|
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 INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$126.65
|
|
|
Service Code
|
HCPCS J3485
|
| Hospital Charge Code |
11691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| 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 |
$63.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.32
|
| Rate for Payer: BCBS Complete |
$50.66
|
| Rate for Payer: BCBS Trust/PPO |
$4.08
|
| Rate for Payer: BCN Commercial |
$4.08
|
| Rate for Payer: Cash Price |
$101.32
|
| 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 |
$46.86
|
| 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
|
OP
|
$19.83
|
|
|
Service Code
|
NDC 00409409001
|
| Hospital Charge Code |
8865
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.34 |
| Max. Negotiated Rate |
$17.85 |
| Rate for Payer: Aetna American Axle |
$12.89
|
| Rate for Payer: Aetna Commercial |
$16.86
|
| Rate for Payer: Aetna Medicare |
$9.92
|
| 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
|
|
|
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 |
$9.92
|
| 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
|
|
|
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
|
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 OXIDE 20 % TOPICAL OINTMENT
|
Facility
|
OP
|
$11.16
|
|
|
Service Code
|
NDC 00536131628
|
| Hospital Charge Code |
8874
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$10.04 |
| Rate for Payer: Aetna American Axle |
$7.25
|
| Rate for Payer: Aetna Commercial |
$9.49
|
| Rate for Payer: Aetna Medicare |
$5.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.25
|
| Rate for Payer: BCBS Complete |
$4.46
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Cofinity Commercial |
$7.81
|
| Rate for Payer: Cofinity Commercial |
$9.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.93
|
| Rate for Payer: Healthscope Commercial |
$10.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.49
|
| Rate for Payer: PHP Commercial |
$9.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.25
|
| Rate for Payer: Priority Health SBD |
$7.03
|
| Rate for Payer: UMR Bronson Commercial |
$4.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.37
|
|
|
ZINC OXIDE 20 % TOPICAL OINTMENT
|
Facility
|
IP
|
$11.16
|
|
|
Service Code
|
NDC 00536131628
|
| Hospital Charge Code |
8874
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$10.04 |
| Rate for Payer: Aetna American Axle |
$7.25
|
| Rate for Payer: Aetna Commercial |
$9.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.25
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Cofinity Commercial |
$7.81
|
| Rate for Payer: Cofinity Commercial |
$9.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$7.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.93
|
| Rate for Payer: Healthscope Commercial |
$10.04
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$7.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.49
|
| Rate for Payer: PHP Commercial |
$9.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.25
|
| Rate for Payer: Priority Health SBD |
$7.03
|
| Rate for Payer: UMR Bronson Commercial |
$4.91
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.37
|
|
|
ZINC OXIDE-COD LIVER OIL 40 % TOPICAL PASTE
|
Facility
|
OP
|
$28.09
|
|
|
Service Code
|
NDC 74300000071
|
| Hospital Charge Code |
119503
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.39 |
| Max. Negotiated Rate |
$25.28 |
| Rate for Payer: Aetna American Axle |
$18.26
|
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna Medicare |
$14.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.26
|
| Rate for Payer: BCBS Complete |
$11.24
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$19.66
|
| Rate for Payer: Cofinity Commercial |
$24.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.47
|
| Rate for Payer: Healthscope Commercial |
$25.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.88
|
| Rate for Payer: PHP Commercial |
$23.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.26
|
| Rate for Payer: Priority Health SBD |
$17.70
|
| Rate for Payer: UMR Bronson Commercial |
$10.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.07
|
|
|
ZINC OXIDE-COD LIVER OIL 40 % TOPICAL PASTE
|
Facility
|
OP
|
$48.39
|
|
|
Service Code
|
NDC 74300000070
|
| Hospital Charge Code |
119503
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.90 |
| Max. Negotiated Rate |
$43.55 |
| Rate for Payer: Aetna American Axle |
$31.45
|
| Rate for Payer: Aetna Commercial |
$41.13
|
| Rate for Payer: Aetna Medicare |
$24.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.45
|
| Rate for Payer: BCBS Complete |
$19.36
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cofinity Commercial |
$33.87
|
| Rate for Payer: Cofinity Commercial |
$41.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.71
|
| Rate for Payer: Healthscope Commercial |
$43.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.13
|
| Rate for Payer: PHP Commercial |
$41.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.45
|
| Rate for Payer: Priority Health SBD |
$30.49
|
| Rate for Payer: UMR Bronson Commercial |
$17.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.29
|
|
|
ZINC OXIDE-COD LIVER OIL 40 % TOPICAL PASTE
|
Facility
|
IP
|
$48.39
|
|
|
Service Code
|
NDC 74300000070
|
| Hospital Charge Code |
119503
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.29 |
| Max. Negotiated Rate |
$43.55 |
| Rate for Payer: Aetna American Axle |
$31.45
|
| Rate for Payer: Aetna Commercial |
$41.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.45
|
| Rate for Payer: Cash Price |
