|
WHITE PETROLATUM-MINERAL OIL 56.8 %-42.5 % EYE OINTMENT
|
Facility
|
IP
|
$31.82
|
|
|
Service Code
|
NDC 0023-0312-04
|
| Hospital Charge Code |
117955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$28.64 |
| Rate for Payer: Aetna American Axle |
$20.68
|
| Rate for Payer: Aetna Commercial |
$27.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.68
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$22.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.05
|
| Rate for Payer: PHP Commercial |
$27.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.27
|
| Rate for Payer: Priority Health SBD |
$20.05
|
| Rate for Payer: UMR Bronson Commercial |
$14.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.86
|
|
|
WHITE PETROLATUM-MINERAL OIL 57.3 %-42.5 % EYE OINTMENT
|
Facility
|
IP
|
$27.93
|
|
|
Service Code
|
NDC 0023-0240-04
|
| Hospital Charge Code |
119426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$25.14 |
| Rate for Payer: Aetna American Axle |
$18.15
|
| Rate for Payer: Aetna Commercial |
$23.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.15
|
| Rate for Payer: Cash Price |
$22.34
|
| Rate for Payer: Cofinity Commercial |
$19.55
|
| Rate for Payer: Cofinity Commercial |
$24.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.34
|
| Rate for Payer: Healthscope Commercial |
$25.14
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.74
|
| Rate for Payer: PHP Commercial |
$23.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.55
|
| Rate for Payer: Priority Health SBD |
$17.60
|
| Rate for Payer: UMR Bronson Commercial |
$12.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.95
|
|
|
WHITE PETROLATUM-MINERAL OIL 57.3 %-42.5 % EYE OINTMENT
|
Facility
|
IP
|
$18.90
|
|
|
Service Code
|
NDC 70000-0513-1
|
| Hospital Charge Code |
119426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$17.01 |
| Rate for Payer: Aetna American Axle |
$12.28
|
| Rate for Payer: Aetna Commercial |
$16.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.28
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cofinity Commercial |
$13.23
|
| Rate for Payer: Cofinity Commercial |
$16.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.12
|
| Rate for Payer: Healthscope Commercial |
$17.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.06
|
| Rate for Payer: PHP Commercial |
$16.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.23
|
| Rate for Payer: Priority Health SBD |
$11.91
|
| Rate for Payer: UMR Bronson Commercial |
$8.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.18
|
|
|
WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT
|
Facility
|
IP
|
$22.51
|
|
|
Service Code
|
NDC 0904-6488-38
|
| Hospital Charge Code |
117765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$20.26 |
| Rate for Payer: Aetna American Axle |
$14.63
|
| Rate for Payer: Aetna Commercial |
$19.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.63
|
| Rate for Payer: Cash Price |
$18.01
|
| Rate for Payer: Cofinity Commercial |
$19.36
|
| Rate for Payer: Cofinity Commercial |
$15.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.01
|
| Rate for Payer: Healthscope Commercial |
$20.26
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.13
|
| Rate for Payer: PHP Commercial |
$19.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.76
|
| Rate for Payer: Priority Health SBD |
$14.18
|
| Rate for Payer: UMR Bronson Commercial |
$9.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.88
|
|
|
WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM
|
Facility
|
IP
|
$20.50
|
|
|
Service Code
|
NDC 61924-174-07
|
| Hospital Charge Code |
11371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$18.45 |
| Rate for Payer: Aetna American Axle |
$13.32
|
| Rate for Payer: Aetna Commercial |
$17.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.32
|
| Rate for Payer: Cash Price |
$16.40
|
| Rate for Payer: Cofinity Commercial |
$14.35
|
| Rate for Payer: Cofinity Commercial |
$17.63
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.40
|
| Rate for Payer: Healthscope Commercial |
$18.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$17.42
|
| Rate for Payer: PHP Commercial |
$17.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.35
|
| Rate for Payer: Priority Health SBD |
$12.92
|
| Rate for Payer: UMR Bronson Commercial |
