|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
IP
|
$178.20
|
|
|
Service Code
|
NDC 20555004000
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$124.03 |
| Max. Negotiated Rate |
$160.38 |
| Rate for Payer: Aetna Commercial |
$151.47
|
| Rate for Payer: BCBS Trust/PPO |
$147.18
|
| Rate for Payer: BCN Commercial |
$147.18
|
| Rate for Payer: Cash Price |
$142.56
|
| Rate for Payer: Cofinity Commercial |
$153.25
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.56
|
| Rate for Payer: Healthscope Commercial |
$160.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$133.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$151.47
|
| Rate for Payer: Nomi Health Commercial |
$146.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$133.65
|
| Rate for Payer: PHP Commercial |
$151.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$155.03
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$156.82
|
| Rate for Payer: UHC Core |
$148.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$133.65
|
|
|
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 |
$115.61 |
| Max. Negotiated Rate |
$149.49 |
| Rate for Payer: Aetna Commercial |
$141.19
|
| Rate for Payer: BCBS Trust/PPO |
$137.18
|
| Rate for Payer: BCN Commercial |
$137.18
|
| 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: Opus (Opus Packaging Group) HMA |
$124.58
|
| Rate for Payer: PHP Commercial |
$141.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$144.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.61
|
| 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 |
$29.28 |
| 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 |
$30.75
|
| Rate for Payer: BCBS MAPPO |
$41.52
|
| Rate for Payer: BCBS Trust/PPO |
$136.55
|
| Rate for Payer: BCN Commercial |
$136.55
|
| 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: Mclaren Medicaid |
$29.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.60
|
| Rate for Payer: Meridian Medicaid |
$30.75
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$45.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.19
|
| Rate for Payer: Nomi Health Commercial |
$136.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.58
|
| 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 Choice Medicaid |
$29.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$144.51
|
| Rate for Payer: Priority Health Medicare |
$41.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$115.61
|
| 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 Exchange |
$41.52
|
| Rate for Payer: UHC Medicaid |
$29.28
|
| Rate for Payer: UHC Medicare Advantage |
$41.52
|
| Rate for Payer: UHCCP Medicaid |
$29.28
|
| Rate for Payer: VA VA |
$41.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$124.58
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
|
IP
|
$317.17
|
|
|
Service Code
|
NDC 00904626908
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$220.75 |
| Max. Negotiated Rate |
$285.45 |
| Rate for Payer: Aetna Commercial |
$269.59
|
| Rate for Payer: BCBS Trust/PPO |
$261.95
|
| Rate for Payer: BCN Commercial |
$261.95
|
| Rate for Payer: Cash Price |
$253.74
|
| Rate for Payer: Cofinity Commercial |
$272.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.74
|
| Rate for Payer: Healthscope Commercial |
$285.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.59
|
| Rate for Payer: Nomi Health Commercial |
$260.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.88
|
| Rate for Payer: PHP Commercial |
$269.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$275.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.11
|
| Rate for Payer: UHC Core |
$264.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.88
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
|
OP
|
$181.83
|
|
|
Service Code
|
NDC 55111025660
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.06 |
| Max. Negotiated Rate |
$163.65 |
| Rate for Payer: Aetna Commercial |
$154.56
|
| Rate for Payer: Aetna Medicare |
$47.28
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$56.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$56.82
|
| Rate for Payer: BCBS Complete |
$33.66
|
| Rate for Payer: BCBS MAPPO |
$45.46
|
| Rate for Payer: BCBS Trust/PPO |
$149.48
|
| Rate for Payer: BCN Commercial |
$149.48
|
| Rate for Payer: BCN Medicare Advantage |
$45.46
|
| Rate for Payer: Cash Price |
$145.46
|
| Rate for Payer: Cofinity Commercial |
