |
$6,106.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,669.60
|
| Rate for Payer: Cash Price |
$5,747.20
|
| Rate for Payer: Cofinity Commercial |
$5,028.80
|
| Rate for Payer: Cofinity Commercial |
$6,178.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,747.20
|
| Rate for Payer: Healthscope Commercial |
$6,465.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,028.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,388.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$6,106.40
|
| Rate for Payer: PHP Commercial |
$6,106.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,028.80
|
| Rate for Payer: Priority Health SBD |
$4,525.92
|
| Rate for Payer: UMR Bronson Commercial |
$3,160.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,388.00
|
|
|
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 |
$75.97 |
| Max. Negotiated Rate |
$155.39 |
| Rate for Payer: Aetna American Axle |
$112.23
|
| 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: Encore Health Key Benefits Commercial |
$138.13
|
| Rate for Payer: Healthscope Commercial |
$155.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$120.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$129.50
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$75.97
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$129.50
|
|
|
ZOLEDRONIC ACID 4 MG/100 ML-MANNITOL-0.9 % NACL INTRAVENOUS PIGGYBACK
|
Facility
OP
|
$103.24
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
167580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna American Axle |
$67.11
|
| Rate for Payer: Aetna Commercial |
$87.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.11
|
| Rate for Payer: BCBS Complete |
$41.30
|
| Rate for Payer: BCBS Trust/PPO |
$23.28
|
| Rate for Payer: Cash Price |
$82.59
|
| Rate for Payer: Cash Price |
$82.59
|
| Rate for Payer: Cofinity Commercial |
$72.27
|
| Rate for Payer: Cofinity Commercial |
$88.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.59
|
| Rate for Payer: Healthscope Commercial |
$92.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.75
|
| Rate for Payer: PHP Commercial |
$87.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.27
|
| Rate for Payer: Priority Health SBD |
$65.04
|
| Rate for Payer: UMR Bronson Commercial |
$38.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.43
|
|
|
ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$333.64
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
35640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.80 |
| Max. Negotiated Rate |
$300.28 |
| Rate for Payer: Aetna American Axle |
$216.87
|
| Rate for Payer: Aetna American Axle |
$75.69
|
| Rate for Payer: Aetna American Axle |
$88.08
|
| Rate for Payer: Aetna American Axle |
$352.27
|
| Rate for Payer: Aetna American Axle |
$282.22
|
| Rate for Payer: Aetna Commercial |
$115.18
|
| Rate for Payer: Aetna Commercial |
$369.06
|
| Rate for Payer: Aetna Commercial |
$98.97
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna Commercial |
$460.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: Cash Price |
$347.35
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cash Price |
$108.41
|
| Rate for Payer: Cash Price |
$433.57
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cofinity Commercial |
$233.55
|
| Rate for Payer: Cofinity Commercial |
$303.93
|
| Rate for Payer: Cofinity Commercial |
$81.51
|
| Rate for Payer: Cofinity Commercial |
$116.54
|
| Rate for Payer: Cofinity Commercial |
$466.09
|
| Rate for Payer: Cofinity Commercial |
$94.86
|
| Rate for Payer: Cofinity Commercial |
$373.40
|
| Rate for Payer: Cofinity Commercial |
$379.37
|
| Rate for Payer: Cofinity Commercial |
$100.14
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Healthscope Commercial |
$390.77
|
| Rate for Payer: Healthscope Commercial |
$121.96
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Healthscope Commercial |
$487.76
|
| Rate for Payer: Healthscope Commercial |
$104.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$379.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$369.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$98.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$115.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.59
|
| Rate for Payer: PHP Commercial |
$460.67
|
| Rate for Payer: PHP Commercial |
$369.06
|
| Rate for Payer: PHP Commercial |
$115.18
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: PHP Commercial |
$98.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.51
|
| Rate for Payer: Priority Health SBD |
$85.37
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: Priority Health SBD |
$341.43
|
| Rate for Payer: Priority Health SBD |
$73.36
|
| Rate for Payer: Priority Health SBD |
$273.54
|