$9.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.38
|
|
|
WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM
|
Facility
|
IP
|
$12.88
|
|
|
Service Code
|
NDC 6192417804
|
| Hospital Charge Code |
11371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$11.59 |
| Rate for Payer: Aetna American Axle |
$8.37
|
| Rate for Payer: Aetna Commercial |
$10.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.37
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cofinity Commercial |
$11.08
|
| Rate for Payer: Cofinity Commercial |
$9.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.30
|
| Rate for Payer: Healthscope Commercial |
$11.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.95
|
| Rate for Payer: PHP Commercial |
$10.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.02
|
| Rate for Payer: Priority Health SBD |
$8.11
|
| Rate for Payer: UMR Bronson Commercial |
$5.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.66
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$59,887.43
|
|
|
Service Code
|
MS-DRG 464
|
| Min. Negotiated Rate |
$22,459.19 |
| Max. Negotiated Rate |
$59,887.43 |
| Rate for Payer: Aetna Medicare |
$24,586.90
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$29,551.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$29,551.56
|
| Rate for Payer: BCBS MAPPO |
$23,641.25
|
| Rate for Payer: BCBS Trust/PPO |
$59,887.43
|
| Rate for Payer: BCN Medicare Advantage |
$23,641.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23,641.25
|
| Rate for Payer: Mclaren Medicare |
$23,641.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24,823.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,187.44
|
| Rate for Payer: PACE Medicare |
$22,459.19
|
| Rate for Payer: PACE SWMI |
$23,641.25
|
| Rate for Payer: PHP Medicare Advantage |
$23,641.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43,069.85
|
| Rate for Payer: Priority Health Medicare |
$23,641.25
|
| Rate for Payer: Priority Health Narrow Network |
$34,455.88
|
| Rate for Payer: Railroad Medicare Medicare |
$23,641.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45,783.36
|
| Rate for Payer: UHC Core |
$37,541.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$23,641.25
|
| Rate for Payer: UHC Exchange |
$29,845.92
|
| Rate for Payer: UHC Medicare Advantage |
$24,350.49
|
| Rate for Payer: VA VA |
$23,641.25
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$109,265.92
|
|
|
Service Code
|
MS-DRG 463
|
| Min. Negotiated Rate |
$41,949.16 |
| Max. Negotiated Rate |
$109,265.92 |
| Rate for Payer: Aetna Medicare |
$45,923.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$55,196.26
|
| Rate for Payer: Amish Plain Church Group Commercial |
$55,196.26
|
| Rate for Payer: BCBS MAPPO |
$44,157.01
|
| Rate for Payer: BCBS Trust/PPO |
$109,265.92
|
| Rate for Payer: BCN Medicare Advantage |
$44,157.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44,157.01
|
| Rate for Payer: Mclaren Medicare |
$44,157.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46,364.86
|
| Rate for Payer: MI Amish Medical Board Commercial |
$50,780.56
|
| Rate for Payer: PACE Medicare |
$41,949.16
|
| Rate for Payer: PACE SWMI |
$44,157.01
|
| Rate for Payer: PHP Medicare Advantage |
$44,157.01
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81,273.64
|
| Rate for Payer: Priority Health Medicare |
$44,157.01
|
| Rate for Payer: Priority Health Narrow Network |
$65,018.91
|
| Rate for Payer: Railroad Medicare Medicare |
$44,157.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86,394.08
|
| Rate for Payer: UHC Core |
$70,841.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$44,157.01
|
| Rate for Payer: UHC Exchange |
$56,319.83
|
| Rate for Payer: UHC Medicare Advantage |
$45,481.72
|
| Rate for Payer: VA VA |
$44,157.01
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$34,057.33
|
|
|
Service Code
|
MS-DRG 465
|
| Min. Negotiated Rate |
$14,182.36 |
| Max. Negotiated Rate |
$34,057.33 |
| Rate for Payer: Aetna Medicare |
$15,525.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,661.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,661.00
|
| Rate for Payer: BCBS MAPPO |
$14,928.80
|
| Rate for Payer: BCBS Trust/PPO |
$34,057.33
|
| Rate for Payer: BCN Medicare Advantage |
$14,928.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,928.80
|
| Rate for Payer: Mclaren Medicare |