$156.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.46
|
| Rate for Payer: Healthscope Commercial |
$163.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.37
|
| Rate for Payer: Mclaren Medicaid |
$32.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.73
|
| Rate for Payer: Meridian Medicaid |
$33.66
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.56
|
| Rate for Payer: Nomi Health Commercial |
$149.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.37
|
| Rate for Payer: PACE Senior Care Partners |
$43.18
|
| Rate for Payer: PACE SWMI |
$45.46
|
| Rate for Payer: PHP Commercial |
$154.56
|
| Rate for Payer: PHP Medicare Advantage |
$45.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$158.19
|
| Rate for Payer: Priority Health Medicare |
$45.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.55
|
| Rate for Payer: Railroad Medicare Medicare |
$45.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.01
|
| Rate for Payer: UHC Core |
$151.83
|
| Rate for Payer: UHC Exchange |
$45.46
|
| Rate for Payer: UHC Medicaid |
$32.06
|
| Rate for Payer: UHC Medicare Advantage |
$45.46
|
| Rate for Payer: UHCCP Medicaid |
$32.06
|
| Rate for Payer: VA VA |
$45.46
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.37
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
|
IP
|
$713.07
|
|
|
Service Code
|
NDC 00904626945
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$496.30 |
| Max. Negotiated Rate |
$641.76 |
| Rate for Payer: Aetna Commercial |
$606.11
|
| Rate for Payer: BCBS Trust/PPO |
$588.92
|
| Rate for Payer: BCN Commercial |
$588.92
|
| Rate for Payer: Cash Price |
$570.46
|
| Rate for Payer: Cofinity Commercial |
$613.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.46
|
| Rate for Payer: Healthscope Commercial |
$641.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$606.11
|
| Rate for Payer: Nomi Health Commercial |
$584.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$534.80
|
| Rate for Payer: PHP Commercial |
$606.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$620.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$496.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$627.50
|
| Rate for Payer: UHC Core |
$595.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.80
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
|
OP
|
$713.07
|
|
|
Service Code
|
NDC 00904626945
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.71 |
| Max. Negotiated Rate |
$641.76 |
| Rate for Payer: Aetna Commercial |
$606.11
|
| Rate for Payer: Aetna Medicare |
$185.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$222.83
|
| Rate for Payer: Amish Plain Church Group Commercial |
$222.83
|
| Rate for Payer: BCBS Complete |
$131.99
|
| Rate for Payer: BCBS MAPPO |
$178.27
|
| Rate for Payer: BCBS Trust/PPO |
$586.21
|
| Rate for Payer: BCN Commercial |
$586.21
|
| Rate for Payer: BCN Medicare Advantage |
$178.27
|
| Rate for Payer: Cash Price |
$570.46
|
| Rate for Payer: Cofinity Commercial |
$613.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$570.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.27
|
| Rate for Payer: Healthscope Commercial |
$641.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$534.80
|
| Rate for Payer: Mclaren Medicaid |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.18
|
| Rate for Payer: Meridian Medicaid |
$131.99
|
| Rate for Payer: MI Amish Medical Board Commercial |
$205.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$196.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$606.11
|
| Rate for Payer: Nomi Health Commercial |
$584.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$534.80
|
| Rate for Payer: PACE Senior Care Partners |
$169.35
|
| Rate for Payer: PACE SWMI |
$178.27
|
| Rate for Payer: PHP Commercial |
$606.11
|
| Rate for Payer: PHP Medicare Advantage |
$178.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$125.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$620.37
|
| Rate for Payer: Priority Health Medicare |
$180.05
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$496.30
|
| Rate for Payer: Railroad Medicare Medicare |
$178.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$627.50
|
| Rate for Payer: UHC Core |
$595.41
|
| Rate for Payer: UHC Exchange |
$178.27
|
| Rate for Payer: UHC Medicaid |
$125.71
|
| Rate for Payer: UHC Medicare Advantage |
$178.27
|
| Rate for Payer: UHCCP Medicaid |
$125.71
|