| Rate for Payer: UMR Bronson Commercial |
$59.62
|
| Rate for Payer: UMR Bronson Commercial |
$146.80
|
| Rate for Payer: UMR Bronson Commercial |
$238.46
|
| Rate for Payer: UMR Bronson Commercial |
$191.04
|
| Rate for Payer: UMR Bronson Commercial |
$51.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.47
|
|
|
ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
OP
|
$434.19
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
35640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$390.77 |
| Rate for Payer: Aetna American Axle |
$282.22
|
| Rate for Payer: Aetna American Axle |
$244.38
|
| Rate for Payer: Aetna American Axle |
$216.87
|
| Rate for Payer: Aetna American Axle |
$352.27
|
| Rate for Payer: Aetna American Axle |
$170.06
|
| Rate for Payer: Aetna American Axle |
$307.54
|
| Rate for Payer: Aetna Commercial |
$369.06
|
| Rate for Payer: Aetna Commercial |
$460.67
|
| Rate for Payer: Aetna Commercial |
$319.57
|
| Rate for Payer: Aetna Commercial |
$222.39
|
| Rate for Payer: Aetna Commercial |
$402.17
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$352.27
|
| Rate for Payer: BCBS Complete |
$133.46
|
| Rate for Payer: BCBS Complete |
$104.65
|
| Rate for Payer: BCBS Complete |
$150.39
|
| Rate for Payer: BCBS Complete |
$173.68
|
| Rate for Payer: BCBS Complete |
$189.26
|
| Rate for Payer: BCBS Complete |
$216.78
|
| Rate for Payer: BCBS Trust/PPO |
$23.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.28
|
| Rate for Payer: Cash Price |
$209.30
|
| Rate for Payer: Cash Price |
$433.57
|
| Rate for Payer: Cash Price |
$378.51
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$300.78
|
| Rate for Payer: Cash Price |
$347.35
|
| Rate for Payer: Cash Price |
$378.51
|
| Rate for Payer: Cash Price |
$300.78
|
| Rate for Payer: Cash Price |
$347.35
|
| Rate for Payer: Cash Price |
$209.30
|
| Rate for Payer: Cash Price |
$433.57
|
| Rate for Payer: Cofinity Commercial |
$373.40
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Cofinity Commercial |
$379.37
|
| Rate for Payer: Cofinity Commercial |
$466.09
|
| Rate for Payer: Cofinity Commercial |
$263.18
|
| Rate for Payer: Cofinity Commercial |
$323.33
|
| Rate for Payer: Cofinity Commercial |
$406.90
|
| Rate for Payer: Cofinity Commercial |
$331.20
|
| Rate for Payer: Cofinity Commercial |
$233.55
|
| Rate for Payer: Cofinity Commercial |
$183.14
|
| Rate for Payer: Cofinity Commercial |
$303.93
|
| Rate for Payer: Cofinity Commercial |
$225.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$433.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$347.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Healthscope Commercial |
$425.83
|
| Rate for Payer: Healthscope Commercial |
$235.47
|
| Rate for Payer: Healthscope Commercial |
$487.76
|
| Rate for Payer: Healthscope Commercial |
$338.37
|
| Rate for Payer: Healthscope Commercial |
$390.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$379.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$303.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$325.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$406.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$319.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$283.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$222.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$369.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$402.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$460.67
|
| Rate for Payer: PHP Commercial |
$369.06
|
| Rate for Payer: PHP Commercial |
$460.67
|
| Rate for Payer: PHP Commercial |
$319.57
|
| Rate for Payer: PHP Commercial |
$222.39
|
| Rate for Payer: PHP Commercial |
$402.17
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$303.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$331.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$263.18
|
| Rate for Payer: Priority Health SBD |
$164.83
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: Priority Health SBD |
$236.86
|
| Rate for Payer: Priority Health SBD |
$273.54
|
| Rate for Payer: Priority Health SBD |
$298.08
|
| Rate for Payer: Priority Health SBD |
$341.43
|
| Rate for Payer: UMR Bronson Commercial |
$175.06
|
| Rate for Payer: UMR Bronson Commercial |
$139.11
|
| Rate for Payer: UMR Bronson Commercial |
$160.65
|
| Rate for Payer: UMR Bronson Commercial |
$96.80
|
| Rate for Payer: UMR Bronson Commercial |
$200.53
|
| Rate for Payer: UMR Bronson Commercial |
$123.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$325.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$406.47
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK
|
Facility
IP
|
$161.94
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
81434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$145.75 |
