|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$24,021.07
|
|
|
Service Code
|
MS-DRG 465
|
| Min. Negotiated Rate |
$16,643.87 |
| Max. Negotiated Rate |
$24,021.07 |
| Rate for Payer: Aetna Medicare |
$17,519.86
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$21,899.82
|
| Rate for Payer: Amish Plain Church Group Commercial |
$21,899.82
|
| Rate for Payer: BCBS MAPPO |
$17,519.86
|
| Rate for Payer: BCN Medicare Advantage |
$17,519.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,519.86
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,519.86
|
| Rate for Payer: Mclaren Medicare |
$17,519.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,395.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,147.84
|
| Rate for Payer: PACE Medicare |
$16,643.87
|
| Rate for Payer: PACE SWMI |
$17,519.86
|
| Rate for Payer: PHP Commercial |
$19,271.85
|
| Rate for Payer: PHP Medicare Advantage |
$17,519.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,021.07
|
| Rate for Payer: Priority Health Medicare |
$17,519.86
|
| Rate for Payer: Priority Health Narrow Network |
$19,216.86
|
| Rate for Payer: Railroad Medicare Medicare |
$17,519.86
|
| Rate for Payer: UHC Medicare Advantage |
$18,045.46
|
| Rate for Payer: VA VA |
$17,519.86
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
IP
|
$24,199.55
|
|
|
Service Code
|
MS-DRG 902
|
| Min. Negotiated Rate |
$16,755.68 |
| Max. Negotiated Rate |
$24,199.55 |
| Rate for Payer: Aetna Medicare |
$17,637.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$22,046.95
|
| Rate for Payer: Amish Plain Church Group Commercial |
$22,046.95
|
| Rate for Payer: BCBS MAPPO |
$17,637.56
|
| Rate for Payer: BCN Medicare Advantage |
$17,637.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17,637.56
|
| Rate for Payer: Humana Choice PPO Medicare |
$17,637.56
|
| Rate for Payer: Mclaren Medicare |
$17,637.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18,519.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$20,283.19
|
| Rate for Payer: PACE Medicare |
$16,755.68
|
| Rate for Payer: PACE SWMI |
$17,637.56
|
| Rate for Payer: PHP Commercial |
$19,401.32
|
| Rate for Payer: PHP Medicare Advantage |
$17,637.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$24,199.55
|
| Rate for Payer: Priority Health Medicare |
$17,637.56
|
| Rate for Payer: Priority Health Narrow Network |
$19,359.64
|
| Rate for Payer: Railroad Medicare Medicare |
$17,637.56
|
| Rate for Payer: UHC Medicare Advantage |
$18,166.69
|
| Rate for Payer: VA VA |
$17,637.56
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
IP
|
$55,568.95
|
|
|
Service Code
|
MS-DRG 901
|
| Min. Negotiated Rate |
$36,405.71 |
| Max. Negotiated Rate |
$55,568.95 |
| Rate for Payer: Aetna Medicare |
$38,321.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$47,902.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$47,902.25
|
| Rate for Payer: BCBS MAPPO |
$38,321.80
|
| Rate for Payer: BCN Medicare Advantage |
$38,321.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38,321.80
|
| Rate for Payer: Humana Choice PPO Medicare |
$38,321.80
|
| Rate for Payer: Mclaren Medicare |
$38,321.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40,237.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$44,070.07
|
| Rate for Payer: PACE Medicare |
$36,405.71
|
| Rate for Payer: PACE SWMI |
$38,321.80
|
| Rate for Payer: PHP Commercial |
$42,153.98
|
| Rate for Payer: PHP Medicare Advantage |
$38,321.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$55,568.95
|
| Rate for Payer: Priority Health Medicare |
$38,321.80
|
| Rate for Payer: Priority Health Narrow Network |
$44,455.16
|
| Rate for Payer: Railroad Medicare Medicare |
$38,321.80
|
| Rate for Payer: UHC Medicare Advantage |
$39,471.45
|
| Rate for Payer: VA VA |
$38,321.80
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC
|
Facility
IP
|
$15,940.86
|
|
|
Service Code
|
MS-DRG 903
|
| Min. Negotiated Rate |
$11,582.38 |
| Max. Negotiated Rate |
$15,940.86 |
| Rate for Payer: Aetna Medicare |
$12,191.98
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$15,239.98
|
| Rate for Payer: Amish Plain Church Group Commercial |