| Rate for Payer: VA VA |
$178.27
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$534.80
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
|
OP
|
$317.17
|
|
|
Service Code
|
NDC 00904626908
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.92 |
| Max. Negotiated Rate |
$285.45 |
| Rate for Payer: Aetna Commercial |
$269.59
|
| Rate for Payer: Aetna Medicare |
$82.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$99.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$99.12
|
| Rate for Payer: BCBS Complete |
$58.71
|
| Rate for Payer: BCBS MAPPO |
$79.29
|
| Rate for Payer: BCBS Trust/PPO |
$260.75
|
| Rate for Payer: BCN Commercial |
$260.75
|
| Rate for Payer: BCN Medicare Advantage |
$79.29
|
| Rate for Payer: Cash Price |
$253.74
|
| Rate for Payer: Cofinity Commercial |
$272.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$253.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.29
|
| Rate for Payer: Healthscope Commercial |
$285.45
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$237.88
|
| Rate for Payer: Mclaren Medicaid |
$55.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.26
|
| Rate for Payer: Meridian Medicaid |
$58.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$87.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$269.59
|
| Rate for Payer: Nomi Health Commercial |
$260.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.88
|
| Rate for Payer: PACE Senior Care Partners |
$75.33
|
| Rate for Payer: PACE SWMI |
$79.29
|
| Rate for Payer: PHP Commercial |
$269.59
|
| Rate for Payer: PHP Medicare Advantage |
$79.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$55.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$275.94
|
| Rate for Payer: Priority Health Medicare |
$80.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$220.75
|
| Rate for Payer: Railroad Medicare Medicare |
$79.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.11
|
| Rate for Payer: UHC Core |
$264.84
|
| Rate for Payer: UHC Exchange |
$79.29
|
| Rate for Payer: UHC Medicaid |
$55.92
|
| Rate for Payer: UHC Medicare Advantage |
$79.29
|
| Rate for Payer: UHCCP Medicaid |
$55.92
|
| Rate for Payer: VA VA |
$79.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$237.88
|
|
|
ZIPRASIDONE 20 MG CAPSULE
|
Facility
|
IP
|
$181.83
|
|
|
Service Code
|
NDC 55111025660
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$126.55 |
| Max. Negotiated Rate |
$163.65 |
| Rate for Payer: Aetna Commercial |
$154.56
|
| Rate for Payer: BCBS Trust/PPO |
$150.17
|
| Rate for Payer: BCN Commercial |
$150.17
|
| Rate for Payer: Cash Price |
$145.46
|
| Rate for Payer: Cofinity Commercial |
$156.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$145.46
|
| Rate for Payer: Healthscope Commercial |
$163.65
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$136.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$154.56
|
| Rate for Payer: Nomi Health Commercial |
$149.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$136.37
|
| Rate for Payer: PHP Commercial |
$154.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$158.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.01
|
| Rate for Payer: UHC Core |
$151.83
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$136.37
|
|
|
ZIPRASIDONE 80 MG CAPSULE
|
Facility
|
OP
|
$184.11
|
|
|
Service Code
|
NDC 55111025960
|
| Hospital Charge Code |
29781
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.46 |
| Max. Negotiated Rate |
$165.70 |
| Rate for Payer: Aetna Commercial |
$156.49
|
| Rate for Payer: Aetna Medicare |
$47.87
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$57.53
|
| Rate for Payer: Amish Plain Church Group Commercial |
$57.53
|
| Rate for Payer: BCBS Complete |
$34.08
|
| Rate for Payer: BCBS MAPPO |
$46.03
|
| Rate for Payer: BCBS Trust/PPO |
$151.36
|
| Rate for Payer: BCN Commercial |
$151.36
|
| Rate for Payer: BCN Medicare Advantage |
$46.03
|
| Rate for Payer: Cash Price |
$147.29
|
| Rate for Payer: Cofinity Commercial |
$158.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.03
|
| Rate for Payer: Healthscope Commercial |
$165.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.08
|
| Rate for Payer: Mclaren Medicaid |
$32.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.33
|
| Rate for Payer: Meridian Medicaid |
$34.08
|
| Rate for Payer: MI Amish Medical Board Commercial |
$52.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.49
