|
WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM
|
Facility
|
IP
|
$20.50
|
|
|
Service Code
|
NDC 61924017407
|
| Hospital Charge Code |
11371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$18.45 |
| Rate for Payer: Aetna American Axle |
$13.32
|
| Rate for Payer: Aetna Commercial |
$17.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.32
|
| Rate for Payer: Cash Price |
$16.40
|
| Rate for Payer: Cofinity Commercial |
$14.35
|
| Rate for Payer: Cofinity Commercial |
$17.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.40
|
| Rate for Payer: Healthscope Commercial |
$18.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.43
|
| Rate for Payer: PHP Commercial |
$17.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.32
|
| Rate for Payer: Priority Health SBD |
$12.91
|
| Rate for Payer: UMR Bronson Commercial |
$9.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.38
|
|
|
WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM
|
Facility
|
OP
|
$20.50
|
|
|
Service Code
|
NDC 61924017407
|
| Hospital Charge Code |
11371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.58 |
| Max. Negotiated Rate |
$18.45 |
| Rate for Payer: Aetna American Axle |
$13.32
|
| Rate for Payer: Aetna Commercial |
$17.43
|
| Rate for Payer: Aetna Medicare |
$10.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.32
|
| Rate for Payer: BCBS Complete |
$8.20
|
| Rate for Payer: Cash Price |
$16.40
|
| Rate for Payer: Cofinity Commercial |
$14.35
|
| Rate for Payer: Cofinity Commercial |
$17.63
|
| Rate for Payer: Cofinity Medicare Advantage |
$14.35
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$16.40
|
| Rate for Payer: Healthscope Commercial |
$18.45
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$14.35
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$15.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.43
|
| Rate for Payer: PHP Commercial |
$17.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.32
|
| Rate for Payer: Priority Health SBD |
$12.91
|
| Rate for Payer: UMR Bronson Commercial |
$7.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.38
|
|
|
WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM
|
Facility
|
IP
|
$12.88
|
|
|
Service Code
|
NDC 61924017804
|
| Hospital Charge Code |
11371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$11.59 |
| Rate for Payer: Aetna American Axle |
$8.37
|
| Rate for Payer: Aetna Commercial |
$10.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.37
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cofinity Commercial |
$11.08
|
| Rate for Payer: Cofinity Commercial |
$9.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.30
|
| Rate for Payer: Healthscope Commercial |
$11.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.95
|
| Rate for Payer: PHP Commercial |
$10.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.37
|
| Rate for Payer: Priority Health SBD |
$8.11
|
| Rate for Payer: UMR Bronson Commercial |
$5.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.66
|
|
|
WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM
|
Facility
|
OP
|
$12.88
|
|
|
Service Code
|
NDC 61924017804
|
| Hospital Charge Code |
11371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.77 |
| Max. Negotiated Rate |
$11.59 |
| Rate for Payer: Aetna American Axle |
$8.37
|
| Rate for Payer: Aetna Commercial |
$10.95
|
| Rate for Payer: Aetna Medicare |
$6.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.37
|
| Rate for Payer: BCBS Complete |
$5.15
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cofinity Commercial |
$11.08
|
| Rate for Payer: Cofinity Commercial |
$9.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.30
|
| Rate for Payer: Healthscope Commercial |
$11.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.02
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10.95
|
| Rate for Payer: PHP Commercial |
$10.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.37
|
| Rate for Payer: Priority Health SBD |
$8.11
|
| Rate for Payer: UMR Bronson Commercial |
$4.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.66
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
OP
|
$329.19
|
|
|
Service Code
|
NDC 31722000860
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$121.80 |
| Max. Negotiated Rate |
$296.27 |
| Rate for Payer: Aetna American Axle |
$213.97
|
| Rate for Payer: Aetna Commercial |
$279.81
|
| Rate for Payer: Aetna Medicare |
$164.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.97
|
| Rate for Payer: BCBS Complete |
$131.68
|
| Rate for Payer: Cash Price |
$263.35
|
| Rate for Payer: Cofinity Commercial |
$230.43
|
| Rate for Payer: Cofinity Commercial |
$283.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.35
|
| Rate for Payer: Healthscope Commercial |
$296.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.81
|
| Rate for Payer: PHP Commercial |
$279.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.97
|
| Rate for Payer: Priority Health SBD |
$207.39
|
| Rate for Payer: UMR Bronson Commercial |
$121.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.89
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$296.26
|
|
|
Service Code
|
NDC 68084005921
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$130.35 |
| Max. Negotiated Rate |
$266.63 |
| Rate for Payer: Aetna American Axle |
$192.57
|
| Rate for Payer: Aetna Commercial |
$251.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.57
|
| Rate for Payer: Cash Price |
$237.01
|
| Rate for Payer: Cofinity Commercial |
$207.38
|
| Rate for Payer: Cofinity Commercial |
$254.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.01
|
| Rate for Payer: Healthscope Commercial |
$266.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.82
|
| Rate for Payer: PHP Commercial |
$251.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.57
|
| Rate for Payer: Priority Health SBD |
$186.64
|
| Rate for Payer: UMR Bronson Commercial |
$130.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.19
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
OP
|
$9.88
|
|
|
Service Code
|
NDC 68084005911
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: Aetna American Axle |
$6.42
|
| Rate for Payer: Aetna Commercial |
$8.40
|
| Rate for Payer: Aetna Medicare |
$4.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.42
|
| Rate for Payer: BCBS Complete |
$3.95
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cofinity Commercial |
$6.92
|
| Rate for Payer: Cofinity Commercial |