$15,239.98
|
| Rate for Payer: BCBS MAPPO |
$12,191.98
|
| Rate for Payer: BCN Medicare Advantage |
$12,191.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12,191.98
|
| Rate for Payer: Humana Choice PPO Medicare |
$12,191.98
|
| Rate for Payer: Mclaren Medicare |
$12,191.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12,801.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$14,020.78
|
| Rate for Payer: PACE Medicare |
$11,582.38
|
| Rate for Payer: PACE SWMI |
$12,191.98
|
| Rate for Payer: PHP Commercial |
$13,411.18
|
| Rate for Payer: PHP Medicare Advantage |
$12,191.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15,940.86
|
| Rate for Payer: Priority Health Medicare |
$12,191.98
|
| Rate for Payer: Priority Health Narrow Network |
$12,752.69
|
| Rate for Payer: Railroad Medicare Medicare |
$12,191.98
|
| Rate for Payer: UHC Medicare Advantage |
$12,557.74
|
| Rate for Payer: VA VA |
$12,191.98
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
IP
|
$493.06
|
|
|
Service Code
|
NDC 55111-626-60
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$345.14 |
| Max. Negotiated Rate |
$493.06 |
| Rate for Payer: Aetna Commercial |
$443.75
|
| Rate for Payer: ASR ASR |
$478.27
|
| Rate for Payer: BCBS Trust/PPO |
$382.27
|
| Rate for Payer: BCN Commercial |
$382.27
|
| Rate for Payer: Cash Price |
$394.44
|
| Rate for Payer: Cofinity Commercial |
$463.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$394.45
|
| Rate for Payer: Healthscope Commercial |
$493.06
|
| Rate for Payer: Healthscope Whirlpool |
$478.27
|
| Rate for Payer: Mclaren Commercial |
$443.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$419.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$433.89
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
IP
|
$10.63
|
|
|
Service Code
|
NDC 68084-059-11
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$10.63 |
| Rate for Payer: Aetna Commercial |
$9.57
|
| Rate for Payer: ASR ASR |
$10.31
|
| Rate for Payer: BCBS Trust/PPO |
$8.24
|
| Rate for Payer: BCN Commercial |
$8.24
|
| Rate for Payer: Cash Price |
$8.50
|
| Rate for Payer: Cofinity Commercial |
$9.99
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.50
|
| Rate for Payer: Healthscope Commercial |
$10.63
|
| Rate for Payer: Healthscope Whirlpool |
$10.31
|
| Rate for Payer: Mclaren Commercial |
$9.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.35
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
IP
|
$318.79
|
|
|
Service Code
|
NDC 68084-059-21
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$223.15 |
| Max. Negotiated Rate |
$318.79 |
| Rate for Payer: Aetna Commercial |
$286.91
|
| Rate for Payer: ASR ASR |
$309.23
|
| Rate for Payer: BCBS Trust/PPO |
$247.16
|
| Rate for Payer: BCN Commercial |
$247.16
|
| Rate for Payer: Cash Price |
$255.03
|
| Rate for Payer: Cofinity Commercial |
$299.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$255.03
|
| Rate for Payer: Healthscope Commercial |
$318.79
|
| Rate for Payer: Healthscope Whirlpool |
$309.23
|
| Rate for Payer: Mclaren Commercial |
$286.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$270.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$280.54
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
IP
|
$220.61
|
|
|
Service Code
|
NDC 31722-008-60
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$154.43 |
| Max. Negotiated Rate |
$220.61 |
| Rate for Payer: Aetna Commercial |
$198.55
|
| Rate for Payer: ASR ASR |
$213.99
|
| Rate for Payer: BCBS Trust/PPO |
$171.04
|
| Rate for Payer: BCN Commercial |
$171.04
|
| Rate for Payer: Cash Price |
$176.49
|
| Rate for Payer: Cofinity Commercial |
$207.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.49
|
| Rate for Payer: Healthscope Commercial |
$220.61
|
| Rate for Payer: Healthscope Whirlpool |
$213.99
|
| Rate for Payer: Mclaren Commercial |
$198.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$194.14
|
|
|
ZIDOVUDINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$126.65
|
|
|
Service Code
|
HCPCS J3485
|
| Hospital Charge Code |
11691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$88.66 |
