|
ZINC SULFATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$39.74
|
|
|
Service Code
|
NDC 70710187601
|
| Hospital Charge Code |
8878
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$35.77 |
| Rate for Payer: Aetna American Axle |
$25.83
|
| Rate for Payer: Aetna Commercial |
$33.78
|
| Rate for Payer: Aetna Medicare |
$19.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.83
|
| Rate for Payer: BCBS Complete |
$15.90
|
| Rate for Payer: Cash Price |
$31.79
|
| Rate for Payer: Cofinity Commercial |
$27.82
|
| Rate for Payer: Cofinity Commercial |
$34.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$27.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.79
|
| Rate for Payer: Healthscope Commercial |
$35.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$27.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$29.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.78
|
| Rate for Payer: PHP Commercial |
$33.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.83
|
| Rate for Payer: Priority Health SBD |
$25.04
|
| Rate for Payer: UMR Bronson Commercial |
$14.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.80
|
|
|
ZINC SULFATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$57.90
|
|
|
Service Code
|
NDC 65219040100
|
| Hospital Charge Code |
8878
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$52.11 |
| Rate for Payer: Aetna American Axle |
$37.63
|
| Rate for Payer: Aetna Commercial |
$49.22
|
| Rate for Payer: Aetna Medicare |
$28.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.63
|
| Rate for Payer: BCBS Complete |
$23.16
|
| Rate for Payer: Cash Price |
$46.32
|
| Rate for Payer: Cofinity Commercial |
$40.53
|
| Rate for Payer: Cofinity Commercial |
$49.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$40.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$46.32
|
| Rate for Payer: Healthscope Commercial |
$52.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$40.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$43.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49.22
|
| Rate for Payer: PHP Commercial |
$49.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.63
|
| Rate for Payer: Priority Health SBD |
$36.48
|
| Rate for Payer: UMR Bronson Commercial |
$21.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.42
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
IP
|
$144.90
|
|
|
Service Code
|
NDC 80681013500
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.76 |
| Max. Negotiated Rate |
$130.41 |
| Rate for Payer: Aetna American Axle |
$94.19
|
| Rate for Payer: Aetna Commercial |
$123.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.19
|
| Rate for Payer: Cash Price |
$115.92
|
| Rate for Payer: Cofinity Commercial |
$101.43
|
| Rate for Payer: Cofinity Commercial |
$124.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.92
|
| Rate for Payer: Healthscope Commercial |
$130.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.17
|
| Rate for Payer: PHP Commercial |
$123.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.19
|
| Rate for Payer: Priority Health SBD |
$91.29
|
| Rate for Payer: UMR Bronson Commercial |
$63.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.67
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
IP
|
$144.10
|
|
|
Service Code
|
NDC 20555004000
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$63.40 |
| Max. Negotiated Rate |
$129.69 |
| Rate for Payer: Aetna American Axle |
$93.67
|
| Rate for Payer: Aetna Commercial |
$122.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.67
|
| Rate for Payer: Cash Price |
$115.28
|
| Rate for Payer: Cofinity Commercial |
$100.87
|
| Rate for Payer: Cofinity Commercial |
$123.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.28
|
| Rate for Payer: Healthscope Commercial |
$129.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.48
|
| Rate for Payer: PHP Commercial |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.67
|
| Rate for Payer: Priority Health SBD |
$90.78
|
| Rate for Payer: UMR Bronson Commercial |
$63.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.08
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
OP
|
$144.10
|
|
|
Service Code
|
NDC 20555004000
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.32 |
| Max. Negotiated Rate |
$129.69 |
| Rate for Payer: Aetna American Axle |
$93.67
|
| Rate for Payer: Aetna Commercial |
$122.48
|
| Rate for Payer: Aetna Medicare |
$72.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.67
|
| Rate for Payer: BCBS Complete |
$57.64
|
| Rate for Payer: Cash Price |
$115.28
|