$8.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.90
|
| Rate for Payer: Healthscope Commercial |
$8.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.40
|
| Rate for Payer: PHP Commercial |
$8.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.42
|
| Rate for Payer: Priority Health SBD |
$6.22
|
| Rate for Payer: UMR Bronson Commercial |
$3.66
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.41
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$329.19
|
|
|
Service Code
|
NDC 31722000860
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$144.84 |
| Max. Negotiated Rate |
$296.27 |
| Rate for Payer: Aetna American Axle |
$213.97
|
| Rate for Payer: Aetna Commercial |
$279.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.97
|
| Rate for Payer: Cash Price |
$263.35
|
| Rate for Payer: Cofinity Commercial |
$230.43
|
| Rate for Payer: Cofinity Commercial |
$283.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$230.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.35
|
| Rate for Payer: Healthscope Commercial |
$296.27
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$230.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$246.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.81
|
| Rate for Payer: PHP Commercial |
$279.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.97
|
| Rate for Payer: Priority Health SBD |
$207.39
|
| Rate for Payer: UMR Bronson Commercial |
$144.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$246.89
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
OP
|
$493.06
|
|
|
Service Code
|
NDC 55111062660
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$182.43 |
| Max. Negotiated Rate |
$443.75 |
| Rate for Payer: Aetna American Axle |
$320.49
|
| Rate for Payer: Aetna Commercial |
$419.10
|
| Rate for Payer: Aetna Medicare |
$246.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.49
|
| Rate for Payer: BCBS Complete |
$197.22
|
| Rate for Payer: Cash Price |
$394.45
|
| Rate for Payer: Cofinity Commercial |
$345.14
|
| Rate for Payer: Cofinity Commercial |
$424.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$345.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.45
|
| Rate for Payer: Healthscope Commercial |
$443.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$345.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.10
|
| Rate for Payer: PHP Commercial |
$419.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.49
|
| Rate for Payer: Priority Health SBD |
$310.63
|
| Rate for Payer: UMR Bronson Commercial |
$182.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.80
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$493.06
|
|
|
Service Code
|
NDC 55111062660
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$216.95 |
| Max. Negotiated Rate |
$443.75 |
| Rate for Payer: Aetna American Axle |
$320.49
|
| Rate for Payer: Aetna Commercial |
$419.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$320.49
|
| Rate for Payer: Cash Price |
$394.45
|
| Rate for Payer: Cofinity Commercial |
$345.14
|
| Rate for Payer: Cofinity Commercial |
$424.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$345.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.45
|
| Rate for Payer: Healthscope Commercial |
$443.75
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$345.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$419.10
|
| Rate for Payer: PHP Commercial |
$419.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.49
|
| Rate for Payer: Priority Health SBD |
$310.63
|
| Rate for Payer: UMR Bronson Commercial |
$216.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.80
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
OP
|
$296.26
|
|
|
Service Code
|
NDC 68084005921
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.62 |
| Max. Negotiated Rate |
$266.63 |
| Rate for Payer: Aetna American Axle |
$192.57
|
| Rate for Payer: Aetna Commercial |
$251.82
|
| Rate for Payer: Aetna Medicare |
$148.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.57
|
| Rate for Payer: BCBS Complete |
$118.50
|
| Rate for Payer: Cash Price |
$237.01
|
| Rate for Payer: Cofinity Commercial |
$207.38
|
| Rate for Payer: Cofinity Commercial |
$254.78
|
| Rate for Payer: Cofinity Medicare Advantage |
$207.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.01
|
| Rate for Payer: Healthscope Commercial |
$266.63
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$207.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$222.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.82
|
| Rate for Payer: PHP Commercial |
$251.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.57
|
| Rate for Payer: Priority Health SBD |
$186.64
|
| Rate for Payer: UMR Bronson Commercial |
$109.62
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$222.19
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$9.88
|
|
|
Service Code
|
NDC 68084005911
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: Aetna American Axle |
$6.42
|
| Rate for Payer: Aetna Commercial |
$8.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.42
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cofinity Commercial |
$6.92
|
| Rate for Payer: Cofinity Commercial |
$8.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$6.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.90
|
| Rate for Payer: Healthscope Commercial |
$8.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$6.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.40
|
| Rate for Payer: PHP Commercial |
$8.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.42
|
| Rate for Payer: Priority Health SBD |
$6.22
|
| Rate for Payer: UMR Bronson Commercial |
$4.35
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.41
|
|
|
ZANAMIVIR 5 MG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$200.99
|
|
|
Service Code
|
NDC 00173068101
|
| Hospital Charge Code |
28245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$88.44 |
| Max. Negotiated Rate |
$180.89 |
| Rate for Payer: Aetna American Axle |
$130.64
|
| Rate for Payer: Aetna Commercial |
$170.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.64
|
| Rate for Payer: Cash Price |
$160.79
|
| Rate for Payer: Cofinity Commercial |
$140.69
|
| Rate for Payer: Cofinity Commercial |
$172.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.69
|
| 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: PHP Commercial |
$170.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.64
|
| 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 Commercial |
