|
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 |
$37.64
|
| 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
|
|
|
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
|
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
|
IP
|
$69.38
|
|
|
Service Code
|
NDC 66794025542
|
| 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
|
OP
|
$69.38
|
|
|
Service Code
|
NDC 66794025502
|
| Hospital Charge Code |
8878
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.67 |
| Max. Negotiated Rate |
$62.44 |
| Rate for Payer: Aetna American Axle |
$45.10
|
| Rate for Payer: Aetna Commercial |
$58.97
|
| Rate for Payer: Aetna Medicare |
$34.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.10
|
| Rate for Payer: BCBS Complete |
$27.75
|
| 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 |
$25.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$52.04
|
|
|
ZINC SULFATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$39.74
|
|
|
Service Code
|
NDC 70710187607
|
| Hospital Charge Code |
8878
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$35.77 |
| Rate for Payer: Aetna American Axle |
$25.83
|
| Rate for Payer: Aetna Commercial |
$33.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.83
|
| 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 |
$17.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$29.80
|
|
|
ZINC SULFATE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$57.90
|
|
|
Service Code
|
NDC 65219040101
|
| 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 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 |
$93.66
|
| Rate for Payer: Aetna Commercial |
$122.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.66
|
| 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 |
$93.66
|
| 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
|
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 |
$94.18
|
| Rate for Payer: Aetna Commercial |
$123.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.18
|
| 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 |
$108.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.16
|
| Rate for Payer: PHP Commercial |
$123.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.18
|
| 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 |
$108.68
|
|
|
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 |
$93.66
|
| Rate for Payer: Aetna Commercial |
$122.48
|
| Rate for Payer: Aetna Medicare |
$72.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$93.66
|
| 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 |
$93.66
|
| 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 |
$94.18
|
| Rate for Payer: Aetna Commercial |
$123.16
|
| Rate for Payer: Aetna Medicare |
$72.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.18
|
| 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 |
$108.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.16
|
| Rate for Payer: PHP Commercial |
$123.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.18
|
| 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 |
$108.68
|
|
|
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 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/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 |
$44.44
|
| 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 |
$44.44
|
|
|
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 |
$20.03 |
| Max. Negotiated Rate |
$53.33 |
| Rate for Payer: Aetna American Axle |
$38.52
|
| Rate for Payer: Aetna Commercial |
$50.37
|
| Rate for Payer: Aetna Medicare |
$29.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.52
|
| Rate for Payer: BCBS Complete |
$23.70
|
| Rate for Payer: BCBS Trust/PPO |
$20.03
|
| Rate for Payer: BCN Commercial |
$20.03
|
| Rate for Payer: Cash Price |
$47.41
|
| 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 |
$44.44
|
| 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 |
$44.44
|
|
|
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 |
$122.26
|
| Rate for Payer: Aetna Commercial |
$159.88
|
| Rate for Payer: Aetna Medicare |
$94.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.26
|
| 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 |
$141.08
|
| 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 |
$122.26
|
| 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 |
$141.08
|
|
|
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: Cofinity Commercial |
$185.54
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.54
|
| 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: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$185.54
|
| 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 |
$122.26
|
| Rate for Payer: Aetna Commercial |
$159.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.26
|
| 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 |
$141.08
|
| 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 |
$122.26
|
| 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 |
$141.08
|
|
|
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
|
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 |
$132.52
|
| 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 |
$185.54
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$185.54
|
| 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 |
$185.54
|
| 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
|
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
|
$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 |
$92.84
|
| 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
|
|
|
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
|
|