| Rate for Payer: Cofinity Commercial |
$100.87
|
| Rate for Payer: Cofinity Commercial |
$123.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$100.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.28
|
| Rate for Payer: Healthscope Commercial |
$129.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$100.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.48
|
| Rate for Payer: PHP Commercial |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.67
|
| Rate for Payer: Priority Health SBD |
$90.78
|
| Rate for Payer: UMR Bronson Commercial |
$53.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.08
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
OP
|
$144.90
|
|
|
Service Code
|
NDC 80681013500
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.61 |
| Max. Negotiated Rate |
$130.41 |
| Rate for Payer: Aetna American Axle |
$94.19
|
| Rate for Payer: Aetna Commercial |
$123.17
|
| Rate for Payer: Aetna Medicare |
$72.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.19
|
| Rate for Payer: BCBS Complete |
$57.96
|
| Rate for Payer: Cash Price |
$115.92
|
| Rate for Payer: Cofinity Commercial |
$101.43
|
| Rate for Payer: Cofinity Commercial |
$124.61
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.92
|
| Rate for Payer: Healthscope Commercial |
$130.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$101.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.17
|
| Rate for Payer: PHP Commercial |
$123.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.19
|
| Rate for Payer: Priority Health SBD |
$91.29
|
| Rate for Payer: UMR Bronson Commercial |
$53.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.67
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
|
IP
|
$161.88
|
|
|
Service Code
|
NDC 55111025660
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.23 |
| Max. Negotiated Rate |
$145.69 |
| Rate for Payer: Aetna American Axle |
$105.22
|
| Rate for Payer: Aetna Commercial |
$137.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.22
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cofinity Commercial |
$113.32
|
| Rate for Payer: Cofinity Commercial |
$139.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.50
|
| Rate for Payer: Healthscope Commercial |
$145.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.60
|
| Rate for Payer: PHP Commercial |
$137.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.22
|
| Rate for Payer: Priority Health SBD |
$101.98
|
| Rate for Payer: UMR Bronson Commercial |
$71.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.41
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
|
OP
|
$161.88
|
|
|
Service Code
|
NDC 55111025660
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.90 |
| Max. Negotiated Rate |
$145.69 |
| Rate for Payer: Aetna American Axle |
$105.22
|
| Rate for Payer: Aetna Commercial |
$137.60
|
| Rate for Payer: Aetna Medicare |
$80.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.22
|
| Rate for Payer: BCBS Complete |
$64.75
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cofinity Commercial |
$113.32
|
| Rate for Payer: Cofinity Commercial |
$139.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.50
|
| Rate for Payer: Healthscope Commercial |
$145.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.60
|
| Rate for Payer: PHP Commercial |
$137.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.22
|
| Rate for Payer: Priority Health SBD |
$101.98
|
| Rate for Payer: UMR Bronson Commercial |
$59.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.41
|
|
|
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 |
$21.93 |
| 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: Cash Price |
$47.41
|
| Rate for Payer: Cofinity Commercial |
$41.48
|
| Rate for Payer: Cofinity Commercial |
$50.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.48
|
| 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: PHP Commercial |
$50.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.52
|
| Rate for Payer: Priority Health SBD |
$37.33
|
| Rate for Payer: UMR Bronson Commercial |
$21.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$44.45
|
|
|
ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION
|
Facility
|
IP
|
$59.26
|
|
|
Service Code
|
HCPCS J3486
|
| Hospital Charge Code |
33175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$53.33 |
| Rate for Payer: Aetna American Axle |
$38.52
|
| Rate for Payer: Aetna Commercial |
$50.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.52
|
| Rate for Payer: Cash Price |
$47.41
|
| Rate for Payer: Cofinity Commercial |
$41.48
|
