|
ZOLMITRIPTAN 5 MG TABLET
|
Facility
|
IP
|
$22.28
|
|
|
Service Code
|
NDC 27241002238
|
| Hospital Charge Code |
22219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Aetna American Axle |
$14.48
|
| Rate for Payer: Aetna Commercial |
$18.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.48
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$15.60
|
| Rate for Payer: Cofinity Commercial |
$19.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Healthscope Commercial |
$20.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.94
|
| Rate for Payer: PHP Commercial |
$18.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: Priority Health SBD |
$14.04
|
| Rate for Payer: UMR Bronson Commercial |
$9.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.71
|
|
|
ZOLMITRIPTAN 5 MG TABLET
|
Facility
|
OP
|
$22.28
|
|
|
Service Code
|
NDC 27241002238
|
| Hospital Charge Code |
22219
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.24 |
| Max. Negotiated Rate |
$20.05 |
| Rate for Payer: Aetna American Axle |
$14.48
|
| Rate for Payer: Aetna Commercial |
$18.94
|
| Rate for Payer: Aetna Medicare |
$11.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.48
|
| Rate for Payer: BCBS Complete |
$8.91
|
| Rate for Payer: Cash Price |
$17.82
|
| Rate for Payer: Cofinity Commercial |
$15.60
|
| Rate for Payer: Cofinity Commercial |
$19.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$15.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.82
|
| Rate for Payer: Healthscope Commercial |
$20.05
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$15.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$16.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.94
|
| Rate for Payer: PHP Commercial |
$18.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.48
|
| Rate for Payer: Priority Health SBD |
$14.04
|
| Rate for Payer: UMR Bronson Commercial |
$8.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$16.71
|
|
|
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 Commercial |
$0.95
|
| Rate for Payer: Cofinity Commercial |
$1.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.95
|
| 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: PHP Commercial |
$1.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.88
|
| 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
|
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 Commercial |
$0.95
|
| Rate for Payer: Cofinity Commercial |
$1.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$0.95
|
| 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: PHP Commercial |
$1.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.88
|
| Rate for Payer: Priority Health SBD |
$0.85
|
| Rate for Payer: UMR Bronson Commercial |
$0.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.01
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
NDC 00093007301
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.49 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna American Axle |
$50.05
|
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.05
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$53.90
|
| Rate for Payer: Cofinity Commercial |
$66.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.60
|
| Rate for Payer: Healthscope Commercial |
$69.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.45
|
| Rate for Payer: PHP Commercial |
$65.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: Priority Health SBD |
$48.51
|
| Rate for Payer: UMR Bronson Commercial |
$28.49
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.75
|
|
|
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 Commercial |
$115.89
|
| Rate for Payer: Cofinity Commercial |
$94.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.33
|
| 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: PHP Commercial |
$114.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.59
|
| 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 Commercial |
$115.89
|
| Rate for Payer: Cofinity Commercial |
$94.33
|
| Rate for Payer: Cofinity Medicare Advantage |
$94.33
|
| 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: PHP Commercial |
$114.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.59
|
| Rate for Payer: Priority Health SBD |
$84.89
|
| 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
|
$13.13
|
|
|
Service Code
|
NDC 00904608261
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$11.82 |
| Rate for Payer: Aetna American Axle |
$8.53
|
| Rate for Payer: Aetna Commercial |
$11.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.53
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Cofinity Commercial |
$9.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$11.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.16
|
| Rate for Payer: PHP Commercial |
$11.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.53
|
| Rate for Payer: Priority Health SBD |
$8.27
|
| Rate for Payer: UMR Bronson Commercial |
$5.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.85
|
|
|
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 Commercial |
$79.62
|
| Rate for Payer: Cofinity Commercial |
$97.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.00
|
| Rate for Payer: Healthscope Commercial |
$102.38
|
| Rate for Payer: 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: PHP Commercial |
$96.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.94
|
| Rate for Payer: Priority Health SBD |
$71.66
|
| 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
|
$204.75
|
|
|
Service Code
|
NDC 60687083801
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.09 |
| Max. Negotiated Rate |
$184.28 |
| Rate for Payer: Aetna American Axle |
$133.09
|
| Rate for Payer: Aetna Commercial |
$174.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.09
