|
ZIV-AFLIBERCEPT 25MG/ML INJECTION
|
Facility
|
OP
|
$7,184.00
|
|
|
Service Code
|
HCPCS J9400
|
| Hospital Charge Code |
161499
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$6,465.60 |
| Rate for Payer: Aetna American Axle |
$4,669.60
|
| Rate for Payer: Aetna Commercial |
$6,106.40
|
| Rate for Payer: Aetna Medicare |
$8.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,669.60
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9.98
|
| Rate for Payer: BCBS Complete |
$4.49
|
| Rate for Payer: BCBS MAPPO |
$7.98
|
| Rate for Payer: BCBS Trust/PPO |
$21.52
|
| Rate for Payer: BCN Commercial |
$21.52
|
| Rate for Payer: BCN Medicare Advantage |
$7.98
|
| Rate for Payer: Cash Price |
$5,747.20
|
| Rate for Payer: Cash Price |
$5,747.20
|
| Rate for Payer: Cofinity Commercial |
$6,178.24
|
| Rate for Payer: Cofinity Commercial |
$5,028.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,028.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,747.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.98
|
| Rate for Payer: Healthscope Commercial |
$6,465.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,028.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,388.00
|
| Rate for Payer: Mclaren Medicaid |
$4.28
|
| Rate for Payer: Mclaren Medicare |
$7.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.38
|
| Rate for Payer: Meridian Medicaid |
$4.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$9.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,106.40
|
| Rate for Payer: Nomi Health Commercial |
$23.94
|
| Rate for Payer: PACE Medicare |
$7.58
|
| Rate for Payer: PACE SWMI |
$7.98
|
| Rate for Payer: PHP Commercial |
$6,106.40
|
| Rate for Payer: PHP Medicare Advantage |
$7.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,669.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.71
|
| Rate for Payer: Priority Health Medicare |
$7.98
|
| Rate for Payer: Priority Health Narrow Network |
$14.97
|
| Rate for Payer: Priority Health SBD |
$4,525.92
|
| Rate for Payer: Railroad Medicare Medicare |
$7.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.98
|
| Rate for Payer: UHC Exchange |
$15.25
|
| Rate for Payer: UHC Medicare Advantage |
$7.98
|
| Rate for Payer: UHCCP Medicaid |
$4.28
|
| Rate for Payer: UMR Bronson Commercial |
$2,658.08
|
| Rate for Payer: VA VA |
$7.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,388.00
|
|
|
ZIV-AFLIBERCEPT 25MG/ML INJECTION
|
Facility
|
IP
|
$7,184.00
|
|
|
Service Code
|
HCPCS J9400
|
| Hospital Charge Code |
161499
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,160.96 |
| Max. Negotiated Rate |
$6,465.60 |
| Rate for Payer: Aetna American Axle |
$4,669.60
|
| Rate for Payer: Aetna Commercial |
$6,106.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,669.60
|
| Rate for Payer: Cash Price |
$5,747.20
|
| Rate for Payer: Cofinity Commercial |
$5,028.80
|
| Rate for Payer: Cofinity Commercial |
$6,178.24
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,028.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,747.20
|
| Rate for Payer: Healthscope Commercial |
$6,465.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$5,028.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$5,388.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,106.40
|
| Rate for Payer: PHP Commercial |
$6,106.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,669.60
|
| Rate for Payer: Priority Health SBD |
$4,525.92
|
| Rate for Payer: UMR Bronson Commercial |
$3,160.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$5,388.00
|
|
|
ZOLEDRONIC ACID 4 MG/100 ML-MANNITOL-0.9 % NACL INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$103.24
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
167580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna American Axle |
$67.11
|
| Rate for Payer: Aetna Commercial |
$87.75
|
| Rate for Payer: Aetna Medicare |
$51.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.11
|
| Rate for Payer: BCBS Complete |
$41.30
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCN Commercial |
$17.44
|
| Rate for Payer: Cash Price |
$82.59
|
| Rate for Payer: Cash Price |
$82.59
|
| Rate for Payer: Cofinity Commercial |
$72.27
|
| Rate for Payer: Cofinity Commercial |
$88.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$72.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.59
|
| Rate for Payer: Healthscope Commercial |
$92.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.75
|
| Rate for Payer: PHP Commercial |
$87.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.11
|
| Rate for Payer: Priority Health SBD |
$65.04
|
| Rate for Payer: UMR Bronson Commercial |
$38.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.43
|
|
|
ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$473.14
