|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
|
OP
|
$204.10
|
|
|
Service Code
|
NDC 63739000532
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.64 |
| Max. Negotiated Rate |
$183.69 |
| Rate for Payer: Aetna Commercial |
$173.48
|
| 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 Commercial |
$142.87
|
| Rate for Payer: Cofinity Commercial |
$175.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.87
|
| 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 |
$173.48
|
| Rate for Payer: PHP Commercial |
$173.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.66
|
| Rate for Payer: Priority Health SBD |
$128.58
|
|
|
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 |
$173.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.66
|
| Rate for Payer: Cash Price |
$163.28
|
| Rate for Payer: Cofinity Commercial |
$142.87
|
| Rate for Payer: Cofinity Commercial |
$175.53
|
| Rate for Payer: Cofinity Medicare Advantage |
$142.87
|
| 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 |
$173.48
|
| Rate for Payer: PHP Commercial |
$173.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.66
|
| Rate for Payer: Priority Health SBD |
$128.58
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
|
OP
|
$185.67
|
|
|
Service Code
|
NDC 00904627008
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.27 |
| Max. Negotiated Rate |
$167.10 |
| Rate for Payer: Aetna Commercial |
$157.82
|
| Rate for Payer: Aetna Medicare |
$92.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.69
|
| Rate for Payer: BCBS Complete |
$74.27
|
| Rate for Payer: Cash Price |
$148.54
|
| Rate for Payer: Cofinity Commercial |
$129.97
|
| Rate for Payer: Cofinity Commercial |
$159.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.54
|
| Rate for Payer: Healthscope Commercial |
$167.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.82
|
| Rate for Payer: PHP Commercial |
$157.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.69
|
| Rate for Payer: Priority Health SBD |
$116.97
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
|
OP
|
$188.10
|
|
|
Service Code
|
NDC 55111025760
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.24 |
| Max. Negotiated Rate |
$169.29 |
| Rate for Payer: Aetna Commercial |
$159.88
|
| Rate for Payer: Aetna Medicare |
$94.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$122.26
|
| Rate for Payer: BCBS Complete |
$75.24
|
| Rate for Payer: Cash Price |
$150.48
|
| Rate for Payer: Cofinity Commercial |
$131.67
|
| Rate for Payer: Cofinity Commercial |
$161.77
|
| Rate for Payer: Cofinity Medicare Advantage |
$131.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$150.48
|
| Rate for Payer: Healthscope Commercial |
$169.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.88
|
| Rate for Payer: PHP Commercial |
$159.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.26
|
| Rate for Payer: Priority Health SBD |
$118.50
|
|
|
ZIPRASIDONE 40 MG CAPSULE
|
Facility
|
IP
|
$185.67
|
|
|
Service Code
|
NDC 00904627008
|
| Hospital Charge Code |
29779
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$116.97 |
| Max. Negotiated Rate |
$167.10 |
| Rate for Payer: Aetna Commercial |
$157.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.69
|
| Rate for Payer: Cash Price |
$148.54
|
| Rate for Payer: Cofinity Commercial |
$129.97
|
| Rate for Payer: Cofinity Commercial |
$159.68
|
| Rate for Payer: Cofinity Medicare Advantage |
$129.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.54
|
| Rate for Payer: Healthscope Commercial |
$167.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.82
|
| Rate for Payer: PHP Commercial |
$157.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.69
|
| Rate for Payer: Priority Health SBD |
$116.97
|
|
|
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 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: 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
|
|
|
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 |
$18.27 |
| 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 |
$18.27
|
| Rate for Payer: BCN Commercial |
$18.27
|
| 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: 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
|
|
|
ZOLEDRONIC ACID 4 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$375.97
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
35640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.27 |
| Max. Negotiated Rate |
$338.37 |
| Rate for Payer: Aetna Commercial |
$319.57
|
| Rate for Payer: Aetna Commercial |
$98.97
|
| Rate for Payer: Aetna Commercial |
$283.59
|
| Rate for Payer: Aetna Medicare |
$58.22
|
| Rate for Payer: Aetna Medicare |
$166.82
|
