|
WATER FOR IRRIGATION, STERILE SOLUTION
|
Facility
IP
|
$47.85
|
|
|
Service Code
|
NDC 0338-0004-05
|
| Hospital Charge Code |
7485
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$40.67
|
| Rate for Payer: BCBS Trust/PPO |
$36.98
|
| Rate for Payer: BCN Commercial |
$36.98
|
| Rate for Payer: Cash Price |
$38.28
|
| Rate for Payer: Cofinity Commercial |
$41.15
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$38.28
|
| Rate for Payer: Healthscope Commercial |
$43.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$35.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$40.67
|
| Rate for Payer: PHP Commercial |
$40.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$29.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.11
|
| Rate for Payer: UHC Core |
$39.95
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$35.89
|
|
|
WATER FOR IRRIGATION, STERILE SOLUTION
|
Facility
IP
|
$71.78
|
|
|
Service Code
|
NDC 0338-0004-02
|
| Hospital Charge Code |
7485
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.78 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Aetna Commercial |
$61.01
|
| Rate for Payer: BCBS Trust/PPO |
$55.47
|
| Rate for Payer: BCN Commercial |
$55.47
|
| Rate for Payer: Cash Price |
$57.42
|
| Rate for Payer: Cofinity Commercial |
$61.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$57.42
|
| Rate for Payer: Healthscope Commercial |
$64.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$53.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$61.01
|
| Rate for Payer: PHP Commercial |
$61.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.17
|
| Rate for Payer: UHC Core |
$59.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$53.84
|
|
|
WHITE PETROLATUM 57.7 %-MINERAL OIL 31.9 % EYE OINTMENT
|
Facility
IP
|
$24.64
|
|
|
Service Code
|
NDC 6373614308
|
| Hospital Charge Code |
175688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: Aetna Commercial |
$20.94
|
| Rate for Payer: BCBS Trust/PPO |
$19.04
|
| Rate for Payer: BCN Commercial |
$19.04
|
| Rate for Payer: Cash Price |
$19.71
|
| Rate for Payer: Cofinity Commercial |
$21.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.71
|
| Rate for Payer: Healthscope Commercial |
$22.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.94
|
| Rate for Payer: PHP Commercial |
$20.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.68
|
| Rate for Payer: UHC Core |
$20.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.48
|
|
|
WHITE PETROLATUM EYE OINTMENT WRAPPER
|
Facility
IP
|
$24.64
|
|
|
Service Code
|
NDC 6373614308
|
| Hospital Charge Code |
301577
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$22.18 |
| Rate for Payer: Aetna Commercial |
$20.94
|
| Rate for Payer: BCBS Trust/PPO |
$19.04
|
| Rate for Payer: BCN Commercial |
$19.04
|
| Rate for Payer: Cash Price |
$19.71
|
| Rate for Payer: Cofinity Commercial |
$21.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$19.71
|
| Rate for Payer: Healthscope Commercial |
$22.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$18.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.94
|
| Rate for Payer: PHP Commercial |
$20.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$15.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.68
|
| Rate for Payer: UHC Core |
$20.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$18.48
|
|
|
WHITE PETROLATUM-MINERAL OIL 56.8 %-42.5 % EYE OINTMENT
|
Facility
IP
|
$31.82
|
|
|
Service Code
|
NDC 0023-0312-04
|
| Hospital Charge Code |
117955
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.41 |
| Max. Negotiated Rate |
$28.64 |
| Rate for Payer: Aetna Commercial |
$27.05
|
| Rate for Payer: BCBS Trust/PPO |
$24.59
|
| Rate for Payer: BCN Commercial |
$24.59
|
| Rate for Payer: Cash Price |
$25.46
|
| Rate for Payer: Cofinity Commercial |
$27.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$25.46
|
| Rate for Payer: Healthscope Commercial |
$28.64
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$23.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$27.05
|
| Rate for Payer: PHP Commercial |
$27.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$19.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$28.00
|
| Rate for Payer: UHC Core |
$26.57
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$23.86
|
|
|
WHITE PETROLATUM-MINERAL OIL TOPICAL CREAM
|
Facility
IP
|
$12.88
|
|
|
Service Code
|
NDC 6192417804
|
| Hospital Charge Code |
11371
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$11.59 |
| Rate for Payer: Aetna Commercial |
$10.95
|
| Rate for Payer: BCBS Trust/PPO |
$9.95
|
| Rate for Payer: BCN Commercial |
$9.95
|
| Rate for Payer: Cash Price |
$10.30
|
| Rate for Payer: Cofinity Commercial |
$11.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.30
|
| Rate for Payer: Healthscope Commercial |
$11.59
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$10.95
|
| Rate for Payer: PHP Commercial |
$10.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.33
|
| Rate for Payer: UHC Core |
$10.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.66
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
IP
|
$10.63
|
|
|
Service Code
|
NDC 68084-059-11
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna Commercial |
$9.04
|
| Rate for Payer: BCBS Trust/PPO |
$8.21
|
| Rate for Payer: BCN Commercial |
$8.21
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cofinity Commercial |
$9.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.50
|
