|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
OP
|
$178.20
|
|
|
Service Code
|
NDC 20555004000
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$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 SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
IP
|
$178.20
|
|
|
Service Code
|
NDC 20555004000
|
| Hospital Charge Code |
8880
|
|
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
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
|
OP
|
$181.83
|
|
|
Service Code
|
NDC 55111025660
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.28 |
| Max. Negotiated Rate |
$163.65 |
| Rate for Payer: Aetna American Axle |
$118.19
|
| Rate for Payer: Aetna Commercial |
$154.56
|
| Rate for Payer: Aetna Medicare |
$90.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.19
|
| Rate for Payer: BCBS Complete |
$72.73
|
| Rate for Payer: Cash Price |
$145.46
|
| Rate for Payer: Cofinity Advantage |
$127.28
|
| Rate for Payer: Cofinity Commercial |
$156.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.46
|
| Rate for Payer: Healthscope Commercial |
$163.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.37
|
| Rate for Payer: MI Amish Medical Board Commercial |
$145.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.37
|
| Rate for Payer: PHP Commercial |
$154.56
|
| Rate for Payer: Priority Health SBD |
$114.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.19
|
| Rate for Payer: UHC Core |
$94.73
|
| Rate for Payer: UHC Exchange |
$71.46
|
| Rate for Payer: UMR Bronson Commercial |
$67.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.37
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
|
IP
|
$181.83
|
|
|
Service Code
|
NDC 55111025660
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.01 |
| Max. Negotiated Rate |
$163.65 |
| Rate for Payer: Aetna American Axle |
$118.19
|
| Rate for Payer: Aetna Commercial |
$154.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$118.19
|
| Rate for Payer: Cash Price |
$145.46
|
| Rate for Payer: Cofinity Advantage |
$127.28
|
| Rate for Payer: Cofinity Commercial |
$156.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.46
|
| Rate for Payer: Healthscope Commercial |
$163.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$127.28
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.37
|
| Rate for Payer: PHP Commercial |
$154.56
|
| Rate for Payer: Priority Health SBD |
$114.55
|
| Rate for Payer: UMR Bronson Commercial |
$80.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.37
|
|
|
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 Advantage |
$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 |
$44.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.45
|
| Rate for Payer: PHP Commercial |
$50.37
|
| 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 |
$44.45
|
|
|
ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION
|
Facility
|
OP
|
$59.26
|
|
|
Service Code
|
HCPCS J3486
|
| Hospital Charge Code |
33175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$53.33 |
| Rate for Payer: Aetna American Axle |
$38.52
|
| Rate for Payer: Aetna Commercial |
$50.37
|
| Rate for Payer: Aetna Medicare |
$29.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.52
|
| Rate for Payer: BCBS Complete |
$23.70
|
| Rate for Payer: BCBS Trust/PPO |
$29.66
|
| Rate for Payer: BCN Commercial |
$29.66
|
| Rate for Payer: Cash Price |
$47.41
|
| Rate for Payer: Cash Price |
$47.41
|
| Rate for Payer: Cofinity Advantage |
$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 |
$44.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$50.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.45
|
| Rate for Payer: PHP Commercial |
$50.37
|
| Rate for Payer: Priority Health SBD |
$37.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.10
|
| Rate for Payer: UHC Core |
$15.10
|
| Rate for Payer: UHC Exchange |
$15.10
|
| Rate for Payer: UMR Bronson Commercial |
$21.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.45
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
|
OP
|
$190.38
|
|
|
Service Code
|
NDC 55111025760
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.44 |
| Max. Negotiated Rate |
$171.34 |
| Rate for Payer: Aetna American Axle |
$123.75
|
| Rate for Payer: Aetna Commercial |
$161.82
|
| Rate for Payer: Aetna Medicare |
$95.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.75