$14,928.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,675.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,168.12
|
| Rate for Payer: PACE Medicare |
$14,182.36
|
| Rate for Payer: PACE SWMI |
$14,928.80
|
| Rate for Payer: PHP Medicare Advantage |
$14,928.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$26,845.83
|
| Rate for Payer: Priority Health Medicare |
$14,928.80
|
| Rate for Payer: Priority Health Narrow Network |
$21,476.66
|
| Rate for Payer: Railroad Medicare Medicare |
$14,928.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,537.18
|
| Rate for Payer: UHC Core |
$23,399.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$14,928.80
|
| Rate for Payer: UHC Exchange |
$18,603.24
|
| Rate for Payer: UHC Medicare Advantage |
$15,376.66
|
| Rate for Payer: VA VA |
$14,928.80
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
|
IP
|
$46,204.69
|
|
|
Service Code
|
MS-DRG 902
|
| Min. Negotiated Rate |
$14,284.11 |
| Max. Negotiated Rate |
$46,204.69 |
| Rate for Payer: Aetna Medicare |
$15,637.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,794.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,794.89
|
| Rate for Payer: BCBS MAPPO |
$15,035.91
|
| Rate for Payer: BCBS Trust/PPO |
$46,204.69
|
| Rate for Payer: BCN Medicare Advantage |
$15,035.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,035.91
|
| Rate for Payer: Mclaren Medicare |
$15,035.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$15,787.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,291.30
|
| Rate for Payer: PACE Medicare |
$14,284.11
|
| Rate for Payer: PACE SWMI |
$15,035.91
|
| Rate for Payer: PHP Medicare Advantage |
$15,035.91
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,045.29
|
| Rate for Payer: Priority Health Medicare |
$15,035.91
|
| Rate for Payer: Priority Health Narrow Network |
$21,636.23
|
| Rate for Payer: Railroad Medicare Medicare |
$15,035.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28,749.21
|
| Rate for Payer: UHC Core |
$23,573.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,035.91
|
| Rate for Payer: UHC Exchange |
$18,741.46
|
| Rate for Payer: UHC Medicare Advantage |
$15,486.99
|
| Rate for Payer: VA VA |
$15,035.91
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
|
IP
|
$70,959.27
|
|
|
Service Code
|
MS-DRG 901
|
| Min. Negotiated Rate |
$32,169.39 |
| Max. Negotiated Rate |
$70,959.27 |
| Rate for Payer: Aetna Medicare |
$35,217.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42,328.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42,328.15
|
| Rate for Payer: BCBS MAPPO |
$33,862.52
|
| Rate for Payer: BCBS Trust/PPO |
$70,959.27
|
| Rate for Payer: BCN Medicare Advantage |
$33,862.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33,862.52
|
| Rate for Payer: Mclaren Medicare |
$33,862.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$35,555.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38,941.90
|
| Rate for Payer: PACE Medicare |
$32,169.39
|
| Rate for Payer: PACE SWMI |
$33,862.52
|
| Rate for Payer: PHP Medicare Advantage |
$33,862.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62,103.58
|
| Rate for Payer: Priority Health Medicare |
$33,862.52
|
| Rate for Payer: Priority Health Narrow Network |
$49,682.86
|
| Rate for Payer: Railroad Medicare Medicare |
$33,862.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66,016.26
|
| Rate for Payer: UHC Core |
$54,132.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$33,862.52
|
| Rate for Payer: UHC Exchange |
$43,035.64
|
| Rate for Payer: UHC Medicare Advantage |
$34,878.40
|
| Rate for Payer: VA VA |
$33,862.52
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$25,671.79
|
|
|
Service Code
|
MS-DRG 903
|
| Min. Negotiated Rate |
$9,575.43 |
| Max. Negotiated Rate |
$25,671.79 |
| Rate for Payer: Aetna Medicare |
$10,482.58
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,599.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,599.25
|
| Rate for Payer: BCBS MAPPO |
$10,079.40
|
| Rate for Payer: BCBS Trust/PPO |
$25,671.79
|
| Rate for Payer: BCN Medicare Advantage |
$10,079.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,079.40
|
| Rate for Payer: Mclaren Medicare |
$10,079.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10,583.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,591.31
