|
ZANAMIVIR 5 MG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$200.99
|
|
|
Service Code
|
NDC 00173068122
|
| 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 Advantage |
$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 Commercial |
$170.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.74
|
| Rate for Payer: PHP Commercial |
$170.84
|
| 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
|
OP
|
$200.99
|
|
|
Service Code
|
NDC 00173068122
|
| Hospital Charge Code |
28245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.37 |
| Max. Negotiated Rate |
$180.89 |
| Rate for Payer: Aetna American Axle |
$130.64
|
| Rate for Payer: Aetna Commercial |
$170.84
|
| Rate for Payer: Aetna Medicare |
$100.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.64
|
| Rate for Payer: BCBS Complete |
$80.40
|
| Rate for Payer: Cash Price |
$160.79
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$160.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$170.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.74
|
| Rate for Payer: PHP Commercial |
$170.84
|
| Rate for Payer: Priority Health SBD |
$126.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$130.64
|
| Rate for Payer: UHC Core |
$104.72
|
| Rate for Payer: UHC Exchange |
$78.99
|
| Rate for Payer: UMR Bronson Commercial |
$74.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.74
|
|
|
ZIDOVUDINE 100 MG CAPSULE
|
Facility
|
OP
|
$676.32
|
|
|
Service Code
|
NDC 65862010701
|
| Hospital Charge Code |
11692
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$250.24 |
| Max. Negotiated Rate |
$608.69 |
| Rate for Payer: Aetna American Axle |
$439.61
|
| Rate for Payer: Aetna Commercial |
$574.87
|
| Rate for Payer: Aetna Medicare |
$338.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$439.61
|
| Rate for Payer: BCBS Complete |
$270.53
|
| Rate for Payer: Cash Price |
$541.06
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$541.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$574.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.24
|
| Rate for Payer: PHP Commercial |
$574.87
|
| Rate for Payer: Priority Health SBD |
$426.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$439.61
|
| Rate for Payer: UHC Core |
$352.36
|
| Rate for Payer: UHC Exchange |
$265.79
|
| Rate for Payer: UMR Bronson Commercial |
$250.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.24
|
|
|
ZIDOVUDINE 100 MG CAPSULE
|
Facility
|
IP
|
$676.32
|
|
|
Service Code
|
NDC 65862010701
|
| 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 Advantage |
$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 Commercial |
$574.87
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$507.24
|
| Rate for Payer: PHP Commercial |
$574.87
|
| 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 Advantage |
$88.66
|
| Rate for Payer: Cofinity Commercial |
$108.92
|
| 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 Commercial |
$107.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.99
|
| Rate for Payer: PHP Commercial |
$107.65
|
| 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 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$126.65
|
|
|
Service Code
|
HCPCS J3485
|
| Hospital Charge Code |
11691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$113.98 |
| Rate for Payer: Aetna American Axle |
$82.32
|
| Rate for Payer: Aetna Commercial |
$107.65
|
| Rate for Payer: Aetna Medicare |
$1.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.89
|
| Rate for Payer: BCBS Complete |
$0.83
|
| Rate for Payer: BCBS MAPPO |
$1.51
|
| Rate for Payer: BCBS Trust/PPO |
$4.90
|
| Rate for Payer: BCN Commercial |
$4.90
|
| Rate for Payer: BCN Medicare Advantage |
$1.51
|
| Rate for Payer: Cash Price |
$101.32
|
| Rate for Payer: Cash Price |
$101.32
|
| Rate for Payer: Cofinity Advantage |
$88.66
|
| Rate for Payer: Cofinity Commercial |
$108.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1.51
|
| 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: Mclaren Medicaid |
$1.51
|
| Rate for Payer: Mclaren Medicare |
$1.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.59
|
| Rate for Payer: Meridian Medicaid |
$1.59
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.65
|