|
| Rate for Payer: BCBS Complete |
$76.15
|
| Rate for Payer: Cash Price |
$152.30
|
| Rate for Payer: Cofinity Advantage |
$133.27
|
| Rate for Payer: Cofinity Commercial |
$163.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.30
|
| Rate for Payer: Healthscope Commercial |
$171.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.78
|
| Rate for Payer: PHP Commercial |
$161.82
|
| Rate for Payer: Priority Health SBD |
$119.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.75
|
| Rate for Payer: UHC Core |
$99.19
|
| Rate for Payer: UHC Exchange |
$74.82
|
| Rate for Payer: UMR Bronson Commercial |
$70.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.78
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
|
OP
|
$265.05
|
|
|
Service Code
|
NDC 00781216660
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.07 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna American Axle |
$172.28
|
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna Medicare |
$132.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: BCBS Complete |
$106.02
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Advantage |
$185.53
|
| 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 |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.79
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.28
|
| Rate for Payer: UHC Core |
$138.09
|
| Rate for Payer: UHC Exchange |
$104.16
|
| Rate for Payer: UMR Bronson Commercial |
$98.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$198.79
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
|
IP
|
$265.05
|
|
|
Service Code
|
NDC 00781216660
|
| 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 Advantage |
$185.53
|
| 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 |
$185.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$198.79
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.79
|
| Rate for Payer: PHP Commercial |
$225.29
|
| 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
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
|
IP
|
$221.16
|
|
|
Service Code
|
NDC 65862070360
|
| 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 Advantage |
$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 Commercial |
$187.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.87
|
| Rate for Payer: PHP Commercial |
$187.99
|
| 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
|
$204.10
|
|
|
Service Code
|
NDC 00904627008
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$89.80 |
| Max. Negotiated Rate |
$183.69 |
| Rate for Payer: Aetna American Axle |
$132.66
|
| Rate for Payer: Aetna Commercial |
$173.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.66
|
| Rate for Payer: Cash Price |
$163.28
|
| Rate for Payer: Cofinity Advantage |
$142.87
|
| Rate for Payer: Cofinity Commercial |
$175.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.28
|
| Rate for Payer: Healthscope Commercial |
$183.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.07
|
| Rate for Payer: PHP Commercial |
$173.49
|
| Rate for Payer: Priority Health SBD |
$128.58
|
| Rate for Payer: UMR Bronson Commercial |
$89.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.07
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
|
IP
|
$190.38
|
|
|
Service Code
|
NDC 55111025760
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.77 |
| Max. Negotiated Rate |
$171.34 |
| Rate for Payer: Aetna American Axle |
$123.75
|
| Rate for Payer: Aetna Commercial |
$161.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.75
|
| Rate for Payer: Cash Price |
$152.30
|
| Rate for Payer: Cofinity Advantage |
$133.27
|
| Rate for Payer: Cofinity Commercial |
$163.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.30
|
| Rate for Payer: Healthscope Commercial |
$171.34
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.78
|
| Rate for Payer: PHP Commercial |
$161.82
|
| Rate for Payer: Priority Health SBD |
$119.94
|
| Rate for Payer: UMR Bronson Commercial |
$83.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.78
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
|
OP
|
$221.16
|
|
|
Service Code
|
NDC 65862070360
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.83 |
| Max. Negotiated Rate |
$199.04 |
| Rate for Payer: Aetna American Axle |
$143.75
|
| Rate for Payer: Aetna Commercial |
$187.99
|
