|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$42,792.24
|
|
|
Service Code
|
MSDRG 464
|
| Min. Negotiated Rate |
$22,974.96 |
| Max. Negotiated Rate |
$42,792.24 |
| Rate for Payer: Aetna Medicare |
$24,184.17
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$30,230.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$30,230.21
|
| Rate for Payer: BCBS MAPPO |
$24,184.17
|
| Rate for Payer: BCN Medicare Advantage |
$24,184.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24,184.17
|
| Rate for Payer: Humana Choice PPO Medicare |
$24,184.17
|
| Rate for Payer: Mclaren Medicare |
$24,184.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25,393.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$27,811.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$26,602.59
|
| Rate for Payer: PACE Medicare |
$22,974.96
|
| Rate for Payer: PACE SWMI |
$24,184.17
|
| Rate for Payer: PHP Commercial |
$26,602.59
|
| Rate for Payer: PHP Medicare Advantage |
$24,184.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$42,792.24
|
| Rate for Payer: Priority Health Medicare |
$24,184.17
|
| Rate for Payer: Priority Health Narrow Network |
$34,233.79
|
| Rate for Payer: Railroad Medicare Medicare |
$24,184.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24,184.17
|
| Rate for Payer: UHC Exchange |
$37,485.46
|
| Rate for Payer: UHCCP DNSP |
$24,184.17
|
| Rate for Payer: VA VA |
$24,184.17
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$78,304.29
|
|
|
Service Code
|
MSDRG 463
|
| Min. Negotiated Rate |
$40,658.05 |
| Max. Negotiated Rate |
$78,304.29 |
| Rate for Payer: Aetna Medicare |
$42,797.95
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53,497.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53,497.44
|
| Rate for Payer: BCBS MAPPO |
$42,797.95
|
| Rate for Payer: BCN Medicare Advantage |
$42,797.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42,797.95
|
| Rate for Payer: Humana Choice PPO Medicare |
$42,797.95
|
| Rate for Payer: Mclaren Medicare |
$42,797.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44,937.85
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49,217.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$47,077.75
|
| Rate for Payer: PACE Medicare |
$40,658.05
|
| Rate for Payer: PACE SWMI |
$42,797.95
|
| Rate for Payer: PHP Commercial |
$47,077.75
|
| Rate for Payer: PHP Medicare Advantage |
$42,797.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$78,304.29
|
| Rate for Payer: Priority Health Medicare |
$42,797.95
|
| Rate for Payer: Priority Health Narrow Network |
$62,643.43
|
| Rate for Payer: Railroad Medicare Medicare |
$42,797.95
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$42,797.95
|
| Rate for Payer: UHC Exchange |
$66,336.82
|
| Rate for Payer: UHCCP DNSP |
$42,797.95
|
| Rate for Payer: VA VA |
$42,797.95
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$25,055.45
|
|
|
Service Code
|
MSDRG 465
|
| Min. Negotiated Rate |
$14,143.00 |
| Max. Negotiated Rate |
$25,055.45 |
| Rate for Payer: Aetna Medicare |
$14,887.37
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$18,609.21
|
| Rate for Payer: Amish Plain Church Group Commercial |
$18,609.21
|
| Rate for Payer: BCBS MAPPO |
$14,887.37
|
| Rate for Payer: BCN Medicare Advantage |
$14,887.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14,887.37
|
| Rate for Payer: Humana Choice PPO Medicare |
$14,887.37
|
| Rate for Payer: Mclaren Medicare |
$14,887.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15,631.74
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,120.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$16,376.11
|
| Rate for Payer: PACE Medicare |
$14,143.00
|
| Rate for Payer: PACE SWMI |
$14,887.37
|
| Rate for Payer: PHP Commercial |
$16,376.11
|
| Rate for Payer: PHP Medicare Advantage |
$14,887.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$25,055.45
|
| Rate for Payer: Priority Health Medicare |
$14,887.37
|
| Rate for Payer: Priority Health Narrow Network |
$20,044.36
|
| Rate for Payer: Railroad Medicare Medicare |
$14,887.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$14,887.37
|
| Rate for Payer: UHC Exchange |
$23,075.42
|
| Rate for Payer: UHCCP DNSP |
$14,887.37
|
| Rate for Payer: VA VA |
$14,887.37
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
|
IP
|
$26,302.93
|
|
|
Service Code
|
MSDRG 902
|