| Rate for Payer: Healthscope Commercial |
$9.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$7.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.04
|
| Rate for Payer: PHP Commercial |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.35
|
| Rate for Payer: UHC Core |
$8.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$7.97
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
IP
|
$318.80
|
|
|
Service Code
|
NDC 68084-059-21
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$194.44 |
| Max. Negotiated Rate |
$286.92 |
| Rate for Payer: Aetna Commercial |
$270.98
|
| Rate for Payer: BCBS Trust/PPO |
$246.37
|
| Rate for Payer: BCN Commercial |
$246.37
|
| Rate for Payer: Cash Price |
$255.04
|
| Rate for Payer: Cofinity Commercial |
$274.17
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.04
|
| Rate for Payer: Healthscope Commercial |
$286.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$239.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$270.98
|
| Rate for Payer: PHP Commercial |
$270.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$277.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$194.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$280.54
|
| Rate for Payer: UHC Core |
$266.20
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$239.10
|
|
|
ZALEPLON 5 MG CAPSULE
|
Facility
IP
|
$465.30
|
|
|
Service Code
|
NDC 29300-131-01
|
| Hospital Charge Code |
25997
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$283.79 |
| Max. Negotiated Rate |
$418.77 |
| Rate for Payer: Aetna Commercial |
$395.50
|
| Rate for Payer: BCBS Trust/PPO |
$359.58
|
| Rate for Payer: BCN Commercial |
$359.58
|
| Rate for Payer: Cash Price |
$372.24
|
| Rate for Payer: Cofinity Commercial |
$400.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$372.24
|
| Rate for Payer: Healthscope Commercial |
$418.77
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$348.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$395.50
|
| Rate for Payer: PHP Commercial |
$395.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$325.71
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$404.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$283.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$409.46
|
| Rate for Payer: UHC Core |
$388.53
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$348.98
|
|
|
ZINC OXIDE 20 % TOPICAL OINTMENT
|
Facility
IP
|
$23.32
|
|
|
Service Code
|
NDC 75834-170-01
|
| Hospital Charge Code |
8874
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.22 |
| Max. Negotiated Rate |
$20.99 |
| Rate for Payer: Aetna Commercial |
$19.82
|
| Rate for Payer: BCBS Trust/PPO |
$18.02
|
| Rate for Payer: BCN Commercial |
$18.02
|
| Rate for Payer: Cash Price |
$18.66
|
| Rate for Payer: Cofinity Commercial |
$20.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.66
|
| Rate for Payer: Healthscope Commercial |
$20.99
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$17.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$19.82
|
| Rate for Payer: PHP Commercial |
$19.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.52
|
| Rate for Payer: UHC Core |
$19.47
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$17.49
|
|
|
ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE
|
Facility
IP
|
$134.64
|
|
|
Service Code
|
NDC 11701-050-32
|
| Hospital Charge Code |
11378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$82.12 |
| Max. Negotiated Rate |
$121.18 |
| Rate for Payer: Aetna Commercial |
$114.44
|
| Rate for Payer: BCBS Trust/PPO |
$104.05
|
| Rate for Payer: BCN Commercial |
$104.05
|
| Rate for Payer: Cash Price |
$107.71
|
| Rate for Payer: Cofinity Commercial |
$115.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.71
|
| Rate for Payer: Healthscope Commercial |
$121.18
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$100.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.44
|
| Rate for Payer: PHP Commercial |
$114.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.48
|
| Rate for Payer: UHC Core |
$112.42
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$100.98
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
IP
|
$158.40
|
|
|
Service Code
|
NDC 2055504000
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.61 |
| Max. Negotiated Rate |
$142.56 |
| Rate for Payer: Aetna Commercial |
$134.64
|
| Rate for Payer: BCBS Trust/PPO |
$122.41
|
| Rate for Payer: BCN Commercial |
$122.41
|
| Rate for Payer: Cash Price |
$126.72
|
| Rate for Payer: Cofinity Commercial |
$136.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$126.72
|
| Rate for Payer: Healthscope Commercial |
$142.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$118.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$134.64
|
| Rate for Payer: PHP Commercial |
$134.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$96.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$139.39
|
| Rate for Payer: UHC Core |
$132.26
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$118.80
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
IP
|
$166.10
|
|
|
Service Code
|
NDC 73140106
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.30 |
| Max. Negotiated Rate |
$149.49 |
| Rate for Payer: Aetna Commercial |
$141.18
|
| Rate for Payer: BCBS Trust/PPO |
$128.36
|
| 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 Multiplan/Beech St/PHCS |
$141.18
|
| Rate for Payer: PHP Commercial |
$141.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.30
|