|
| Rate for Payer: PACE Medicare |
$9,575.43
|
| Rate for Payer: PACE SWMI |
$10,079.40
|
| Rate for Payer: PHP Medicare Advantage |
$10,079.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17,815.43
|
| Rate for Payer: Priority Health Medicare |
$10,079.40
|
| Rate for Payer: Priority Health Narrow Network |
$14,252.34
|
| Rate for Payer: Railroad Medicare Medicare |
$10,079.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18,937.84
|
| Rate for Payer: UHC Core |
$15,528.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$10,079.40
|
| Rate for Payer: UHC Exchange |
$12,345.48
|
| Rate for Payer: UHC Medicare Advantage |
$10,381.78
|
| Rate for Payer: VA VA |
$10,079.40
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$493.06
|
|
|
Service Code
|
NDC 55111-626-60
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.95 |
| Max. Negotiated Rate |
$443.75 |
| Rate for Payer: Aetna American Axle |
$320.49
|
| Rate for Payer: Aetna Commercial |
$419.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.49
|
| Rate for Payer: Cash Price |
$394.45
|
| Rate for Payer: Cofinity Commercial |
$345.14
|
| Rate for Payer: Cofinity Commercial |
$424.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.45
|
| Rate for Payer: Healthscope Commercial |
$443.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$345.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$419.10
|
| Rate for Payer: PHP Commercial |
$419.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.14
|
| Rate for Payer: Priority Health SBD |
$310.63
|
| Rate for Payer: UMR Bronson Commercial |
$216.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.80
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$220.61
|
|
|
Service Code
|
NDC 31722-008-60
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.07 |
| Max. Negotiated Rate |
$198.55 |
| Rate for Payer: Aetna American Axle |
$143.40
|
| Rate for Payer: Aetna Commercial |
$187.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.40
|
| Rate for Payer: Cash Price |
$176.49
|
| Rate for Payer: Cofinity Commercial |
$154.43
|
| Rate for Payer: Cofinity Commercial |
$189.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.49
|
| Rate for Payer: Healthscope Commercial |
$198.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$154.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.52
|
| Rate for Payer: PHP Commercial |
$187.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.43
|
| Rate for Payer: Priority Health SBD |
$138.98
|
| Rate for Payer: UMR Bronson Commercial |
$97.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.46
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$10.63
|
|
|
Service Code
|
NDC 68084-059-11
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.68 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna American Axle |
$6.91
|
| Rate for Payer: Aetna Commercial |
$9.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.91
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cofinity Commercial |
$7.44
|
| Rate for Payer: Cofinity Commercial |
$9.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.50
|
| Rate for Payer: Healthscope Commercial |
$9.57
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.04
|
| Rate for Payer: PHP Commercial |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.44
|
| Rate for Payer: Priority Health SBD |
$6.70
|
| Rate for Payer: UMR Bronson Commercial |
$4.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.97
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$318.80
|
|
|
Service Code
|
NDC 68084-059-21
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$140.27 |
| Max. Negotiated Rate |
$286.92 |
| Rate for Payer: Aetna American Axle |
$207.22
|
| Rate for Payer: Aetna Commercial |
$270.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$207.22
|
| Rate for Payer: Cash Price |
$255.04
|
| Rate for Payer: Cofinity Commercial |
$223.16
|
| Rate for Payer: Cofinity Commercial |
$274.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.04
|
| Rate for Payer: Healthscope Commercial |
$286.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$223.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$270.98
|
| Rate for Payer: PHP Commercial |
$270.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.16
|
| Rate for Payer: Priority Health SBD |
$200.84
|