| Min. Negotiated Rate |
$14,764.18 |
| Max. Negotiated Rate |
$26,302.93 |
| Rate for Payer: Aetna Medicare |
$15,541.24
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,426.55
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,426.55
|
| Rate for Payer: BCBS MAPPO |
$15,541.24
|
| Rate for Payer: BCN Medicare Advantage |
$15,541.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,541.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$15,541.24
|
| Rate for Payer: Mclaren Medicare |
$15,541.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$16,318.30
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,872.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$17,095.36
|
| Rate for Payer: PACE Medicare |
$14,764.18
|
| Rate for Payer: PACE SWMI |
$15,541.24
|
| Rate for Payer: PHP Commercial |
$17,095.36
|
| Rate for Payer: PHP Medicare Advantage |
$15,541.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$26,302.93
|
| Rate for Payer: Priority Health Medicare |
$15,541.24
|
| Rate for Payer: Priority Health Narrow Network |
$21,042.35
|
| Rate for Payer: Railroad Medicare Medicare |
$15,541.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$15,541.24
|
| Rate for Payer: UHC Exchange |
$24,088.92
|
| Rate for Payer: UHCCP DNSP |
$15,541.24
|
| Rate for Payer: VA VA |
$15,541.24
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
|
IP
|
$57,656.25
|
|
|
Service Code
|
MSDRG 901
|
| Min. Negotiated Rate |
$30,376.44 |
| Max. Negotiated Rate |
$57,656.25 |
| Rate for Payer: Aetna Medicare |
$31,975.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$39,969.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$39,969.00
|
| Rate for Payer: BCBS MAPPO |
$31,975.20
|
| Rate for Payer: BCN Medicare Advantage |
$31,975.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31,975.20
|
| Rate for Payer: Humana Choice PPO Medicare |
$31,975.20
|
| Rate for Payer: Mclaren Medicare |
$31,975.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33,573.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36,771.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$35,172.72
|
| Rate for Payer: PACE Medicare |
$30,376.44
|
| Rate for Payer: PACE SWMI |
$31,975.20
|
| Rate for Payer: PHP Commercial |
$35,172.72
|
| Rate for Payer: PHP Medicare Advantage |
$31,975.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$57,656.25
|
| Rate for Payer: Priority Health Medicare |
$31,975.20
|
| Rate for Payer: Priority Health Narrow Network |
$46,125.00
|
| Rate for Payer: Railroad Medicare Medicare |
$31,975.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$31,975.20
|
| Rate for Payer: UHC Exchange |
$49,561.56
|
| Rate for Payer: UHCCP DNSP |
$31,975.20
|
| Rate for Payer: VA VA |
$31,975.20
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$16,068.90
|
|
|
Service Code
|
MSDRG 903
|
| Min. Negotiated Rate |
$9,668.18 |
| Max. Negotiated Rate |
$16,068.90 |
| Rate for Payer: Aetna Medicare |
$10,177.03
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$12,721.29
|
| Rate for Payer: Amish Plain Church Group Commercial |
$12,721.29
|
| Rate for Payer: BCBS MAPPO |
$10,177.03
|
| Rate for Payer: BCN Medicare Advantage |
$10,177.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10,177.03
|
| Rate for Payer: Humana Choice PPO Medicare |
$10,177.03
|
| Rate for Payer: Mclaren Medicare |
$10,177.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10,685.88
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11,703.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$11,194.73
|
| Rate for Payer: PACE Medicare |
$9,668.18
|
| Rate for Payer: PACE SWMI |
$10,177.03
|
| Rate for Payer: PHP Commercial |
$11,194.73
|
| Rate for Payer: PHP Medicare Advantage |
$10,177.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$16,068.90
|
| Rate for Payer: Priority Health Medicare |
$10,177.03
|
| Rate for Payer: Priority Health Narrow Network |
$12,855.12
|
| Rate for Payer: Railroad Medicare Medicare |
$10,177.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$10,177.03
|
| Rate for Payer: UHC Exchange |
$15,774.40
|
| Rate for Payer: UHCCP DNSP |
$10,177.03
|
| Rate for Payer: VA VA |
$10,177.03
|
|
|
ZIDOVUDINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$126.65
|
|
|
Service Code
|
HCPCS J3485
|
| Hospital Charge Code |
11691
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$126.65 |