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
35640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$425.83 |
| Rate for Payer: Aetna American Axle |
$307.54
|
| Rate for Payer: Aetna American Axle |
$276.30
|
| Rate for Payer: Aetna American Axle |
$216.87
|
| Rate for Payer: Aetna American Axle |
$170.06
|
| Rate for Payer: Aetna American Axle |
$244.38
|
| Rate for Payer: Aetna American Axle |
$75.69
|
| Rate for Payer: Aetna American Axle |
$166.24
|
| Rate for Payer: Aetna American Axle |
$88.08
|
| Rate for Payer: Aetna Commercial |
$217.39
|
| Rate for Payer: Aetna Commercial |
$98.97
|
| Rate for Payer: Aetna Commercial |
$115.18
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna Commercial |
$222.39
|
| Rate for Payer: Aetna Commercial |
$319.57
|
| Rate for Payer: Aetna Commercial |
$361.31
|
| Rate for Payer: Aetna Commercial |
$402.17
|
| Rate for Payer: Aetna Medicare |
$130.82
|
| Rate for Payer: Aetna Medicare |
$67.76
|
| Rate for Payer: Aetna Medicare |
$212.54
|
| Rate for Payer: Aetna Medicare |
$127.88
|
| Rate for Payer: Aetna Medicare |
$236.57
|
| Rate for Payer: Aetna Medicare |
$166.82
|
| Rate for Payer: Aetna Medicare |
$58.22
|
| Rate for Payer: Aetna Medicare |
$187.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$307.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: BCBS Complete |
$189.26
|
| Rate for Payer: BCBS Complete |
$150.39
|
| Rate for Payer: BCBS Complete |
$104.65
|
| Rate for Payer: BCBS Complete |
$54.20
|
| Rate for Payer: BCBS Complete |
$46.58
|
| Rate for Payer: BCBS Complete |
$102.30
|
| Rate for Payer: BCBS Complete |
$170.03
|
| Rate for Payer: BCBS Complete |
$133.46
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCN Commercial |
$17.44
|
| Rate for Payer: BCN Commercial |
$17.44
|
| Rate for Payer: BCN Commercial |
$17.44
|
| Rate for Payer: BCN Commercial |
$17.44
|
| Rate for Payer: BCN Commercial |
$17.44
|
| Rate for Payer: BCN Commercial |
$17.44
|
| Rate for Payer: BCN Commercial |
$17.44
|
| Rate for Payer: BCN Commercial |
$17.44
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$108.41
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cash Price |
$108.41
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$209.30
|
| Rate for Payer: Cash Price |
$209.30
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$300.78
|
| Rate for Payer: Cash Price |
$300.78
|
| Rate for Payer: Cash Price |
$340.06
|
| Rate for Payer: Cash Price |
$340.06
|
| Rate for Payer: Cash Price |
$378.51
|
| Rate for Payer: Cash Price |
$378.51
|
| Rate for Payer: Cofinity Commercial |
$183.14
|
| Rate for Payer: Cofinity Commercial |
$323.33
|
| Rate for Payer: Cofinity Commercial |
$263.18
|
| Rate for Payer: Cofinity Commercial |
$100.14
|
| Rate for Payer: Cofinity Commercial |
$94.86
|
| Rate for Payer: Cofinity Commercial |
$331.20
|
| Rate for Payer: Cofinity Commercial |
$225.00
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Cofinity Commercial |
$179.02
|
| Rate for Payer: Cofinity Commercial |
$116.54
|
| Rate for Payer: Cofinity Commercial |
$81.51
|
| Rate for Payer: Cofinity Commercial |
$219.94
|
| Rate for Payer: Cofinity Commercial |
$233.55
|
| Rate for Payer: Cofinity Commercial |
$365.56
|
| Rate for Payer: Cofinity Commercial |
$297.55
|
| Rate for Payer: Cofinity Commercial |
$406.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.02
|
| Rate for Payer: Cofinity Medicare Advantage |
$183.14
|
| Rate for Payer: Cofinity Medicare Advantage |
$263.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$331.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$209.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$378.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.15
|
| Rate for Payer: Healthscope Commercial |
$230.18
|
| Rate for Payer: Healthscope Commercial |
$235.47
|
| Rate for Payer: Healthscope Commercial |
$382.56
|
| Rate for Payer: Healthscope Commercial |
$425.83
|
| Rate for Payer: Healthscope Commercial |
$338.37
|
| Rate for Payer: Healthscope Commercial |
$104.80
|
| Rate for Payer: Healthscope Commercial |
$121.96
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$331.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$263.18
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$183.14
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$281.98
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$196.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$354.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$402.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$222.39
|
| Rate for Payer: PHP Commercial |
$319.57
|
| Rate for Payer: PHP Commercial |
$115.18
|
| Rate for Payer: PHP Commercial |
$402.17
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: PHP Commercial |
$98.97
|