|
| Rate for Payer: Nomi Health Commercial |
$150.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.08
|
| Rate for Payer: PACE Senior Care Partners |
$43.73
|
| Rate for Payer: PACE SWMI |
$46.03
|
| Rate for Payer: PHP Commercial |
$156.49
|
| Rate for Payer: PHP Medicare Advantage |
$46.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$160.18
|
| Rate for Payer: Priority Health Medicare |
$46.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$128.14
|
| Rate for Payer: Railroad Medicare Medicare |
$46.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.02
|
| Rate for Payer: UHC Core |
$153.73
|
| Rate for Payer: UHC Exchange |
$46.03
|
| Rate for Payer: UHC Medicaid |
$32.46
|
| Rate for Payer: UHC Medicare Advantage |
$46.03
|
| Rate for Payer: UHCCP Medicaid |
$32.46
|
| Rate for Payer: VA VA |
$46.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.08
|
|
|
ZIPRASIDONE 80 MG CAPSULE
|
Facility
|
IP
|
$184.11
|
|
|
Service Code
|
NDC 55111025960
|
| Hospital Charge Code |
29781
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$128.14 |
| Max. Negotiated Rate |
$165.70 |
| Rate for Payer: Aetna Commercial |
$156.49
|
| Rate for Payer: BCBS Trust/PPO |
$152.06
|
| Rate for Payer: BCN Commercial |
$152.06
|
| Rate for Payer: Cash Price |
$147.29
|
| Rate for Payer: Cofinity Commercial |
$158.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$147.29
|
| Rate for Payer: Healthscope Commercial |
$165.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$138.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$156.49
|
| Rate for Payer: Nomi Health Commercial |
$150.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.08
|
| Rate for Payer: PHP Commercial |
$156.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$160.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$128.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.02
|
| Rate for Payer: UHC Core |
$153.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$138.08
|
|
|
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 |
$141.13 |
| 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 |
$181.65
|
| Rate for Payer: BCBS Trust/PPO |
$167.47
|
| Rate for Payer: BCBS Trust/PPO |
$231.85
|
| Rate for Payer: BCN Commercial |
$181.65
|
| Rate for Payer: BCN Commercial |
$167.47
|
| Rate for Payer: BCN Commercial |
$231.85
|
| 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: Opus (Opus Packaging Group) HMA |
$164.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.54
|
| Rate for Payer: PHP Commercial |
$172.35
|
| Rate for Payer: PHP Commercial |
$238.61
|
| Rate for Payer: PHP Commercial |
$186.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$244.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$191.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$176.41
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.13
|
| 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
|
|
|
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 |
$35.75 |
| 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 |
$68.73
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$63.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$68.73
|
| Rate for Payer: Amish Plain Church Group Commercial |
$63.37
|
| Rate for Payer: Amish Plain Church Group Commercial |
$87.72
|
| Rate for Payer: BCBS Complete |
$40.71
|
| Rate for Payer: BCBS Complete |
$37.53
|
| Rate for Payer: BCBS Complete |
$51.96
|
| 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 |
$166.70
|
| Rate for Payer: BCBS Trust/PPO |
$180.81
|
| Rate for Payer: BCBS Trust/PPO |
$230.78
|
| Rate for Payer: BCN Commercial |
$180.81
|
| Rate for Payer: BCN Commercial |
$230.78
|
| Rate for Payer: BCN Commercial |
$166.70
|
| Rate for Payer: BCN Medicare Advantage |
$70.18
|
| Rate for Payer: BCN Medicare Advantage |
$54.98
|
| Rate for Payer: BCN Medicare Advantage |
$50.69
|
| Rate for Payer: Cash Price |
$224.58
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$162.22
|
| 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 |
$175.95
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$224.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.98
|
| 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 |
$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: Mclaren Medicaid |
$35.75
|
| Rate for Payer: Mclaren Medicaid |
$49.49
|
| Rate for Payer: Mclaren Medicaid |
$38.78
|
