|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
|
OP
|
$784.40
|
|
|
Service Code
|
NDC 68084010309
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$308.27 |
| Max. Negotiated Rate |
$705.96 |
| Rate for Payer: Aetna Commercial |
$666.74
|
| Rate for Payer: Aetna Medicare |
$392.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$509.86
|
| Rate for Payer: BCBS Complete |
$313.76
|
| Rate for Payer: Cash Price |
$627.52
|
| Rate for Payer: Cofinity Advantage |
$549.08
|
| Rate for Payer: Cofinity Commercial |
$674.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$627.52
|
| Rate for Payer: Healthscope Commercial |
$705.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$627.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$666.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$588.30
|
| Rate for Payer: PHP Commercial |
$666.74
|
| Rate for Payer: Priority Health SBD |
$494.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$509.86
|
| Rate for Payer: UHC Core |
$408.67
|
| Rate for Payer: UHC Exchange |
$308.27
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
|
IP
|
$784.40
|
|
|
Service Code
|
NDC 68084010309
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$494.17 |
| Max. Negotiated Rate |
$705.96 |
| Rate for Payer: Aetna Commercial |
$666.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$509.86
|
| Rate for Payer: Cash Price |
$627.52
|
| Rate for Payer: Cofinity Advantage |
$549.08
|
| Rate for Payer: Cofinity Commercial |
$674.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$627.52
|
| Rate for Payer: Healthscope Commercial |
$705.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$666.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$588.30
|
| Rate for Payer: PHP Commercial |
$666.74
|
| Rate for Payer: Priority Health SBD |
$494.17
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
|
IP
|
$265.05
|
|
|
Service Code
|
NDC 00781216460
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$166.98 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Advantage |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.79
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health SBD |
$166.98
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
|
OP
|
$265.05
|
|
|
Service Code
|
NDC 00781216460
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$104.16 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Aetna Commercial |
$225.29
|
| Rate for Payer: Aetna Medicare |
$132.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.28
|
| Rate for Payer: BCBS Complete |
$106.02
|
| Rate for Payer: Cash Price |
$212.04
|
| Rate for Payer: Cofinity Advantage |
$185.53
|
| Rate for Payer: Cofinity Commercial |
$227.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$212.04
|
| Rate for Payer: Healthscope Commercial |
$238.54
|
| Rate for Payer: MI Amish Medical Board Commercial |
$212.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$225.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$198.79
|
| Rate for Payer: PHP Commercial |
$225.29
|
| Rate for Payer: Priority Health SBD |
$166.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.28
|
| Rate for Payer: UHC Core |
$138.09
|
| Rate for Payer: UHC Exchange |
$104.16
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
|
IP
|
$221.16
|
|
|
Service Code
|
NDC 65862070260
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.33 |
| Max. Negotiated Rate |
$199.04 |
| 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 Advantage |
$154.81
|
| Rate for Payer: Cofinity Commercial |
$190.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.93
|
| Rate for Payer: Healthscope Commercial |
$199.04
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.87
|
| Rate for Payer: PHP Commercial |
$187.99
|
| Rate for Payer: Priority Health SBD |
$139.33
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
|
IP
|
$204.10
|
|
|
Service Code
|
NDC 63739000532
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.58 |
| Max. Negotiated Rate |
$183.69 |
| Rate for Payer: Aetna Commercial |
$173.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.66
|
| Rate for Payer: Cash Price |
$163.28
|
| Rate for Payer: Cofinity Advantage |
$142.87
|
| Rate for Payer: Cofinity Commercial |
$175.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.28
|
| Rate for Payer: Healthscope Commercial |
$183.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.07
|
| Rate for Payer: PHP Commercial |
$173.49
|
| Rate for Payer: Priority Health SBD |
$128.58
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
|
OP
|
$190.38
|
|
|
Service Code
|
NDC 55111025760
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.82 |
| Max. Negotiated Rate |
$171.34 |
| Rate for Payer: Aetna Commercial |
$161.82
|
| Rate for Payer: Aetna Medicare |