| Rate for Payer: PHP Commercial |
$217.39
|
| Rate for Payer: PHP Commercial |
$361.31
|
| Rate for Payer: PHP Commercial |
$222.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$170.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$244.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$307.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.30
|
| Rate for Payer: Priority Health SBD |
$73.36
|
| Rate for Payer: Priority Health SBD |
$298.08
|
| Rate for Payer: Priority Health SBD |
$164.83
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: Priority Health SBD |
$85.37
|
| Rate for Payer: Priority Health SBD |
$161.12
|
| Rate for Payer: Priority Health SBD |
$267.79
|
| Rate for Payer: Priority Health SBD |
$236.86
|
| Rate for Payer: UMR Bronson Commercial |
$157.28
|
| Rate for Payer: UMR Bronson Commercial |
$175.06
|
| Rate for Payer: UMR Bronson Commercial |
$139.11
|
| Rate for Payer: UMR Bronson Commercial |
$123.45
|
| Rate for Payer: UMR Bronson Commercial |
$96.80
|
| Rate for Payer: UMR Bronson Commercial |
$50.14
|
| Rate for Payer: UMR Bronson Commercial |
$43.08
|
| Rate for Payer: UMR Bronson Commercial |
$94.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$281.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$196.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$354.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.23
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.33
|
|
|
ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$333.64
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
35640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$146.80 |
| Max. Negotiated Rate |
$300.28 |
| Rate for Payer: Aetna American Axle |
$216.87
|
| Rate for Payer: Aetna American Axle |
$75.69
|
| Rate for Payer: Aetna American Axle |
$88.08
|
| Rate for Payer: Aetna American Axle |
$276.30
|
| Rate for Payer: Aetna American Axle |
$166.24
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna Commercial |
$115.18
|
| Rate for Payer: Aetna Commercial |
$98.97
|
| Rate for Payer: Aetna Commercial |
$361.31
|
| Rate for Payer: Aetna Commercial |
$217.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.08
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$340.06
|
| Rate for Payer: Cash Price |
$108.41
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cofinity Commercial |
$297.55
|
| Rate for Payer: Cofinity Commercial |
$100.14
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Cofinity Commercial |
$233.55
|
| Rate for Payer: Cofinity Commercial |
$179.02
|
| Rate for Payer: Cofinity Commercial |
$116.54
|
| Rate for Payer: Cofinity Commercial |
$94.86
|
| Rate for Payer: Cofinity Commercial |
$219.94
|
| Rate for Payer: Cofinity Commercial |
$81.51
|
| Rate for Payer: Cofinity Commercial |
$365.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.86
|
| Rate for Payer: Cofinity Medicare Advantage |
$297.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$179.02
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$108.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$340.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$204.60
|
| Rate for Payer: Healthscope Commercial |
$121.96
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Healthscope Commercial |
$230.18
|
| Rate for Payer: Healthscope Commercial |
$382.56
|
| Rate for Payer: Healthscope Commercial |
$104.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$233.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$81.51
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$179.02
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$297.55
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$191.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.63
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$87.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$250.23
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$318.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$115.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$361.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.97
|
| Rate for Payer: PHP Commercial |
$98.97
|
| Rate for Payer: PHP Commercial |
$361.31
|
| Rate for Payer: PHP Commercial |
$217.39
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: PHP Commercial |
$115.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$216.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$166.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$276.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.69
|
| Rate for Payer: Priority Health SBD |
$267.79
|
| Rate for Payer: Priority Health SBD |
$161.12
|
| Rate for Payer: Priority Health SBD |
$85.37
|
| Rate for Payer: Priority Health SBD |
$73.36
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: UMR Bronson Commercial |