$38.71
|
| Rate for Payer: Cofinity Commercial |
$33.87
|
| Rate for Payer: Cofinity Commercial |
$41.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$33.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.71
|
| Rate for Payer: Healthscope Commercial |
$43.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$33.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$36.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.13
|
| Rate for Payer: PHP Commercial |
$41.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.45
|
| Rate for Payer: Priority Health SBD |
$30.49
|
| Rate for Payer: UMR Bronson Commercial |
$21.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$36.29
|
|
|
ZINC OXIDE-COD LIVER OIL 40 % TOPICAL PASTE
|
Facility
|
IP
|
$28.09
|
|
|
Service Code
|
NDC 74300000071
|
| Hospital Charge Code |
119503
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.36 |
| Max. Negotiated Rate |
$25.28 |
| Rate for Payer: Aetna American Axle |
$18.26
|
| Rate for Payer: Aetna Commercial |
$23.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.26
|
| Rate for Payer: Cash Price |
$22.47
|
| Rate for Payer: Cofinity Commercial |
$19.66
|
| Rate for Payer: Cofinity Commercial |
$24.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$19.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$22.47
|
| Rate for Payer: Healthscope Commercial |
$25.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$19.66
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$21.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.88
|
| Rate for Payer: PHP Commercial |
$23.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.26
|
| Rate for Payer: Priority Health SBD |
$17.70
|
| Rate for Payer: UMR Bronson Commercial |
$12.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$21.07
|
|
|
ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE
|
Facility
|
OP
|
$138.72
|
|
|
Service Code
|
NDC 11701005032
|
| Hospital Charge Code |
11378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.33 |
| Max. Negotiated Rate |
$124.85 |
| Rate for Payer: Aetna American Axle |
$90.17
|
| Rate for Payer: Aetna Commercial |
$117.91
|
| Rate for Payer: Aetna Medicare |
$69.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.17
|
| Rate for Payer: BCBS Complete |
$55.49
|
| Rate for Payer: Cash Price |
$110.98
|
| Rate for Payer: Cofinity Commercial |
$119.30
|
| Rate for Payer: Cofinity Commercial |
$97.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.98
|
| Rate for Payer: Healthscope Commercial |
$124.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.91
|
| Rate for Payer: PHP Commercial |
$117.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.17
|
| Rate for Payer: Priority Health SBD |
$87.39
|
| Rate for Payer: UMR Bronson Commercial |
$51.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.04
|
|
|
ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE
|
Facility
|
IP
|
$138.72
|
|
|
Service Code
|
NDC 11701005032
|
| Hospital Charge Code |
11378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.04 |
| Max. Negotiated Rate |
$124.85 |
| Rate for Payer: Aetna American Axle |
$90.17
|
| Rate for Payer: Aetna Commercial |
$117.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.17
|
| Rate for Payer: Cash Price |
$110.98
|
| Rate for Payer: Cofinity Commercial |
$119.30
|
| Rate for Payer: Cofinity Commercial |
$97.10
|
| Rate for Payer: Cofinity Medicare Advantage |
$97.10
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.98
|
| Rate for Payer: Healthscope Commercial |
$124.85
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.91
|
| Rate for Payer: PHP Commercial |
$117.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.17
|
| Rate for Payer: Priority Health SBD |
$87.39
|
| Rate for Payer: UMR Bronson Commercial |
$61.04
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.04
|
|
|
ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE
|
Facility
|
OP
|
$83.50
|
|
|
Service Code
|
NDC 11701005033
|
| Hospital Charge Code |
11378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.90 |
| Max. Negotiated Rate |
$75.15 |
| Rate for Payer: Aetna American Axle |
$54.28
|
| Rate for Payer: Aetna Commercial |
$70.98
|
| Rate for Payer: Aetna Medicare |
$41.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.28
|
| Rate for Payer: BCBS Complete |
$33.40
|
| Rate for Payer: Cash Price |
$66.80
|
| Rate for Payer: Cofinity Commercial |
$58.45
|
| Rate for Payer: Cofinity Commercial |
$71.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.80
|
| Rate for Payer: Healthscope Commercial |
$75.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.98
|
| Rate for Payer: PHP Commercial |
$70.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.28
|
| Rate for Payer: Priority Health SBD |
$52.60
|
| Rate for Payer: UMR Bronson Commercial |
$30.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.62
|
|
|
ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE
|
Facility
|
IP
|
$83.50
|
|
|
Service Code
|
NDC 11701005033
|
| Hospital Charge Code |
11378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.74 |
| Max. Negotiated Rate |
$75.15 |
| Rate for Payer: Aetna American Axle |
$54.28
|
| Rate for Payer: Aetna Commercial |
$70.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.28
|
| Rate for Payer: Cash Price |
$66.80
|
| Rate for Payer: Cofinity Commercial |
$58.45
|
| Rate for Payer: Cofinity Commercial |
$71.81
|
| Rate for Payer: Cofinity Medicare Advantage |
$58.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.80
|
| Rate for Payer: Healthscope Commercial |
$75.15
