|
ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE
|
Facility
|
IP
|
$83.50
|
|
|
Service Code
|
NDC 11701005033
|
| Hospital Charge Code |
11378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$54.27 |
| Max. Negotiated Rate |
$75.15 |
| Rate for Payer: Aetna Commercial |
$70.97
|
| Rate for Payer: BCBS Trust/PPO |
$68.16
|
| Rate for Payer: BCN Commercial |
$64.53
|
| Rate for Payer: Cash Price |
$66.80
|
| Rate for Payer: Cofinity Commercial |
$71.81
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.80
|
| Rate for Payer: Healthscope Commercial |
$75.15
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$62.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.97
|
| Rate for Payer: Nomi Health Commercial |
$68.47
|
| Rate for Payer: PHP Commercial |
$70.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.27
|
| Rate for Payer: Priority Health HMO/PPO |
$72.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$55.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.48
|
| Rate for Payer: UHC Core |
$69.72
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$62.62
|
|
|
ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE
|
Facility
|
OP
|
$138.72
|
|
|
Service Code
|
NDC 11701005032
|
| Hospital Charge Code |
11378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.95 |
| Max. Negotiated Rate |
$124.85 |
| Rate for Payer: Aetna Commercial |
$117.91
|
| Rate for Payer: Aetna Medicare |
$36.07
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$43.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$43.35
|
| Rate for Payer: BCBS Complete |
$55.49
|
| Rate for Payer: BCBS MAPPO |
$34.68
|
| Rate for Payer: BCBS Trust/PPO |
$114.04
|
| Rate for Payer: BCN Commercial |
$107.85
|
| Rate for Payer: BCN Medicare Advantage |
$34.68
|
| Rate for Payer: Cash Price |
$110.98
|
| Rate for Payer: Cofinity Commercial |
$119.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.68
|
| Rate for Payer: Healthscope Commercial |
$124.85
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$104.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.41
|
| Rate for Payer: MI Amish Medical Board Commercial |
$39.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.91
|
| Rate for Payer: Nomi Health Commercial |
$113.75
|
| Rate for Payer: PACE Senior Care Partners |
$32.95
|
| Rate for Payer: PACE SWMI |
$34.68
|
| Rate for Payer: PHP Commercial |
$117.91
|
| Rate for Payer: PHP Medicare Advantage |
$34.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.17
|
| Rate for Payer: Priority Health HMO/PPO |
$120.69
|
| Rate for Payer: Priority Health Medicare |
$35.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.94
|
| Rate for Payer: Railroad Medicare Medicare |
$34.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.07
|
| Rate for Payer: UHC Core |
$115.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.68
|
| Rate for Payer: UHC Exchange |
$34.68
|
| Rate for Payer: UHC Medicare Advantage |
$34.68
|
| Rate for Payer: VA VA |
$34.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$104.04
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
OP
|
$144.10
|
|
|
Service Code
|
NDC 20555004000
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.22 |
| Max. Negotiated Rate |
$129.69 |
| Rate for Payer: Aetna Commercial |
$122.48
|
| Rate for Payer: Aetna Medicare |
$37.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.03
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.03
|
| Rate for Payer: BCBS Complete |
$57.64
|
| Rate for Payer: BCBS MAPPO |
$36.02
|
| Rate for Payer: BCBS Trust/PPO |
$118.46
|
| Rate for Payer: BCN Commercial |
$112.04
|
| Rate for Payer: BCN Medicare Advantage |
$36.02
|
| Rate for Payer: Cash Price |
$115.28
|
| Rate for Payer: Cofinity Commercial |
$123.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.02
|
| Rate for Payer: Healthscope Commercial |
$129.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.48
|
| Rate for Payer: Nomi Health Commercial |
$118.16
|
| Rate for Payer: PACE Senior Care Partners |
$34.22
|
| Rate for Payer: PACE SWMI |
$36.02
|
| Rate for Payer: PHP Commercial |
$122.48
|
| Rate for Payer: PHP Medicare Advantage |
$36.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.67
|
| Rate for Payer: Priority Health HMO/PPO |
$125.37
|
| Rate for Payer: Priority Health Medicare |
$36.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.55
|
| Rate for Payer: Railroad Medicare Medicare |
$36.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.81
|
| Rate for Payer: UHC Core |