$51.23
|
| Rate for Payer: UMR Bronson Commercial |
$59.62
|
| Rate for Payer: UMR Bronson Commercial |
$146.80
|
| Rate for Payer: UMR Bronson Commercial |
$187.03
|
| Rate for Payer: UMR Bronson Commercial |
$112.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$87.33
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$191.81
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.63
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$318.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$250.23
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK
|
Facility
|
OP
|
$4,662.65
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
81434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$4,196.38 |
| Rate for Payer: Aetna American Axle |
$3,030.72
|
| Rate for Payer: Aetna American Axle |
$252.14
|
| Rate for Payer: Aetna American Axle |
$182.47
|
| Rate for Payer: Aetna American Axle |
$142.96
|
| Rate for Payer: Aetna American Axle |
$251.69
|
| Rate for Payer: Aetna American Axle |
$692.08
|
| Rate for Payer: Aetna American Axle |
$105.26
|
| Rate for Payer: Aetna American Axle |
$83.30
|
| Rate for Payer: Aetna Commercial |
$137.65
|
| Rate for Payer: Aetna Commercial |
$905.03
|
| Rate for Payer: Aetna Commercial |
$108.93
|
| Rate for Payer: Aetna Commercial |
$238.61
|
| Rate for Payer: Aetna Commercial |
$186.95
|
| Rate for Payer: Aetna Commercial |
$329.14
|
| Rate for Payer: Aetna Commercial |
$329.72
|
| Rate for Payer: Aetna Commercial |
$3,963.25
|
| Rate for Payer: Aetna Medicare |
$109.97
|
| Rate for Payer: Aetna Medicare |
$64.08
|
| Rate for Payer: Aetna Medicare |
$193.96
|
| Rate for Payer: Aetna Medicare |
$80.97
|
| Rate for Payer: Aetna Medicare |
$2,331.32
|
| Rate for Payer: Aetna Medicare |
$140.36
|
| Rate for Payer: Aetna Medicare |
$532.37
|
| Rate for Payer: Aetna Medicare |
$193.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$692.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,030.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$252.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.47
|
| Rate for Payer: BCBS Complete |
$1,865.06
|
| Rate for Payer: BCBS Complete |
$154.89
|
| Rate for Payer: BCBS Complete |
$87.98
|
| Rate for Payer: BCBS Complete |
$51.26
|
| Rate for Payer: BCBS Complete |
$425.90
|
| Rate for Payer: BCBS Complete |
$64.78
|
| Rate for Payer: BCBS Complete |
$155.16
|
| Rate for Payer: BCBS Complete |
$112.29
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCBS Trust/PPO |
$17.44
|
| Rate for Payer: BCN Commercial |
$17.44
|
| Rate for Payer: BCN Commercial |
$17.44
|
| Rate for Payer: BCN Commercial |
$17.44
|
| Rate for Payer: BCN Commercial |
$17.44
|
| Rate for Payer: BCN Commercial |
$17.44
|
| Rate for Payer: BCN Commercial |
$17.44
|
| Rate for Payer: BCN Commercial |
$17.44
|
| Rate for Payer: BCN Commercial |
$17.44
|
| Rate for Payer: Cash Price |
$129.55
|
| Rate for Payer: Cash Price |
$102.52
|
| Rate for Payer: Cash Price |
$851.79
|
| Rate for Payer: Cash Price |
$102.52
|
| Rate for Payer: Cash Price |
$851.79
|
| Rate for Payer: Cash Price |
$129.55
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Cash Price |
$309.78
|
| Rate for Payer: Cash Price |
$309.78
|
| Rate for Payer: Cash Price |
$310.33
|
| Rate for Payer: Cash Price |
$310.33
|
| Rate for Payer: Cash Price |
$3,730.12
|
| Rate for Payer: Cash Price |
$3,730.12
|
| Rate for Payer: Cofinity Commercial |
$153.96
|
| Rate for Payer: Cofinity Commercial |
$333.01
|
| Rate for Payer: Cofinity Commercial |
$271.05
|
| Rate for Payer: Cofinity Commercial |
$745.32
|
| Rate for Payer: Cofinity Commercial |
$89.70
|
| Rate for Payer: Cofinity Commercial |
$3,263.86
|
| Rate for Payer: Cofinity Commercial |
$189.15
|
| Rate for Payer: Cofinity Commercial |
$241.42
|
| Rate for Payer: Cofinity Commercial |
$113.36
|
| Rate for Payer: Cofinity Commercial |
$110.21
|
| Rate for Payer: Cofinity Commercial |
$915.68
|
| Rate for Payer: Cofinity Commercial |
$139.27
|
| Rate for Payer: Cofinity Commercial |
$196.50
|
| Rate for Payer: Cofinity Commercial |
$333.60
|
| Rate for Payer: Cofinity Commercial |
$271.54
|
| Rate for Payer: Cofinity Commercial |
$4,009.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$745.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$271.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$271.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,263.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,730.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$310.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$851.79
|
| Rate for Payer: Healthscope Commercial |
$145.75
|
| Rate for Payer: Healthscope Commercial |
$197.95
|
| Rate for Payer: Healthscope Commercial |
$349.12
|
| Rate for Payer: Healthscope Commercial |
$4,196.38