| Rate for Payer: Aetna Medicare |
$110.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.75
|
| Rate for Payer: BCBS Complete |
$88.46
|
| Rate for Payer: Cash Price |
$176.93
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$176.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.87
|
| Rate for Payer: PHP Commercial |
$187.99
|
| Rate for Payer: Priority Health SBD |
$139.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.75
|
| Rate for Payer: UHC Core |
$115.22
|
| Rate for Payer: UHC Exchange |
$86.92
|
| Rate for Payer: UMR Bronson Commercial |
$81.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.87
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
|
OP
|
$204.10
|
|
|
Service Code
|
NDC 00904627008
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$183.69 |
| Rate for Payer: Aetna American Axle |
$132.66
|
| Rate for Payer: Aetna Commercial |
$173.49
|
| Rate for Payer: Aetna Medicare |
$102.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.66
|
| Rate for Payer: BCBS Complete |
$81.64
|
| Rate for Payer: Cash Price |
$163.28
|
| Rate for Payer: Cofinity Advantage |
$142.87
|
| Rate for Payer: Cofinity Commercial |
$175.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.28
|
| Rate for Payer: Healthscope Commercial |
$183.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$142.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.07
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.07
|
| Rate for Payer: PHP Commercial |
$173.49
|
| Rate for Payer: Priority Health SBD |
$128.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.66
|
| Rate for Payer: UHC Core |
$106.34
|
| Rate for Payer: UHC Exchange |
$80.21
|
| Rate for Payer: UMR Bronson Commercial |
$75.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.07
|
|
|
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 |
$4.50 |
| 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 |
$8.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,669.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$10.76
|
| Rate for Payer: Amish Plain Church Group Commercial |
$10.76
|
| Rate for Payer: BCBS Complete |
$4.73
|
| Rate for Payer: BCBS MAPPO |
$8.61
|
| Rate for Payer: BCBS Trust/PPO |
$23.42
|
| Rate for Payer: BCN Commercial |
$23.42
|
| Rate for Payer: BCN Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$5,747.20
|
| Rate for Payer: Cash Price |
$5,747.20
|
| Rate for Payer: Cofinity Advantage |
$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 |
$8.61
|
| 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 |
$8.61
|
| Rate for Payer: Mclaren Medicare |
$8.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.04
|
| Rate for Payer: Meridian Medicaid |
$9.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$9.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,106.40
|
| Rate for Payer: Nomi Health Commercial |
$25.83
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,388.00
|
| Rate for Payer: PACE Medicare |
$8.18
|
| Rate for Payer: PACE SWMI |
$8.61
|
| Rate for Payer: PHP Commercial |
$6,106.40
|
| Rate for Payer: PHP Medicare Advantage |
$8.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.85
|
| Rate for Payer: Priority Health Medicare |
$8.61
|
| Rate for Payer: Priority Health SBD |
$4,525.92
|
| Rate for Payer: Priority Health Tiered Network |
$19.88
|
| Rate for Payer: Railroad Medicare Medicare |
$8.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.91
|
| Rate for Payer: UHC Core |
$11.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$8.61
|
| Rate for Payer: UHC Exchange |
$11.91
|
| Rate for Payer: UHC Medicaid |
$4.50
|
| Rate for Payer: UHCCP Medicaid |
$4.50
|
| Rate for Payer: UMR Bronson Commercial |
$2,658.08
|
| Rate for Payer: VA VA |
$8.61
|
| 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 Advantage |
$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 Commercial |
$6,106.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,388.00
|
| Rate for Payer: PHP Commercial |
$6,106.40
|
| 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
|
|
|
ZOLBETUXIMAB-CLZB 300 MG INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$21,552.00
|
|
|
Service Code
|
HCPCS J1326
|
| Hospital Charge Code |
211138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$19,396.80 |
| Rate for Payer: Aetna American Axle |
$14,008.80
|