| Rate for Payer: UMR Bronson Commercial |
$140.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.10
|
|
|
ZANAMIVIR 5 MG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$200.99
|
|
|
Service Code
|
NDC 0173-0681-22
|
| Hospital Charge Code |
28245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.44 |
| Max. Negotiated Rate |
$180.89 |
| Rate for Payer: Aetna American Axle |
$130.64
|
| Rate for Payer: Aetna Commercial |
$170.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.64
|
| Rate for Payer: Cash Price |
$160.79
|
| Rate for Payer: Cofinity Commercial |
$140.69
|
| Rate for Payer: Cofinity Commercial |
$172.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.79
|
| Rate for Payer: Healthscope Commercial |
$180.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.84
|
| Rate for Payer: PHP Commercial |
$170.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.69
|
| Rate for Payer: Priority Health SBD |
$126.62
|
| Rate for Payer: UMR Bronson Commercial |
$88.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.74
|
|
|
ZANAMIVIR 5 MG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$200.99
|
|
|
Service Code
|
NDC 0173-0681-01
|
| Hospital Charge Code |
28245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.44 |
| Max. Negotiated Rate |
$180.89 |
| Rate for Payer: Aetna American Axle |
$130.64
|
| Rate for Payer: Aetna Commercial |
$170.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.64
|
| Rate for Payer: Cash Price |
$160.79
|
| Rate for Payer: Cofinity Commercial |
$140.69
|
| Rate for Payer: Cofinity Commercial |
$172.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$160.79
|
| Rate for Payer: Healthscope Commercial |
$180.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$140.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$150.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$170.84
|
| Rate for Payer: PHP Commercial |
$170.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.69
|
| Rate for Payer: Priority Health SBD |
$126.62
|
| Rate for Payer: UMR Bronson Commercial |
$88.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.74
|
|
|
ZIDOVUDINE 100 MG CAPSULE
|
Facility
|
IP
|
$676.32
|
|
|
Service Code
|
NDC 65862-107-01
|
| Hospital Charge Code |
11692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$297.58 |
| Max. Negotiated Rate |
$608.69 |
| Rate for Payer: Aetna American Axle |
$439.61
|
| Rate for Payer: Aetna Commercial |
$574.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.61
|
| Rate for Payer: Cash Price |
$541.06
|
| Rate for Payer: Cofinity Commercial |
$473.42
|
| Rate for Payer: Cofinity Commercial |
$581.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$541.06
|
| Rate for Payer: Healthscope Commercial |
$608.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$473.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$507.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$574.87
|
| Rate for Payer: PHP Commercial |
$574.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$473.42
|
| Rate for Payer: Priority Health SBD |
$426.08
|
| Rate for Payer: UMR Bronson Commercial |
$297.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.24
|
|
|
ZIDOVUDINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$126.65
|
|
|
Service Code
|
HCPCS J3485
|
| Hospital Charge Code |
11691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.73 |
| Max. Negotiated Rate |
$113.98 |
| Rate for Payer: Aetna American Axle |
$82.32
|
| Rate for Payer: Aetna Commercial |
$107.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.32
|
| Rate for Payer: Cash Price |
$101.32
|
| Rate for Payer: Cofinity Commercial |
$108.92
|
| Rate for Payer: Cofinity Commercial |
$88.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.32
|
| Rate for Payer: Healthscope Commercial |
$113.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.65
|
| Rate for Payer: PHP Commercial |
$107.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.66
|
| Rate for Payer: Priority Health SBD |
$79.79
|
| Rate for Payer: UMR Bronson Commercial |
$55.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.99
|
|
|
ZIDOVUDINE 10 MG/ML ORAL SYRUP
|
Facility
|
IP
|
$789.60
|
|
|
Service Code
|
NDC 65862-048-24
|
| Hospital Charge Code |
11693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$347.42 |
| Max. Negotiated Rate |
$710.64 |