| Rate for Payer: Aetna Commercial |
$113.98
|
| Rate for Payer: Aetna Medicare |
$1.51
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1.89
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1.89
|
| Rate for Payer: ASR ASR |
$122.85
|
| Rate for Payer: BCBS Complete |
$0.83
|
| Rate for Payer: BCBS MAPPO |
$1.51
|
| Rate for Payer: BCBS Trust/PPO |
$104.42
|
| Rate for Payer: BCN Commercial |
$104.42
|
| Rate for Payer: BCN Medicare Advantage |
$1.51
|
| Rate for Payer: Cash Price |
$101.32
|
| 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: Health Alliance Plan Medicare Advantage |
$1.51
|
| Rate for Payer: Healthscope Commercial |
$122.85
|
| Rate for Payer: Healthscope Whirlpool |
$126.65
|
| Rate for Payer: Humana Choice PPO Medicare |
$1.51
|
| Rate for Payer: Mclaren Commercial |
$113.98
|
| Rate for Payer: Mclaren Medicaid |
$1.51
|
| Rate for Payer: Mclaren Medicare |
$1.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1.59
|
| Rate for Payer: Meridian Medicaid |
$0.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.74
|
| Rate for Payer: Molina Medicare/Medicaid |
$1.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.65
|
| Rate for Payer: Nomi Health Commercial |
$103.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.99
|
| Rate for Payer: PACE Medicare |
$1.43
|
| Rate for Payer: PACE SWMI |
$1.51
|
| Rate for Payer: PHP Commercial |
$1.66
|
| Rate for Payer: PHP Medicaid |
$0.81
|
| Rate for Payer: PHP Medicare Advantage |
$1.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.57
|
| Rate for Payer: Priority Health Medicare |
$1.51
|
| Rate for Payer: Priority Health Narrow Network |
$1.26
|
| Rate for Payer: Railroad Medicare Medicare |
$1.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1.51
|
| Rate for Payer: UHC Exchange |
$2.34
|
| Rate for Payer: UHC Medicaid |
$0.79
|
| Rate for Payer: UHCCP DNSP |
$1.51
|
| Rate for Payer: UHCCP Medicaid |
$0.79
|
| Rate for Payer: VA VA |
$1.51
|
|
|
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 |
$94.99 |
| 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 |
$104.00
|
| Rate for Payer: BCN Commercial |
$104.00
|
| 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 |
$122.85
|
| Rate for Payer: Healthscope Whirlpool |
$126.65
|
| Rate for Payer: Mclaren Commercial |
$113.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.65
|
| Rate for Payer: Nomi Health Commercial |
$103.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.99
|
| 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 53329013744
|
| Hospital Charge Code |
172300
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.80 |
| 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 |
$19.49
|
| Rate for Payer: BCN Commercial |
$19.49
|
| 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 |
$23.02
|
| Rate for Payer: Healthscope Whirlpool |
$23.73
|
| Rate for Payer: Mclaren Commercial |
$21.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.17
|
| Rate for Payer: Nomi Health Commercial |
$19.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.88
|
|
|
ZINC OXIDE 17 %-WHITE PETROLATUM 57 % TOPICAL PASTE
|
Facility
|
OP
|
$23.73
|
|
|
Service Code
|
NDC 53329013744
|
| Hospital Charge Code |
172300
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$23.73 |
| Rate for Payer: Aetna Commercial |
$21.36
|
| Rate for Payer: Aetna Medicare |
$8.78
|
| Rate for Payer: ASR ASR |
$23.02
|
| Rate for Payer: BCBS Complete |
$9.49
|
| Rate for Payer: BCBS Trust/PPO |
$19.57
|
| Rate for Payer: BCN Commercial |
$19.57
|
| 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 |
$23.02
|
| Rate for Payer: Healthscope Whirlpool |
$23.73
|
| Rate for Payer: Mclaren Commercial |
$21.36
|
| Rate for Payer: MI Amish Medical Board Commercial |
$18.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.17
|
| Rate for Payer: Nomi Health Commercial |
$19.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$20.79
|
| Rate for Payer: Priority Health Narrow Network |
$16.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.88
|
|
|
ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE
|
Facility
|
IP
|
$83.50
|
|
|
Service Code
|
NDC 11701005033
|
| Hospital Charge Code |
11378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.62 |
| Max. Negotiated Rate |
$83.50 |
| Rate for Payer: Aetna Commercial |
$75.15
|
| Rate for Payer: ASR ASR |
$80.99
|