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cofinity Commercial |
$143.32
|
| Rate for Payer: Cofinity Commercial |
$176.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.80
|
| Rate for Payer: Healthscope Commercial |
$184.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.04
|
| Rate for Payer: PHP Commercial |
$174.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.09
|
| Rate for Payer: Priority Health SBD |
$128.99
|
| Rate for Payer: UMR Bronson Commercial |
$90.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.56
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$204.75
|
|
|
Service Code
|
NDC 60687083801
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$75.76 |
| Max. Negotiated Rate |
$184.28 |
| Rate for Payer: Aetna American Axle |
$133.09
|
| Rate for Payer: Aetna Commercial |
$174.04
|
| Rate for Payer: Aetna Medicare |
$102.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.09
|
| Rate for Payer: BCBS Complete |
$81.90
|
| Rate for Payer: Cash Price |
$163.80
|
| Rate for Payer: Cofinity Commercial |
$143.32
|
| Rate for Payer: Cofinity Commercial |
$176.09
|
| Rate for Payer: Cofinity Medicare Advantage |
$143.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$163.80
|
| Rate for Payer: Healthscope Commercial |
$184.28
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$143.32
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$153.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$174.04
|
| Rate for Payer: PHP Commercial |
$174.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.09
|
| Rate for Payer: Priority Health SBD |
$128.99
|
| Rate for Payer: UMR Bronson Commercial |
$75.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$153.56
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$13.13
|
|
|
Service Code
|
NDC 00904608261
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$11.82 |
| Rate for Payer: Aetna American Axle |
$8.53
|
| Rate for Payer: Aetna Commercial |
$11.16
|
| Rate for Payer: Aetna Medicare |
$6.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.53
|
| Rate for Payer: BCBS Complete |
$5.25
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$11.29
|
| Rate for Payer: Cofinity Commercial |
$9.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$9.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$11.82
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$9.19
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$9.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.16
|
| Rate for Payer: PHP Commercial |
$11.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.53
|
| Rate for Payer: Priority Health SBD |
$8.27
|
| Rate for Payer: UMR Bronson Commercial |
$4.86
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$9.85
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
NDC 00093007301
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Aetna American Axle |
$50.05
|
| Rate for Payer: Aetna Commercial |
$65.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.05
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$53.90
|
| Rate for Payer: Cofinity Commercial |
$66.22
|
| Rate for Payer: Cofinity Medicare Advantage |
$53.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$61.60
|
| Rate for Payer: Healthscope Commercial |
$69.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$53.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$57.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.45
|
| Rate for Payer: PHP Commercial |
$65.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: Priority Health SBD |
$48.51
|
| Rate for Payer: UMR Bronson Commercial |
$33.88
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$57.75
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$2.05
|
|
|
Service Code
|
NDC 60687083811
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna American Axle |
$1.33
|
| Rate for Payer: Aetna Commercial |
$1.74
|
| Rate for Payer: Aetna Medicare |
$1.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.33
|
| Rate for Payer: BCBS Complete |
$0.82
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cofinity Commercial |
$1.44
|
| Rate for Payer: Cofinity Commercial |
$1.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.64
|
| Rate for Payer: Healthscope Commercial |
$1.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.74
|
| Rate for Payer: PHP Commercial |
$1.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.33
|
| Rate for Payer: Priority Health SBD |
$1.29
|
| Rate for Payer: UMR Bronson Commercial |
$0.76
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.54
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$2.05
|
|
|
Service Code
|
NDC 60687083811
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna American Axle |
$1.33
|
| Rate for Payer: Aetna Commercial |
$1.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.33
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cofinity Commercial |
$1.44
|
| Rate for Payer: Cofinity Commercial |
$1.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.64
|
| Rate for Payer: Healthscope Commercial |
$1.84
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.44
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.74
|
| Rate for Payer: PHP Commercial |
$1.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.33
|
| Rate for Payer: Priority Health SBD |
$1.29
|
| Rate for Payer: UMR Bronson Commercial |
$0.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.54
|
|
|
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 Commercial |
$79.62
|
| Rate for Payer: Cofinity Commercial |
$97.83
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.00
|
| Rate for Payer: Healthscope Commercial |
$102.38
|
| Rate for Payer: 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: PHP Commercial |