$95.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.75
|
| Rate for Payer: BCBS Complete |
$76.15
|
| Rate for Payer: Cash Price |
$152.30
|
| Rate for Payer: Cofinity Advantage |
$133.27
|
| Rate for Payer: Cofinity Commercial |
$163.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.30
|
| Rate for Payer: Healthscope Commercial |
$171.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.78
|
| Rate for Payer: PHP Commercial |
$161.82
|
| Rate for Payer: Priority Health SBD |
$119.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.75
|
| Rate for Payer: UHC Core |
$99.19
|
| Rate for Payer: UHC Exchange |
$74.82
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
|
OP
|
$204.10
|
|
|
Service Code
|
NDC 00904627008
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.21 |
| Max. Negotiated Rate |
$183.69 |
| Rate for Payer: Aetna Commercial |
$173.49
|
| Rate for Payer: Aetna Medicare |
$102.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.66
|
| Rate for Payer: BCBS Complete |
$81.64
|
| Rate for Payer: Cash Price |
$163.28
|
| Rate for Payer: Cofinity Advantage |
$142.87
|
| Rate for Payer: Cofinity Commercial |
$175.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.28
|
| Rate for Payer: Healthscope Commercial |
$183.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.07
|
| Rate for Payer: PHP Commercial |
$173.49
|
| Rate for Payer: Priority Health SBD |
$128.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.66
|
| Rate for Payer: UHC Core |
$106.34
|
| Rate for Payer: UHC Exchange |
$80.21
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
|
IP
|
$190.38
|
|
|
Service Code
|
NDC 55111025760
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.94 |
| Max. Negotiated Rate |
$171.34 |
| Rate for Payer: Aetna Commercial |
$161.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.75
|
| Rate for Payer: Cash Price |
$152.30
|
| Rate for Payer: Cofinity Advantage |
$133.27
|
| Rate for Payer: Cofinity Commercial |
$163.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.30
|
| Rate for Payer: Healthscope Commercial |
$171.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.82
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.78
|
| Rate for Payer: PHP Commercial |
$161.82
|
| Rate for Payer: Priority Health SBD |
$119.94
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
|
IP
|
$204.10
|
|
|
Service Code
|
NDC 00904627008
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.58 |
| Max. Negotiated Rate |
$183.69 |
| Rate for Payer: Aetna Commercial |
$173.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.66
|
| Rate for Payer: Cash Price |
$163.28
|
| Rate for Payer: Cofinity Advantage |
$142.87
|
| Rate for Payer: Cofinity Commercial |
$175.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.28
|
| Rate for Payer: Healthscope Commercial |
$183.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.07
|
| Rate for Payer: PHP Commercial |
$173.49
|
| Rate for Payer: Priority Health SBD |
$128.58
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
|
OP
|
$204.10
|
|
|
Service Code
|
NDC 63739000532
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$80.21 |
| Max. Negotiated Rate |
$183.69 |
| Rate for Payer: Aetna Commercial |
$173.49
|
| Rate for Payer: Aetna Medicare |
$102.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.66
|
| Rate for Payer: BCBS Complete |
$81.64
|
| Rate for Payer: Cash Price |
$163.28
|
| Rate for Payer: Cofinity Advantage |
$142.87
|
| Rate for Payer: Cofinity Commercial |
$175.53
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.28
|
| Rate for Payer: Healthscope Commercial |
$183.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$163.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$153.07
|
| Rate for Payer: PHP Commercial |
$173.49
|
| Rate for Payer: Priority Health SBD |
$128.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.66
|
| Rate for Payer: UHC Core |
$106.34
|
| Rate for Payer: UHC Exchange |
$80.21
|
|
|
ZOLEDRONIC ACID 4 MG/100 ML-MANNITOL-0.9 % NACL INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$103.24
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
167580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.04 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna Commercial |
$87.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.11
|
| Rate for Payer: Cash Price |
$82.59
|
| Rate for Payer: Cofinity Advantage |
$72.27
|
| Rate for Payer: Cofinity Commercial |
$88.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.59
|
| Rate for Payer: Healthscope Commercial |
$92.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.43
|
| Rate for Payer: PHP Commercial |
$87.75
|
| Rate for Payer: Priority Health SBD |
$65.04
|
|
|
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 |
$8.38 |
| Max. Negotiated Rate |