| Rate for Payer: BCBS Trust/PPO |
$68.57
|
| Rate for Payer: BCN Commercial |
$68.57
|
| Rate for Payer: Cash Price |
$66.80
|
| Rate for Payer: Cofinity Commercial |
$78.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.80
|
| Rate for Payer: Healthscope Commercial |
$80.99
|
| Rate for Payer: Healthscope Whirlpool |
$83.50
|
| Rate for Payer: Mclaren Commercial |
$75.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.97
|
| Rate for Payer: Nomi Health Commercial |
$68.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.48
|
|
|
ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE
|
Facility
|
OP
|
$83.50
|
|
|
Service Code
|
NDC 11701005033
|
| Hospital Charge Code |
11378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$83.50 |
| Rate for Payer: Aetna Commercial |
$75.15
|
| Rate for Payer: Aetna Medicare |
$30.89
|
| Rate for Payer: ASR ASR |
$80.99
|
| Rate for Payer: BCBS Complete |
$33.40
|
| Rate for Payer: BCBS Trust/PPO |
$68.84
|
| Rate for Payer: BCN Commercial |
$68.84
|
| Rate for Payer: Cash Price |
$66.80
|
| Rate for Payer: Cofinity Commercial |
$78.49
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$66.80
|
| Rate for Payer: Healthscope Commercial |
$80.99
|
| Rate for Payer: Healthscope Whirlpool |
$83.50
|
| Rate for Payer: Mclaren Commercial |
$75.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$66.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$70.97
|
| Rate for Payer: Nomi Health Commercial |
$68.47
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$73.16
|
| Rate for Payer: Priority Health Narrow Network |
$58.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$73.48
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
OP
|
$196.90
|
|
|
Service Code
|
NDC 77333098310
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.85 |
| Max. Negotiated Rate |
$196.90 |
| Rate for Payer: Aetna Commercial |
$177.21
|
| Rate for Payer: Aetna Medicare |
$72.85
|
| Rate for Payer: ASR ASR |
$190.99
|
| Rate for Payer: BCBS Complete |
$78.76
|
| Rate for Payer: BCBS Trust/PPO |
$162.34
|
| Rate for Payer: BCN Commercial |
$162.34
|
| Rate for Payer: Cash Price |
$157.52
|
| Rate for Payer: Cofinity Commercial |
$185.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.52
|
| Rate for Payer: Healthscope Commercial |
$190.99
|
| Rate for Payer: Healthscope Whirlpool |
$196.90
|
| Rate for Payer: Mclaren Commercial |
$177.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$157.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.37
|
| Rate for Payer: Nomi Health Commercial |
$161.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$172.52
|
| Rate for Payer: Priority Health Narrow Network |
$138.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.27
|
|
|
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 |
$133.65 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna Commercial |
$160.38
|
| Rate for Payer: ASR ASR |
$172.85
|
| Rate for Payer: BCBS Trust/PPO |
$146.34
|
| Rate for Payer: BCN Commercial |
$146.34
|
| Rate for Payer: Cash Price |
$142.56
|
| Rate for Payer: Cofinity Commercial |
$167.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.56
|
| Rate for Payer: Healthscope Commercial |
$172.85
|
| Rate for Payer: Healthscope Whirlpool |
$178.20
|
| Rate for Payer: Mclaren Commercial |
$160.38
|
| 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: UHC All Payor (Choice/PPO) + Core |
$156.82
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
IP
|
$196.90
|
|
|
Service Code
|
NDC 77333098310
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$147.68 |
| Max. Negotiated Rate |
$196.90 |
| Rate for Payer: Aetna Commercial |
$177.21
|
| Rate for Payer: ASR ASR |
$190.99
|
| Rate for Payer: BCBS Trust/PPO |
$161.69
|
| Rate for Payer: BCN Commercial |
$161.69
|
| Rate for Payer: Cash Price |
$157.52
|
| Rate for Payer: Cofinity Commercial |
$185.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$157.52
|
| Rate for Payer: Healthscope Commercial |
$190.99
|
| Rate for Payer: Healthscope Whirlpool |
$196.90
|
| Rate for Payer: Mclaren Commercial |
$177.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167.37
|
| Rate for Payer: Nomi Health Commercial |
$161.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$147.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.27
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
IP
|
$1.97
|