| Rate for Payer: Aetna American Axle |
$105.26
|
| Rate for Payer: Aetna American Axle |
$2,757.87
|
| Rate for Payer: Aetna Commercial |
$3,606.45
|
| Rate for Payer: Aetna Commercial |
$137.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,757.87
|
| Rate for Payer: Cash Price |
$129.55
|
| Rate for Payer: Cash Price |
$3,394.30
|
| Rate for Payer: Cofinity Commercial |
$2,970.02
|
| Rate for Payer: Cofinity Commercial |
$139.27
|
| Rate for Payer: Cofinity Commercial |
$3,648.88
|
| Rate for Payer: Cofinity Commercial |
$113.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,394.30
|
| Rate for Payer: Healthscope Commercial |
$3,818.59
|
| Rate for Payer: Healthscope Commercial |
$145.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,970.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,182.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,606.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.65
|
| Rate for Payer: PHP Commercial |
$137.65
|
| Rate for Payer: PHP Commercial |
$3,606.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,970.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.36
|
| Rate for Payer: Priority Health SBD |
$2,673.01
|
| Rate for Payer: Priority Health SBD |
$102.02
|
| Rate for Payer: UMR Bronson Commercial |
$1,866.87
|
| Rate for Payer: UMR Bronson Commercial |
$71.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,182.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.46
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK
|
Facility
OP
|
$387.91
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
81434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.28 |
| Max. Negotiated Rate |
$349.12 |
| Rate for Payer: Aetna American Axle |
$252.14
|
| Rate for Payer: Aetna American Axle |
$182.47
|
| Rate for Payer: Aetna American Axle |
$142.96
|
| Rate for Payer: Aetna American Axle |
$340.07
|
| Rate for Payer: Aetna American Axle |
$2,757.87
|
| Rate for Payer: Aetna American Axle |
$105.26
|
| Rate for Payer: Aetna American Axle |
$251.69
|
| Rate for Payer: Aetna American Axle |
$692.08
|
| Rate for Payer: Aetna Commercial |
$444.70
|
| Rate for Payer: Aetna Commercial |
$186.95
|
| Rate for Payer: Aetna Commercial |
$329.72
|
| Rate for Payer: Aetna Commercial |
$329.14
|
| Rate for Payer: Aetna Commercial |
$905.03
|
| Rate for Payer: Aetna Commercial |
$238.61
|
| Rate for Payer: Aetna Commercial |
$3,606.45
|
| Rate for Payer: Aetna Commercial |
$137.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$692.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,757.87
|
| Rate for Payer: BCBS Complete |
$154.89
|
| Rate for Payer: BCBS Complete |
$425.90
|
| Rate for Payer: BCBS Complete |
$209.27
|
| Rate for Payer: BCBS Complete |
$1,697.15
|
| Rate for Payer: BCBS Complete |
$155.16
|
| Rate for Payer: BCBS Complete |
$64.78
|
| Rate for Payer: BCBS Complete |
$87.98
|
| Rate for Payer: BCBS Complete |
$112.29
|
| Rate for Payer: BCBS Trust/PPO |
$23.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.28
|
| Rate for Payer: BCBS Trust/PPO |
$23.28
|
| Rate for Payer: Cash Price |
$309.78
|
| Rate for Payer: Cash Price |
$851.79
|
| Rate for Payer: Cash Price |
$851.79
|
| Rate for Payer: Cash Price |
$129.55
|
| Rate for Payer: Cash Price |
$129.55
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Cash Price |
$309.78
|
| Rate for Payer: Cash Price |
$310.33
|
| Rate for Payer: Cash Price |
$310.33
|
| Rate for Payer: Cash Price |
$3,394.30
|
| Rate for Payer: Cash Price |
$3,394.30
|
| Rate for Payer: Cash Price |
$418.54
|
| Rate for Payer: Cash Price |
$418.54
|
| Rate for Payer: Cofinity Commercial |
$271.54
|
| Rate for Payer: Cofinity Commercial |
$189.15
|
| Rate for Payer: Cofinity Commercial |
$449.93
|
| Rate for Payer: Cofinity Commercial |
$196.50
|
| Rate for Payer: Cofinity Commercial |
$241.42
|
| Rate for Payer: Cofinity Commercial |
$366.23
|
| Rate for Payer: Cofinity Commercial |
$3,648.88
|
| Rate for Payer: Cofinity Commercial |
$153.96
|
| Rate for Payer: Cofinity Commercial |
$333.60
|
| Rate for Payer: Cofinity Commercial |
$2,970.02
|
| Rate for Payer: Cofinity Commercial |
$745.32
|
| Rate for Payer: Cofinity Commercial |
$113.36
|
| Rate for Payer: Cofinity Commercial |
$139.27
|
| Rate for Payer: Cofinity Commercial |
$271.05
|
| Rate for Payer: Cofinity Commercial |
$333.01
|
| Rate for Payer: Cofinity Commercial |
$915.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$851.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$418.54
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,394.30
|
| Rate for Payer: Healthscope Commercial |
$470.86
|
| Rate for Payer: Healthscope Commercial |
$958.27
|
| Rate for Payer: Healthscope Commercial |