| Rate for Payer: Cofinity Commercial |
$50.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$41.48
|
| 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: PHP Commercial |
$50.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.52
|
| 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 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 Commercial |
$154.81
|
| Rate for Payer: Cofinity Commercial |
$190.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.81
|
| 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: PHP Commercial |
$187.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.75
|
| Rate for Payer: Priority Health SBD |
$139.33
|
| 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
|
$188.10
|
|
|
Service Code
|
NDC 55111025760
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$169.29 |
| Rate for Payer: Aetna American Axle |
$122.27
|
| Rate for Payer: Aetna Commercial |
$159.88
|
| Rate for Payer: Aetna Medicare |
$94.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.27
|
| Rate for Payer: BCBS Complete |
$75.24
|
| Rate for Payer: Cash Price |
$150.48
|
| Rate for Payer: Cofinity Commercial |
$131.67
|
| Rate for Payer: Cofinity Commercial |
$161.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.48
|
| Rate for Payer: Healthscope Commercial |
$169.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.88
|
| Rate for Payer: PHP Commercial |
$159.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.27
|
| Rate for Payer: Priority Health SBD |
$118.50
|
| Rate for Payer: UMR Bronson Commercial |
$69.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.07
|
|
|
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 Commercial |
$154.81
|
| Rate for Payer: Cofinity Commercial |
$190.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$154.81
|
| 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: PHP Commercial |
$187.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.75
|
| 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
|
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 Commercial |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.53
|
| 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: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.28
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| 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
|
$185.67
|
|
|
Service Code
|
NDC 00904627008
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.69 |
| Max. Negotiated Rate |
$167.10 |
| Rate for Payer: Aetna American Axle |
$120.69
|
| Rate for Payer: Aetna Commercial |
$157.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.69
|
| Rate for Payer: Cash Price |
$148.54
|
| Rate for Payer: Cofinity Commercial |
$129.97
|
| Rate for Payer: Cofinity Commercial |
$159.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.54
|
| Rate for Payer: Healthscope Commercial |
$167.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.82
|
| Rate for Payer: PHP Commercial |
$157.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.69
|
| Rate for Payer: Priority Health SBD |
$116.97
|
| Rate for Payer: UMR Bronson Commercial |
$81.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.25
|
|
|
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 Commercial |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.53
|
| 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: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.28
|
| 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
|
$188.10
|
|
|
Service Code
|
NDC 55111025760
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.76 |
| Max. Negotiated Rate |
$169.29 |
| Rate for Payer: Aetna American Axle |
$122.27
|
| Rate for Payer: Aetna Commercial |
$159.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.27
|
| Rate for Payer: Cash Price |
$150.48
|
| Rate for Payer: Cofinity Commercial |
$131.67
|
| Rate for Payer: Cofinity Commercial |
$161.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.48
|
| Rate for Payer: Healthscope Commercial |
$169.29
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$131.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$141.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.88
|
| Rate for Payer: PHP Commercial |
$159.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.27
|
| Rate for Payer: Priority Health SBD |
$118.50
|
| Rate for Payer: UMR Bronson Commercial |
$82.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$141.07
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
|
OP
|
$185.67
|
|
|
Service Code
|
NDC 00904627008
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.70 |