|
|
Service Code
|
NDC 77333098325
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: ASR ASR |
$1.91
|
| Rate for Payer: BCBS Trust/PPO |
$1.62
|
| Rate for Payer: BCN Commercial |
$1.62
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cofinity Commercial |
$1.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.58
|
| Rate for Payer: Healthscope Commercial |
$1.91
|
| Rate for Payer: Healthscope Whirlpool |
$1.97
|
| Rate for Payer: Mclaren Commercial |
$1.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.67
|
| Rate for Payer: Nomi Health Commercial |
$1.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.73
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
OP
|
$178.20
|
|
|
Service Code
|
NDC 20555004000
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.93 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Aetna Commercial |
$160.38
|
| Rate for Payer: Aetna Medicare |
$65.93
|
| Rate for Payer: ASR ASR |
$172.85
|
| Rate for Payer: BCBS Complete |
$71.28
|
| Rate for Payer: BCBS Trust/PPO |
$146.93
|
| Rate for Payer: BCN Commercial |
$146.93
|
| Rate for Payer: Cash Price |
$142.56
|
| Rate for Payer: Cofinity Commercial |
$167.51
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$142.56
|
| Rate for Payer: Healthscope Commercial |
$172.85
|
| Rate for Payer: Healthscope Whirlpool |
$178.20
|
| Rate for Payer: Mclaren Commercial |
$160.38
|
| Rate for Payer: MI Amish Medical Board Commercial |
$142.56
|
| 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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$156.14
|
| Rate for Payer: Priority Health Narrow Network |
$124.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$156.82
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
OP
|
$1.97
|
|
|
Service Code
|
NDC 77333098325
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Aetna Medicare |
$0.73
|
| Rate for Payer: ASR ASR |
$1.91
|
| Rate for Payer: BCBS Complete |
$0.79
|
| Rate for Payer: BCBS Trust/PPO |
$1.62
|
| Rate for Payer: BCN Commercial |
$1.62
|
| Rate for Payer: Cash Price |
$1.58
|
| Rate for Payer: Cofinity Commercial |
$1.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.58
|
| Rate for Payer: Healthscope Commercial |
$1.91
|
| Rate for Payer: Healthscope Whirlpool |
$1.97
|
| Rate for Payer: Mclaren Commercial |
$1.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.67
|
| Rate for Payer: Nomi Health Commercial |
$1.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.73
|
| Rate for Payer: Priority Health Narrow Network |
$1.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.73
|
|
|
ZOLEDRONIC ACID 4 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK
|
Facility
|
OP
|
$80.78
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
155408
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Aetna Commercial |
$72.71
|
| Rate for Payer: Aetna Medicare |
$29.89
|
| Rate for Payer: ASR ASR |
$78.36
|
| Rate for Payer: BCBS Complete |
$32.31
|
| Rate for Payer: BCBS Trust/PPO |
$66.61
|
| Rate for Payer: BCN Commercial |
$66.61
|
| Rate for Payer: Cash Price |
$64.63
|
| Rate for Payer: Cash Price |
$64.63
|
| Rate for Payer: Cofinity Commercial |
$75.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.63
|
| Rate for Payer: Healthscope Commercial |
$78.36
|
| Rate for Payer: Healthscope Whirlpool |
$80.78
|
| Rate for Payer: Mclaren Commercial |
$72.71
|
| Rate for Payer: MI Amish Medical Board Commercial |
$64.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.67
|
| Rate for Payer: Nomi Health Commercial |
$66.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.27
|
| Rate for Payer: Priority Health Narrow Network |
$4.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.09
|
|
|
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 |
$60.59 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Aetna Commercial |
$72.71
|
| Rate for Payer: ASR ASR |
$78.36
|
| Rate for Payer: BCBS Trust/PPO |
$66.34
|
| Rate for Payer: BCN Commercial |
$66.34
|
| Rate for Payer: Cash Price |
$64.63
|
| Rate for Payer: Cofinity Commercial |
$75.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$64.63
|
| Rate for Payer: Healthscope Commercial |
$78.36
|
| Rate for Payer: Healthscope Whirlpool |
$80.78
|
| Rate for Payer: Mclaren Commercial |
$72.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.67
|
| Rate for Payer: Nomi Health Commercial |
