|
WHITE PETROLATUM-MINERAL OIL 56.8 %-42.5 % EYE OINTMENT
|
Facility
|
IP
|
$31.82
|
|
|
Service Code
|
NDC 00023031204
|
| Hospital Charge Code |
117955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$28.64 |
| Rate for Payer: Aetna American Axle |
$20.68
|
| Rate for Payer: Aetna Commercial |
$27.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$20.68
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$22.27
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Cofinity Medicare Advantage |
$22.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$28.64
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$22.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.05
|
| Rate for Payer: PHP Commercial |
$27.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.68
|
| Rate for Payer: Priority Health SBD |
$20.05
|
| Rate for Payer: UMR Bronson Commercial |
$14.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.86
|
|
|
WHITE PETROLATUM-MINERAL OIL 57.3 %-42.5 % EYE OINTMENT
|
Facility
|
OP
|
$18.90
|
|
|
Service Code
|
NDC 70000051301
|
| Hospital Charge Code |
119426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$17.01 |
| Rate for Payer: Aetna American Axle |
$12.28
|
| Rate for Payer: Aetna Commercial |
$16.06
|
| Rate for Payer: Aetna Medicare |
$9.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.28
|
| Rate for Payer: BCBS Complete |
$7.56
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cofinity Commercial |
$13.23
|
| Rate for Payer: Cofinity Commercial |
$16.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.12
|
| Rate for Payer: Healthscope Commercial |
$17.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.06
|
| Rate for Payer: PHP Commercial |
$16.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.28
|
| Rate for Payer: Priority Health SBD |
$11.91
|
| Rate for Payer: UMR Bronson Commercial |
$6.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.18
|
|
|
WHITE PETROLATUM-MINERAL OIL 57.3 %-42.5 % EYE OINTMENT
|
Facility
|
OP
|
$28.11
|
|
|
Service Code
|
NDC 00023024004
|
| Hospital Charge Code |
119426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$25.30 |
| Rate for Payer: Aetna American Axle |
$18.27
|
| Rate for Payer: Aetna Commercial |
$23.89
|
| Rate for Payer: Aetna Medicare |
$14.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.27
|
| Rate for Payer: BCBS Complete |
$11.24
|
| Rate for Payer: Cash Price |
$22.49
|
| Rate for Payer: Cofinity Commercial |
$19.68
|
| Rate for Payer: Cofinity Commercial |
$24.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.49
|
| Rate for Payer: Healthscope Commercial |
$25.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.89
|
| Rate for Payer: PHP Commercial |
$23.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.27
|
| Rate for Payer: Priority Health SBD |
$17.71
|
| Rate for Payer: UMR Bronson Commercial |
$10.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.08
|
|
|
WHITE PETROLATUM-MINERAL OIL 57.3 %-42.5 % EYE OINTMENT
|
Facility
|
IP
|
$18.90
|
|
|
Service Code
|
NDC 70000051301
|
| Hospital Charge Code |
119426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.32 |
| Max. Negotiated Rate |
$17.01 |
| Rate for Payer: Aetna American Axle |
$12.28
|
| Rate for Payer: Aetna Commercial |
$16.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.28
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Cofinity Commercial |
$13.23
|
| Rate for Payer: Cofinity Commercial |
$16.25
|
| Rate for Payer: Cofinity Medicare Advantage |
$13.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$15.12
|
| Rate for Payer: Healthscope Commercial |
$17.01
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$13.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$14.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.06
|
| Rate for Payer: PHP Commercial |
$16.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.28
|
| Rate for Payer: Priority Health SBD |
$11.91
|
| Rate for Payer: UMR Bronson Commercial |
$8.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$14.18
|
|
|
WHITE PETROLATUM-MINERAL OIL 57.3 %-42.5 % EYE OINTMENT
|
Facility
|
IP
|
$28.11
|
|
|
Service Code
|
NDC 00023024004
|
| Hospital Charge Code |
119426
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.37 |
| Max. Negotiated Rate |
$25.30 |
| Rate for Payer: Aetna American Axle |
$18.27
|
| Rate for Payer: Aetna Commercial |
$23.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.27
|
| Rate for Payer: Cash Price |
$22.49
|
| Rate for Payer: Cofinity Commercial |
$19.68
|
| Rate for Payer: Cofinity Commercial |
$24.17
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.68
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.49
|
| Rate for Payer: Healthscope Commercial |
$25.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.68
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.89
|
| Rate for Payer: PHP Commercial |
$23.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.27
|
| Rate for Payer: Priority Health SBD |
$17.71
|
| Rate for Payer: UMR Bronson Commercial |
$12.37
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.08
|
|
|
WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT
|
Facility
|
OP
|
$22.10
|
|
|
Service Code
|
NDC 00904648838
|
| Hospital Charge Code |
117765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$19.89 |
| Rate for Payer: Aetna American Axle |
$14.36
|
| Rate for Payer: Aetna Commercial |
$18.78
|
| Rate for Payer: Aetna Medicare |
$11.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.36
|
| Rate for Payer: BCBS Complete |
$8.84
|
| Rate for Payer: Cash Price |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$15.47
|
| Rate for Payer: Cofinity Commercial |
$19.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.68
|
| Rate for Payer: Healthscope Commercial |
$19.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.78
|
| Rate for Payer: PHP Commercial |
$18.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.36
|
| Rate for Payer: Priority Health SBD |
$13.92
|
| Rate for Payer: UMR Bronson Commercial |
$8.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.58
|
|
|
WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT
|
Facility
|
IP
|
$22.10
|
|
|
Service Code
|
NDC 00904648838
|
| Hospital Charge Code |
117765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.72 |
| Max. Negotiated Rate |
$19.89 |
| Rate for Payer: Aetna American Axle |
$14.36
|
| Rate for Payer: Aetna Commercial |
$18.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.36
|
| Rate for Payer: Cash Price |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$15.47
|
| Rate for Payer: Cofinity Commercial |
$19.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.47
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.68
|
| Rate for Payer: Healthscope Commercial |
$19.89
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.47
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.78
|
| Rate for Payer: PHP Commercial |
$18.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.36
|
| Rate for Payer: Priority Health SBD |
$13.92
|
| Rate for Payer: UMR Bronson Commercial |
$9.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.58
|
|
|
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 |
$17.42
|
| 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 |
$17.42
|
| Rate for Payer: PHP Commercial |
$17.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.32
|
| Rate for Payer: Priority Health SBD |
$12.92
|
| 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
|
$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 |
$17.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.32
|
| Rate for Payer: Cash Price |
$16.40
|
| Rate for Payer: Cofinity Commercial |
$14.35
|
| Rate for Payer: Cofinity Commercial |
$17.63
|
| Rate for Payer: 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 |
$17.42
|
| Rate for Payer: PHP Commercial |
$17.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.32
|
| Rate for Payer: Priority Health SBD |
$12.92
|
| Rate for Payer: UMR Bronson Commercial |
$9.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$15.38
|
|
|
WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM
|
Facility
|
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
|
|
|
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
|
|
|
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
|
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
|
$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
|
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 |
$222.20
|
| 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 |
$222.20
|
|
|
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
|
|
|
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 |
$164.60
|
| 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 |
$222.20
|
| 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 |
$222.20
|
|
|
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
|
|
|
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 00173068101
|
| Hospital Charge Code |
28245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.37 |
| Max. Negotiated Rate |
$180.89 |
| Rate for Payer: Cofinity Medicare Advantage |
$140.69
|
| 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: 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
|
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
|
|
|
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 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
|
|