| Max. Negotiated Rate |
$126.65 |
| Rate for Payer: Aetna Commercial |
$113.98
|
| Rate for Payer: ASR ASR |
$122.85
|
| Rate for Payer: BCBS Trust/PPO |
$98.19
|
| Rate for Payer: BCN Commercial |
$98.19
|
| Rate for Payer: Cash Price |
$101.32
|
| Rate for Payer: Cofinity Commercial |
$119.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.32
|
| Rate for Payer: Healthscope Commercial |
$126.65
|
| Rate for Payer: Healthscope Whirlpool |
$122.85
|
| Rate for Payer: Mclaren Commercial |
$113.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$107.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$88.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.45
|
|
|
ZINC OXIDE 17 %-WHITE PETROLATUM 57 % TOPICAL PASTE
|
Facility
IP
|
$23.73
|
|
|
Service Code
|
NDC 53329-137-44
|
| Hospital Charge Code |
172300
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$23.73 |
| Rate for Payer: Aetna Commercial |
$21.36
|
| Rate for Payer: ASR ASR |
$23.02
|
| Rate for Payer: BCBS Trust/PPO |
$18.40
|
| Rate for Payer: BCN Commercial |
$18.40
|
| Rate for Payer: Cash Price |
$18.98
|
| Rate for Payer: Cofinity Commercial |
$22.31
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$18.98
|
| Rate for Payer: Healthscope Commercial |
$23.73
|
| Rate for Payer: Healthscope Whirlpool |
$23.02
|
| Rate for Payer: Mclaren Commercial |
$21.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$20.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.88
|
|
|
ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE
|
Facility
IP
|
$39.19
|
|
|
Service Code
|
NDC 11701-050-33
|
| Hospital Charge Code |
11378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$27.43 |
| Max. Negotiated Rate |
$39.19 |
| Rate for Payer: Aetna Commercial |
$35.27
|
| Rate for Payer: ASR ASR |
$38.01
|
| Rate for Payer: BCBS Trust/PPO |
$30.38
|
| Rate for Payer: BCN Commercial |
$30.38
|
| Rate for Payer: Cash Price |
$31.35
|
| Rate for Payer: Cofinity Commercial |
$36.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$31.35
|
| Rate for Payer: Healthscope Commercial |
$39.19
|
| Rate for Payer: Healthscope Whirlpool |
$38.01
|
| Rate for Payer: Mclaren Commercial |
$35.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$33.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.49
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
IP
|
$1.61
|
|
|
Service Code
|
NDC 7733398325
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Aetna Commercial |
$1.45
|
| Rate for Payer: ASR ASR |
$1.56
|
| Rate for Payer: BCBS Trust/PPO |
$1.25
|
| Rate for Payer: BCN Commercial |
$1.25
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Cofinity Commercial |
$1.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.29
|
| Rate for Payer: Healthscope Commercial |
$1.61
|
| Rate for Payer: Healthscope Whirlpool |
$1.56
|
| Rate for Payer: Mclaren Commercial |
$1.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.42
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
IP
|
$160.60
|
|
|
Service Code
|
NDC 7733398310
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$112.42 |
| Max. Negotiated Rate |
$160.60 |
| Rate for Payer: Aetna Commercial |
$144.54
|
| Rate for Payer: ASR ASR |
$155.78
|
| Rate for Payer: BCBS Trust/PPO |
$124.51
|
| Rate for Payer: BCN Commercial |
$124.51
|
| Rate for Payer: Cash Price |
$128.48
|
| Rate for Payer: Cofinity Commercial |
$150.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$128.48
|
| Rate for Payer: Healthscope Commercial |
$160.60
|
| Rate for Payer: Healthscope Whirlpool |
$155.78
|
| Rate for Payer: Mclaren Commercial |
$144.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$136.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$141.33
|
|
|
ZOLEDRONIC ACID 4 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK
|
Facility
IP
|
$80.78
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
155408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.55 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Aetna Commercial |
$72.70
|
| Rate for Payer: ASR ASR |
$78.36
|
| Rate for Payer: BCBS Trust/PPO |
$62.63
|
| Rate for Payer: BCN Commercial |
$62.63