$66.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$60.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.09
|
|
|
ZOLEDRONIC ACID 4 MG/100 ML-MANNITOL-0.9 % NACL INTRAVENOUS PIGGYBACK
|
Facility
|
OP
|
$105.47
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
167580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$105.47 |
| Rate for Payer: Aetna Commercial |
$94.92
|
| Rate for Payer: Aetna Medicare |
$39.02
|
| Rate for Payer: ASR ASR |
$102.30
|
| Rate for Payer: BCBS Complete |
$42.19
|
| Rate for Payer: BCBS Trust/PPO |
$86.96
|
| Rate for Payer: BCN Commercial |
$86.96
|
| Rate for Payer: Cash Price |
$84.37
|
| Rate for Payer: Cash Price |
$84.37
|
| Rate for Payer: Cofinity Commercial |
$99.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.37
|
| Rate for Payer: Healthscope Commercial |
$102.30
|
| Rate for Payer: Healthscope Whirlpool |
$105.47
|
| Rate for Payer: Mclaren Commercial |
$94.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$84.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.65
|
| Rate for Payer: Nomi Health Commercial |
$86.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.27
|
| Rate for Payer: Priority Health Narrow Network |
$4.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.81
|
|
|
ZOLEDRONIC ACID 4 MG/100 ML-MANNITOL-0.9 % NACL INTRAVENOUS PIGGYBACK
|
Facility
|
IP
|
$105.47
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
167580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.10 |
| Max. Negotiated Rate |
$105.47 |
| Rate for Payer: Aetna Commercial |
$94.92
|
| Rate for Payer: ASR ASR |
$102.30
|
| Rate for Payer: BCBS Trust/PPO |
$86.61
|
| Rate for Payer: BCN Commercial |
$86.61
|
| Rate for Payer: Cash Price |
$84.37
|
| Rate for Payer: Cofinity Commercial |
$99.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.37
|
| Rate for Payer: Healthscope Commercial |
$102.30
|
| Rate for Payer: Healthscope Whirlpool |
$105.47
|
| Rate for Payer: Mclaren Commercial |
$94.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.65
|
| Rate for Payer: Nomi Health Commercial |
$86.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$79.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.81
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK
|
Facility
|
IP
|
$1,112.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
81434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$834.00 |
| Max. Negotiated Rate |
$1,112.00 |
| Rate for Payer: Aetna Commercial |
$1,000.80
|
| Rate for Payer: Aetna Commercial |
$97.56
|
| Rate for Payer: Aetna Commercial |
$126.36
|
| Rate for Payer: Aetna Commercial |
$175.68
|
| Rate for Payer: Aetna Commercial |
$786.96
|
| Rate for Payer: Aetna Commercial |
$157.32
|
| Rate for Payer: Aetna Commercial |
$282.96
|
| Rate for Payer: ASR ASR |
$189.34
|
| Rate for Payer: ASR ASR |
$136.19
|
| Rate for Payer: ASR ASR |
$848.17
|
| Rate for Payer: ASR ASR |
$105.15
|
| Rate for Payer: ASR ASR |
$1,078.64
|
| Rate for Payer: ASR ASR |
$169.56
|
| Rate for Payer: ASR ASR |
$304.97
|
| Rate for Payer: BCBS Trust/PPO |
$718.06
|
| Rate for Payer: BCBS Trust/PPO |
$258.19
|
| Rate for Payer: BCBS Trust/PPO |
$160.30
|
| Rate for Payer: BCBS Trust/PPO |
$913.17
|
| Rate for Payer: BCBS Trust/PPO |
$89.02
|
| Rate for Payer: BCBS Trust/PPO |
$143.55
|
| Rate for Payer: BCBS Trust/PPO |
$115.30
|
| Rate for Payer: BCN Commercial |
$258.19
|
| Rate for Payer: BCN Commercial |
$115.30
|
| Rate for Payer: BCN Commercial |
$913.17
|
| Rate for Payer: BCN Commercial |
$143.55
|
| Rate for Payer: BCN Commercial |
$160.30
|
| Rate for Payer: BCN Commercial |
$89.02
|
| Rate for Payer: BCN Commercial |
$718.06
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Cash Price |
$156.16
|
| Rate for Payer: Cash Price |
$112.32
|
| Rate for Payer: Cash Price |
$86.72
|
| Rate for Payer: Cash Price |
$699.52
|
| Rate for Payer: Cash Price |
$251.52
|
| Rate for Payer: Cash Price |
$139.84
|
| Rate for Payer: Cofinity Commercial |
$295.54
|
| Rate for Payer: Cofinity Commercial |
$1,045.28
|
| Rate for Payer: Cofinity Commercial |
$164.31
|
| Rate for Payer: Cofinity Commercial |
$183.49
|
| Rate for Payer: Cofinity Commercial |
$131.98
|
| Rate for Payer: Cofinity Commercial |
$101.90
|
| Rate for Payer: Cofinity Commercial |
$821.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$889.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.52