| Rate for Payer: Aetna Medicare |
$187.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.38
|
| Rate for Payer: BCBS Complete |
$133.46
|
| Rate for Payer: BCBS Complete |
$46.58
|
| Rate for Payer: BCBS Complete |
$150.39
|
| Rate for Payer: BCBS Trust/PPO |
$18.27
|
| Rate for Payer: BCBS Trust/PPO |
$18.27
|
| Rate for Payer: BCBS Trust/PPO |
$18.27
|
| Rate for Payer: BCN Commercial |
$18.27
|
| Rate for Payer: BCN Commercial |
$18.27
|
| Rate for Payer: BCN Commercial |
$18.27
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cash Price |
$300.78
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cash Price |
$300.78
|
| Rate for Payer: Cofinity Commercial |
$233.55
|
| Rate for Payer: Cofinity Commercial |
$100.14
|
| Rate for Payer: Cofinity Commercial |
$81.51
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Cofinity Commercial |
$263.18
|
| Rate for Payer: Cofinity Commercial |
$323.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$263.18
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$300.78
|
| Rate for Payer: Healthscope Commercial |
$300.28
|
| Rate for Payer: Healthscope Commercial |
$104.80
|
| Rate for Payer: Healthscope Commercial |
$338.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$283.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.57
|
| Rate for Payer: PHP Commercial |
$283.59
|
| Rate for Payer: PHP Commercial |
$319.57
|
| Rate for Payer: PHP Commercial |
$98.97
|
| 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 |
$75.69
|
| Rate for Payer: Priority Health SBD |
$73.36
|
| Rate for Payer: Priority Health SBD |
$236.86
|
| Rate for Payer: Priority Health SBD |
$210.19
|
|
|
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) |
$244.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.87
|
| Rate for Payer: Cash Price |
$266.91
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cash Price |
$300.78
|
| Rate for Payer: Cofinity Commercial |
$263.18
|
| Rate for Payer: Cofinity Commercial |
$323.33
|
| Rate for Payer: Cofinity Commercial |
$286.93
|
| Rate for Payer: Cofinity Commercial |
$81.51
|
| Rate for Payer: Cofinity Commercial |
$100.14
|
| Rate for Payer: Cofinity Commercial |
$233.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$81.51
|
| Rate for Payer: Cofinity Medicare Advantage |
$233.55
|
| Rate for Payer: Cofinity Medicare Advantage |
$263.18
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$93.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$266.91
|
| 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 |
$283.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$319.57
|
| 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 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 SBD |
$236.86
|
| Rate for Payer: Priority Health SBD |
$73.36
|
| Rate for Payer: Priority Health SBD |
$210.19
|
|
|
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 |
$186.95
|
| Rate for Payer: Aetna Commercial |
$172.35
|
| Rate for Payer: Aetna Commercial |
$238.61
|
| Rate for Payer: Aetna Commercial |
$3,963.25
|
| Rate for Payer: Aetna Commercial |
$108.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.69
|
| 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) |
$131.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.96
|
| Rate for Payer: Cash Price |
$3,730.12
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$162.22
|
| Rate for Payer: Cash Price |
$102.52
|
| Rate for Payer: Cash Price |
$309.78
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Cofinity Commercial |
$189.15
|
| Rate for Payer: Cofinity Commercial |
$141.94
|
| Rate for Payer: Cofinity Commercial |
$174.38
|
| Rate for Payer: Cofinity Commercial |
$153.96
|
| Rate for Payer: Cofinity Commercial |
$110.21
|
| Rate for Payer: Cofinity Commercial |
$89.70
|
| Rate for Payer: Cofinity Commercial |
$196.50
|
| Rate for Payer: Cofinity Commercial |
$241.42
|
| Rate for Payer: Cofinity Commercial |
$271.05
|
| Rate for Payer: Cofinity Commercial |
$4,009.88
|
| Rate for Payer: Cofinity Commercial |
$3,263.86
|
| Rate for Payer: Cofinity Commercial |
$333.01
|
| Rate for Payer: Cofinity Medicare Advantage |
$271.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,263.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.78
|
| 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 |
$102.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.95
|
| Rate for Payer: Healthscope Commercial |
$197.95
|
| Rate for Payer: Healthscope Commercial |
$252.65
|
| Rate for Payer: Healthscope Commercial |
$115.34
|
| Rate for Payer: Healthscope Commercial |
$4,196.38
|
| Rate for Payer: Healthscope Commercial |
$348.50
|
| Rate for Payer: Healthscope Commercial |