| Rate for Payer: Nomi Health Commercial |
$4.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.99
|
| Rate for Payer: PACE Medicare |
$1.43
|
| Rate for Payer: PACE SWMI |
$1.51
|
| Rate for Payer: PHP Commercial |
$107.65
|
| Rate for Payer: PHP Medicare Advantage |
$1.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.79
|
| Rate for Payer: Priority Health Medicare |
$1.51
|
| Rate for Payer: Priority Health SBD |
$79.79
|
| Rate for Payer: Priority Health Tiered Network |
$3.83
|
| Rate for Payer: Railroad Medicare Medicare |
$1.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.49
|
| Rate for Payer: UHC Core |
$2.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.51
|
| Rate for Payer: UHC Exchange |
$2.49
|
| Rate for Payer: UHC Medicaid |
$0.79
|
| Rate for Payer: UHCCP Medicaid |
$0.79
|
| Rate for Payer: UMR Bronson Commercial |
$46.86
|
| Rate for Payer: VA VA |
$1.51
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.99
|
|
|
ZIDOVUDINE 10 MG/ML ORAL SYRUP
|
Facility
|
OP
|
$789.60
|
|
|
Service Code
|
NDC 65862004824
|
| Hospital Charge Code |
11693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$292.15 |
| Max. Negotiated Rate |
$710.64 |
| Rate for Payer: Aetna American Axle |
$513.24
|
| Rate for Payer: Aetna Commercial |
$671.16
|
| Rate for Payer: Aetna Medicare |
$394.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$513.24
|
| Rate for Payer: BCBS Complete |
$315.84
|
| Rate for Payer: Cash Price |
$631.68
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$631.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$671.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$592.20
|
| Rate for Payer: PHP Commercial |
$671.16
|
| Rate for Payer: Priority Health SBD |
$497.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$513.24
|
| Rate for Payer: UHC Core |
$411.38
|
| Rate for Payer: UHC Exchange |
$310.31
|
| Rate for Payer: UMR Bronson Commercial |
$292.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$592.20
|
|
|
ZIDOVUDINE 10 MG/ML ORAL SYRUP
|
Facility
|
IP
|
$789.60
|
|
|
Service Code
|
NDC 65862004824
|
| 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 Advantage |
$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 Commercial |
$671.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$592.20
|
| Rate for Payer: PHP Commercial |
$671.16
|
| 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 50 MG (ELEMENTAL AS SULFATE) CAPSULE CUSTOM
|
Facility
|
OP
|
$178.20
|
|
|
Service Code
|
NDC 20555004000
|
| Hospital Charge Code |
302057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.93 |
| Max. Negotiated Rate |
$160.38 |
| Rate for Payer: Aetna American Axle |
$115.83
|
| Rate for Payer: Aetna Commercial |
$151.47
|
| Rate for Payer: Aetna Medicare |
$89.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.83
|
| Rate for Payer: BCBS Complete |
$71.28
|
| Rate for Payer: Cash Price |
$142.56
|
| Rate for Payer: Cofinity Advantage |
$124.74
|
| Rate for Payer: Cofinity Commercial |
$153.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.56
|
| Rate for Payer: Healthscope Commercial |
$160.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.65
|
| Rate for Payer: PHP Commercial |
$151.47
|
| Rate for Payer: Priority Health SBD |
$112.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.83
|
| Rate for Payer: UHC Core |
$92.84
|
| Rate for Payer: UHC Exchange |
$70.03
|
| Rate for Payer: UMR Bronson Commercial |
$65.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.65
|
|
|
ZINC 50 MG (ELEMENTAL AS SULFATE) CAPSULE CUSTOM
|
Facility
|
IP
|
$178.20
|
|
|
Service Code
|
NDC 20555004000
|
| Hospital Charge Code |
302057
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$78.41 |
| Max. Negotiated Rate |
$160.38 |
| Rate for Payer: Aetna American Axle |
$115.83
|
| Rate for Payer: Aetna Commercial |
$151.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.83
|
| Rate for Payer: Cash Price |
$142.56
|
| Rate for Payer: Cofinity Advantage |
$124.74
|
| Rate for Payer: Cofinity Commercial |
$153.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.56
|
| Rate for Payer: Healthscope Commercial |
$160.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$124.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.65
|