$120.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.02
|
| Rate for Payer: UHC Exchange |
$36.02
|
| Rate for Payer: UHC Medicare Advantage |
$36.02
|
| Rate for Payer: VA VA |
$36.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.08
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
IP
|
$144.10
|
|
|
Service Code
|
NDC 20555004000
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.67 |
| Max. Negotiated Rate |
$129.69 |
| Rate for Payer: Aetna Commercial |
$122.48
|
| Rate for Payer: BCBS Trust/PPO |
$117.63
|
| Rate for Payer: BCN Commercial |
$111.36
|
| Rate for Payer: Cash Price |
$115.28
|
| Rate for Payer: Cofinity Commercial |
$123.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.28
|
| Rate for Payer: Healthscope Commercial |
$129.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.48
|
| Rate for Payer: Nomi Health Commercial |
$118.16
|
| Rate for Payer: PHP Commercial |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.67
|
| Rate for Payer: Priority Health HMO/PPO |
$125.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.81
|
| Rate for Payer: UHC Core |
$120.32
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.08
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
IP
|
$166.10
|
|
|
Service Code
|
NDC 00731040106
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$107.97 |
| Max. Negotiated Rate |
$149.49 |
| Rate for Payer: Aetna Commercial |
$141.19
|
| Rate for Payer: BCBS Trust/PPO |
$135.59
|
| Rate for Payer: BCN Commercial |
$128.36
|
| Rate for Payer: Cash Price |
$132.88
|
| Rate for Payer: Cofinity Commercial |
$142.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.88
|
| Rate for Payer: Healthscope Commercial |
$149.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.19
|
| Rate for Payer: Nomi Health Commercial |
$136.20
|
| Rate for Payer: PHP Commercial |
$141.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.97
|
| Rate for Payer: Priority Health HMO/PPO |
$144.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.17
|
| Rate for Payer: UHC Core |
$138.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.58
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
OP
|
$166.10
|
|
|
Service Code
|
NDC 00731040106
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$39.45 |
| Max. Negotiated Rate |
$149.49 |
| Rate for Payer: Aetna Commercial |
$141.19
|
| Rate for Payer: Aetna Medicare |
$43.19
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.91
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.91
|
| Rate for Payer: BCBS Complete |
$66.44
|
| Rate for Payer: BCBS MAPPO |
$41.52
|
| Rate for Payer: BCBS Trust/PPO |
$136.55
|
| Rate for Payer: BCN Commercial |
$129.14
|
| Rate for Payer: BCN Medicare Advantage |
$41.52
|
| Rate for Payer: Cash Price |
$132.88
|
| Rate for Payer: Cofinity Commercial |
$142.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$132.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.52
|
| Rate for Payer: Healthscope Commercial |
$149.49
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$124.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.19
|
| Rate for Payer: Nomi Health Commercial |
$136.20
|
| Rate for Payer: PACE Senior Care Partners |
$39.45
|
| Rate for Payer: PACE SWMI |
$41.52
|
| Rate for Payer: PHP Commercial |
$141.19
|
| Rate for Payer: PHP Medicare Advantage |
$41.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.97
|
| Rate for Payer: Priority Health HMO/PPO |
$144.51
|
| Rate for Payer: Priority Health Medicare |
$41.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.29
|
| Rate for Payer: Railroad Medicare Medicare |
$41.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.17
|
| Rate for Payer: UHC Core |
$138.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.52
|
| Rate for Payer: UHC Exchange |
$41.52
|
| Rate for Payer: UHC Medicare Advantage |
$41.52
|
| Rate for Payer: VA VA |
$41.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.58
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
|
OP
|
$161.88
|
|
|
Service Code
|
NDC 55111025660
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.45 |
| Max. Negotiated Rate |
$145.69 |
| Rate for Payer: Aetna Commercial |
$137.60
|
| Rate for Payer: Aetna Medicare |
$42.09
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$50.59
|
| Rate for Payer: Amish Plain Church Group Commercial |
$50.59
|
| Rate for Payer: BCBS Complete |
$64.75
|
| Rate for Payer: BCBS MAPPO |
$40.47
|
| Rate for Payer: BCBS Trust/PPO |
$133.08
|
| Rate for Payer: BCN Commercial |
$125.86
|