|
| Rate for Payer: Healthscope Commercial |
$348.50
|
| Rate for Payer: Healthscope Commercial |
$958.27
|
| Rate for Payer: Healthscope Commercial |
$115.34
|
| Rate for Payer: Healthscope Commercial |
$252.65
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,263.86
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$271.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$196.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$89.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$745.32
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$153.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.11
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$798.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$290.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,496.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$905.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,963.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.95
|
| Rate for Payer: PHP Commercial |
$329.14
|
| Rate for Payer: PHP Commercial |
$108.93
|
| Rate for Payer: PHP Commercial |
$3,963.25
|
| Rate for Payer: PHP Commercial |
$238.61
|
| Rate for Payer: PHP Commercial |
$905.03
|
| Rate for Payer: PHP Commercial |
$137.65
|
| Rate for Payer: PHP Commercial |
$329.72
|
| Rate for Payer: PHP Commercial |
$186.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$692.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,030.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$252.14
|
| Rate for Payer: Priority Health SBD |
$670.79
|
| Rate for Payer: Priority Health SBD |
$2,937.47
|
| Rate for Payer: Priority Health SBD |
$138.56
|
| Rate for Payer: Priority Health SBD |
$176.85
|
| Rate for Payer: Priority Health SBD |
$80.73
|
| Rate for Payer: Priority Health SBD |
$102.02
|
| Rate for Payer: Priority Health SBD |
$244.38
|
| Rate for Payer: Priority Health SBD |
$243.95
|
| Rate for Payer: UMR Bronson Commercial |
$143.53
|
| Rate for Payer: UMR Bronson Commercial |
$1,725.18
|
| Rate for Payer: UMR Bronson Commercial |
$143.27
|
| Rate for Payer: UMR Bronson Commercial |
$103.87
|
| Rate for Payer: UMR Bronson Commercial |
$81.38
|
| Rate for Payer: UMR Bronson Commercial |
$47.42
|
| Rate for Payer: UMR Bronson Commercial |
$393.95
|
| Rate for Payer: UMR Bronson Commercial |
$59.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$290.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,496.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$798.56
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK
|
Facility
|
IP
|
$161.94
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
81434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$145.75 |
| Rate for Payer: Aetna American Axle |
$105.26
|
| Rate for Payer: Aetna American Axle |
$3,030.72
|
| Rate for Payer: Aetna Commercial |
$137.65
|
| Rate for Payer: Aetna Commercial |
$3,963.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,030.72
|
| Rate for Payer: Cash Price |
$129.55
|
| Rate for Payer: Cash Price |
$3,730.12
|
| Rate for Payer: Cofinity Commercial |
$4,009.88
|
| Rate for Payer: Cofinity Commercial |
$3,263.86
|
| Rate for Payer: Cofinity Commercial |
$113.36
|
| Rate for Payer: Cofinity Commercial |
$139.27
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,263.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,730.12
|
| Rate for Payer: Healthscope Commercial |
$145.75
|
| Rate for Payer: Healthscope Commercial |
$4,196.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$113.36
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3,263.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3,496.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,963.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.65
|
| Rate for Payer: PHP Commercial |
$3,963.25
|
| Rate for Payer: PHP Commercial |
$137.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,030.72
|
| Rate for Payer: Priority Health SBD |
$102.02
|
| Rate for Payer: Priority Health SBD |
$2,937.47
|
| Rate for Payer: UMR Bronson Commercial |
$71.25
|
| Rate for Payer: UMR Bronson Commercial |
$2,051.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3,496.99
|
|
|
ZOLMITRIPTAN 5 MG TABLET
|
Facility
|
IP
|
$22.28
|
|
|
Service Code
|
NDC 27241002238
|
| Hospital Charge Code |
22219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Aetna American Axle |
$14.48
|
| Rate for Payer: Aetna Commercial |
$18.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.48
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$15.60
|
| Rate for Payer: Cofinity Commercial |
$19.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Healthscope Commercial |
$20.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.94
|
| Rate for Payer: PHP Commercial |