| Rate for Payer: Aetna Commercial |
$18,319.20
|
| Rate for Payer: Aetna Medicare |
$35.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,008.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$42.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$42.06
|
| Rate for Payer: BCBS Complete |
$18.48
|
| Rate for Payer: BCBS MAPPO |
$33.65
|
| Rate for Payer: BCBS Trust/PPO |
$109.16
|
| Rate for Payer: BCN Commercial |
$109.16
|
| Rate for Payer: BCN Medicare Advantage |
$33.65
|
| Rate for Payer: Cash Price |
$17,241.60
|
| Rate for Payer: Cash Price |
$17,241.60
|
| Rate for Payer: Cofinity Advantage |
$15,086.40
|
| Rate for Payer: Cofinity Commercial |
$18,534.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,241.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.65
|
| Rate for Payer: Healthscope Commercial |
$19,396.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,086.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,164.00
|
| Rate for Payer: Mclaren Medicaid |
$33.65
|
| Rate for Payer: Mclaren Medicare |
$33.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.33
|
| Rate for Payer: Meridian Medicaid |
$35.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$38.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$37.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,319.20
|
| Rate for Payer: Nomi Health Commercial |
$100.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16,164.00
|
| Rate for Payer: PACE Medicare |
$31.97
|
| Rate for Payer: PACE SWMI |
$33.65
|
| Rate for Payer: PHP Commercial |
$18,319.20
|
| Rate for Payer: PHP Medicare Advantage |
$33.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$106.30
|
| Rate for Payer: Priority Health Medicare |
$33.65
|
| Rate for Payer: Priority Health SBD |
$13,577.76
|
| Rate for Payer: Priority Health Tiered Network |
$85.04
|
| Rate for Payer: Railroad Medicare Medicare |
$33.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.56
|
| Rate for Payer: UHC Core |
$55.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$33.65
|
| Rate for Payer: UHC Exchange |
$55.56
|
| Rate for Payer: UHC Medicaid |
$17.60
|
| Rate for Payer: UHCCP Medicaid |
$17.60
|
| Rate for Payer: UMR Bronson Commercial |
$7,974.24
|
| Rate for Payer: VA VA |
$33.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,164.00
|
|
|
ZOLBETUXIMAB-CLZB 300 MG INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$21,552.00
|
|
|
Service Code
|
HCPCS J1326
|
| Hospital Charge Code |
211138
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9,482.88 |
| Max. Negotiated Rate |
$19,396.80 |
| Rate for Payer: Aetna American Axle |
$14,008.80
|
| Rate for Payer: Aetna Commercial |
$18,319.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,008.80
|
| Rate for Payer: Cash Price |
$17,241.60
|
| Rate for Payer: Cofinity Advantage |
$15,086.40
|
| Rate for Payer: Cofinity Commercial |
$18,534.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,241.60
|
| Rate for Payer: Healthscope Commercial |
$19,396.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15,086.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16,164.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,319.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$16,164.00
|
| Rate for Payer: PHP Commercial |
$18,319.20
|
| Rate for Payer: Priority Health SBD |
$13,577.76
|
| Rate for Payer: UMR Bronson Commercial |
$9,482.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16,164.00
|
|
|
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 |
$8.38 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna American Axle |
$67.11
|
| Rate for Payer: Aetna Commercial |
$87.75
|
| Rate for Payer: Aetna Medicare |
$51.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.11
|
| Rate for Payer: BCBS Complete |
$41.30
|
| Rate for Payer: BCBS Trust/PPO |
$16.45
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: Cash Price |
$82.59
|
| Rate for Payer: Cash Price |
$82.59
|
| Rate for Payer: Cofinity Advantage |
$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: MI Amish Medical Board Commercial |
$82.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.43
|
| Rate for Payer: PHP Commercial |
$87.75
|
| Rate for Payer: Priority Health SBD |
$65.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UMR Bronson Commercial |
$38.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.43