$3,818.59
|
| Rate for Payer: Healthscope Commercial |
$348.50
|
| Rate for Payer: Healthscope Commercial |
$145.75
|
| Rate for Payer: Healthscope Commercial |
$252.65
|
| Rate for Payer: Healthscope Commercial |
$349.12
|
| Rate for Payer: Healthscope Commercial |
$197.95
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$366.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$2,970.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$745.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$798.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,182.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$392.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3,606.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$137.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$329.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$444.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$329.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$905.03
|
| Rate for Payer: PHP Commercial |
$329.72
|
| Rate for Payer: PHP Commercial |
$186.95
|
| Rate for Payer: PHP Commercial |
$329.14
|
| Rate for Payer: PHP Commercial |
$905.03
|
| Rate for Payer: PHP Commercial |
$3,606.45
|
| Rate for Payer: PHP Commercial |
$137.65
|
| Rate for Payer: PHP Commercial |
$238.61
|
| Rate for Payer: PHP Commercial |
$444.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$366.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$745.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,970.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.96
|
| Rate for Payer: Priority Health SBD |
$670.79
|
| Rate for Payer: Priority Health SBD |
$102.02
|
| Rate for Payer: Priority Health SBD |
$138.56
|
| Rate for Payer: Priority Health SBD |
$176.85
|
| Rate for Payer: Priority Health SBD |
$243.95
|
| Rate for Payer: Priority Health SBD |
$244.38
|
| Rate for Payer: Priority Health SBD |
$2,673.01
|
| Rate for Payer: Priority Health SBD |
$329.60
|
| Rate for Payer: UMR Bronson Commercial |
$103.87
|
| Rate for Payer: UMR Bronson Commercial |
$59.92
|
| Rate for Payer: UMR Bronson Commercial |
$393.95
|
| Rate for Payer: UMR Bronson Commercial |
$81.38
|
| Rate for Payer: UMR Bronson Commercial |
$143.27
|
| Rate for Payer: UMR Bronson Commercial |
$1,569.87
|
| Rate for Payer: UMR Bronson Commercial |
$193.58
|
| Rate for Payer: UMR Bronson Commercial |
$143.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,182.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$798.56
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$392.38
|
|
|
ZOLMITRIPTAN 5 MG TABLET
|
Facility
IP
|
$22.22
|
|
|
Service Code
|
NDC 27241-022-38
|
| Hospital Charge Code |
22219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.78 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna American Axle |
$14.44
|
| Rate for Payer: Aetna Commercial |
$18.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.44
|
| Rate for Payer: Cash Price |
$17.78
|
| Rate for Payer: Cofinity Commercial |
$15.55
|
| Rate for Payer: Cofinity Commercial |
$19.11
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.78
|
| Rate for Payer: Healthscope Commercial |
$20.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$18.89
|
| Rate for Payer: PHP Commercial |
$18.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.55
|
| Rate for Payer: Priority Health SBD |
$14.00
|
| Rate for Payer: UMR Bronson Commercial |
$9.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.66
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
IP
|
$192.50
|
|
|
Service Code
|
NDC 68084-189-01
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.70 |
| Max. Negotiated Rate |
$173.25 |
| Rate for Payer: Aetna American Axle |
$125.12
|
| Rate for Payer: Aetna Commercial |
$163.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.12
|
| Rate for Payer: Cash Price |
$154.00
|
| Rate for Payer: Cofinity Commercial |
$134.75
|
| Rate for Payer: Cofinity Commercial |
$165.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.00
|
| Rate for Payer: Healthscope Commercial |
$173.25
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$134.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.62
|
| Rate for Payer: PHP Commercial |
$163.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.75
|
| Rate for Payer: Priority Health SBD |
$121.28
|
| Rate for Payer: UMR Bronson Commercial |
$84.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.38
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
IP
|
$11.03
|
|
|
Service Code
|
NDC 0904-6082-61
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$9.93 |
| Rate for Payer: Aetna American Axle |
$7.17
|
| Rate for Payer: Aetna Commercial |
$9.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.17