| Rate for Payer: PHP Commercial |
$151.47
|
| Rate for Payer: Priority Health SBD |
$112.27
|
| Rate for Payer: UMR Bronson Commercial |
$78.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.65
|
|
|
ZINC CHLORIDE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$19.83
|
|
|
Service Code
|
NDC 00409409001
|
| Hospital Charge Code |
8865
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Aetna American Axle |
$12.89
|
| Rate for Payer: Aetna Commercial |
$16.86
|
| Rate for Payer: Aetna Medicare |
$9.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.89
|
| Rate for Payer: BCBS Complete |
$7.93
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$15.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.87
|
| Rate for Payer: PHP Commercial |
$16.86
|
| Rate for Payer: Priority Health SBD |
$12.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.89
|
| Rate for Payer: UHC Core |
$10.33
|
| Rate for Payer: UHC Exchange |
$7.79
|
| Rate for Payer: UMR Bronson Commercial |
$7.34
|
| 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 00409409011
|
| 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 Advantage |
$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 Commercial |
$16.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.87
|
| Rate for Payer: PHP Commercial |
$16.86
|
| 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
|
OP
|
$19.83
|
|
|
Service Code
|
NDC 00409409011
|
| Hospital Charge Code |
8865
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Aetna American Axle |
$12.89
|
| Rate for Payer: Aetna Commercial |
$16.86
|
| Rate for Payer: Aetna Medicare |
$9.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.89
|
| Rate for Payer: BCBS Complete |
$7.93
|
| Rate for Payer: Cash Price |
$15.86
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$15.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.87
|
| Rate for Payer: PHP Commercial |
$16.86
|
| Rate for Payer: Priority Health SBD |
$12.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.89
|
| Rate for Payer: UHC Core |
$10.33
|
| Rate for Payer: UHC Exchange |
$7.79
|
| Rate for Payer: UMR Bronson Commercial |
$7.34
|
| 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 00409409001
|
| 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 Advantage |
$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 Commercial |
$16.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$14.87
|
| Rate for Payer: PHP Commercial |
$16.86
|
| 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
|
$11.52
|
|
|
Service Code
|
NDC 00536131628
|
| Hospital Charge Code |
8874
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$10.37 |
| Rate for Payer: Aetna American Axle |
$7.49
|
| Rate for Payer: Aetna Commercial |
$9.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.49
|
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: Cofinity Advantage |
$8.06
|
| Rate for Payer: Cofinity Commercial |
$9.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.22
|
| Rate for Payer: Healthscope Commercial |
$10.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.64
|
| Rate for Payer: PHP Commercial |
$9.79
|
| Rate for Payer: Priority Health SBD |
$7.26
|
| Rate for Payer: UMR Bronson Commercial |
$5.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.64
|
|
|
ZINC OXIDE 20 % TOPICAL OINTMENT
|
Facility
|
OP
|
$11.52
|
|
|
Service Code
|
NDC 00536131628
|
| Hospital Charge Code |
8874
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$10.37 |
| Rate for Payer: Aetna American Axle |
$7.49
|
| Rate for Payer: Aetna Commercial |
$9.79
|
| Rate for Payer: Aetna Medicare |
$5.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.49
|
| Rate for Payer: BCBS Complete |
$4.61
|
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: Cofinity Advantage |
$8.06
|
| Rate for Payer: Cofinity Commercial |
$9.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$9.22
|
| Rate for Payer: Healthscope Commercial |
$10.37
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$8.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$8.64
|
| Rate for Payer: PHP Commercial |
$9.79
|
| Rate for Payer: Priority Health SBD |
$7.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.49
|
| Rate for Payer: UHC Core |
$6.00
|