$182.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.93
|
| 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 |
$329.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,963.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.61
|
| Rate for Payer: PHP Commercial |
$108.93
|
| Rate for Payer: PHP Commercial |
$186.95
|
| Rate for Payer: PHP Commercial |
$329.14
|
| Rate for Payer: PHP Commercial |
$172.35
|
| Rate for Payer: PHP Commercial |
$238.61
|
| Rate for Payer: PHP Commercial |
$3,963.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,030.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.47
|
| Rate for Payer: Priority Health SBD |
$80.73
|
| Rate for Payer: Priority Health SBD |
$243.95
|
| Rate for Payer: Priority Health SBD |
$2,937.47
|
| Rate for Payer: Priority Health SBD |
$138.56
|
| Rate for Payer: Priority Health SBD |
$127.75
|
| Rate for Payer: Priority Health SBD |
$176.85
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK
|
Facility
|
OP
|
$219.94
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
81434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.27 |
| Max. Negotiated Rate |
$197.95 |
| 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 |
$137.65
|
| Rate for Payer: Aetna Commercial |
$108.93
|
| Rate for Payer: Aetna Commercial |
$329.14
|
| Rate for Payer: Aetna Commercial |
$238.61
|
| Rate for Payer: Aetna Medicare |
$140.36
|
| Rate for Payer: Aetna Medicare |
$101.38
|
| Rate for Payer: Aetna Medicare |
$64.08
|
| Rate for Payer: Aetna Medicare |
$109.97
|
| 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 New Business (MI Preferred) |
$142.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.47
|
| 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) |
$131.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,030.72
|
| Rate for Payer: BCBS Complete |
$64.78
|
| Rate for Payer: BCBS Complete |
$51.26
|
| Rate for Payer: BCBS Complete |
$112.29
|
| Rate for Payer: BCBS Complete |
$154.89
|
| Rate for Payer: BCBS Complete |
$1,865.06
|
| Rate for Payer: BCBS Complete |
$81.11
|
| Rate for Payer: BCBS Complete |
$87.98
|
| Rate for Payer: BCBS Trust/PPO |
$18.27
|
| Rate for Payer: BCBS Trust/PPO |
$18.27
|
| Rate for Payer: BCBS Trust/PPO |
$18.27
|
| Rate for Payer: BCBS Trust/PPO |
$18.27
|
| Rate for Payer: BCBS Trust/PPO |
$18.27
|
| Rate for Payer: BCBS Trust/PPO |
$18.27
|
| Rate for Payer: BCBS Trust/PPO |
$18.27
|
| Rate for Payer: BCN Commercial |
$18.27
|
| Rate for Payer: BCN Commercial |
$18.27
|
| Rate for Payer: BCN Commercial |
$18.27
|
| Rate for Payer: BCN Commercial |
$18.27
|
| Rate for Payer: BCN Commercial |
$18.27
|
| Rate for Payer: BCN Commercial |
$18.27
|
| Rate for Payer: BCN Commercial |
$18.27
|
| Rate for Payer: Cash Price |
$3,730.12
|
| Rate for Payer: Cash Price |
$129.55
|
| Rate for Payer: Cash Price |
$102.52
|
| Rate for Payer: Cash Price |
$162.22
|
| Rate for Payer: Cash Price |
$129.55
|
| 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 |
$102.52
|
| 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 |
$3,730.12
|
| Rate for Payer: Cofinity Commercial |
$189.15
|
| Rate for Payer: Cofinity Commercial |
$110.21
|
| Rate for Payer: Cofinity Commercial |
$89.70
|
| Rate for Payer: Cofinity Commercial |
$113.36
|
| Rate for Payer: Cofinity Commercial |
$139.27
|
| Rate for Payer: Cofinity Commercial |
$141.94
|
| Rate for Payer: Cofinity Commercial |
$174.38
|
| Rate for Payer: Cofinity Commercial |
$153.96
|
| Rate for Payer: Cofinity Commercial |
$4,009.88
|
| Rate for Payer: Cofinity Commercial |
$3,263.86
|
| Rate for Payer: Cofinity Commercial |
$196.50
|
| Rate for Payer: Cofinity Commercial |
$241.42
|
| Rate for Payer: Cofinity Commercial |
$333.01
|
| Rate for Payer: Cofinity Commercial |
$271.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$196.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$113.36
|
| Rate for Payer: Cofinity Medicare Advantage |
$153.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$89.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$271.05
|
| Rate for Payer: Cofinity Medicare Advantage |
$141.94
|
| Rate for Payer: Cofinity Medicare Advantage |
$3,263.86
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$309.78
|
| 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 |
$129.55
|
| Rate for Payer: Healthscope Commercial |
$252.65
|
| Rate for Payer: Healthscope Commercial |
$182.49
|
| Rate for Payer: Healthscope Commercial |
$197.95
|
| Rate for Payer: Healthscope Commercial |
$4,196.38
|
| Rate for Payer: Healthscope Commercial |
$145.75
|
| Rate for Payer: Healthscope Commercial |
$348.50
|
| Rate for Payer: Healthscope Commercial |
