|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$1.96
|
|
|
Service Code
|
NDC 68084018911
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna American Axle |
$1.27
|
| Rate for Payer: Aetna Commercial |
$1.67
|
| Rate for Payer: Aetna Medicare |
$0.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.27
|
| Rate for Payer: BCBS Complete |
$0.78
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: Cofinity Advantage |
$1.37
|
| Rate for Payer: Cofinity Commercial |
$1.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.57
|
| Rate for Payer: Healthscope Commercial |
$1.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.47
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.47
|
| Rate for Payer: PHP Commercial |
$1.67
|
| Rate for Payer: Priority Health SBD |
$1.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.27
|
| Rate for Payer: UHC Core |
$1.02
|
| Rate for Payer: UHC Exchange |
$0.77
|
| Rate for Payer: UMR Bronson Commercial |
$0.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.47
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$1.96
|
|
|
Service Code
|
NDC 68084018911
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.86 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: Aetna American Axle |
$1.27
|
| Rate for Payer: Aetna Commercial |
$1.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.27
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: Cofinity Advantage |
$1.37
|
| Rate for Payer: Cofinity Commercial |
$1.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.57
|
| Rate for Payer: Healthscope Commercial |
$1.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.47
|
| Rate for Payer: PHP Commercial |
$1.67
|
| Rate for Payer: Priority Health SBD |
$1.23
|
| Rate for Payer: UMR Bronson Commercial |
$0.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.47
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$1.35
|
|
|
Service Code
|
NDC 51079072401
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna American Axle |
$0.88
|
| Rate for Payer: Aetna Commercial |
$1.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.88
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cofinity Advantage |
$0.95
|
| Rate for Payer: Cofinity Commercial |
$1.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.08
|
| Rate for Payer: Healthscope Commercial |
$1.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.01
|
| Rate for Payer: PHP Commercial |
$1.15
|
| Rate for Payer: Priority Health SBD |
$0.85
|
| Rate for Payer: UMR Bronson Commercial |
$0.59
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.01
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$75.25
|
|
|
Service Code
|
NDC 00093007301
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.11 |
| Max. Negotiated Rate |
$67.72 |
| Rate for Payer: Aetna American Axle |
$48.91
|
| Rate for Payer: Aetna Commercial |
$63.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.91
|
| Rate for Payer: Cash Price |
$60.20
|
| Rate for Payer: Cofinity Advantage |
$52.67
|
| Rate for Payer: Cofinity Commercial |
$64.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.20
|
| Rate for Payer: Healthscope Commercial |
$67.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.44
|
| Rate for Payer: PHP Commercial |
$63.96
|
| Rate for Payer: Priority Health SBD |
$47.41
|
| Rate for Payer: UMR Bronson Commercial |
$33.11
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.44
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$113.75
|
|
|
Service Code
|
NDC 00781531701
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna American Axle |
$73.94
|
| Rate for Payer: Aetna Commercial |
$96.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.94
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cofinity Advantage |
$79.62
|
| Rate for Payer: Cofinity Commercial |
$97.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.00
|
| Rate for Payer: Healthscope Commercial |
$102.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.31
|
| Rate for Payer: PHP Commercial |
$96.69
|
| Rate for Payer: Priority Health SBD |
$71.66
|
| Rate for Payer: UMR Bronson Commercial |
$50.05
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.31
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$113.75
|
|
|
Service Code
|
NDC 00781531701
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$42.09 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna American Axle |
$73.94
|
| Rate for Payer: Aetna Commercial |
$96.69
|
| Rate for Payer: Aetna Medicare |
$56.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.94
|
| Rate for Payer: BCBS Complete |
$45.50
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cofinity Advantage |
$79.62
|
| Rate for Payer: Cofinity Commercial |
$97.83
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.00
|
| Rate for Payer: Healthscope Commercial |
$102.38
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.62
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.31
|