| Rate for Payer: UHC Exchange |
$4.53
|
| Rate for Payer: UMR Bronson Commercial |
$4.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.64
|
|
|
ZINC OXIDE-COD LIVER OIL 40 % TOPICAL PASTE
|
Facility
|
OP
|
$28.88
|
|
|
Service Code
|
NDC 74300000071
|
| Hospital Charge Code |
119503
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.69 |
| Max. Negotiated Rate |
$25.99 |
| Rate for Payer: Aetna American Axle |
$18.77
|
| Rate for Payer: Aetna Commercial |
$24.55
|
| Rate for Payer: Aetna Medicare |
$14.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.77
|
| Rate for Payer: BCBS Complete |
$11.55
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cofinity Advantage |
$20.22
|
| Rate for Payer: Cofinity Commercial |
$24.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.10
|
| Rate for Payer: Healthscope Commercial |
$25.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$23.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.66
|
| Rate for Payer: PHP Commercial |
$24.55
|
| Rate for Payer: Priority Health SBD |
$18.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.77
|
| Rate for Payer: UHC Core |
$15.05
|
| Rate for Payer: UHC Exchange |
$11.35
|
| Rate for Payer: UMR Bronson Commercial |
$10.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.66
|
|
|
ZINC OXIDE-COD LIVER OIL 40 % TOPICAL PASTE
|
Facility
|
OP
|
$48.39
|
|
|
Service Code
|
NDC 74300000070
|
| Hospital Charge Code |
119503
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$43.55 |
| Rate for Payer: Aetna American Axle |
$31.45
|
| Rate for Payer: Aetna Commercial |
$41.13
|
| Rate for Payer: Aetna Medicare |
$24.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.45
|
| Rate for Payer: BCBS Complete |
$19.36
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cofinity Advantage |
$33.87
|
| Rate for Payer: Cofinity Commercial |
$41.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.71
|
| Rate for Payer: Healthscope Commercial |
$43.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.29
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.29
|
| Rate for Payer: PHP Commercial |
$41.13
|
| Rate for Payer: Priority Health SBD |
$30.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$31.45
|
| Rate for Payer: UHC Core |
$25.21
|
| Rate for Payer: UHC Exchange |
$19.02
|
| Rate for Payer: UMR Bronson Commercial |
$17.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.29
|
|
|
ZINC OXIDE-COD LIVER OIL 40 % TOPICAL PASTE
|
Facility
|
IP
|
$28.88
|
|
|
Service Code
|
NDC 74300000071
|
| Hospital Charge Code |
119503
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$25.99 |
| Rate for Payer: Aetna American Axle |
$18.77
|
| Rate for Payer: Aetna Commercial |
$24.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.77
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cofinity Advantage |
$20.22
|
| Rate for Payer: Cofinity Commercial |
$24.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$23.10
|
| Rate for Payer: Healthscope Commercial |
$25.99
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$20.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.66
|
| Rate for Payer: PHP Commercial |
$24.55
|
| Rate for Payer: Priority Health SBD |
$18.19
|
| Rate for Payer: UMR Bronson Commercial |
$12.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.66
|
|
|
ZINC OXIDE-COD LIVER OIL 40 % TOPICAL PASTE
|
Facility
|
IP
|
$48.39
|
|
|
Service Code
|
NDC 74300000070
|
| Hospital Charge Code |
119503
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.29 |
| Max. Negotiated Rate |
$43.55 |
| Rate for Payer: Aetna American Axle |
$31.45
|
| Rate for Payer: Aetna Commercial |
$41.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.45
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cofinity Advantage |
$33.87
|
| Rate for Payer: Cofinity Commercial |
$41.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.71
|
| Rate for Payer: Healthscope Commercial |
$43.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.29
|
| Rate for Payer: PHP Commercial |
$41.13
|
| Rate for Payer: Priority Health SBD |
$30.49
|
| Rate for Payer: UMR Bronson Commercial |
$21.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.29
|
|
|
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 |