| 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: Meridian Medicaid |
$51.96
|
| Rate for Payer: Meridian Medicaid |
$37.53
|
| Rate for Payer: Meridian Medicaid |
$40.71
|
| 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: Molina Medicare/Medicaid |
$77.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$55.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$238.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.95
|
| Rate for Payer: Nomi Health Commercial |
$230.19
|
| Rate for Payer: Nomi Health Commercial |
$180.35
|
| Rate for Payer: Nomi Health Commercial |
$166.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$164.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$152.08
|
| Rate for Payer: PACE Senior Care Partners |
$52.24
|
| Rate for Payer: PACE Senior Care Partners |
$48.16
|
| Rate for Payer: PACE Senior Care Partners |
$66.67
|
| Rate for Payer: PACE SWMI |
$70.18
|
| Rate for Payer: PACE SWMI |
$54.98
|
| Rate for Payer: PACE SWMI |
$50.69
|
| Rate for Payer: PHP Commercial |
$172.35
|
| Rate for Payer: PHP Commercial |
$238.61
|
| Rate for Payer: PHP Commercial |
$186.95
|
| Rate for Payer: PHP Medicare Advantage |
$54.98
|
| Rate for Payer: PHP Medicare Advantage |
$50.69
|
| Rate for Payer: PHP Medicare Advantage |
$70.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$49.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$191.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$176.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$244.23
|
| Rate for Payer: Priority Health Medicare |
$70.88
|
| Rate for Payer: Priority Health Medicare |
$55.53
|
| Rate for Payer: Priority Health Medicare |
$51.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.13
|
| 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 |
$169.31
|
| Rate for Payer: UHC Core |
$234.40
|
| Rate for Payer: UHC Core |
$183.65
|
| Rate for Payer: UHC Exchange |
$70.18
|
| Rate for Payer: UHC Exchange |
$54.98
|
| Rate for Payer: UHC Exchange |
$50.69
|
| Rate for Payer: UHC Medicaid |
$35.75
|
| Rate for Payer: UHC Medicaid |
$49.49
|
| Rate for Payer: UHC Medicaid |
$38.78
|
| Rate for Payer: UHC Medicare Advantage |
$54.98
|
| Rate for Payer: UHC Medicare Advantage |
$50.69
|
| Rate for Payer: UHC Medicare Advantage |
$70.18
|
| Rate for Payer: UHCCP Medicaid |
$38.78
|
| Rate for Payer: UHCCP Medicaid |
$35.75
|
| Rate for Payer: UHCCP Medicaid |
$49.49
|
| Rate for Payer: VA VA |
$50.69
|
| Rate for Payer: VA VA |
$70.18
|
| Rate for Payer: VA VA |
$54.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$164.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$152.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$210.54
|
|
|
ZOLPIDEM 10 MG TABLET
|
Facility
|
OP
|
$185.65
|
|
|
Service Code
|
NDC 51079072520
|
| Hospital Charge Code |
11700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.73 |
| 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 |
$34.36
|
| Rate for Payer: BCBS MAPPO |
$46.41
|
| Rate for Payer: BCBS Trust/PPO |
$152.62
|
| Rate for Payer: BCN Commercial |
$152.62
|
| 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: Mclaren Medicaid |
$32.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.73
|
| Rate for Payer: Meridian Medicaid |
$34.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$53.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.24
|
| 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 Choice Medicaid |
$32.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$161.52
|
| Rate for Payer: Priority Health Medicare |
$46.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| 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 Exchange |
$46.41
|
| Rate for Payer: UHC Medicaid |
$32.73
|
| Rate for Payer: UHC Medicare Advantage |
$46.41
|
| Rate for Payer: UHCCP Medicaid |
$32.73
|
| Rate for Payer: VA VA |
$46.41
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$139.24
|
|
|
ZOLPIDEM 10 MG TABLET
|
Facility
|
OP
|
$1.86
|
|
|
Service Code
|
NDC 51079072501
|
| Hospital Charge Code |
11700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.33 |
| 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 |
$0.34
|
| Rate for Payer: BCBS MAPPO |
$0.47
|
| Rate for Payer: BCBS Trust/PPO |
$1.53
|
| Rate for Payer: BCN Commercial |
$1.53
|
| 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: Mclaren Medicaid |
$0.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.49
|