|
|
|
ZOLEDRONIC ACID 4 MG/100 ML-MANNITOL-0.9 % NACL INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$103.24
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
167580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.43 |
| 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: Cash Price |
$82.59
|
| Rate for Payer: Cofinity Advantage |
$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 Commercial |
$87.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.43
|
| Rate for Payer: PHP Commercial |
$87.75
|
| Rate for Payer: Priority Health SBD |
$65.04
|
| Rate for Payer: UMR Bronson Commercial |
$45.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.43
|
|
|
ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$375.97
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
35640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$338.37 |
| Rate for Payer: Aetna American Axle |
$244.38
|
| Rate for Payer: Aetna American Axle |
$216.87
|
| Rate for Payer: Aetna American Axle |
$166.24
|
| Rate for Payer: Aetna American Axle |
$169.32
|
| Rate for Payer: Aetna American Axle |
$170.06
|
| Rate for Payer: Aetna American Axle |
$75.69
|
| Rate for Payer: Aetna American Axle |
$88.08
|
| Rate for Payer: Aetna American Axle |
$307.54
|
| Rate for Payer: Aetna Commercial |
$217.39
|
| Rate for Payer: Aetna Commercial |
$98.97
|
| Rate for Payer: Aetna Commercial |
$222.39
|
| Rate for Payer: Aetna Commercial |
$221.43
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna Commercial |
$319.57
|
| Rate for Payer: Aetna Commercial |
$402.17
|
| Rate for Payer: Aetna Commercial |
$115.18
|
| Rate for Payer: Aetna Medicare |
$127.88
|
| Rate for Payer: Aetna Medicare |
$67.75
|
| Rate for Payer: Aetna Medicare |
$187.99
|
| Rate for Payer: Aetna Medicare |
$58.22
|
| Rate for Payer: Aetna Medicare |
$130.81
|
| Rate for Payer: Aetna Medicare |
$130.25
|
| Rate for Payer: Aetna Medicare |
$236.57
|
| Rate for Payer: Aetna Medicare |
$166.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.06
|
| Rate for Payer: BCBS Complete |
$189.26
|
| Rate for Payer: BCBS Complete |
$133.46
|
| Rate for Payer: BCBS Complete |
$104.20
|
| Rate for Payer: BCBS Complete |
$46.58
|
| Rate for Payer: BCBS Complete |
$102.30
|
| Rate for Payer: BCBS Complete |
$54.20
|
| Rate for Payer: BCBS Complete |
$150.39
|
| Rate for Payer: BCBS Complete |
$104.65
|
| Rate for Payer: BCBS Trust/PPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$16.45
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: Cash Price |
$108.41
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$108.41
|
| Rate for Payer: Cash Price |
$208.40
|
| Rate for Payer: Cash Price |
$208.40
|
| Rate for Payer: Cash Price |
$209.30
|
| Rate for Payer: Cash Price |
$209.30
|
| 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 |
$300.78
|
| Rate for Payer: Cash Price |
$378.51
|
| Rate for Payer: Cash Price |
$378.51
|
| Rate for Payer: Cofinity Advantage |
$233.55
|
| Rate for Payer: Cofinity Advantage |
$331.20
|
| Rate for Payer: Cofinity Advantage |
$179.03
|
| Rate for Payer: Cofinity Advantage |
$183.14
|
| Rate for Payer: Cofinity Advantage |
$263.18
|
| Rate for Payer: Cofinity Advantage |
$182.35
|
| Rate for Payer: Cofinity Advantage |
$81.51
|
| Rate for Payer: Cofinity Advantage |
$94.86
|
| Rate for Payer: Cofinity Commercial |
$224.03
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Cofinity Commercial |
$406.90
|
| Rate for Payer: Cofinity Commercial |
$100.14
|
| Rate for Payer: Cofinity Commercial |
$116.54
|
| Rate for Payer: Cofinity Commercial |
$219.94
|
| Rate for Payer: Cofinity Commercial |
$323.33
|
| Rate for Payer: Cofinity Commercial |
$225.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.78
|
| Rate for Payer: Healthscope Commercial |
$104.80
|
| Rate for Payer: Healthscope Commercial |
$425.83
|
| Rate for Payer: Healthscope Commercial |
$230.18
|
| Rate for Payer: Healthscope Commercial |
$234.45
|
| Rate for Payer: Healthscope Commercial |
$338.37
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Healthscope Commercial |
$121.96
|
| Rate for Payer: Healthscope Commercial |
$235.47
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.35
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.33
|
| Rate for Payer: MI Amish Medical Board Commercial |