$140.69
|
| Rate for Payer: Cofinity Commercial |
$172.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.69
|
| 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: PHP Commercial |
$170.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.64
|
| Rate for Payer: Priority Health SBD |
$126.62
|
| Rate for Payer: UMR Bronson Commercial |
$74.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.74
|
|
|
ZANAMIVIR 5 MG/ACTUATION BLISTER POWDER FOR INHALATION
|
Facility
|
IP
|
$200.99
|
|
|
Service Code
|
NDC 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 Commercial |
$140.69
|
| Rate for Payer: Cofinity Commercial |
$172.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.69
|
| 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: PHP Commercial |
$170.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.64
|
| 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 00173068101
|
| 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 Commercial |
$140.69
|
| Rate for Payer: Cofinity Commercial |
$172.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$140.69
|
| 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: PHP Commercial |
$170.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.64
|
| Rate for Payer: Priority Health SBD |
$126.62
|
| Rate for Payer: UMR Bronson Commercial |
$74.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$150.74
|
|
|
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 Commercial |
$473.42
|
| Rate for Payer: Cofinity Commercial |
$581.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$473.42
|
| 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: PHP Commercial |
$574.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$439.61
|
| 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 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 Commercial |
$473.42
|
| Rate for Payer: Cofinity Commercial |
$581.64
|
| Rate for Payer: Cofinity Medicare Advantage |
$473.42
|
| 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: PHP Commercial |
$574.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$439.61
|
| Rate for Payer: Priority Health SBD |
$426.08
|
| Rate for Payer: UMR Bronson Commercial |
$250.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$507.24
|
|
|
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 |
$46.86 |
| 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 |
$63.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.32
|
| Rate for Payer: BCBS Complete |
$50.66
|
| Rate for Payer: Cash Price |
$101.32
|
| Rate for Payer: Cofinity Commercial |
$108.92
|
| Rate for Payer: Cofinity Commercial |
$88.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.32
|
| Rate for Payer: Healthscope Commercial |
$113.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.65
|
| Rate for Payer: PHP Commercial |
$107.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.32
|
| Rate for Payer: Priority Health SBD |
$79.79
|
| Rate for Payer: UMR Bronson Commercial |
$46.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.99
|
|
|
ZIDOVUDINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$126.65
|
|
|
Service Code
|
HCPCS J3485
|
| Hospital Charge Code |
11691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.73 |
| Max. Negotiated Rate |
$113.98 |
| Rate for Payer: Aetna American Axle |
$82.32
|
| Rate for Payer: Aetna Commercial |
$107.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.32
|
| Rate for Payer: Cash Price |
$101.32
|
| Rate for Payer: Cofinity Commercial |
$108.92
|
| Rate for Payer: Cofinity Commercial |
$88.66
|
| Rate for Payer: Cofinity Medicare Advantage |
$88.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.32
|
| Rate for Payer: Healthscope Commercial |
$113.98
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$88.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$94.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.65
|
| Rate for Payer: PHP Commercial |
$107.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.32
|
| Rate for Payer: Priority Health SBD |
$79.79
|
| Rate for Payer: UMR Bronson Commercial |
$55.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$94.99
|
|
|
ZIDOVUDINE 10 MG/ML ORAL SYRUP
|
Facility
|
IP
|
$789.60
|
|
|
Service Code
|
NDC 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 Commercial |
$552.72
|
| Rate for Payer: Cofinity Commercial |
$679.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$552.72
|
| 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: PHP Commercial |
$671.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.24
|
| 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
|
|
|
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 Commercial |
$552.72
|
| Rate for Payer: Cofinity Commercial |
$679.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$552.72
|
| 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: PHP Commercial |
$671.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$513.24
|
| Rate for Payer: Priority Health SBD |
$497.45
|
| Rate for Payer: UMR Bronson Commercial |
$292.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$592.20
|
|
|
ZINC CHLORIDE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.83
|
|
|
Service Code
|
NDC 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 Commercial |
$13.88
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.88
|
| 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: PHP Commercial |
$16.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.89
|
| Rate for Payer: Priority Health SBD |
$12.49
|
| Rate for Payer: UMR Bronson Commercial |
$8.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.87
|
|
|
ZINC CHLORIDE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$19.83
|
|
|
Service Code
|
NDC 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 Commercial |
$13.88
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.88
|
| 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: PHP Commercial |
$16.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.89
|
| 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 Commercial |
$13.88
|
| Rate for Payer: Cofinity Commercial |
$17.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.88
|
| 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: PHP Commercial |
$16.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.89
|
| Rate for Payer: Priority Health SBD |
$12.49
|
| Rate for Payer: UMR Bronson Commercial |
$7.34
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.87
|
|