$18.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: Priority Health SBD |
$14.04
|
| Rate for Payer: UMR Bronson Commercial |
$9.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.71
|
|
|
ZOLMITRIPTAN 5 MG TABLET
|
Facility
|
OP
|
$22.28
|
|
|
Service Code
|
NDC 27241002238
|
| Hospital Charge Code |
22219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Aetna American Axle |
$14.48
|
| Rate for Payer: Aetna Commercial |
$18.94
|
| Rate for Payer: Aetna Medicare |
$11.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.48
|
| Rate for Payer: BCBS Complete |
$8.91
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$15.60
|
| Rate for Payer: Cofinity Commercial |
$19.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Healthscope Commercial |
$20.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.94
|
| Rate for Payer: PHP Commercial |
$18.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: Priority Health SBD |
$14.04
|
| Rate for Payer: UMR Bronson Commercial |
$8.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.71
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
NDC 68084018901
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.52 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna American Axle |
$127.40
|
| Rate for Payer: Aetna Commercial |
$166.60
|
| Rate for Payer: Aetna Medicare |
$98.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.40
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$137.20
|
| Rate for Payer: Cofinity Commercial |
$168.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.80
|
| Rate for Payer: Healthscope Commercial |
$176.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.60
|
| Rate for Payer: PHP Commercial |
$166.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health SBD |
$123.48
|
| Rate for Payer: UMR Bronson Commercial |
$72.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.00
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$113.75
|
|
|
Service Code
|
NDC 00781531701
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.09 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna American Axle |
$73.94
|
| Rate for Payer: Aetna Commercial |
$96.69
|
| Rate for Payer: Aetna Medicare |
$56.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.94
|
| Rate for Payer: BCBS Complete |
$45.50
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cofinity Commercial |
$79.62
|
| Rate for Payer: Cofinity Commercial |
$97.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.00
|
| Rate for Payer: Healthscope Commercial |
$102.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.69
|
| Rate for Payer: PHP Commercial |
$96.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.94
|
| Rate for Payer: Priority Health SBD |
$71.66
|
| Rate for Payer: UMR Bronson Commercial |
$42.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.31
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$1.35
|
|
|
Service Code
|
NDC 51079072401
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna American Axle |
$0.88
|
| Rate for Payer: Aetna Commercial |
$1.15
|
| Rate for Payer: Aetna Medicare |
$0.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.88
|
| Rate for Payer: BCBS Complete |
$0.54
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cofinity Commercial |
$0.95
|
| Rate for Payer: Cofinity Commercial |
$1.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.08
|
| Rate for Payer: Healthscope Commercial |
$1.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.15
|
| Rate for Payer: PHP Commercial |
$1.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.88
|
| Rate for Payer: Priority Health SBD |
$0.85
|
| Rate for Payer: UMR Bronson Commercial |
$0.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.01
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$204.75
|
|
|
Service Code
|
NDC 60687083801
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.76 |
| Max. Negotiated Rate |
$184.28 |
| Rate for Payer: Aetna American Axle |
$133.09
|
| Rate for Payer: Aetna Commercial |
$174.04
|
| Rate for Payer: Aetna Medicare |
$102.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.09
|
| Rate for Payer: BCBS Complete |
$81.90
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cofinity Commercial |
$143.32
|
| Rate for Payer: Cofinity Commercial |
$176.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.80
|
| Rate for Payer: Healthscope Commercial |
$184.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.04
|
| Rate for Payer: PHP Commercial |
$174.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.09
|
| Rate for Payer: Priority Health SBD |
$128.99
|
| Rate for Payer: UMR Bronson Commercial |
$75.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.56
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$1.96
|
|
|
Service Code
|
NDC 68084018911