| Max. Negotiated Rate |
$167.10 |
| Rate for Payer: Aetna American Axle |
$120.69
|
| Rate for Payer: Aetna Commercial |
$157.82
|
| Rate for Payer: Aetna Medicare |
$92.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.69
|
| Rate for Payer: BCBS Complete |
$74.27
|
| Rate for Payer: Cash Price |
$148.54
|
| Rate for Payer: Cofinity Commercial |
$129.97
|
| Rate for Payer: Cofinity Commercial |
$159.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.54
|
| Rate for Payer: Healthscope Commercial |
$167.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$129.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.82
|
| Rate for Payer: PHP Commercial |
$157.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.69
|
| Rate for Payer: Priority Health SBD |
$116.97
|
| Rate for Payer: UMR Bronson Commercial |
$68.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.25
|
|
|
ZIV-AFLIBERCEPT 25MG/ML INJECTION
|
Facility
|
IP
|
$7,184.00
|
|
|
Service Code
|
HCPCS J9400
|
| Hospital Charge Code |
161499
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,160.96 |
| Max. Negotiated Rate |
$6,465.60 |
| Rate for Payer: Aetna American Axle |
$4,669.60
|
| Rate for Payer: Aetna Commercial |
$6,106.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,669.60
|
| Rate for Payer: Cash Price |
$5,747.20
|
| Rate for Payer: Cofinity Commercial |
$5,028.80
|
| Rate for Payer: Cofinity Commercial |
$6,178.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,028.80
|
| 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: PHP Commercial |
$6,106.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,669.60
|
| 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
|
|
|
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 |
$4.22 |
| 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 |
$8.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,669.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.85
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.85
|
| Rate for Payer: BCBS Complete |
$4.43
|
| Rate for Payer: BCBS MAPPO |
$7.88
|
| Rate for Payer: BCN Medicare Advantage |
$7.88
|
| Rate for Payer: Cash Price |
$5,747.20
|
| Rate for Payer: Cash Price |
$5,747.20
|
| Rate for Payer: Cofinity Commercial |
$5,028.80
|
| Rate for Payer: Cofinity Commercial |
$6,178.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,028.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,747.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.88
|
| 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 |
$4.22
|
| Rate for Payer: Mclaren Medicare |
$7.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.27
|
| Rate for Payer: Meridian Medicaid |
$4.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,106.40
|
| Rate for Payer: PACE Medicare |
$7.49
|
| Rate for Payer: PACE SWMI |
$7.88
|
| Rate for Payer: PHP Commercial |
$6,106.40
|
| Rate for Payer: PHP Medicare Advantage |
$7.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,669.60
|
| Rate for Payer: Priority Health Medicare |
$7.88
|
| Rate for Payer: Priority Health SBD |
$4,525.92
|
| Rate for Payer: Railroad Medicare Medicare |
$7.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.88
|
| Rate for Payer: UHC Exchange |
$15.06
|
| Rate for Payer: UHC Medicare Advantage |
$7.88
|
| Rate for Payer: UHCCP Medicaid |
$4.22
|
| Rate for Payer: UMR Bronson Commercial |
$2,658.08
|
| Rate for Payer: VA VA |
$7.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,388.00
|
|
|
ZOLEDRONIC ACID 4 MG/100 ML-MANNITOL-0.9 % NACL INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$103.24
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
167580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.20 |
| 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: Cash Price |
$82.59
|
| Rate for Payer: Cofinity Commercial |
$72.27
|
| Rate for Payer: Cofinity Commercial |
$88.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.27
|
| 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: PHP Commercial |
$87.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.11
|
| Rate for Payer: Priority Health SBD |
$65.04
|
| Rate for Payer: UMR Bronson Commercial |
$38.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.43
|
|
|
ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$333.64
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
35640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.80 |
| Max. Negotiated Rate |
$300.28 |
| Rate for Payer: Aetna American Axle |
$216.87
|
| Rate for Payer: Aetna American Axle |
$75.69
|
| Rate for Payer: Aetna American Axle |