$209.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$208.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$300.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$108.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$378.51
|
| Rate for Payer: MI Amish Medical Board Commercial |
$204.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$266.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$196.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$354.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.81
|
| Rate for Payer: PHP Commercial |
$98.97
|
| Rate for Payer: PHP Commercial |
$221.43
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: PHP Commercial |
$217.39
|
| Rate for Payer: PHP Commercial |
$402.17
|
| Rate for Payer: PHP Commercial |
$319.57
|
| Rate for Payer: PHP Commercial |
$222.39
|
| Rate for Payer: PHP Commercial |
$115.18
|
| Rate for Payer: Priority Health SBD |
$85.37
|
| Rate for Payer: Priority Health SBD |
$298.08
|
| Rate for Payer: Priority Health SBD |
$73.36
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: Priority Health SBD |
$236.86
|
| Rate for Payer: Priority Health SBD |
$161.12
|
| Rate for Payer: Priority Health SBD |
$164.12
|
| Rate for Payer: Priority Health SBD |
$164.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UMR Bronson Commercial |
$139.11
|
| Rate for Payer: UMR Bronson Commercial |
$175.06
|
| Rate for Payer: UMR Bronson Commercial |
$96.80
|
| Rate for Payer: UMR Bronson Commercial |
$94.63
|
| Rate for Payer: UMR Bronson Commercial |
$123.45
|
| Rate for Payer: UMR Bronson Commercial |
$43.08
|
| Rate for Payer: UMR Bronson Commercial |
$50.14
|
| Rate for Payer: UMR Bronson Commercial |
$96.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.98
|
|
|
ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$260.50
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
35640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.62 |
| Max. Negotiated Rate |
$234.45 |
| Rate for Payer: Aetna American Axle |
$169.32
|
| Rate for Payer: Aetna American Axle |
$166.24
|
| Rate for Payer: Aetna American Axle |
$216.87
|
| Rate for Payer: Aetna American Axle |
$88.08
|
| Rate for Payer: Aetna American Axle |
$75.69
|
| Rate for Payer: Aetna Commercial |
$98.97
|
| Rate for Payer: Aetna Commercial |
$217.39
|
| Rate for Payer: Aetna Commercial |
$221.43
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna Commercial |
$115.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.08
|
| 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 |
$204.60
|
| Rate for Payer: Cash Price |
$108.41
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$208.40
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cofinity Advantage |
$81.51
|
| Rate for Payer: Cofinity Advantage |
$233.55
|
| Rate for Payer: Cofinity Advantage |
$94.86
|
| Rate for Payer: Cofinity Advantage |
$182.35
|
| Rate for Payer: Cofinity Advantage |
$179.03
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Cofinity Commercial |
$100.14
|
| Rate for Payer: Cofinity Commercial |
$116.54
|
| Rate for Payer: Cofinity Commercial |
$219.94
|
| Rate for Payer: Cofinity Commercial |
$224.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$208.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Healthscope Commercial |
$104.80
|
| Rate for Payer: Healthscope Commercial |
$121.96
|
| Rate for Payer: Healthscope Commercial |
$230.18
|
| Rate for Payer: Healthscope Commercial |
$234.45
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$182.35
|
| 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 |
$191.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$195.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$221.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.59
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$195.38
|
| Rate for Payer: PHP Commercial |
$217.39
|
| Rate for Payer: PHP Commercial |
$98.97
|
| Rate for Payer: PHP Commercial |
$221.43
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: PHP Commercial |
$115.18
|
| Rate for Payer: Priority Health SBD |
$164.12
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: Priority Health SBD |
$85.37
|
| Rate for Payer: Priority Health SBD |
$73.36
|
| Rate for Payer: Priority Health SBD |
$161.12
|
| Rate for Payer: UMR Bronson Commercial |
$59.62
|
| Rate for Payer: UMR Bronson Commercial |