| Rate for Payer: BCN Medicare Advantage |
$40.47
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cofinity Commercial |
$139.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.47
|
| Rate for Payer: Healthscope Commercial |
$145.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$46.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.60
|
| Rate for Payer: Nomi Health Commercial |
$132.74
|
| Rate for Payer: PACE Senior Care Partners |
$38.45
|
| Rate for Payer: PACE SWMI |
$40.47
|
| Rate for Payer: PHP Commercial |
$137.60
|
| Rate for Payer: PHP Medicare Advantage |
$40.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.22
|
| Rate for Payer: Priority Health HMO/PPO |
$140.84
|
| Rate for Payer: Priority Health Medicare |
$40.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.46
|
| Rate for Payer: Railroad Medicare Medicare |
$40.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.45
|
| Rate for Payer: UHC Core |
$135.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.47
|
| Rate for Payer: UHC Exchange |
$40.47
|
| Rate for Payer: UHC Medicare Advantage |
$40.47
|
| Rate for Payer: VA VA |
$40.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.41
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
|
IP
|
$161.88
|
|
|
Service Code
|
NDC 55111025660
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$105.22 |
| Max. Negotiated Rate |
$145.69 |
| Rate for Payer: Aetna Commercial |
$137.60
|
| Rate for Payer: BCBS Trust/PPO |
$132.14
|
| Rate for Payer: BCN Commercial |
$125.10
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: Cofinity Commercial |
$139.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$129.50
|
| Rate for Payer: Healthscope Commercial |
$145.69
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$121.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.60
|
| Rate for Payer: Nomi Health Commercial |
$132.74
|
| Rate for Payer: PHP Commercial |
$137.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.22
|
| Rate for Payer: Priority Health HMO/PPO |
$140.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$142.45
|
| Rate for Payer: UHC Core |
$135.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$121.41
|
|
|
ZIPRASIDONE 80 MG CAPSULE
|
Facility
|
IP
|
$152.19
|
|
|
Service Code
|
NDC 55111025960
|
| Hospital Charge Code |
29781
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$98.92 |
| Max. Negotiated Rate |
$136.97 |
| Rate for Payer: Aetna Commercial |
$129.36
|
| Rate for Payer: BCBS Trust/PPO |
$124.23
|
| Rate for Payer: BCN Commercial |
$117.61
|
| Rate for Payer: Cash Price |
$121.75
|
| Rate for Payer: Cofinity Commercial |
$130.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.75
|
| Rate for Payer: Healthscope Commercial |
$136.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.36
|
| Rate for Payer: Nomi Health Commercial |
$124.80
|
| Rate for Payer: PHP Commercial |
$129.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.92
|
| Rate for Payer: Priority Health HMO/PPO |
$132.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.93
|
| Rate for Payer: UHC Core |
$127.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.14
|
|
|
ZIPRASIDONE 80 MG CAPSULE
|
Facility
|
OP
|
$152.19
|
|
|
Service Code
|
NDC 55111025960
|
| Hospital Charge Code |
29781
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$136.97 |
| Rate for Payer: Aetna Commercial |
$129.36
|
| Rate for Payer: Aetna Medicare |
$39.57
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47.56
|
| Rate for Payer: BCBS Complete |
$60.88
|
| Rate for Payer: BCBS MAPPO |
$38.05
|
| Rate for Payer: BCBS Trust/PPO |
$125.12
|
| Rate for Payer: BCN Commercial |
$118.33
|
| Rate for Payer: BCN Medicare Advantage |
$38.05
|
| Rate for Payer: Cash Price |
$121.75
|
| Rate for Payer: Cofinity Commercial |
$130.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$121.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.05
|
| Rate for Payer: Healthscope Commercial |
$136.97
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$114.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$43.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$129.36
|
| Rate for Payer: Nomi Health Commercial |
$124.80
|
| Rate for Payer: PACE Senior Care Partners |
$36.15
|
| Rate for Payer: PACE SWMI |
$38.05
|
| Rate for Payer: PHP Commercial |
$129.36
|
| Rate for Payer: PHP Medicare Advantage |
$38.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.92
|
| Rate for Payer: Priority Health HMO/PPO |
$132.41
|
| Rate for Payer: Priority Health Medicare |