$88.08
|
| Rate for Payer: Aetna American Axle |
$276.30
|
| Rate for Payer: Aetna American Axle |
$166.24
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna Commercial |
$115.18
|
| Rate for Payer: Aetna Commercial |
$98.97
|
| Rate for Payer: Aetna Commercial |
$361.31
|
| Rate for Payer: Aetna Commercial |
$217.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.08
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$340.06
|
| Rate for Payer: Cash Price |
$108.41
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cofinity Commercial |
$297.55
|
| Rate for Payer: Cofinity Commercial |
$100.14
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Cofinity Commercial |
$233.55
|
| Rate for Payer: Cofinity Commercial |
$179.03
|
| Rate for Payer: Cofinity Commercial |
$116.54
|
| Rate for Payer: Cofinity Commercial |
$94.86
|
| Rate for Payer: Cofinity Commercial |
$219.94
|
| Rate for Payer: Cofinity Commercial |
$81.51
|
| Rate for Payer: Cofinity Commercial |
$365.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.60
|
| Rate for Payer: Healthscope Commercial |
$121.96
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Healthscope Commercial |
$230.18
|
| Rate for Payer: Healthscope Commercial |
$382.56
|
| Rate for Payer: Healthscope Commercial |
$104.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.03
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.80
|
| 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 |
$361.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.97
|
| Rate for Payer: PHP Commercial |
$98.97
|
| Rate for Payer: PHP Commercial |
$361.31
|
| Rate for Payer: PHP Commercial |
$217.39
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: PHP Commercial |
$115.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.69
|
| Rate for Payer: Priority Health SBD |
$267.79
|
| Rate for Payer: Priority Health SBD |
$161.12
|
| Rate for Payer: Priority Health SBD |
$85.37
|
| Rate for Payer: Priority Health SBD |
$73.36
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: UMR Bronson Commercial |
$51.23
|
| Rate for Payer: UMR Bronson Commercial |
$59.62
|
| Rate for Payer: UMR Bronson Commercial |
$146.80
|
| Rate for Payer: UMR Bronson Commercial |
$187.03
|
| Rate for Payer: UMR Bronson Commercial |
$112.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.23
|
|
|
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 |
$139.11 |
| 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 |
$88.08
|
| Rate for Payer: Aetna American Axle |
$170.06
|
| Rate for Payer: Aetna American Axle |
$75.69
|
| Rate for Payer: Aetna American Axle |
$307.54
|
| Rate for Payer: Aetna American Axle |
$276.30
|
| Rate for Payer: Aetna Commercial |
$361.31
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna Commercial |
$319.57
|
| Rate for Payer: Aetna Commercial |
$98.97
|
| Rate for Payer: Aetna Commercial |
$402.17
|
| Rate for Payer: Aetna Commercial |
$115.18
|
| Rate for Payer: Aetna Commercial |
$222.39
|
| Rate for Payer: Aetna Commercial |
$217.39
|
| Rate for Payer: Aetna Medicare |
$127.88
|
| Rate for Payer: Aetna Medicare |
$58.22
|
| Rate for Payer: Aetna Medicare |
$130.81
|
| Rate for Payer: Aetna Medicare |
$67.75
|
| Rate for Payer: Aetna Medicare |
$187.99
|
| Rate for Payer: Aetna Medicare |
$236.57
|
| Rate for Payer: Aetna Medicare |
$166.82
|
| Rate for Payer: Aetna Medicare |
$212.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| 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) |
$170.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.38
|
| Rate for Payer: BCBS Complete |
$54.20
|
| Rate for Payer: BCBS Complete |
$46.58
|
| Rate for Payer: BCBS Complete |
$104.65
|
| Rate for Payer: BCBS Complete |
$102.30
|
| Rate for Payer: BCBS Complete |
$133.46
|
| Rate for Payer: BCBS Complete |
$150.39
|
| Rate for Payer: BCBS Complete |
$170.03
|
| Rate for Payer: BCBS Complete |
$189.26
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cash Price |
$108.41
|
| Rate for Payer: Cash Price |
$340.06
|
| Rate for Payer: Cash Price |
$209.30
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$300.78
|
| Rate for Payer: Cash Price |
$378.51
|
| Rate for Payer: Cofinity Commercial |
$233.55
|
| Rate for Payer: Cofinity Commercial |
$406.90
|
| Rate for Payer: Cofinity Commercial |
$331.20
|
| Rate for Payer: Cofinity Commercial |
$365.56
|
| Rate for Payer: Cofinity Commercial |
$297.55
|
| Rate for Payer: Cofinity Commercial |
$94.86
|
| Rate for Payer: Cofinity Commercial |
$225.00
|
| Rate for Payer: Cofinity Commercial |
$100.14
|
| Rate for Payer: Cofinity Commercial |