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna American Axle |
$1.27
|
| Rate for Payer: Aetna Commercial |
$1.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.27
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: Cofinity Commercial |
$1.37
|
| Rate for Payer: Cofinity Commercial |
$1.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.57
|
| Rate for Payer: Healthscope Commercial |
$1.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.67
|
| Rate for Payer: PHP Commercial |
$1.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.27
|
| Rate for Payer: Priority Health SBD |
$1.23
|
| Rate for Payer: UMR Bronson Commercial |
$0.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.47
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
NDC 00093007301
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna American Axle |
$50.05
|
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.05
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$53.90
|
| Rate for Payer: Cofinity Commercial |
$66.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.60
|
| Rate for Payer: Healthscope Commercial |
$69.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.45
|
| Rate for Payer: PHP Commercial |
$65.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: Priority Health SBD |
$48.51
|
| Rate for Payer: UMR Bronson Commercial |
$33.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.75
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
NDC 68084018901
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.24 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna American Axle |
$127.40
|
| Rate for Payer: Aetna Commercial |
$166.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.40
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$137.20
|
| Rate for Payer: Cofinity Commercial |
$168.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.80
|
| Rate for Payer: Healthscope Commercial |
$176.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.60
|
| Rate for Payer: PHP Commercial |
$166.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health SBD |
$123.48
|
| Rate for Payer: UMR Bronson Commercial |
$86.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.00
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$2.05
|
|
|
Service Code
|
NDC 60687083811
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna American Axle |
$1.33
|
| Rate for Payer: Aetna Commercial |
$1.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.33
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cofinity Commercial |
$1.44
|
| Rate for Payer: Cofinity Commercial |
$1.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.64
|
| Rate for Payer: Healthscope Commercial |
$1.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.74
|
| Rate for Payer: PHP Commercial |
$1.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.33
|
| Rate for Payer: Priority Health SBD |
$1.29
|
| Rate for Payer: UMR Bronson Commercial |
$0.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.54
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$1.96
|
|
|
Service Code
|
NDC 68084018911
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna American Axle |
$1.27
|
| Rate for Payer: Aetna Commercial |
$1.67
|
| Rate for Payer: Aetna Medicare |
$0.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.27
|
| Rate for Payer: BCBS Complete |
$0.78
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: Cofinity Commercial |
$1.37
|
| Rate for Payer: Cofinity Commercial |
$1.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.57
|
| Rate for Payer: Healthscope Commercial |
$1.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.67
|
| Rate for Payer: PHP Commercial |
$1.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.27
|
| Rate for Payer: Priority Health SBD |
$1.23
|
| Rate for Payer: UMR Bronson Commercial |
$0.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.47
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$13.13
|
|
|
Service Code
|
NDC 00904608261
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$11.82 |
| Rate for Payer: Aetna American Axle |
$8.53
|
| Rate for Payer: Aetna Commercial |
$11.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.53
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Cofinity Commercial |
$9.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$11.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.16
|
| Rate for Payer: PHP Commercial |
$11.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.53
|
| Rate for Payer: Priority Health SBD |
$8.27
|
| Rate for Payer: UMR Bronson Commercial |
$5.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.85
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$13.13
|
|
|
Service Code
|
NDC 00904608261