$38.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.97
|
| Rate for Payer: Railroad Medicare Medicare |
$38.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.93
|
| Rate for Payer: UHC Core |
$127.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.05
|
| Rate for Payer: UHC Exchange |
$38.05
|
| Rate for Payer: UHC Medicare Advantage |
$38.05
|
| Rate for Payer: VA VA |
$38.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$114.14
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK
|
Facility
|
OP
|
$202.77
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
81434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.16 |
| Max. Negotiated Rate |
$182.49 |
| Rate for Payer: Aetna Commercial |
$172.35
|
| Rate for Payer: Aetna Commercial |
$238.61
|
| Rate for Payer: Aetna Commercial |
$186.95
|
| Rate for Payer: Aetna Medicare |
$72.99
|
| Rate for Payer: Aetna Medicare |
$52.72
|
| Rate for Payer: Aetna Medicare |
$57.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$87.72
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$68.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.72
|
| Rate for Payer: BCBS Complete |
$87.98
|
| Rate for Payer: BCBS Complete |
$81.11
|
| Rate for Payer: BCBS Complete |
$112.29
|
| Rate for Payer: BCBS MAPPO |
$70.18
|
| Rate for Payer: BCBS MAPPO |
$50.69
|
| Rate for Payer: BCBS MAPPO |
$54.98
|
| Rate for Payer: BCBS Trust/PPO |
$180.81
|
| Rate for Payer: BCBS Trust/PPO |
$166.70
|
| Rate for Payer: BCBS Trust/PPO |
$230.78
|
| Rate for Payer: BCN Commercial |
$171.00
|
| Rate for Payer: BCN Commercial |
$218.26
|
| Rate for Payer: BCN Commercial |
$157.65
|
| Rate for Payer: BCN Medicare Advantage |
$50.69
|
| Rate for Payer: BCN Medicare Advantage |
$54.98
|
| Rate for Payer: BCN Medicare Advantage |
$70.18
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Cash Price |
$162.22
|
| Rate for Payer: Cofinity Commercial |
$241.42
|
| Rate for Payer: Cofinity Commercial |
$174.38
|
| Rate for Payer: Cofinity Commercial |
$189.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$175.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$162.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.69
|
| Rate for Payer: Healthscope Commercial |
$197.95
|
| Rate for Payer: Healthscope Commercial |
$182.49
|
| Rate for Payer: Healthscope Commercial |
$252.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.96
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$73.69
|
| Rate for Payer: MI Amish Medical Board Commercial |
$63.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$58.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$80.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.35
|
| Rate for Payer: Nomi Health Commercial |
$230.19
|
| Rate for Payer: Nomi Health Commercial |
$166.27
|
| Rate for Payer: Nomi Health Commercial |
$180.35
|
| Rate for Payer: PACE Senior Care Partners |
$66.67
|
| Rate for Payer: PACE Senior Care Partners |
$48.16
|
| Rate for Payer: PACE Senior Care Partners |
$52.24
|
| Rate for Payer: PACE SWMI |
$54.98
|
| Rate for Payer: PACE SWMI |
$50.69
|
| Rate for Payer: PACE SWMI |
$70.18
|
| Rate for Payer: PHP Commercial |
$238.61
|
| Rate for Payer: PHP Commercial |
$186.95
|
| Rate for Payer: PHP Commercial |
$172.35
|
| Rate for Payer: PHP Medicare Advantage |
$54.98
|
| Rate for Payer: PHP Medicare Advantage |
$70.18
|
| Rate for Payer: PHP Medicare Advantage |
$50.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.96
|
| Rate for Payer: Priority Health HMO/PPO |
$244.23
|
| Rate for Payer: Priority Health HMO/PPO |
$176.41
|
| Rate for Payer: Priority Health HMO/PPO |
$191.35
|
| Rate for Payer: Priority Health Medicare |
$51.20
|
| Rate for Payer: Priority Health Medicare |
$70.88
|
| Rate for Payer: Priority Health Medicare |
$55.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.86
|
| Rate for Payer: Railroad Medicare Medicare |
$54.98
|
| Rate for Payer: Railroad Medicare Medicare |
$70.18
|
| Rate for Payer: Railroad Medicare Medicare |
$50.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.44
|
| Rate for Payer: UHC Core |
$234.40
|
| Rate for Payer: UHC Core |
$183.65
|
| Rate for Payer: UHC Core |
$169.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.98
|
| Rate for Payer: UHC Exchange |
$54.98
|
| Rate for Payer: UHC Exchange |
$50.69
|
| Rate for Payer: UHC Exchange |
$70.18
|
| Rate for Payer: UHC Medicare Advantage |
$50.69
|
| Rate for Payer: UHC Medicare Advantage |
$54.98
|
| Rate for Payer: UHC Medicare Advantage |
$70.18
|