$219.94
|
| Rate for Payer: Cofinity Commercial |
$323.33
|
| Rate for Payer: Cofinity Commercial |
$263.18
|
| Rate for Payer: Cofinity Commercial |
$179.03
|
| Rate for Payer: Cofinity Commercial |
$183.14
|
| Rate for Payer: Cofinity Commercial |
$81.51
|
| Rate for Payer: Cofinity Commercial |
$116.54
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$331.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.03
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$263.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.15
|
| 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 |
$300.78
|
| Rate for Payer: Healthscope Commercial |
$104.80
|
| Rate for Payer: Healthscope Commercial |
$235.47
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Healthscope Commercial |
$338.37
|
| Rate for Payer: Healthscope Commercial |
$382.56
|
| Rate for Payer: Healthscope Commercial |
$425.83
|
| Rate for Payer: Healthscope Commercial |
$230.18
|
| Rate for Payer: Healthscope Commercial |
$121.96
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.55
|
| 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 |
$183.14
|
| 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 |
$94.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.31
|
| Rate for Payer: PHP Commercial |
$222.39
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: PHP Commercial |
$402.17
|
| Rate for Payer: PHP Commercial |
$319.57
|
| Rate for Payer: PHP Commercial |
$217.39
|
| Rate for Payer: PHP Commercial |
$361.31
|
| Rate for Payer: PHP Commercial |
$98.97
|
| Rate for Payer: PHP Commercial |
$115.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.54
|
| Rate for Payer: Priority Health SBD |
$73.36
|
| Rate for Payer: Priority Health SBD |
$298.08
|
| Rate for Payer: Priority Health SBD |
$267.79
|
| Rate for Payer: Priority Health SBD |
$164.83
|
| Rate for Payer: Priority Health SBD |
$161.12
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: Priority Health SBD |
$85.37
|
| Rate for Payer: Priority Health SBD |
$236.86
|
| Rate for Payer: UMR Bronson Commercial |
$139.11
|
| Rate for Payer: UMR Bronson Commercial |
$157.28
|
| Rate for Payer: UMR Bronson Commercial |
$50.14
|
| Rate for Payer: UMR Bronson Commercial |
$175.06
|
| Rate for Payer: UMR Bronson Commercial |
$123.45
|
| Rate for Payer: UMR Bronson Commercial |
$96.80
|
| Rate for Payer: UMR Bronson Commercial |
$94.63
|
| Rate for Payer: UMR Bronson Commercial |
$43.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.22
|
|
|
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 Commercial |
$4,009.88
|
| Rate for Payer: Cofinity Commercial |
$3,263.86
|
| Rate for Payer: Cofinity Commercial |
$113.36
|
| Rate for Payer: Cofinity Commercial |
$139.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,263.86
|
| 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 |
$113.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,263.86
|
| 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 |
$3,963.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.65
|
| Rate for Payer: PHP Commercial |
$3,963.25
|
| Rate for Payer: PHP Commercial |
$137.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,030.72
|
| Rate for Payer: Priority Health SBD |
$102.02
|
| Rate for Payer: Priority Health SBD |
$2,937.47
|
| 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
|
$387.22
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
81434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$143.27 |
| Max. Negotiated Rate |
$348.50 |
| Rate for Payer: Aetna American Axle |
$251.69
|
| Rate for Payer: Aetna American Axle |
$182.47
|
| Rate for Payer: Aetna American Axle |
$105.26
|
| Rate for Payer: Aetna American Axle |
$83.30
|
| Rate for Payer: Aetna American Axle |
$142.96
|
| Rate for Payer: Aetna American Axle |
$692.08
|
| Rate for Payer: Aetna American Axle |
$3,030.72
|
| Rate for Payer: Aetna American Axle |
$252.14
|
| Rate for Payer: Aetna Commercial |
$329.72
|
| Rate for Payer: Aetna Commercial |
$238.61
|
| Rate for Payer: Aetna Commercial |
$329.14
|
| Rate for Payer: Aetna Commercial |
$905.03
|
| Rate for Payer: Aetna Commercial |
$3,963.25
|
| Rate for Payer: Aetna Commercial |
$108.93
|
| Rate for Payer: Aetna Commercial |
$186.95
|
| Rate for Payer: Aetna Commercial |
$137.65
|
| Rate for Payer: Aetna Medicare |
$80.97
|
| Rate for Payer: Aetna Medicare |
$532.37
|
| Rate for Payer: Aetna Medicare |
$109.97
|
| Rate for Payer: Aetna Medicare |
$64.08
|
| Rate for Payer: Aetna Medicare |
$193.61
|
| Rate for Payer: Aetna Medicare |
$2,331.32
|