|
| Rate for Payer: Cash Price |
$64.63
|
| Rate for Payer: Cofinity Commercial |
$75.93
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.62
|
| Rate for Payer: Healthscope Commercial |
$80.78
|
| Rate for Payer: Healthscope Whirlpool |
$78.36
|
| Rate for Payer: Mclaren Commercial |
$72.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$68.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.09
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK
|
Facility
IP
|
$174.80
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
81434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$122.36 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna Commercial |
$157.32
|
| Rate for Payer: Aetna Commercial |
$1,000.80
|
| Rate for Payer: Aetna Commercial |
$786.96
|
| Rate for Payer: Aetna Commercial |
$126.36
|
| Rate for Payer: Aetna Commercial |
$491.76
|
| Rate for Payer: Aetna Commercial |
$175.68
|
| Rate for Payer: ASR ASR |
$530.01
|
| Rate for Payer: ASR ASR |
$169.56
|
| Rate for Payer: ASR ASR |
$136.19
|
| Rate for Payer: ASR ASR |
$848.17
|
| Rate for Payer: ASR ASR |
$189.34
|
| Rate for Payer: ASR ASR |
$1,078.64
|
| Rate for Payer: BCBS Trust/PPO |
$423.62
|
| Rate for Payer: BCBS Trust/PPO |
$862.13
|
| Rate for Payer: BCBS Trust/PPO |
$108.85
|
| Rate for Payer: BCBS Trust/PPO |
$135.52
|
| Rate for Payer: BCBS Trust/PPO |
$151.34
|
| Rate for Payer: BCBS Trust/PPO |
$677.92
|
| Rate for Payer: BCN Commercial |
$135.52
|
| Rate for Payer: BCN Commercial |
$108.85
|
| Rate for Payer: BCN Commercial |
$677.92
|
| Rate for Payer: BCN Commercial |
$862.13
|
| Rate for Payer: BCN Commercial |
$423.62
|
| Rate for Payer: BCN Commercial |
$151.34
|
| Rate for Payer: Cash Price |
$112.32
|
| Rate for Payer: Cash Price |
$139.84
|
| Rate for Payer: Cash Price |
$156.16
|
| Rate for Payer: Cash Price |
$437.12
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Cash Price |
$699.52
|
| Rate for Payer: Cofinity Commercial |
$1,045.28
|
| Rate for Payer: Cofinity Commercial |
$513.62
|
| Rate for Payer: Cofinity Commercial |
$164.31
|
| Rate for Payer: Cofinity Commercial |
$821.94
|
| Rate for Payer: Cofinity Commercial |
$131.98
|
| Rate for Payer: Cofinity Commercial |
$183.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$889.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$437.12
|
| Rate for Payer: Healthscope Commercial |
$1,112.00
|
| Rate for Payer: Healthscope Commercial |
$140.40
|
| Rate for Payer: Healthscope Commercial |
$195.20
|
| Rate for Payer: Healthscope Commercial |
$174.80
|
| Rate for Payer: Healthscope Commercial |
$874.40
|
| Rate for Payer: Healthscope Commercial |
$546.40
|
| Rate for Payer: Healthscope Whirlpool |
$530.01
|
| Rate for Payer: Healthscope Whirlpool |
$1,078.64
|
| Rate for Payer: Healthscope Whirlpool |
$136.19
|
| Rate for Payer: Healthscope Whirlpool |
$848.17
|
| Rate for Payer: Healthscope Whirlpool |
$169.56
|
| Rate for Payer: Healthscope Whirlpool |
$189.34
|
| Rate for Payer: Mclaren Commercial |
$786.96
|
| Rate for Payer: Mclaren Commercial |
$157.32
|
| Rate for Payer: Mclaren Commercial |
$1,000.80
|
| Rate for Payer: Mclaren Commercial |
$175.68
|
| Rate for Payer: Mclaren Commercial |
$126.36
|
| Rate for Payer: Mclaren Commercial |
$491.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$165.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$945.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$464.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$743.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$382.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$778.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$978.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$769.47
|
|
|
ZOLPIDEM 10 MG TABLET
|
Facility
IP
|
$185.65
|
|
|
Service Code
|
NDC 51079-725-20
|
| Hospital Charge Code |
11700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$129.96 |
| Max. Negotiated Rate |
$185.65 |
| Rate for Payer: Aetna Commercial |
$167.08
|
| Rate for Payer: ASR ASR |
$180.08
|
| Rate for Payer: BCBS Trust/PPO |
$143.93
|
| Rate for Payer: BCN Commercial |
$143.93
|
| Rate for Payer: Cash Price |