$92.92 |
| 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 |
$12.73
|
| Rate for Payer: BCN Commercial |
$12.73
|
| Rate for Payer: Cash Price |
$82.59
|
| Rate for Payer: Cash Price |
$82.59
|
| Rate for Payer: Cofinity Advantage |
$72.27
|
| Rate for Payer: Cofinity Commercial |
$88.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.59
|
| Rate for Payer: Healthscope Commercial |
$92.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$82.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$87.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.43
|
| Rate for Payer: PHP Commercial |
$87.75
|
| Rate for Payer: Priority Health SBD |
$65.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
|
|
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 |
$210.19 |
| Max. Negotiated Rate |
$300.28 |
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna Commercial |
$98.97
|
| Rate for Payer: Aetna Commercial |
$319.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.69
|
| Rate for Payer: Cash Price |
$300.78
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cofinity Advantage |
$233.55
|
| Rate for Payer: Cofinity Advantage |
$81.51
|
| Rate for Payer: Cofinity Advantage |
$263.18
|
| Rate for Payer: Cofinity Commercial |
$323.33
|
| Rate for Payer: Cofinity Commercial |
$100.14
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.78
|
| Rate for Payer: Healthscope Commercial |
$104.80
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Healthscope Commercial |
$338.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.23
|
| Rate for Payer: PHP Commercial |
$98.97
|
| Rate for Payer: PHP Commercial |
$319.57
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: Priority Health SBD |
$236.86
|
| Rate for Payer: Priority Health SBD |
$73.36
|
| Rate for Payer: Priority Health SBD |
$210.19
|
|
|
ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$116.44
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
35640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$104.80 |
| Rate for Payer: Aetna Commercial |
$98.97
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna Commercial |
$319.57
|
| Rate for Payer: Aetna Medicare |
$58.22
|
| Rate for Payer: Aetna Medicare |
$166.82
|
| Rate for Payer: Aetna Medicare |
$187.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.38
|
| Rate for Payer: BCBS Complete |
$150.39
|
| Rate for Payer: BCBS Complete |
$46.58
|
| Rate for Payer: BCBS Complete |
$133.46
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCN Commercial |
$12.73
|
| Rate for Payer: BCN Commercial |
$12.73
|
| Rate for Payer: BCN Commercial |
$12.73
|
| Rate for Payer: Cash Price |
$300.78
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$300.78
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cofinity Advantage |
$233.55
|
| Rate for Payer: Cofinity Advantage |
$81.51
|
| Rate for Payer: Cofinity Advantage |
$263.18
|
| Rate for Payer: Cofinity Commercial |
$100.14
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Cofinity Commercial |
$323.33
|
| 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 |
$93.15
|
| Rate for Payer: Healthscope Commercial |
$338.37
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Healthscope Commercial |
$104.80
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$300.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$266.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.57
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$250.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$281.98
|
| Rate for Payer: PHP Commercial |
$98.97
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: PHP Commercial |
$319.57
|
| Rate for Payer: Priority Health SBD |
$73.36
|
| Rate for Payer: Priority Health SBD |
$236.86
|
| Rate for Payer: Priority Health SBD |
$210.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK
|
Facility
|
IP
|
$387.22
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
81434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$243.95 |
| Max. Negotiated Rate |
$348.50 |
| Rate for Payer: Aetna Commercial |
$329.14
|
| Rate for Payer: Aetna Commercial |
$137.26
|
| Rate for Payer: Aetna Commercial |
$172.35
|
| Rate for Payer: Aetna Commercial |
$137.65
|
| Rate for Payer: Aetna Commercial |
$3,963.25
|
| Rate for Payer: Aetna Commercial |
$186.95
|
| Rate for Payer: Aetna Commercial |
$238.61
|
| Rate for Payer: Aetna Commercial |
$100.97
|
| Rate for Payer: Aetna Commercial |
$310.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,030.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.69
|
| Rate for Payer: Cash Price |
$291.77
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$95.03
|
| Rate for Payer: Cash Price |
$129.18
|
| Rate for Payer: Cash Price |
$129.55
|
| Rate for Payer: Cash Price |
$162.22
|