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$58.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.98
|
| Rate for Payer: PHP Commercial |
$70.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.28
|
| Rate for Payer: Priority Health SBD |
$52.60
|
| Rate for Payer: UMR Bronson Commercial |
$36.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.62
|
|
|
ZINC SULFATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.10
|
|
|
Service Code
|
NDC 00517610125
|
| Hospital Charge Code |
8878
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$66.69 |
| Rate for Payer: Aetna American Axle |
$48.16
|
| Rate for Payer: Aetna Commercial |
$62.98
|
| Rate for Payer: Aetna Medicare |
$37.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.16
|
| Rate for Payer: BCBS Complete |
$29.64
|
| Rate for Payer: Cash Price |
$59.28
|
| Rate for Payer: Cofinity Commercial |
$51.87
|
| Rate for Payer: Cofinity Commercial |
$63.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.28
|
| Rate for Payer: Healthscope Commercial |
$66.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.98
|
| Rate for Payer: PHP Commercial |
$62.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.16
|
| Rate for Payer: Priority Health SBD |
$46.68
|
| Rate for Payer: UMR Bronson Commercial |
$27.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.58
|
|
|
ZINC SULFATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.38
|
|
|
Service Code
|
NDC 66794025502
|
| Hospital Charge Code |
8878
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$62.44 |
| Rate for Payer: Aetna American Axle |
$45.10
|
| Rate for Payer: Aetna Commercial |
$58.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.10
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cofinity Commercial |
$48.57
|
| Rate for Payer: Cofinity Commercial |
$59.67
|
| Rate for Payer: Cofinity Medicare Advantage |
$48.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.50
|
| Rate for Payer: Healthscope Commercial |
$62.44
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$48.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$52.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$58.97
|
| Rate for Payer: PHP Commercial |
$58.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.10
|
| Rate for Payer: Priority Health SBD |
$43.71
|
| Rate for Payer: UMR Bronson Commercial |
$30.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.04
|
|
|
ZINC SULFATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$74.10
|
|
|
Service Code
|
NDC 00517610101
|
| Hospital Charge Code |
8878
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.42 |
| Max. Negotiated Rate |
$66.69 |
| Rate for Payer: Aetna American Axle |
$48.16
|
| Rate for Payer: Aetna Commercial |
$62.98
|
| Rate for Payer: Aetna Medicare |
$37.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.16
|
| Rate for Payer: BCBS Complete |
$29.64
|
| Rate for Payer: Cash Price |
$59.28
|
| Rate for Payer: Cofinity Commercial |
$51.87
|
| Rate for Payer: Cofinity Commercial |
$63.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.28
|
| Rate for Payer: Healthscope Commercial |
$66.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.98
|
| Rate for Payer: PHP Commercial |
$62.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.16
|
| Rate for Payer: Priority Health SBD |
$46.68
|
| Rate for Payer: UMR Bronson Commercial |
$27.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.58
|
|
|
ZINC SULFATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$57.90
|
|
|
Service Code
|
NDC 65219040100
|
| Hospital Charge Code |
8878
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$52.11 |
| Rate for Payer: Aetna American Axle |
$37.64
|
| Rate for Payer: Aetna Commercial |
$49.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.64
|
| 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 |
$37.64
|
| Rate for Payer: Priority Health SBD |
$36.48
|
| Rate for Payer: UMR Bronson Commercial |
$25.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$43.42
|
|
|
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
|
IP
|
$74.10
|
|
|
Service Code
|
NDC 00517610125
|
| Hospital Charge Code |
8878
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$66.69 |
| Rate for Payer: Aetna American Axle |
$48.16
|
| Rate for Payer: Aetna Commercial |
$62.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.16
|
| Rate for Payer: Cash Price |
$59.28
|
| Rate for Payer: Cofinity Commercial |
$51.87
|
| Rate for Payer: Cofinity Commercial |
$63.73
|
| Rate for Payer: Cofinity Medicare Advantage |
$51.87
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$59.28
|
| Rate for Payer: Healthscope Commercial |
$66.69
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$51.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$55.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$62.98
|
| Rate for Payer: PHP Commercial |
$62.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.16
|
| Rate for Payer: Priority Health SBD |
$46.68
|
| Rate for Payer: UMR Bronson Commercial |
$32.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$55.58
|
|
|
ZINC SULFATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$57.90
|
|
|
Service Code
|
NDC 65219040101
|
| Hospital Charge Code |
8878
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$52.11 |
| Rate for Payer: Aetna American Axle |
$37.64
|
| Rate for Payer: Aetna Commercial |
$49.22
|
| Rate for Payer: Aetna Medicare |
$28.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.64
|
| 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 |
$37.64
|
| 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
|
|