| Rate for Payer: MI Amish Medical Board Commercial |
$91.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.31
|
| Rate for Payer: PHP Commercial |
$96.69
|
| Rate for Payer: Priority Health SBD |
$71.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.94
|
| Rate for Payer: UHC Core |
$59.26
|
| Rate for Payer: UHC Exchange |
$44.70
|
| Rate for Payer: UMR Bronson Commercial |
$42.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.31
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$14.18
|
|
|
Service Code
|
NDC 00904608261
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna American Axle |
$9.22
|
| Rate for Payer: Aetna Commercial |
$12.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.22
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: Cofinity Advantage |
$9.93
|
| Rate for Payer: Cofinity Commercial |
$12.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.34
|
| Rate for Payer: Healthscope Commercial |
$12.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.63
|
| Rate for Payer: PHP Commercial |
$12.05
|
| Rate for Payer: Priority Health SBD |
$8.93
|
| Rate for Payer: UMR Bronson Commercial |
$6.24
|
| 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 |
$5.25 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Aetna American Axle |
$9.22
|
| Rate for Payer: Aetna Commercial |
$12.05
|
| Rate for Payer: Aetna Medicare |
$7.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.22
|
| Rate for Payer: BCBS Complete |
$5.67
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: Cofinity Advantage |
$9.93
|
| Rate for Payer: Cofinity Commercial |
$12.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.34
|
| Rate for Payer: Healthscope Commercial |
$12.76
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.93
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$10.63
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.63
|
| Rate for Payer: PHP Commercial |
$12.05
|
| Rate for Payer: Priority Health SBD |
$8.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.22
|
| Rate for Payer: UHC Core |
$7.39
|
| Rate for Payer: UHC Exchange |
$5.57
|
| Rate for Payer: UMR Bronson Commercial |
$5.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$10.63
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$1.35
|
|
|
Service Code
|
NDC 51079072401
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.22 |
| Rate for Payer: Aetna American Axle |
$0.88
|
| Rate for Payer: Aetna Commercial |
$1.15
|
| Rate for Payer: Aetna Medicare |
$0.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.88
|
| Rate for Payer: BCBS Complete |
$0.54
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cofinity Advantage |
$0.95
|
| Rate for Payer: Cofinity Commercial |
$1.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.08
|
| Rate for Payer: Healthscope Commercial |
$1.22
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$0.95
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.01
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.01
|
| Rate for Payer: PHP Commercial |
$1.15
|
| Rate for Payer: Priority Health SBD |
$0.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.88
|
| Rate for Payer: UHC Core |
$0.70
|
| Rate for Payer: UHC Exchange |
$0.53
|
| Rate for Payer: UMR Bronson Commercial |
$0.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.01
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$134.75
|
|
|
Service Code
|
NDC 51079072420
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$121.28 |
| Rate for Payer: Aetna American Axle |
$87.59
|
| Rate for Payer: Aetna Commercial |
$114.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.59
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cofinity Advantage |
$94.33
|
| Rate for Payer: Cofinity Commercial |
$115.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.80
|
| Rate for Payer: Healthscope Commercial |
$121.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.06
|
| Rate for Payer: PHP Commercial |
$114.54
|
| Rate for Payer: Priority Health SBD |
$84.89
|
| Rate for Payer: UMR Bronson Commercial |
$59.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.06
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$134.75
|
|
|
Service Code
|
NDC 51079072420
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$49.86 |
| Max. Negotiated Rate |
$121.28 |
| Rate for Payer: Aetna American Axle |
$87.59
|
| Rate for Payer: Aetna Commercial |
$114.54
|
| Rate for Payer: Aetna Medicare |
$67.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.59
|
| Rate for Payer: BCBS Complete |
$53.90
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cofinity Advantage |
$94.33
|
| Rate for Payer: Cofinity Commercial |
$115.89
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.80
|
| Rate for Payer: Healthscope Commercial |
$121.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$94.33
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$101.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.06
|
| Rate for Payer: PHP Commercial |
$114.54
|