| Rate for Payer: Cash Price |
$3,730.12
|
| Rate for Payer: Cash Price |
$309.78
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Cofinity Advantage |
$113.04
|
| Rate for Payer: Cofinity Advantage |
$255.30
|
| Rate for Payer: Cofinity Advantage |
$141.94
|
| Rate for Payer: Cofinity Advantage |
$271.05
|
| Rate for Payer: Cofinity Advantage |
$196.50
|
| Rate for Payer: Cofinity Advantage |
$153.96
|
| Rate for Payer: Cofinity Advantage |
$113.36
|
| Rate for Payer: Cofinity Advantage |
$3,263.86
|
| Rate for Payer: Cofinity Advantage |
$83.15
|
| Rate for Payer: Cofinity Commercial |
$4,009.88
|
| Rate for Payer: Cofinity Commercial |
$189.15
|
| Rate for Payer: Cofinity Commercial |
$139.27
|
| Rate for Payer: Cofinity Commercial |
$138.87
|
| Rate for Payer: Cofinity Commercial |
$313.65
|
| Rate for Payer: Cofinity Commercial |
$102.16
|
| Rate for Payer: Cofinity Commercial |
$174.38
|
| Rate for Payer: Cofinity Commercial |
$241.42
|
| Rate for Payer: Cofinity Commercial |
$333.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.55
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3,730.12
|
| Rate for Payer: Healthscope Commercial |
$182.49
|
| Rate for Payer: Healthscope Commercial |
$328.24
|
| Rate for Payer: Healthscope Commercial |
$348.50
|
| Rate for Payer: Healthscope Commercial |
$197.95
|
| Rate for Payer: Healthscope Commercial |
$4,196.39
|
| Rate for Payer: Healthscope Commercial |
$106.91
|
| Rate for Payer: Healthscope Commercial |
$145.33
|
| Rate for Payer: Healthscope Commercial |
$252.65
|
| Rate for Payer: Healthscope Commercial |
$145.75
|
| 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 |
$238.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,963.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,496.99
|
| Rate for Payer: PHP Commercial |
$186.95
|
| Rate for Payer: PHP Commercial |
$172.35
|
| Rate for Payer: PHP Commercial |
$238.61
|
| Rate for Payer: PHP Commercial |
$137.65
|
| Rate for Payer: PHP Commercial |
$137.26
|
| Rate for Payer: PHP Commercial |
$310.00
|
| Rate for Payer: PHP Commercial |
$100.97
|
| Rate for Payer: PHP Commercial |
$3,963.25
|
| Rate for Payer: PHP Commercial |
$329.14
|
| Rate for Payer: Priority Health SBD |
$243.95
|
| Rate for Payer: Priority Health SBD |
$229.77
|
| Rate for Payer: Priority Health SBD |
$101.73
|
| Rate for Payer: Priority Health SBD |
$2,937.47
|
| Rate for Payer: Priority Health SBD |
$102.02
|
| Rate for Payer: Priority Health SBD |
$74.84
|
| Rate for Payer: Priority Health SBD |
$176.85
|
| Rate for Payer: Priority Health SBD |
$127.75
|
| Rate for Payer: Priority Health SBD |
$138.56
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK
|
Facility
|
OP
|
$161.94
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
81434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$145.75 |
| Rate for Payer: Aetna Commercial |
$137.65
|
| Rate for Payer: Aetna Commercial |
$137.26
|
| Rate for Payer: Aetna Commercial |
$238.61
|
| Rate for Payer: Aetna Commercial |
$310.00
|
| Rate for Payer: Aetna Commercial |
$329.14
|
| Rate for Payer: Aetna Commercial |
$186.95
|
| Rate for Payer: Aetna Commercial |
$172.35
|
| Rate for Payer: Aetna Commercial |
$3,963.25
|
| Rate for Payer: Aetna Commercial |
$100.97
|
| Rate for Payer: Aetna Medicare |
$109.97
|
| Rate for Payer: Aetna Medicare |
$101.39
|
| Rate for Payer: Aetna Medicare |
$59.40
|
| Rate for Payer: Aetna Medicare |
$80.74
|
| Rate for Payer: Aetna Medicare |
$80.97
|
| Rate for Payer: Aetna Medicare |
$2,331.32
|
| Rate for Payer: Aetna Medicare |
$193.61
|
| Rate for Payer: Aetna Medicare |
$182.35
|
| Rate for Payer: Aetna Medicare |
$140.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,030.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$237.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.21
|
| Rate for Payer: BCBS Complete |
$112.29
|
| Rate for Payer: BCBS Complete |
$64.78
|
| Rate for Payer: BCBS Complete |
$64.59
|
| 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 |
$47.52
|
| Rate for Payer: BCBS Complete |
$145.88
|
| Rate for Payer: BCBS Complete |
$81.11
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCBS Trust/PPO |
$12.73
|
| Rate for Payer: BCN Commercial |
$12.73
|
| Rate for Payer: BCN Commercial |
$12.73
|
| Rate for Payer: BCN Commercial |
$12.73
|
| Rate for Payer: BCN Commercial |
$12.73
|
| Rate for Payer: BCN Commercial |
$12.73
|
| Rate for Payer: BCN Commercial |
$12.73
|
| Rate for Payer: BCN Commercial |
$12.73
|
| Rate for Payer: BCN Commercial |
$12.73
|
| Rate for Payer: BCN Commercial |
$12.73
|
| Rate for Payer: Cash Price |
$95.03
|
| Rate for Payer: Cash Price |
$129.18
|
| Rate for Payer: Cash Price |
$95.03
|
| Rate for Payer: Cash Price |
$129.55
|
| Rate for Payer: Cash Price |
$129.18
|
| Rate for Payer: Cash Price |