| 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
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
IP
|
$245.34
|
|
|
Service Code
|
NDC 55111-256-60
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$149.63 |
| Max. Negotiated Rate |
$220.81 |
| Rate for Payer: Aetna Commercial |
$208.54
|
| Rate for Payer: BCBS Trust/PPO |
$189.60
|
| Rate for Payer: BCN Commercial |
$189.60
|
| Rate for Payer: Cash Price |
$196.27
|
| Rate for Payer: Cofinity Commercial |
$210.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$196.27
|
| Rate for Payer: Healthscope Commercial |
$220.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$184.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$208.54
|
| Rate for Payer: PHP Commercial |
$208.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$171.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$213.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.90
|
| Rate for Payer: UHC Core |
$204.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$184.00
|
|
|
ZIPRASIDONE 80 MG CAPSULE
|
Facility
IP
|
$149.91
|
|
|
Service Code
|
NDC 55111-259-60
|
| Hospital Charge Code |
29781
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$91.43 |
| Max. Negotiated Rate |
$134.92 |
| Rate for Payer: Aetna Commercial |
$127.42
|
| Rate for Payer: BCBS Trust/PPO |
$115.85
|
| Rate for Payer: BCN Commercial |
$115.85
|
| Rate for Payer: Cash Price |
$119.93
|
| Rate for Payer: Cofinity Commercial |
$128.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$119.93
|
| Rate for Payer: Healthscope Commercial |
$134.92
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$112.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$127.42
|
| Rate for Payer: PHP Commercial |
$127.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$130.42
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.92
|
| Rate for Payer: UHC Core |
$125.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$112.43
|
|
|
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 |
$123.67 |
| 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 |
$216.94
|
| Rate for Payer: BCBS Trust/PPO |
$156.70
|
| Rate for Payer: BCBS Trust/PPO |
$169.97
|
| 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 |
$224.58
|
| Rate for Payer: Cash Price |
$162.22
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cofinity Commercial |
$174.38
|
| Rate for Payer: Cofinity Commercial |
$189.15
|
| Rate for Payer: Cofinity Commercial |
$241.42
|
| 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 |
$175.95
|
| Rate for Payer: Healthscope Commercial |
$252.65
|
| Rate for Payer: Healthscope Commercial |
$182.49
|
| Rate for Payer: Healthscope Commercial |
$197.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$152.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$210.54
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$164.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$186.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$238.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$172.35
|
| Rate for Payer: PHP Commercial |
$238.61
|
| Rate for Payer: PHP Commercial |
$172.35
|
| Rate for Payer: PHP Commercial |
$186.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.94
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$244.23
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$191.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$123.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$171.21
|
| 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 |
$183.65
|
| Rate for Payer: UHC Core |
$169.31
|
| Rate for Payer: UHC Core |
$234.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.08
|
|
|
ZOLPIDEM 10 MG TABLET
|
Facility
IP
|
$185.65
|
|
|
Service Code
|
NDC 51079-725-20
|
| Hospital Charge Code |
11700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$113.23 |
| Max. Negotiated Rate |
$167.08 |
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: BCBS Trust/PPO |
$143.47
|
| 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 |
$167.08
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$139.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.80
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$113.23
|
| 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
IP
|
$1.86
|
|
|
Service Code
|
NDC 51079-725-01
|
| Hospital Charge Code |
11700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna Commercial |
$1.58
|
| Rate for Payer: BCBS Trust/PPO |
$1.44
|
| 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 Multiplan/Beech St/PHCS |
$1.58
|
| Rate for Payer: PHP Commercial |
$1.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.13
|
| 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 5 MG TABLET
|
Facility
IP
|
$11.03
|
|
|
Service Code
|
NDC 0904-6082-61
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$9.93 |
| Rate for Payer: Aetna Commercial |
$9.38
|
| Rate for Payer: BCBS Trust/PPO |
$8.52
|
| Rate for Payer: BCN Commercial |
$8.52
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cofinity Commercial |
$9.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.82
|
| Rate for Payer: Healthscope Commercial |
$9.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$8.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.38
|
| Rate for Payer: PHP Commercial |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$6.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.71
|
| Rate for Payer: UHC Core |
$9.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$8.27
|
|