$36.74 |
| Max. Negotiated Rate |
$75.15 |
| Rate for Payer: Aetna American Axle |
$54.27
|
| Rate for Payer: Aetna Commercial |
$70.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.27
|
| Rate for Payer: Cash Price |
$66.80
|
| Rate for Payer: Cofinity Advantage |
$58.45
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$58.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.62
|
| Rate for Payer: PHP Commercial |
$70.97
|
| Rate for Payer: Priority Health SBD |
$52.60
|
| Rate for Payer: UMR Bronson Commercial |
$36.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.62
|
|
|
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 |
$61.04 |
| Max. Negotiated Rate |
$124.85 |
| Rate for Payer: Aetna American Axle |
$90.17
|
| Rate for Payer: Aetna Commercial |
$117.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.17
|
| Rate for Payer: Cash Price |
$110.98
|
| Rate for Payer: Cofinity Advantage |
$97.10
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$97.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.04
|
| Rate for Payer: PHP Commercial |
$117.91
|
| Rate for Payer: Priority Health SBD |
$87.39
|
| Rate for Payer: UMR Bronson Commercial |
$61.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.04
|
|
|
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 |
$51.33 |
| Max. Negotiated Rate |
$124.85 |
| Rate for Payer: Aetna American Axle |
$90.17
|
| Rate for Payer: Aetna Commercial |
$117.91
|
| Rate for Payer: Aetna Medicare |
$69.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.17
|
| Rate for Payer: BCBS Complete |
$55.49
|
| Rate for Payer: Cash Price |
$110.98
|
| Rate for Payer: Cofinity Advantage |
$97.10
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$97.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$110.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.04
|
| Rate for Payer: PHP Commercial |
$117.91
|
| Rate for Payer: Priority Health SBD |
$87.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.17
|
| Rate for Payer: UHC Core |
$72.27
|
| Rate for Payer: UHC Exchange |
$54.52
|
| Rate for Payer: UMR Bronson Commercial |
$51.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.04
|
|
|
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 |
$30.89 |
| Max. Negotiated Rate |
$75.15 |
| Rate for Payer: Aetna American Axle |
$54.27
|
| Rate for Payer: Aetna Commercial |
$70.97
|
| Rate for Payer: Aetna Medicare |
$41.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.27
|
| Rate for Payer: BCBS Complete |
$33.40
|
| Rate for Payer: Cash Price |
$66.80
|
| Rate for Payer: Cofinity Advantage |
$58.45
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$58.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.62
|
| Rate for Payer: PHP Commercial |
$70.97
|
| Rate for Payer: Priority Health SBD |
$52.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.27
|
| Rate for Payer: UHC Core |
$43.50
|
| Rate for Payer: UHC Exchange |
$32.82
|
| Rate for Payer: UMR Bronson Commercial |
$30.89
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.62
|
|
|
ZINC SULFATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$25.95
|
|
|
Service Code
|
NDC 70710187607
|
| Hospital Charge Code |
8878
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$23.36 |
| Rate for Payer: Aetna American Axle |
$16.87
|
| Rate for Payer: Aetna Commercial |
$22.06
|
| Rate for Payer: Aetna Medicare |
$12.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.87
|
| Rate for Payer: BCBS Complete |
$10.38
|
| Rate for Payer: Cash Price |
$20.76
|
| Rate for Payer: Cofinity Advantage |
$18.16
|
| Rate for Payer: Cofinity Commercial |
$22.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$20.76
|
| Rate for Payer: Healthscope Commercial |
$23.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$18.16
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$19.46
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.46
|
| Rate for Payer: PHP Commercial |
$22.06
|
| Rate for Payer: Priority Health SBD |
$16.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.87
|
| Rate for Payer: UHC Core |
$13.52
|
| Rate for Payer: UHC Exchange |
$10.20
|
| Rate for Payer: UMR Bronson Commercial |
$9.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$19.46
|
|