$115.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,963.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.35
|
| Rate for Payer: PHP Commercial |
$186.95
|
| Rate for Payer: PHP Commercial |
$137.65
|
| Rate for Payer: PHP Commercial |
$329.14
|
| Rate for Payer: PHP Commercial |
$3,963.25
|
| Rate for Payer: PHP Commercial |
$238.61
|
| Rate for Payer: PHP Commercial |
$172.35
|
| Rate for Payer: PHP Commercial |
$108.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.80
|
| 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 |
$142.96
|
| 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 SBD |
$176.85
|
| Rate for Payer: Priority Health SBD |
$243.95
|
| Rate for Payer: Priority Health SBD |
$138.56
|
| Rate for Payer: Priority Health SBD |
$127.75
|
| Rate for Payer: Priority Health SBD |
$80.73
|
| Rate for Payer: Priority Health SBD |
$102.02
|
| Rate for Payer: Priority Health SBD |
$2,937.47
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$113.75
|
|
|
Service Code
|
NDC 00781531701
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.50 |
| 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 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: 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
|
|
|
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 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: 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
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$13.13
|
|
|
Service Code
|
NDC 00904608261
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$11.82 |
| 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: 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
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$13.13
|
|
|
Service Code
|
NDC 00904608261
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.27 |
| Max. Negotiated Rate |
$11.82 |
| 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: 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
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$247.20
|
|
|
Service Code
|
NDC 60687023001
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$155.74 |
| Max. Negotiated Rate |
$222.48 |
| Rate for Payer: Aetna Commercial |
$210.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.68
|
| Rate for Payer: Cash Price |
$197.76
|
| Rate for Payer: Cofinity Commercial |
$173.04
|
| Rate for Payer: Cofinity Commercial |
$212.59
|
| Rate for Payer: Cofinity Medicare Advantage |
$173.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$197.76
|
| Rate for Payer: Healthscope Commercial |
$222.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$210.12
|
| Rate for Payer: PHP Commercial |
$210.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.68
|
| Rate for Payer: Priority Health SBD |
$155.74
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$324.90
|
|
|
Service Code
|
NDC 69097086107
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.69 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna Commercial |
$276.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.18
|
| Rate for Payer: Cash Price |
$259.92
|
| Rate for Payer: Cofinity Commercial |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.92
|
| Rate for Payer: Healthscope Commercial |
$292.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.16
|
| Rate for Payer: PHP Commercial |
$276.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.18
|
| Rate for Payer: Priority Health SBD |
$204.69
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$2.48
|
|
|
Service Code
|
NDC 60687023011
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Aetna Commercial |
$2.11
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.61
|
| Rate for Payer: BCBS Complete |
$0.99
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$1.74
|
| Rate for Payer: Cofinity Commercial |
$2.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.11
|
| Rate for Payer: PHP Commercial |
$2.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.61
|
| Rate for Payer: Priority Health SBD |
$1.56
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$2.48
|
|
|
Service Code
|
NDC 60687023011
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Aetna Commercial |
$2.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.61
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$1.74
|
| Rate for Payer: Cofinity Commercial |
$2.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.11
|
| Rate for Payer: PHP Commercial |
$2.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.61
|
| Rate for Payer: Priority Health SBD |
$1.56
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$324.90
|
|
|
Service Code
|
NDC 68462013001