| Rate for Payer: Aetna Medicare |
$140.36
|
| Rate for Payer: Aetna Medicare |
$193.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$692.08
|
| 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) |
$251.69
|
| Rate for Payer: BCBS Complete |
$51.26
|
| 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 |
$112.29
|
| Rate for Payer: BCBS Complete |
$154.89
|
| Rate for Payer: BCBS Complete |
$155.16
|
| Rate for Payer: BCBS Complete |
$1,865.06
|
| Rate for Payer: Cash Price |
$129.55
|
| Rate for Payer: Cash Price |
$851.79
|
| Rate for Payer: Cash Price |
$102.52
|
| Rate for Payer: Cash Price |
$310.33
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Cash Price |
$309.78
|
| Rate for Payer: Cash Price |
$3,730.12
|
| Rate for Payer: Cofinity Commercial |
$196.50
|
| Rate for Payer: Cofinity Commercial |
$4,009.88
|
| Rate for Payer: Cofinity Commercial |
$3,263.86
|
| Rate for Payer: Cofinity Commercial |
$333.60
|
| Rate for Payer: Cofinity Commercial |
$271.54
|
| Rate for Payer: Cofinity Commercial |
$89.70
|
| Rate for Payer: Cofinity Commercial |
$189.15
|
| Rate for Payer: Cofinity Commercial |
$745.32
|
| Rate for Payer: Cofinity Commercial |
$139.27
|
| Rate for Payer: Cofinity Commercial |
$333.01
|
| Rate for Payer: Cofinity Commercial |
$271.05
|
| Rate for Payer: Cofinity Commercial |
$113.36
|
| Rate for Payer: Cofinity Commercial |
$153.96
|
| Rate for Payer: Cofinity Commercial |
$915.68
|
| Rate for Payer: Cofinity Commercial |
$110.21
|
| Rate for Payer: Cofinity Commercial |
$241.42
|
| Rate for Payer: Cofinity Medicare Advantage |
$271.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$745.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,263.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$271.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.50
|
| 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 |
$310.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$851.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,730.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.78
|
| Rate for Payer: Healthscope Commercial |
$958.27
|
| Rate for Payer: Healthscope Commercial |
$197.95
|
| Rate for Payer: Healthscope Commercial |
$252.65
|
| Rate for Payer: Healthscope Commercial |
$348.50
|
| Rate for Payer: Healthscope Commercial |
$349.12
|
| Rate for Payer: Healthscope Commercial |
$4,196.39
|
| Rate for Payer: Healthscope Commercial |
$145.75
|
| Rate for Payer: Healthscope Commercial |
$115.33
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$745.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.96
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$89.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.93
|
| 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 |
$210.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$798.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$905.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,963.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.93
|
| 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 |
$137.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.72
|
| Rate for Payer: PHP Commercial |
$186.95
|
| Rate for Payer: PHP Commercial |
$238.61
|
| Rate for Payer: PHP Commercial |
$3,963.25
|
| Rate for Payer: PHP Commercial |
$329.14
|
| Rate for Payer: PHP Commercial |
$137.65
|
| Rate for Payer: PHP Commercial |
$329.72
|
| Rate for Payer: PHP Commercial |
$905.03
|
| Rate for Payer: PHP Commercial |
$108.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$692.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,030.72
|
| Rate for Payer: Priority Health SBD |
$670.79
|
| Rate for Payer: Priority Health SBD |
$2,937.47
|
| Rate for Payer: Priority Health SBD |
$244.38
|
| Rate for Payer: Priority Health SBD |
$138.56
|
| Rate for Payer: Priority Health SBD |
$102.02
|
| Rate for Payer: Priority Health SBD |
$176.85
|
| Rate for Payer: Priority Health SBD |
$80.73
|
| Rate for Payer: Priority Health SBD |
$243.95
|
| Rate for Payer: UMR Bronson Commercial |
$143.27
|
| Rate for Payer: UMR Bronson Commercial |
$143.53
|
| Rate for Payer: UMR Bronson Commercial |
$47.42
|
| Rate for Payer: UMR Bronson Commercial |
$1,725.18
|
| Rate for Payer: UMR Bronson Commercial |
$103.87
|
| Rate for Payer: UMR Bronson Commercial |
$81.38
|
| Rate for Payer: UMR Bronson Commercial |
$59.92
|
| Rate for Payer: UMR Bronson Commercial |
$393.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.11
|
| 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 |
$3,496.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.96
|
|