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$11.82 |
| Rate for Payer: Aetna American Axle |
$8.53
|
| Rate for Payer: Aetna Commercial |
$11.16
|
| Rate for Payer: Aetna Medicare |
$6.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.53
|
| Rate for Payer: BCBS Complete |
$5.25
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Cofinity Commercial |
$9.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$11.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.16
|
| Rate for Payer: PHP Commercial |
$11.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.53
|
| Rate for Payer: Priority Health SBD |
$8.27
|
| Rate for Payer: UMR Bronson Commercial |
$4.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.85
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$204.75
|
|
|
Service Code
|
NDC 60687083801
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.09 |
| Max. Negotiated Rate |
$184.28 |
| Rate for Payer: Aetna American Axle |
$133.09
|
| Rate for Payer: Aetna Commercial |
$174.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.09
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cofinity Commercial |
$143.32
|
| Rate for Payer: Cofinity Commercial |
$176.08
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.80
|
| Rate for Payer: Healthscope Commercial |
$184.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.04
|
| Rate for Payer: PHP Commercial |
$174.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.09
|
| Rate for Payer: Priority Health SBD |
$128.99
|
| Rate for Payer: UMR Bronson Commercial |
$90.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.56
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$2.05
|
|
|
Service Code
|
NDC 60687083811
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna American Axle |
$1.33
|
| Rate for Payer: Aetna Commercial |
$1.74
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.33
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cofinity Commercial |
$1.44
|
| Rate for Payer: Cofinity Commercial |
$1.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.64
|
| Rate for Payer: Healthscope Commercial |
$1.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.74
|
| Rate for Payer: PHP Commercial |
$1.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.33
|
| Rate for Payer: Priority Health SBD |
$1.29
|
| Rate for Payer: UMR Bronson Commercial |
$0.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.54
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
NDC 00093007301
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna American Axle |
$50.05
|
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.05
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$53.90
|
| Rate for Payer: Cofinity Commercial |
$66.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.60
|
| Rate for Payer: Healthscope Commercial |
$69.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.45
|
| Rate for Payer: PHP Commercial |
$65.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: Priority Health SBD |
$48.51
|
| Rate for Payer: UMR Bronson Commercial |
$28.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.75
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$113.75
|
|
|
Service Code
|
NDC 00781531701
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna American Axle |
$73.94
|
| Rate for Payer: Aetna Commercial |
$96.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.94
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cofinity Commercial |
$79.62
|
| Rate for Payer: Cofinity Commercial |
$97.82
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.00
|
| Rate for Payer: Healthscope Commercial |
$102.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.69
|
| Rate for Payer: PHP Commercial |
$96.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.94
|
| Rate for Payer: Priority Health SBD |
$71.66
|
| Rate for Payer: UMR Bronson Commercial |
$50.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.31
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$134.75
|
|
|
Service Code
|
NDC 51079072420
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$121.28 |
| Rate for Payer: Aetna American Axle |
$87.59
|
| Rate for Payer: Aetna Commercial |
$114.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.59
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cofinity Commercial |
$115.88
|
| Rate for Payer: Cofinity Commercial |
$94.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.80
|
| Rate for Payer: Healthscope Commercial |
$121.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.54
|
| Rate for Payer: PHP Commercial |
$114.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.59
|
| Rate for Payer: Priority Health SBD |
$84.89
|
| Rate for Payer: UMR Bronson Commercial |
$59.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.06
|
|