|
| Rate for Payer: Healthscope Commercial |
$1,078.64
|
| Rate for Payer: Healthscope Commercial |
$136.19
|
| Rate for Payer: Healthscope Commercial |
$169.56
|
| Rate for Payer: Healthscope Commercial |
$105.15
|
| Rate for Payer: Healthscope Commercial |
$189.34
|
| Rate for Payer: Healthscope Commercial |
$304.97
|
| Rate for Payer: Healthscope Commercial |
$848.17
|
| Rate for Payer: Healthscope Whirlpool |
$195.20
|
| Rate for Payer: Healthscope Whirlpool |
$108.40
|
| Rate for Payer: Healthscope Whirlpool |
$1,112.00
|
| Rate for Payer: Healthscope Whirlpool |
$314.40
|
| Rate for Payer: Healthscope Whirlpool |
$140.40
|
| Rate for Payer: Healthscope Whirlpool |
$874.40
|
| Rate for Payer: Healthscope Whirlpool |
$174.80
|
| Rate for Payer: Mclaren Commercial |
$97.56
|
| 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 |
$282.96
|
| Rate for Payer: Mclaren Commercial |
$126.36
|
| Rate for Payer: Mclaren Commercial |
$786.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$945.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.34
|
| Rate for Payer: Nomi Health Commercial |
$88.89
|
| Rate for Payer: Nomi Health Commercial |
$160.06
|
| Rate for Payer: Nomi Health Commercial |
$115.13
|
| Rate for Payer: Nomi Health Commercial |
$257.81
|
| Rate for Payer: Nomi Health Commercial |
$717.01
|
| Rate for Payer: Nomi Health Commercial |
$911.84
|
| Rate for Payer: Nomi Health Commercial |
$143.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$834.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$655.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$235.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$276.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$769.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$978.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.78
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK
|
Facility
|
OP
|
$174.80
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
81434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna Commercial |
$157.32
|
| Rate for Payer: Aetna Commercial |
$126.36
|
| Rate for Payer: Aetna Commercial |
$1,000.80
|
| Rate for Payer: Aetna Commercial |
$175.68
|
| Rate for Payer: Aetna Commercial |
$282.96
|
| Rate for Payer: Aetna Commercial |
$786.96
|
| Rate for Payer: Aetna Commercial |
$97.56
|
| Rate for Payer: Aetna Medicare |
$51.95
|
| Rate for Payer: Aetna Medicare |
$40.11
|
| Rate for Payer: Aetna Medicare |
$116.33
|
| Rate for Payer: Aetna Medicare |
$72.22
|
| Rate for Payer: Aetna Medicare |
$323.53
|
| Rate for Payer: Aetna Medicare |
$64.68
|
| Rate for Payer: Aetna Medicare |
$411.44
|
| Rate for Payer: ASR ASR |
$169.56
|
| Rate for Payer: ASR ASR |
$1,078.64
|
| Rate for Payer: ASR ASR |
$105.15
|
| Rate for Payer: ASR ASR |
$136.19
|
| Rate for Payer: ASR ASR |
$304.97
|
| Rate for Payer: ASR ASR |
$848.17
|
| Rate for Payer: ASR ASR |
$189.34
|
| Rate for Payer: BCBS Complete |
$43.36
|
| Rate for Payer: BCBS Complete |
$125.76
|
| Rate for Payer: BCBS Complete |
$349.76
|
| Rate for Payer: BCBS Complete |
$78.08
|
| Rate for Payer: BCBS Complete |
$444.80
|
| Rate for Payer: BCBS Complete |
$56.16
|
| Rate for Payer: BCBS Complete |
$69.92
|
| Rate for Payer: BCBS Trust/PPO |
$160.94
|
| Rate for Payer: BCBS Trust/PPO |
$144.12
|
| Rate for Payer: BCBS Trust/PPO |
$115.76
|
| Rate for Payer: BCBS Trust/PPO |
$89.38
|
| Rate for Payer: BCBS Trust/PPO |
$916.84
|
| Rate for Payer: BCBS Trust/PPO |
$720.94
|
| Rate for Payer: BCBS Trust/PPO |
$259.22
|
| Rate for Payer: BCN Commercial |
$259.22
|
| Rate for Payer: BCN Commercial |
$160.94
|
| Rate for Payer: BCN Commercial |
$916.84
|
| Rate for Payer: BCN Commercial |
$89.38
|
| Rate for Payer: BCN Commercial |
$144.12
|
| Rate for Payer: BCN Commercial |
$115.76
|
| Rate for Payer: BCN Commercial |
$720.94
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Cash Price |
$699.52
|
| Rate for Payer: Cash Price |
$156.16
|
| Rate for Payer: Cash Price |
$86.72
|
| Rate for Payer: Cash Price |
$112.32
|
| Rate for Payer: Cash Price |
$156.16
|
| Rate for Payer: Cash Price |
$251.52
|
| Rate for Payer: Cash Price |
$139.84
|
| Rate for Payer: Cash Price |
$699.52
|
| Rate for Payer: Cash Price |
$251.52
|
| Rate for Payer: Cash Price |
$139.84
|
| Rate for Payer: Cash Price |
$112.32
|
| Rate for Payer: Cash Price |