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.96 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna Commercial |
$276.16
|
| Rate for Payer: Aetna Medicare |
$162.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.18
|
| Rate for Payer: BCBS Complete |
$129.96
|
| Rate for Payer: Cash Price |
$259.92
|
| Rate for Payer: Cofinity Commercial |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.92
|
| Rate for Payer: Healthscope Commercial |
$292.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.16
|
| Rate for Payer: PHP Commercial |
$276.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.18
|
| Rate for Payer: Priority Health SBD |
$204.69
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$4.14
|
|
|
Service Code
|
NDC 50268081611
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$3.73 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Aetna Medicare |
$2.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.69
|
| Rate for Payer: BCBS Complete |
$1.66
|
| Rate for Payer: Cash Price |
$3.31
|
| Rate for Payer: Cofinity Commercial |
$2.90
|
| Rate for Payer: Cofinity Commercial |
$3.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$2.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.31
|
| Rate for Payer: Healthscope Commercial |
$3.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.52
|
| Rate for Payer: PHP Commercial |
$3.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.69
|
| Rate for Payer: Priority Health SBD |
$2.61
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$324.90
|
|
|
Service Code
|
NDC 68462013001
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$204.69 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna Commercial |
$276.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.18
|
| Rate for Payer: Cash Price |
$259.92
|
| Rate for Payer: Cofinity Commercial |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.92
|
| Rate for Payer: Healthscope Commercial |
$292.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.16
|
| Rate for Payer: PHP Commercial |
$276.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.18
|
| Rate for Payer: Priority Health SBD |
$204.69
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$324.90
|
|
|
Service Code
|
NDC 69097086107
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.96 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna Commercial |
$276.16
|
| Rate for Payer: Aetna Medicare |
$162.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.18
|
| Rate for Payer: BCBS Complete |
$129.96
|
| Rate for Payer: Cash Price |
$259.92
|
| Rate for Payer: Cofinity Commercial |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.92
|
| Rate for Payer: Healthscope Commercial |
$292.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.16
|
| Rate for Payer: PHP Commercial |
$276.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.18
|
| Rate for Payer: Priority Health SBD |
$204.69
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$7,670.10
|
|
|
Service Code
|
NDC 59212068010
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,832.16 |
| Max. Negotiated Rate |
$6,903.09 |
| Rate for Payer: Aetna Commercial |
$6,519.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,985.56
|
| Rate for Payer: Cash Price |
$6,136.08
|
| Rate for Payer: Cofinity Commercial |
$5,369.07
|
| Rate for Payer: Cofinity Commercial |
$6,596.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,369.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,136.08
|
| Rate for Payer: Healthscope Commercial |
$6,903.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,519.58
|
| Rate for Payer: PHP Commercial |
$6,519.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,985.56
|
| Rate for Payer: Priority Health SBD |
$4,832.16
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$7,670.10
|
|
|
Service Code
|
NDC 59212068010
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3,068.04 |
| Max. Negotiated Rate |
$6,903.09 |
| Rate for Payer: Aetna Commercial |
$6,519.58
|
| Rate for Payer: Aetna Medicare |
$3,835.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,985.56
|
| Rate for Payer: BCBS Complete |
$3,068.04
|
| Rate for Payer: Cash Price |
$6,136.08
|
| Rate for Payer: Cofinity Commercial |
$5,369.07
|
| Rate for Payer: Cofinity Commercial |
$6,596.29
|
| Rate for Payer: Cofinity Medicare Advantage |
$5,369.07
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$6,136.08
|
| Rate for Payer: Healthscope Commercial |
$6,903.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,519.58
|
| Rate for Payer: PHP Commercial |
$6,519.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,985.56
|
| Rate for Payer: Priority Health SBD |
$4,832.16
|
|