$148.52
|
| Rate for Payer: Cofinity Commercial |
$174.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$148.52
|
| Rate for Payer: Healthscope Commercial |
$185.65
|
| Rate for Payer: Healthscope Whirlpool |
$180.08
|
| Rate for Payer: Mclaren Commercial |
$167.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$157.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$129.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.37
|
|
|
ZOLPIDEM 10 MG TABLET
|
Facility
IP
|
$1.86
|
|
|
Service Code
|
NDC 51079-725-01
|
| Hospital Charge Code |
11700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna Commercial |
$1.67
|
| Rate for Payer: ASR ASR |
$1.80
|
| Rate for Payer: BCBS Trust/PPO |
$1.44
|
| Rate for Payer: BCN Commercial |
$1.44
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Cofinity Commercial |
$1.75
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.49
|
| Rate for Payer: Healthscope Commercial |
$1.86
|
| Rate for Payer: Healthscope Whirlpool |
$1.80
|
| Rate for Payer: Mclaren Commercial |
$1.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.64
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
IP
|
$6,594.06
|
|
|
Service Code
|
NDC 0024-5401-31
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,615.84 |
| Max. Negotiated Rate |
$6,594.06 |
| Rate for Payer: Aetna Commercial |
$5,934.65
|
| Rate for Payer: ASR ASR |
$6,396.24
|
| Rate for Payer: BCBS Trust/PPO |
$5,112.37
|
| Rate for Payer: BCN Commercial |
$5,112.37
|
| Rate for Payer: Cash Price |
$5,275.25
|
| Rate for Payer: Cofinity Commercial |
$6,198.42
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,275.25
|
| Rate for Payer: Healthscope Commercial |
$6,594.06
|
| Rate for Payer: Healthscope Whirlpool |
$6,396.24
|
| Rate for Payer: Mclaren Commercial |
$5,934.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$5,604.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,615.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,802.77
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
IP
|
$11.03
|
|
|
Service Code
|
NDC 0904-6082-61
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$11.03 |
| Rate for Payer: Aetna Commercial |
$9.93
|
| Rate for Payer: ASR ASR |
$10.70
|
| Rate for Payer: BCBS Trust/PPO |
$8.55
|
| Rate for Payer: BCN Commercial |
$8.55
|
| Rate for Payer: Cash Price |
$8.82
|
| Rate for Payer: Cofinity Commercial |
$10.37
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$8.82
|
| Rate for Payer: Healthscope Commercial |
$11.03
|
| Rate for Payer: Healthscope Whirlpool |
$10.70
|
| Rate for Payer: Mclaren Commercial |
$9.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$9.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.71
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
IP
|
$1.35
|
|
|
Service Code
|
NDC 51079-724-01
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Aetna Commercial |
$1.22
|
| Rate for Payer: ASR ASR |
$1.31
|
| Rate for Payer: BCBS Trust/PPO |
$1.05
|
| Rate for Payer: BCN Commercial |
$1.05
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cofinity Commercial |
$1.27
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.08
|
| Rate for Payer: Healthscope Commercial |
$1.35
|
| Rate for Payer: Healthscope Whirlpool |
$1.31
|
| Rate for Payer: Mclaren Commercial |
$1.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.19
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
IP
|
$134.75
|
|
|
Service Code
|
NDC 51079-724-20
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$94.32 |
| Max. Negotiated Rate |
$134.75 |
| Rate for Payer: Aetna Commercial |
$121.28
|
| Rate for Payer: ASR ASR |
$130.71
|
| Rate for Payer: BCBS Trust/PPO |
$104.47
|
| Rate for Payer: BCN Commercial |
$104.47
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cofinity Commercial |
$126.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.80
|
| Rate for Payer: Healthscope Commercial |
$134.75
|
| Rate for Payer: Healthscope Whirlpool |
$130.71
|
| Rate for Payer: Mclaren Commercial |
$121.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$114.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.58
|
|