$96.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.94
|
| 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
|
$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 Commercial |
$1.37
|
| Rate for Payer: Cofinity Commercial |
$1.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.37
|
| 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: PHP Commercial |
$1.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.27
|
| Rate for Payer: Priority Health SBD |
$1.23
|
| 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 Commercial |
$1.37
|
| Rate for Payer: Cofinity Commercial |
$1.69
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.37
|
| 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: PHP Commercial |
$1.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.27
|
| 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
|
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 Commercial |
$137.20
|
| Rate for Payer: Cofinity Commercial |
$168.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.20
|
| 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: Multiplan/Beech St/PHCS Commercial |
$166.60
|
| Rate for Payer: PHP Commercial |
$166.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health SBD |
$123.48
|
| Rate for Payer: UMR Bronson Commercial |
$72.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.00
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
NDC 68084018901
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$86.24 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Aetna American Axle |
$127.40
|
| Rate for Payer: Aetna Commercial |
$166.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.40
|
| Rate for Payer: Cash Price |
$156.80
|
| Rate for Payer: Cofinity Commercial |
$137.20
|
| Rate for Payer: Cofinity Commercial |
$168.56
|
| Rate for Payer: Cofinity Medicare Advantage |
$137.20
|
| 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: Multiplan/Beech St/PHCS Commercial |
$166.60
|
| Rate for Payer: PHP Commercial |
$166.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$127.40
|
| Rate for Payer: Priority Health SBD |
$123.48
|
| Rate for Payer: UMR Bronson Commercial |
$86.24
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$147.00
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
OP
|
$2.48
|
|
|
Service Code
|
NDC 60687023011
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Aetna American Axle |
$1.61
|
| Rate for Payer: Aetna Commercial |
$2.11
|
| Rate for Payer: Aetna Medicare |
$1.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.61
|
| Rate for Payer: BCBS Complete |
$0.99
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Cofinity Commercial |
$1.74
|
| Rate for Payer: Cofinity Commercial |
$2.13
|
| Rate for Payer: Cofinity Medicare Advantage |
$1.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.98
|
| Rate for Payer: Healthscope Commercial |
$2.23
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.74
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.11
|
| Rate for Payer: PHP Commercial |
$2.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.61
|
| Rate for Payer: Priority Health SBD |
$1.56
|
| Rate for Payer: UMR Bronson Commercial |
$0.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.86
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$206.80
|
|
|
Service Code
|
NDC 72578004201
|
| Hospital Charge Code |
27780
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.99 |
| Max. Negotiated Rate |
$186.12 |
| Rate for Payer: Aetna American Axle |
$134.42
|
| Rate for Payer: Aetna Commercial |
$175.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.42
|
| Rate for Payer: Cash Price |
$165.44
|
| Rate for Payer: Cofinity Commercial |
$144.76
|
| Rate for Payer: Cofinity Commercial |
$177.85
|
| Rate for Payer: Cofinity Medicare Advantage |
$144.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$165.44
|
| Rate for Payer: Healthscope Commercial |
$186.12
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$144.76
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$155.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$175.78
|
| Rate for Payer: PHP Commercial |
$175.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.42
|
| Rate for Payer: Priority Health SBD |
$130.28
|
| Rate for Payer: UMR Bronson Commercial |
$90.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$155.10
|
|
|
ZONISAMIDE 100 MG CAPSULE
|
Facility
|
IP
|
$324.90
|
|
|
Service Code
|
NDC 59651038001
|
| 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 Commercial |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.92
|
| Rate for Payer: Healthscope Commercial |
$292.41
|
| Rate for Payer: 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: PHP Commercial |
$276.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.19
|
| 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 Commercial |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.92
|
| Rate for Payer: Healthscope Commercial |
$292.41
|
| Rate for Payer: 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: PHP Commercial |
$276.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.19
|
| Rate for Payer: Priority Health SBD |
$204.69
|
| 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 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 Commercial |
$227.43
|
| Rate for Payer: Cofinity Commercial |
$279.41
|
| Rate for Payer: Cofinity Medicare Advantage |
$227.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.92
|
| Rate for Payer: Healthscope Commercial |
$292.41
|
| Rate for Payer: 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: PHP Commercial |
$276.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.19
|
| 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
|
|