| Rate for Payer: Aetna American Axle |
$513.24
|
| Rate for Payer: Aetna Commercial |
$671.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.24
|
| Rate for Payer: Cash Price |
$631.68
|
| Rate for Payer: Cofinity Commercial |
$552.72
|
| Rate for Payer: Cofinity Commercial |
$679.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$631.68
|
| Rate for Payer: Healthscope Commercial |
$710.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$552.72
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$592.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$671.16
|
| Rate for Payer: PHP Commercial |
$671.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$552.72
|
| Rate for Payer: Priority Health SBD |
$497.45
|
| Rate for Payer: UMR Bronson Commercial |
$347.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$592.20
|
|
|
ZINC CHLORIDE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.83
|
|
|
Service Code
|
NDC 0409-4090-01
|
| Hospital Charge Code |
8865
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Aetna American Axle |
$12.89
|
| Rate for Payer: Aetna Commercial |
$16.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.89
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cofinity Commercial |
$13.88
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$17.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.86
|
| Rate for Payer: PHP Commercial |
$16.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health SBD |
$12.49
|
| Rate for Payer: UMR Bronson Commercial |
$8.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.87
|
|
|
ZINC CHLORIDE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.83
|
|
|
Service Code
|
NDC 0409-4090-11
|
| Hospital Charge Code |
8865
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.73 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Aetna American Axle |
$12.89
|
| Rate for Payer: Aetna Commercial |
$16.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.89
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cofinity Commercial |
$13.88
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.86
|
| Rate for Payer: Healthscope Commercial |
$17.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$16.86
|
| Rate for Payer: PHP Commercial |
$16.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.88
|
| Rate for Payer: Priority Health SBD |
$12.49
|
| Rate for Payer: UMR Bronson Commercial |
$8.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.87
|
|
|
ZINC OXIDE 20 % TOPICAL OINTMENT
|
Facility
|
IP
|
$10.98
|
|
|
Service Code
|
NDC 0536-1316-28
|
| Hospital Charge Code |
8874
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.83 |
| Max. Negotiated Rate |
$9.88 |
| Rate for Payer: Aetna American Axle |
$7.14
|
| Rate for Payer: Aetna Commercial |
$9.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.14
|
| Rate for Payer: Cash Price |
$8.78
|
| Rate for Payer: Cofinity Commercial |
$7.69
|
| Rate for Payer: Cofinity Commercial |
$9.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.78
|
| Rate for Payer: Healthscope Commercial |
$9.88
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.33
|
| Rate for Payer: PHP Commercial |
$9.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.69
|
| Rate for Payer: Priority Health SBD |
$6.92
|
| Rate for Payer: UMR Bronson Commercial |
$4.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.24
|
|
|
ZINC OXIDE-COD LIVER OIL 40 % TOPICAL PASTE
|
Facility
|
IP
|
$27.29
|
|
|
Service Code
|
NDC 7430000071
|
| Hospital Charge Code |
119503
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$24.56 |
| Rate for Payer: Aetna American Axle |
$17.74
|
| Rate for Payer: Aetna Commercial |
$23.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.74
|
| Rate for Payer: Cash Price |
$21.83
|
| Rate for Payer: Cofinity Commercial |
$19.10
|
| Rate for Payer: Cofinity Commercial |
$23.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$21.83
|
| Rate for Payer: Healthscope Commercial |
$24.56
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$20.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$23.20
|
| Rate for Payer: PHP Commercial |
$23.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.10
|
| Rate for Payer: Priority Health SBD |
$17.19
|
| Rate for Payer: UMR Bronson Commercial |
$12.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$20.47
|
|