| Rate for Payer: VA VA |
$54.98
|
| Rate for Payer: VA VA |
$70.18
|
| Rate for Payer: VA VA |
$50.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.96
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK
|
Facility
|
IP
|
$202.77
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
81434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.80 |
| Max. Negotiated Rate |
$182.49 |
| Rate for Payer: Aetna Commercial |
$172.35
|
| Rate for Payer: Aetna Commercial |
$186.95
|
| Rate for Payer: Aetna Commercial |
$238.61
|
| Rate for Payer: BCBS Trust/PPO |
$179.54
|
| Rate for Payer: BCBS Trust/PPO |
$165.52
|
| Rate for Payer: BCBS Trust/PPO |
$229.15
|
| Rate for Payer: BCN Commercial |
$169.97
|
| Rate for Payer: BCN Commercial |
$156.70
|
| Rate for Payer: BCN Commercial |
$216.94
|
| Rate for Payer: Cash Price |
$162.22
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cofinity Commercial |
$241.42
|
| Rate for Payer: Cofinity Commercial |
$189.15
|
| Rate for Payer: Cofinity Commercial |
$174.38
|
| 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 |
$224.58
|
| Rate for Payer: Healthscope Commercial |
$197.95
|
| Rate for Payer: Healthscope Commercial |
$182.49
|
| Rate for Payer: Healthscope Commercial |
$252.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.96
|
| 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 |
$238.61
|
| Rate for Payer: Nomi Health Commercial |
$166.27
|
| Rate for Payer: Nomi Health Commercial |
$180.35
|
| Rate for Payer: Nomi Health Commercial |
$230.19
|
| Rate for Payer: PHP Commercial |
$186.95
|
| Rate for Payer: PHP Commercial |
$172.35
|
| Rate for Payer: PHP Commercial |
$238.61
|
| 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 |
$142.96
|
| Rate for Payer: Priority Health HMO/PPO |
$244.23
|
| Rate for Payer: Priority Health HMO/PPO |
$191.35
|
| Rate for Payer: Priority Health HMO/PPO |
$176.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$188.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$135.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$247.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$178.44
|
| Rate for Payer: UHC Core |
$169.31
|
| Rate for Payer: UHC Core |
$234.40
|
| Rate for Payer: UHC Core |
$183.65
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.96
|
|
|
ZOLPIDEM 10 MG TABLET
|
Facility
|
OP
|
$1.86
|
|
|
Service Code
|
NDC 51079072501
|
| Hospital Charge Code |
11700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna Commercial |
$1.58
|
| Rate for Payer: Aetna Medicare |
$0.48
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.58
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.58
|
| Rate for Payer: BCBS Complete |
$0.74
|
| Rate for Payer: BCBS MAPPO |
$0.47
|
| Rate for Payer: BCBS Trust/PPO |
$1.53
|
| Rate for Payer: BCN Commercial |
$1.45
|
| Rate for Payer: BCN Medicare Advantage |
$0.47
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cofinity Commercial |
$1.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.47
|
| Rate for Payer: Healthscope Commercial |
$1.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.49
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.58
|
| Rate for Payer: Nomi Health Commercial |
$1.53
|
| Rate for Payer: PACE Senior Care Partners |
$0.44
|
| Rate for Payer: PACE SWMI |
$0.47
|
| Rate for Payer: PHP Commercial |
$1.58
|
| Rate for Payer: PHP Medicare Advantage |
$0.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.21
|
| Rate for Payer: Priority Health HMO/PPO |
$1.62
|
| Rate for Payer: Priority Health Medicare |
$0.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.25
|
| Rate for Payer: Railroad Medicare Medicare |
$0.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.64
|
| Rate for Payer: UHC Core |
$1.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.47
|
| Rate for Payer: UHC Exchange |
$0.47
|
| Rate for Payer: UHC Medicare Advantage |
$0.47
|
| Rate for Payer: VA VA |
$0.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.40
|
|
|
ZOLPIDEM 10 MG TABLET
|
Facility
|
IP
|
$1.86
|
|
|
Service Code
|
NDC 51079072501
|
| Hospital Charge Code |
11700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna Commercial |
$1.58
|
| Rate for Payer: BCBS Trust/PPO |
$1.52
|
| Rate for Payer: BCN Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cofinity Commercial |
$1.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.49
|
| Rate for Payer: Healthscope Commercial |
$1.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.58
|
| Rate for Payer: Nomi Health Commercial |
$1.53
|