$146.80
|
| Rate for Payer: UMR Bronson Commercial |
$112.53
|
| Rate for Payer: UMR Bronson Commercial |
$51.23
|
| Rate for Payer: UMR Bronson Commercial |
$114.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$195.38
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.63
|
|
|
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 |
$3,030.72
|
| Rate for Payer: Aetna Commercial |
$137.65
|
| Rate for Payer: Aetna Commercial |
$3,963.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,030.72
|
| Rate for Payer: Cash Price |
$129.55
|
| Rate for Payer: Cash Price |
$3,730.12
|
| Rate for Payer: Cofinity Advantage |
$3,263.86
|
| Rate for Payer: Cofinity Advantage |
$113.36
|
| Rate for Payer: Cofinity Commercial |
$4,009.88
|
| Rate for Payer: Cofinity Commercial |
$139.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,730.12
|
| Rate for Payer: Healthscope Commercial |
$145.75
|
| Rate for Payer: Healthscope Commercial |
$4,196.39
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,263.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.36
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,496.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,963.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,496.99
|
| Rate for Payer: PHP Commercial |
$137.65
|
| Rate for Payer: PHP Commercial |
$3,963.25
|
| Rate for Payer: Priority Health SBD |
$2,937.47
|
| Rate for Payer: Priority Health SBD |
$102.02
|
| Rate for Payer: UMR Bronson Commercial |
$71.25
|
| Rate for Payer: UMR Bronson Commercial |
$2,051.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,496.99
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK
|
Facility
|
OP
|
$395.80
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
81434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$356.22 |
| Rate for Payer: Aetna American Axle |
$257.27
|
| Rate for Payer: Aetna American Axle |
$251.69
|
| Rate for Payer: Aetna American Axle |
$142.96
|
| Rate for Payer: Aetna American Axle |
$182.47
|
| Rate for Payer: Aetna American Axle |
$237.06
|
| Rate for Payer: Aetna American Axle |
$692.08
|
| Rate for Payer: Aetna American Axle |
$105.26
|
| Rate for Payer: Aetna American Axle |
$3,030.72
|
| Rate for Payer: Aetna Commercial |
$186.95
|
| Rate for Payer: Aetna Commercial |
$905.03
|
| Rate for Payer: Aetna Commercial |
$310.00
|
| Rate for Payer: Aetna Commercial |
$238.61
|
| Rate for Payer: Aetna Commercial |
$329.14
|
| Rate for Payer: Aetna Commercial |
$336.43
|
| Rate for Payer: Aetna Commercial |
$3,963.25
|
| Rate for Payer: Aetna Commercial |
$137.65
|
| Rate for Payer: Aetna Medicare |
$109.97
|
| Rate for Payer: Aetna Medicare |
$80.97
|
| Rate for Payer: Aetna Medicare |
$197.90
|
| Rate for Payer: Aetna Medicare |
$532.37
|
| Rate for Payer: Aetna Medicare |
$182.35
|
| Rate for Payer: Aetna Medicare |
$140.36
|
| Rate for Payer: Aetna Medicare |
$2,331.32
|
| Rate for Payer: Aetna Medicare |
$193.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$692.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,030.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.06
|
| Rate for Payer: BCBS Complete |
$1,865.06
|
| Rate for Payer: BCBS Complete |
$154.89
|
| Rate for Payer: BCBS Complete |
$112.29
|
| Rate for Payer: BCBS Complete |
$425.90
|
| Rate for Payer: BCBS Complete |
$87.98
|
| Rate for Payer: BCBS Complete |
$64.78
|
| Rate for Payer: BCBS Complete |
$158.32
|
| Rate for Payer: BCBS Complete |
$145.88
|
| Rate for Payer: BCBS Trust/PPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$16.45
|
| Rate for Payer: BCBS Trust/PPO |
$16.45
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: BCN Commercial |
$16.45
|
| Rate for Payer: Cash Price |
$129.55
|
| Rate for Payer: Cash Price |
$851.79
|
| Rate for Payer: Cash Price |
$851.79
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$129.55
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Cash Price |
$291.77
|
| Rate for Payer: Cash Price |
$291.77
|
| Rate for Payer: Cash Price |
$309.78
|
| Rate for Payer: Cash Price |
$309.78
|
| Rate for Payer: Cash Price |
$316.64
|
| Rate for Payer: Cash Price |
$316.64
|
| Rate for Payer: Cash Price |
$3,730.12
|
| Rate for Payer: Cash Price |
$3,730.12
|
| Rate for Payer: Cofinity Advantage |
$271.05
|
| Rate for Payer: Cofinity Advantage |
$3,263.86
|