| Rate for Payer: Priority Health SBD |
$84.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.59
|
| Rate for Payer: UHC Core |
$70.20
|
| Rate for Payer: UHC Exchange |
$52.96
|
| Rate for Payer: UMR Bronson Commercial |
$49.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$101.06
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$190.75
|
|
|
Service Code
|
NDC 60687083801
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.93 |
| Max. Negotiated Rate |
$171.68 |
| Rate for Payer: Aetna American Axle |
$123.99
|
| Rate for Payer: Aetna Commercial |
$162.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.99
|
| Rate for Payer: Cash Price |
$152.60
|
| Rate for Payer: Cofinity Advantage |
$133.53
|
| Rate for Payer: Cofinity Commercial |
$164.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.60
|
| Rate for Payer: Healthscope Commercial |
$171.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.06
|
| Rate for Payer: PHP Commercial |
$162.14
|
| Rate for Payer: Priority Health SBD |
$120.17
|
| Rate for Payer: UMR Bronson Commercial |
$83.93
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.06
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$190.75
|
|
|
Service Code
|
NDC 60687083801
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.58 |
| Max. Negotiated Rate |
$171.68 |
| Rate for Payer: Aetna American Axle |
$123.99
|
| Rate for Payer: Aetna Commercial |
$162.14
|
| Rate for Payer: Aetna Medicare |
$95.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.99
|
| Rate for Payer: BCBS Complete |
$76.30
|
| Rate for Payer: Cash Price |
$152.60
|
| Rate for Payer: Cofinity Advantage |
$133.53
|
| Rate for Payer: Cofinity Commercial |
$164.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.60
|
| Rate for Payer: Healthscope Commercial |
$171.68
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.53
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$143.06
|
| Rate for Payer: MI Amish Medical Board Commercial |
$152.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$143.06
|
| Rate for Payer: PHP Commercial |
$162.14
|
| Rate for Payer: Priority Health SBD |
$120.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.99
|
| Rate for Payer: UHC Core |
$99.38
|
| Rate for Payer: UHC Exchange |
$74.96
|
| Rate for Payer: UMR Bronson Commercial |
$70.58
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$143.06
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$75.25
|
|
|
Service Code
|
NDC 00093007301
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.84 |
| Max. Negotiated Rate |
$67.72 |
| Rate for Payer: Aetna American Axle |
$48.91
|
| Rate for Payer: Aetna Commercial |
$63.96
|
| Rate for Payer: Aetna Medicare |
$37.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.91
|
| Rate for Payer: BCBS Complete |
$30.10
|
| Rate for Payer: Cash Price |
$60.20
|
| Rate for Payer: Cofinity Advantage |
$52.67
|
| Rate for Payer: Cofinity Commercial |
$64.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$60.20
|
| Rate for Payer: Healthscope Commercial |
$67.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$52.67
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$56.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.44
|
| Rate for Payer: PHP Commercial |
$63.96
|
| Rate for Payer: Priority Health SBD |
$47.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.91
|
| Rate for Payer: UHC Core |
$39.21
|
| Rate for Payer: UHC Exchange |
$29.57
|
| Rate for Payer: UMR Bronson Commercial |
$27.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$56.44
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$1.91
|
|
|
Service Code
|
NDC 60687083811
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Aetna American Axle |
$1.24
|
| Rate for Payer: Aetna Commercial |
$1.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.24
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cofinity Advantage |
$1.34
|
| Rate for Payer: Cofinity Commercial |
$1.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.53
|
| Rate for Payer: Healthscope Commercial |
$1.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.43
|
| Rate for Payer: PHP Commercial |
$1.62
|
| Rate for Payer: Priority Health SBD |
$1.20
|
| Rate for Payer: UMR Bronson Commercial |
$0.84
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.43
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$1.91
|
|
|
Service Code
|
NDC 60687083811
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.72 |
| Rate for Payer: Aetna American Axle |
$1.24
|
| Rate for Payer: Aetna Commercial |
$1.62
|
| Rate for Payer: Aetna Medicare |
$0.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.24
|
| Rate for Payer: BCBS Complete |
$0.76
|
| Rate for Payer: Cash Price |
$1.53
|
| Rate for Payer: Cofinity Advantage |
$1.34
|
| Rate for Payer: Cofinity Commercial |
$1.64
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.53
|
| Rate for Payer: Healthscope Commercial |
$1.72
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.34