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cofinity Commercial |
$7.72
|
| Rate for Payer: Cofinity Commercial |
$9.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.82
|
| Rate for Payer: Healthscope Commercial |
$9.93
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.38
|
| Rate for Payer: PHP Commercial |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.72
|
| Rate for Payer: Priority Health SBD |
$6.95
|
| Rate for Payer: UMR Bronson Commercial |
$4.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.27
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
IP
|
$134.75
|
|
|
Service Code
|
NDC 51079-724-20
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$121.28 |
| Rate for Payer: Aetna American Axle |
$87.59
|
| Rate for Payer: Aetna Commercial |
$114.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.59
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cofinity Commercial |
$115.88
|
| Rate for Payer: Cofinity Commercial |
$94.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.80
|
| Rate for Payer: Healthscope Commercial |
$121.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.54
|
| Rate for Payer: PHP Commercial |
$114.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.32
|
| Rate for Payer: Priority Health SBD |
$84.89
|
| Rate for Payer: UMR Bronson Commercial |
$59.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.06
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
IP
|
$1.35
|
|
|
Service Code
|
NDC 51079-724-01
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna American Axle |
$0.88
|
| Rate for Payer: Aetna Commercial |
$1.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.88
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cofinity Commercial |
$0.95
|
| Rate for Payer: Cofinity Commercial |
$1.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.08
|
| Rate for Payer: Healthscope Commercial |
$1.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.15
|
| Rate for Payer: PHP Commercial |
$1.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.95
|
| Rate for Payer: Priority Health SBD |
$0.85
|
| Rate for Payer: UMR Bronson Commercial |
$0.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.01
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
IP
|
$1.93
|
|
|
Service Code
|
NDC 68084-189-11
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.74 |
| Rate for Payer: Aetna American Axle |
$1.25
|
| Rate for Payer: Aetna Commercial |
$1.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.25
|
| Rate for Payer: Cash Price |
$1.54
|
| Rate for Payer: Cofinity Commercial |
$1.35
|
| Rate for Payer: Cofinity Commercial |
$1.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.54
|
| Rate for Payer: Healthscope Commercial |
$1.74
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.64
|
| Rate for Payer: PHP Commercial |
$1.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.35
|
| Rate for Payer: Priority Health SBD |
$1.22
|
| Rate for Payer: UMR Bronson Commercial |
$0.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.45
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
IP
|
$324.90
|
|
|
Service Code
|
NDC 69097-861-07
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.96 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna American Axle |
$211.18
|
| Rate for Payer: Aetna Commercial |
$276.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.18
|
| Rate for Payer: Cash Price |
$259.92
|
| Rate for Payer: Cofinity Commercial |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.92
|
| Rate for Payer: Healthscope Commercial |
$292.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.16
|
| Rate for Payer: PHP Commercial |
$276.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.43
|
| Rate for Payer: Priority Health SBD |
$204.69
|
| Rate for Payer: UMR Bronson Commercial |
$142.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.68
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
IP
|
$324.90
|
|
|
Service Code
|
NDC 68462-130-01
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.96 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna American Axle |
$211.18
|
| Rate for Payer: Aetna Commercial |
$276.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.18
|
| Rate for Payer: Cash Price |
$259.92
|
| Rate for Payer: Cofinity Commercial |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.92
|
| Rate for Payer: Healthscope Commercial |
$292.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$276.16
|
| Rate for Payer: PHP Commercial |
$276.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.43
|
| Rate for Payer: Priority Health SBD |
$204.69
|
| Rate for Payer: UMR Bronson Commercial |
$142.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.68
|
|