| Rate for Payer: Cofinity Advantage |
$153.96
|
| Rate for Payer: Cofinity Advantage |
$255.30
|
| Rate for Payer: Cofinity Advantage |
$277.06
|
| Rate for Payer: Cofinity Advantage |
$196.50
|
| Rate for Payer: Cofinity Advantage |
$745.32
|
| Rate for Payer: Cofinity Advantage |
$113.36
|
| Rate for Payer: Cofinity Commercial |
$241.42
|
| Rate for Payer: Cofinity Commercial |
$333.01
|
| Rate for Payer: Cofinity Commercial |
$4,009.88
|
| Rate for Payer: Cofinity Commercial |
$915.68
|
| Rate for Payer: Cofinity Commercial |
$139.27
|
| Rate for Payer: Cofinity Commercial |
$189.15
|
| Rate for Payer: Cofinity Commercial |
$340.39
|
| Rate for Payer: Cofinity Commercial |
$313.65
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,730.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$851.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$316.64
|
| Rate for Payer: Healthscope Commercial |
$958.27
|
| Rate for Payer: Healthscope Commercial |
$4,196.39
|
| Rate for Payer: Healthscope Commercial |
$197.95
|
| Rate for Payer: Healthscope Commercial |
$252.65
|
| Rate for Payer: Healthscope Commercial |
$356.22
|
| Rate for Payer: Healthscope Commercial |
$348.50
|
| Rate for Payer: Healthscope Commercial |
$145.75
|
| Rate for Payer: Healthscope Commercial |
$328.24
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$277.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,263.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$745.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$255.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$296.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$273.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,496.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$798.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$291.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$224.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$851.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$316.64
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,730.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$309.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$336.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$905.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,963.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$798.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,496.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$296.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.96
|
| Rate for Payer: PHP Commercial |
$905.03
|
| Rate for Payer: PHP Commercial |
$238.61
|
| Rate for Payer: PHP Commercial |
$329.14
|
| Rate for Payer: PHP Commercial |
$186.95
|
| Rate for Payer: PHP Commercial |
$3,963.25
|
| Rate for Payer: PHP Commercial |
$336.43
|
| Rate for Payer: PHP Commercial |
$310.00
|
| Rate for Payer: PHP Commercial |
$137.65
|
| Rate for Payer: Priority Health SBD |
$102.02
|
| Rate for Payer: Priority Health SBD |
$2,937.47
|
| Rate for Payer: Priority Health SBD |
$670.79
|
| Rate for Payer: Priority Health SBD |
$243.95
|
| Rate for Payer: Priority Health SBD |
$249.35
|
| Rate for Payer: Priority Health SBD |
$138.56
|
| Rate for Payer: Priority Health SBD |
$176.85
|
| Rate for Payer: Priority Health SBD |
$229.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UMR Bronson Commercial |
$146.45
|
| Rate for Payer: UMR Bronson Commercial |
$1,725.18
|
| Rate for Payer: UMR Bronson Commercial |
$134.94
|
| Rate for Payer: UMR Bronson Commercial |
$81.38
|
| Rate for Payer: UMR Bronson Commercial |
$143.27
|
| Rate for Payer: UMR Bronson Commercial |
$393.95
|
| Rate for Payer: UMR Bronson Commercial |
$59.92
|
| Rate for Payer: UMR Bronson Commercial |
$103.87
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,496.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$798.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$273.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$296.85
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$1.35
|
|
|
Service Code
|
NDC 51079072401
|
| 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 Advantage |
$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 Commercial |
$1.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.01
|
| Rate for Payer: PHP Commercial |
$1.15
|
| 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
|
|