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.43
|
| Rate for Payer: PHP Commercial |
$1.62
|
| Rate for Payer: Priority Health SBD |
$1.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1.24
|
| Rate for Payer: UHC Core |
$1.00
|
| Rate for Payer: UHC Exchange |
$0.75
|
| Rate for Payer: UMR Bronson Commercial |
$0.71
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.43
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
NDC 68084018901
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.52 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna American Axle |
$127.40
|
| Rate for Payer: Aetna Commercial |
$166.60
|
| Rate for Payer: Aetna Medicare |
$98.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.40
|
| Rate for Payer: BCBS Complete |
$78.40
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Advantage |
$137.20
|
| Rate for Payer: Cofinity Commercial |
$168.56
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.80
|
| Rate for Payer: Healthscope Commercial |
$176.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$137.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$147.00
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$166.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.00
|
| Rate for Payer: PHP Commercial |
$166.60
|
| Rate for Payer: Priority Health SBD |
$123.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.40
|
| Rate for Payer: UHC Core |
$102.12
|
| Rate for Payer: UHC Exchange |
$77.03
|
| Rate for Payer: UMR Bronson Commercial |
$72.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.00
|
|
|
ZONISAMIDE 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
OP
|
$1,808.33
|
|
|
Service Code
|
NDC 52652800101
|
| Hospital Charge Code |
201496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$669.08 |
| Max. Negotiated Rate |
$1,627.50 |
| Rate for Payer: Aetna American Axle |
$1,175.41
|
| Rate for Payer: Aetna Commercial |
$1,537.08
|
| Rate for Payer: Aetna Medicare |
$904.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,175.41
|
| Rate for Payer: BCBS Complete |
$723.33
|
| Rate for Payer: Cash Price |
$1,446.66
|
| Rate for Payer: Cofinity Advantage |
$1,265.83
|
| Rate for Payer: Cofinity Commercial |
$1,555.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,446.66
|
| Rate for Payer: Healthscope Commercial |
$1,627.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,265.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,356.25
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,446.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,537.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,356.25
|
| Rate for Payer: PHP Commercial |
$1,537.08
|
| Rate for Payer: Priority Health SBD |
$1,139.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,175.41
|
| Rate for Payer: UHC Core |
$942.14
|
| Rate for Payer: UHC Exchange |
$710.67
|
| Rate for Payer: UMR Bronson Commercial |
$669.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,356.25
|
|
|
ZONISAMIDE 100 MG/5 ML ORAL SUSPENSION
|
Facility
|
IP
|
$1,808.33
|
|
|
Service Code
|
NDC 52652800101
|
| Hospital Charge Code |
201496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$795.67 |
| Max. Negotiated Rate |
$1,627.50 |
| Rate for Payer: Aetna American Axle |
$1,175.41
|
| Rate for Payer: Aetna Commercial |
$1,537.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,175.41
|
| Rate for Payer: Cash Price |
$1,446.66
|
| Rate for Payer: Cofinity Advantage |
$1,265.83
|
| Rate for Payer: Cofinity Commercial |
$1,555.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1,446.66
|
| Rate for Payer: Healthscope Commercial |
$1,627.50
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1,265.83
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1,356.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,537.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,356.25
|
| Rate for Payer: PHP Commercial |
$1,537.08
|
| Rate for Payer: Priority Health SBD |
$1,139.25
|
| Rate for Payer: UMR Bronson Commercial |
$795.67
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1,356.25
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$249.10
|
|
|
Service Code
|
NDC 72578004201
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$92.17 |
| Max. Negotiated Rate |
$224.19 |
| Rate for Payer: Aetna American Axle |
$161.91
|
| Rate for Payer: Aetna Commercial |
$211.74
|
| Rate for Payer: Aetna Medicare |
$124.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.91
|
| Rate for Payer: BCBS Complete |
$99.64
|
| Rate for Payer: Cash Price |
$199.28
|
| Rate for Payer: Cofinity Advantage |
$174.37
|
| Rate for Payer: Cofinity Commercial |
$214.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$224.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.82
|
| Rate for Payer: MI Amish Medical Board Commercial |
$199.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.82
|
| Rate for Payer: PHP Commercial |
$211.74
|
| Rate for Payer: Priority Health SBD |
$156.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.91