$86.72
|
| Rate for Payer: Cofinity Commercial |
$164.31
|
| Rate for Payer: Cofinity Commercial |
$1,045.28
|
| Rate for Payer: Cofinity Commercial |
$131.98
|
| Rate for Payer: Cofinity Commercial |
$101.90
|
| Rate for Payer: Cofinity Commercial |
$183.49
|
| Rate for Payer: Cofinity Commercial |
$295.54
|
| Rate for Payer: Cofinity Commercial |
$821.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$86.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$889.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$251.52
|
| Rate for Payer: Healthscope Commercial |
$304.97
|
| Rate for Payer: Healthscope Commercial |
$136.19
|
| Rate for Payer: Healthscope Commercial |
$1,078.64
|
| Rate for Payer: Healthscope Commercial |
$105.15
|
| Rate for Payer: Healthscope Commercial |
$848.17
|
| Rate for Payer: Healthscope Commercial |
$189.34
|
| Rate for Payer: Healthscope Commercial |
$169.56
|
| Rate for Payer: Healthscope Whirlpool |
$314.40
|
| Rate for Payer: Healthscope Whirlpool |
$174.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,112.00
|
| Rate for Payer: Healthscope Whirlpool |
$874.40
|
| Rate for Payer: Healthscope Whirlpool |
$108.40
|
| Rate for Payer: Healthscope Whirlpool |
$195.20
|
| Rate for Payer: Healthscope Whirlpool |
$140.40
|
| Rate for Payer: Mclaren Commercial |
$97.56
|
| Rate for Payer: Mclaren Commercial |
$126.36
|
| Rate for Payer: Mclaren Commercial |
$1,000.80
|
| Rate for Payer: Mclaren Commercial |
$175.68
|
| Rate for Payer: Mclaren Commercial |
$157.32
|
| Rate for Payer: Mclaren Commercial |
$282.96
|
| Rate for Payer: Mclaren Commercial |
$786.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$112.32
|
| Rate for Payer: MI Amish Medical Board Commercial |
$699.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.72
|
| Rate for Payer: MI Amish Medical Board Commercial |
$139.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$251.52
|
| Rate for Payer: MI Amish Medical Board Commercial |
$156.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$889.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$148.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$945.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$267.24
|
| Rate for Payer: Nomi Health Commercial |
$911.84
|
| Rate for Payer: Nomi Health Commercial |
$115.13
|
| Rate for Payer: Nomi Health Commercial |
$717.01
|
| Rate for Payer: Nomi Health Commercial |
$143.34
|
| Rate for Payer: Nomi Health Commercial |
$88.89
|
| Rate for Payer: Nomi Health Commercial |
$257.81
|
| Rate for Payer: Nomi Health Commercial |
$160.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$146.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$655.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$834.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$105.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$131.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$235.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5.27
|
| Rate for Payer: Priority Health Narrow Network |
$4.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.22
|
| Rate for Payer: Priority Health Narrow Network |
$4.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$978.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$276.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$769.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$153.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.39
|
|
|
ZOLPIDEM 10 MG TABLET
|
Facility
|
OP
|
$185.65
|
|
|
Service Code
|
NDC 51079072520
|
| Hospital Charge Code |
11700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$68.69 |
| Max. Negotiated Rate |
$185.65 |
| Rate for Payer: Aetna Commercial |
$167.09
|
| Rate for Payer: Aetna Medicare |
$68.69
|
| Rate for Payer: ASR ASR |
$180.08
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCBS Trust/PPO |
$153.07
|
| Rate for Payer: BCN Commercial |
$153.07
|
| 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 |
$180.08
|
| Rate for Payer: Healthscope Whirlpool |
$185.65
|
| Rate for Payer: Mclaren Commercial |
$167.09
|
| Rate for Payer: MI Amish Medical Board Commercial |
$148.52
|
| 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: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$162.67
|
| Rate for Payer: Priority Health Narrow Network |
$130.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.37
|
|