$129.55
|
| Rate for Payer: Cash Price |
$162.22
|
| Rate for Payer: Cash Price |
$162.22
|
| 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 |
$291.77
|
| Rate for Payer: Cash Price |
$291.77
|
| Rate for Payer: Cash Price |
$309.78
|
| Rate for Payer: Cash Price |
$309.78
|
| Rate for Payer: Cash Price |
$3,730.12
|
| Rate for Payer: Cash Price |
$3,730.12
|
| Rate for Payer: Cofinity Advantage |
$3,263.86
|
| Rate for Payer: Cofinity Advantage |
$153.96
|
| Rate for Payer: Cofinity Advantage |
$113.36
|
| Rate for Payer: Cofinity Advantage |
$113.04
|
| Rate for Payer: Cofinity Advantage |
$196.50
|
| Rate for Payer: Cofinity Advantage |
$141.94
|
| Rate for Payer: Cofinity Advantage |
$83.15
|
| Rate for Payer: Cofinity Advantage |
$271.05
|
| Rate for Payer: Cofinity Advantage |
$255.30
|
| Rate for Payer: Cofinity Commercial |
$138.87
|
| Rate for Payer: Cofinity Commercial |
$102.16
|
| Rate for Payer: Cofinity Commercial |
$189.15
|
| Rate for Payer: Cofinity Commercial |
$139.27
|
| Rate for Payer: Cofinity Commercial |
$241.42
|
| Rate for Payer: Cofinity Commercial |
$174.38
|
| Rate for Payer: Cofinity Commercial |
$4,009.88
|
| Rate for Payer: Cofinity Commercial |
$313.65
|
| Rate for Payer: Cofinity Commercial |
$333.01
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$95.03
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$291.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.22
|
| 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 |
$106.91
|
| Rate for Payer: Healthscope Commercial |
$4,196.39
|
| Rate for Payer: Healthscope Commercial |
$348.50
|
| Rate for Payer: Healthscope Commercial |
$197.95
|
| Rate for Payer: Healthscope Commercial |
$182.49
|
| Rate for Payer: Healthscope Commercial |
$145.33
|
| Rate for Payer: Healthscope Commercial |
$145.75
|
| Rate for Payer: Healthscope Commercial |
$328.24
|
| Rate for Payer: Healthscope Commercial |
$252.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,730.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.18
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$309.78
|
| Rate for Payer: MI Amish Medical Board Commercial |
$129.55
|
| Rate for Payer: MI Amish Medical Board Commercial |
$162.22
|
| Rate for Payer: MI Amish Medical Board Commercial |
$224.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$291.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$310.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,963.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,496.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$121.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$89.09
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$290.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$273.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.96
|
| Rate for Payer: PHP Commercial |
$100.97
|
| Rate for Payer: PHP Commercial |
$186.95
|
| Rate for Payer: PHP Commercial |
$137.26
|
| Rate for Payer: PHP Commercial |
$172.35
|
| Rate for Payer: PHP Commercial |
$310.00
|
| Rate for Payer: PHP Commercial |
$238.61
|
| Rate for Payer: PHP Commercial |
$137.65
|
| Rate for Payer: PHP Commercial |
$3,963.25
|
| Rate for Payer: PHP Commercial |
$329.14
|
| Rate for Payer: Priority Health SBD |
$243.95
|
| Rate for Payer: Priority Health SBD |
$229.77
|
| Rate for Payer: Priority Health SBD |
$138.56
|
| Rate for Payer: Priority Health SBD |
$74.84
|
| Rate for Payer: Priority Health SBD |
$101.73
|
| Rate for Payer: Priority Health SBD |
$102.02
|
| Rate for Payer: Priority Health SBD |
$176.85
|
| Rate for Payer: Priority Health SBD |
$2,937.47
|
| Rate for Payer: Priority Health SBD |
$127.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Core |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
| Rate for Payer: UHC Exchange |
$8.38
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$113.75
|
|
|
Service Code
|
NDC 00781531701
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.70 |
| Max. Negotiated Rate |
$102.38 |
| 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 Advantage |
$79.62
|
| Rate for Payer: Cofinity Commercial |
$97.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.00
|
| Rate for Payer: Healthscope Commercial |
$102.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.31
|
| Rate for Payer: PHP Commercial |
$96.69
|
| Rate for Payer: Priority Health SBD |
$71.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.94
|
| Rate for Payer: UHC Core |
$59.26
|
| Rate for Payer: UHC Exchange |
$44.70
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$14.18
|
|
|
Service Code
|
NDC 00904608261
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.93 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna Commercial |
$12.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.22