|
| Rate for Payer: UHC Core |
$129.78
|
| Rate for Payer: UHC Exchange |
$97.90
|
| Rate for Payer: UMR Bronson Commercial |
$92.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.82
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$249.10
|
|
|
Service Code
|
NDC 72578004201
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.60 |
| Max. Negotiated Rate |
$224.19 |
| Rate for Payer: Aetna American Axle |
$161.91
|
| Rate for Payer: Aetna Commercial |
$211.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.91
|
| Rate for Payer: Cash Price |
$199.28
|
| Rate for Payer: Cofinity Advantage |
$174.37
|
| Rate for Payer: Cofinity Commercial |
$214.23
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$199.28
|
| Rate for Payer: Healthscope Commercial |
$224.19
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$174.37
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$186.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$186.82
|
| Rate for Payer: PHP Commercial |
$211.74
|
| Rate for Payer: Priority Health SBD |
$156.93
|
| Rate for Payer: UMR Bronson Commercial |
$109.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$186.82
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$324.90
|
|
|
Service Code
|
NDC 68462013001
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.96 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna American Axle |
$211.19
|
| Rate for Payer: Aetna Commercial |
$276.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.19
|
| Rate for Payer: Cash Price |
$259.92
|
| Rate for Payer: Cofinity Advantage |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.92
|
| Rate for Payer: Healthscope Commercial |
$292.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.68
|
| Rate for Payer: PHP Commercial |
$276.17
|
| Rate for Payer: Priority Health SBD |
$204.69
|
| Rate for Payer: UMR Bronson Commercial |
$142.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.68
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$324.90
|
|
|
Service Code
|
NDC 69097086107
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.21 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna American Axle |
$211.19
|
| Rate for Payer: Aetna Commercial |
$276.17
|
| Rate for Payer: Aetna Medicare |
$162.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.19
|
| Rate for Payer: BCBS Complete |
$129.96
|
| Rate for Payer: Cash Price |
$259.92
|
| Rate for Payer: Cofinity Advantage |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.92
|
| Rate for Payer: Healthscope Commercial |
$292.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$259.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.68
|
| Rate for Payer: PHP Commercial |
$276.17
|
| Rate for Payer: Priority Health SBD |
$204.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.19
|
| Rate for Payer: UHC Core |
$169.27
|
| Rate for Payer: UHC Exchange |
$127.69
|
| Rate for Payer: UMR Bronson Commercial |
$120.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.68
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$324.90
|
|
|
Service Code
|
NDC 69097086107
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$142.96 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna American Axle |
$211.19
|
| Rate for Payer: Aetna Commercial |
$276.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.19
|
| Rate for Payer: Cash Price |
$259.92
|
| Rate for Payer: Cofinity Advantage |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.92
|
| Rate for Payer: Healthscope Commercial |
$292.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.68
|
| Rate for Payer: PHP Commercial |
$276.17
|
| Rate for Payer: Priority Health SBD |
$204.69
|
| Rate for Payer: UMR Bronson Commercial |
$142.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.68
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$324.90
|
|
|
Service Code
|
NDC 59651038001
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.21 |
| Max. Negotiated Rate |
$292.41 |
| Rate for Payer: Aetna American Axle |
$211.19
|
| Rate for Payer: Aetna Commercial |
$276.17
|
| Rate for Payer: Aetna Medicare |
$162.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.19
|
| Rate for Payer: BCBS Complete |
$129.96
|
| Rate for Payer: Cash Price |
$259.92
|
| Rate for Payer: Cofinity Advantage |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.92
|
| Rate for Payer: Healthscope Commercial |
$292.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$227.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$259.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$276.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$243.68
|
| Rate for Payer: PHP Commercial |
$276.17
|
| Rate for Payer: Priority Health SBD |
$204.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.19
|
| Rate for Payer: UHC Core |
$169.27
|
| Rate for Payer: UHC Exchange |
$127.69
|
| Rate for Payer: UMR Bronson Commercial |
$120.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.68
|
|