| Rate for Payer: Meridian Medicaid |
$0.34
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.58
|
| Rate for Payer: Nomi Health Commercial |
$1.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.40
|
| 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 Choice Medicaid |
$0.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.62
|
| Rate for Payer: Priority Health Medicare |
$0.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.29
|
| 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 Exchange |
$0.47
|
| Rate for Payer: UHC Medicaid |
$0.33
|
| Rate for Payer: UHC Medicare Advantage |
$0.47
|
| Rate for Payer: UHCCP Medicaid |
$0.33
|
| 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 |
$1.29 |
| Max. Negotiated Rate |
$1.67 |
| Rate for Payer: Aetna Commercial |
$1.58
|
| Rate for Payer: BCBS Trust/PPO |
$1.54
|
| Rate for Payer: BCN Commercial |
$1.54
|
| 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: Opus (Opus Packaging Group) HMA |
$1.40
|
| Rate for Payer: PHP Commercial |
$1.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$1.62
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.29
|
| 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 |
$129.21 |
| Max. Negotiated Rate |
$167.09 |
| Rate for Payer: Aetna Commercial |
$157.80
|
| Rate for Payer: BCBS Trust/PPO |
$153.33
|
| Rate for Payer: BCN Commercial |
$153.33
|
| 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: Opus (Opus Packaging Group) HMA |
$139.24
|
| Rate for Payer: PHP Commercial |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$161.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| 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 5 MG TABLET
|
Facility
|
IP
|
$14.18
|
|
|
Service Code
|
NDC 00904608261
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna Commercial |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$11.71
|
| Rate for Payer: BCN Commercial |
$11.71
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: Cofinity Commercial |
$12.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.34
|
| Rate for Payer: Healthscope Commercial |
$12.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.05
|
| Rate for Payer: Nomi Health Commercial |
$11.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.63
|
| Rate for Payer: PHP Commercial |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.34
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.48
|
| Rate for Payer: UHC Core |
$11.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.63
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$14.18
|
|
|
Service Code
|
NDC 00904608261
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna Commercial |
$12.05
|
| Rate for Payer: Aetna Medicare |
$3.69
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.43
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.43
|
| Rate for Payer: BCBS Complete |
$2.62
|
| Rate for Payer: BCBS MAPPO |
$3.54
|
| Rate for Payer: BCBS Trust/PPO |
$11.66
|
| Rate for Payer: BCN Commercial |
$11.66
|
| Rate for Payer: BCN Medicare Advantage |
$3.54
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: Cofinity Commercial |
$12.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.54
|
| Rate for Payer: Healthscope Commercial |
$12.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.63
|
| Rate for Payer: Mclaren Medicaid |
$2.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.72
|
| Rate for Payer: Meridian Medicaid |
$2.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$3.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.05
|
| Rate for Payer: Nomi Health Commercial |
$11.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.63
|
| Rate for Payer: PACE Senior Care Partners |
$3.37
|
| Rate for Payer: PACE SWMI |
$3.54
|
| Rate for Payer: PHP Commercial |
$12.05
|
| Rate for Payer: PHP Medicare Advantage |
$3.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$12.34
|
| Rate for Payer: Priority Health Medicare |
$3.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$9.87
|
| Rate for Payer: Railroad Medicare Medicare |
$3.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.48
|
| Rate for Payer: UHC Core |
$11.84
|
| Rate for Payer: UHC Exchange |
$3.54
|
| Rate for Payer: UHC Medicaid |
$2.50
|
| Rate for Payer: UHC Medicare Advantage |
$3.54
|
| Rate for Payer: UHCCP Medicaid |
$2.50
|
| Rate for Payer: VA VA |
$3.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.63
|
|