| Rate for Payer: PHP Commercial |
$1.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.21
|
| Rate for Payer: Priority Health HMO/PPO |
$1.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.64
|
| Rate for Payer: UHC Core |
$1.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.40
|
|
|
ZOLPIDEM 10 MG TABLET
|
Facility
|
IP
|
$185.65
|
|
|
Service Code
|
NDC 51079072520
|
| Hospital Charge Code |
11700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: BCBS Trust/PPO |
$151.55
|
| Rate for Payer: BCN Commercial |
$143.47
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$167.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health HMO/PPO |
$161.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.37
|
| Rate for Payer: UHC Core |
$155.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
ZOLPIDEM 10 MG TABLET
|
Facility
|
OP
|
$185.65
|
|
|
Service Code
|
NDC 51079072520
|
| Hospital Charge Code |
11700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: Aetna Medicare |
$48.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$58.02
|
| Rate for Payer: Amish Plain Church Group Commercial |
$58.02
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCBS MAPPO |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$152.62
|
| Rate for Payer: BCN Commercial |
$144.34
|
| Rate for Payer: BCN Medicare Advantage |
$46.41
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.41
|
| Rate for Payer: Healthscope Commercial |
$167.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.73
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| Rate for Payer: PACE Senior Care Partners |
$44.09
|
| Rate for Payer: PACE SWMI |
$46.41
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: PHP Medicare Advantage |
$46.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: Priority Health HMO/PPO |
$161.52
|
| Rate for Payer: Priority Health Medicare |
$46.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.39
|
| Rate for Payer: Railroad Medicare Medicare |
$46.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.37
|
| Rate for Payer: UHC Core |
$155.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.41
|
| Rate for Payer: UHC Exchange |
$46.41
|
| Rate for Payer: UHC Medicare Advantage |
$46.41
|
| Rate for Payer: VA VA |
$46.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$13.13
|
|
|
Service Code
|
NDC 00904608261
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$11.82 |
| Rate for Payer: Aetna Commercial |
$11.16
|
| Rate for Payer: BCBS Trust/PPO |
$10.72
|
| Rate for Payer: BCN Commercial |
$10.15
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$11.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.16
|
| Rate for Payer: Nomi Health Commercial |
$10.77
|
| Rate for Payer: PHP Commercial |
$11.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.53
|
| Rate for Payer: Priority Health HMO/PPO |
$11.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.55
|
| Rate for Payer: UHC Core |
$10.96
|
| 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 |
$3.12 |
| Max. Negotiated Rate |
$11.82 |
| Rate for Payer: Aetna Commercial |
$11.16
|
| Rate for Payer: Aetna Medicare |
$3.41
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.10
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.10
|
| Rate for Payer: BCBS Complete |
$5.25
|
| Rate for Payer: BCBS MAPPO |
$3.28
|
| Rate for Payer: BCBS Trust/PPO |
$10.79
|
| Rate for Payer: BCN Commercial |
$10.21
|
| Rate for Payer: BCN Medicare Advantage |
$3.28
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.28
|
| Rate for Payer: Healthscope Commercial |
$11.82
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.45
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.16
|
| Rate for Payer: Nomi Health Commercial |
$10.77
|
| Rate for Payer: PACE Senior Care Partners |
$3.12
|
| Rate for Payer: PACE SWMI |
$3.28
|
| Rate for Payer: PHP Commercial |
$11.16
|
| Rate for Payer: PHP Medicare Advantage |
$3.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.53
|
| Rate for Payer: Priority Health HMO/PPO |
$11.42
|
| Rate for Payer: Priority Health Medicare |
$3.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$8.80
|
| Rate for Payer: Railroad Medicare Medicare |
$3.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.55
|
| Rate for Payer: UHC Core |
$10.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.28
|
| Rate for Payer: UHC Exchange |
$3.28
|
| Rate for Payer: UHC Medicare Advantage |
$3.28
|
| Rate for Payer: VA VA |
$3.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.85
|
|