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: Cofinity Advantage |
$9.93
|
| Rate for Payer: Cofinity Commercial |
$12.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.34
|
| Rate for Payer: Healthscope Commercial |
$12.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.63
|
| Rate for Payer: PHP Commercial |
$12.05
|
| Rate for Payer: Priority Health SBD |
$8.93
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$14.18
|
|
|
Service Code
|
NDC 00904608261
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.57 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna Commercial |
$12.05
|
| Rate for Payer: Aetna Medicare |
$7.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.22
|
| Rate for Payer: BCBS Complete |
$5.67
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: Cofinity Advantage |
$9.93
|
| Rate for Payer: Cofinity Commercial |
$12.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.34
|
| Rate for Payer: Healthscope Commercial |
$12.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.63
|
| Rate for Payer: PHP Commercial |
$12.05
|
| Rate for Payer: Priority Health SBD |
$8.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.22
|
| Rate for Payer: UHC Core |
$7.39
|
| Rate for Payer: UHC Exchange |
$5.57
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$113.75
|
|
|
Service Code
|
NDC 00781531701
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$71.66 |
| Max. Negotiated Rate |
$102.38 |
| 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 Advantage |
$79.62
|
| Rate for Payer: Cofinity Commercial |
$97.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.00
|
| Rate for Payer: Healthscope Commercial |
$102.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.31
|
| Rate for Payer: PHP Commercial |
$96.69
|
| Rate for Payer: Priority Health SBD |
$71.66
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$324.90
|
|
|
Service Code
|
NDC 68462013001
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$127.69 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna Commercial |
$276.17
|
| Rate for Payer: Aetna Medicare |
$162.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.19
|
| Rate for Payer: BCBS Complete |
$129.96
|
| Rate for Payer: Cash Price |
$259.92
|
| Rate for Payer: Cofinity Advantage |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.92
|
| Rate for Payer: Healthscope Commercial |
$292.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$259.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.68
|
| Rate for Payer: PHP Commercial |
$276.17
|
| Rate for Payer: Priority Health SBD |
$204.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.19
|
| Rate for Payer: UHC Core |
$169.27
|
| Rate for Payer: UHC Exchange |
$127.69
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$4.75
|
|
|
Service Code
|
NDC 50268081611
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Aetna Commercial |
$4.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3.09
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cofinity Advantage |
$3.33
|
| Rate for Payer: Cofinity Commercial |
$4.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.80
|
| Rate for Payer: Healthscope Commercial |
$4.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3.56
|
| Rate for Payer: PHP Commercial |
$4.04
|
| Rate for Payer: Priority Health SBD |
$2.99
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$254.88
|
|
|
Service Code
|
NDC 60687023001
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$100.17 |
| Max. Negotiated Rate |
$229.39 |
| Rate for Payer: Aetna Commercial |
$216.65
|
| Rate for Payer: Aetna Medicare |
$127.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.67
|
| Rate for Payer: BCBS Complete |
$101.95
|
| Rate for Payer: Cash Price |
$203.90
|
| Rate for Payer: Cofinity Advantage |
$178.42
|
| Rate for Payer: Cofinity Commercial |
$219.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.90
|
| Rate for Payer: Healthscope Commercial |
$229.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$203.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$216.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.16
|
| Rate for Payer: PHP Commercial |
$216.65
|
| Rate for Payer: Priority Health SBD |
$160.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.67
|
| Rate for Payer: UHC Core |
$132.79
|
| Rate for Payer: UHC Exchange |
$100.17
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$2.55
|
|
|
Service Code
|
NDC 60687023011
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.66
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Advantage |
$1.78
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$2.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.91
|
| Rate for Payer: PHP Commercial |
$2.17
|
| Rate for Payer: Priority Health SBD |
$1.61
|
|
