|
ZOLPIDEM 10 MG TABLET
|
Facility
|
OP
|
$1.86
|
|
|
Service Code
|
NDC 51079072501
|
| Hospital Charge Code |
11700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna Commercial |
$1.67
|
| Rate for Payer: Aetna Medicare |
$0.69
|
| Rate for Payer: ASR ASR |
$1.80
|
| Rate for Payer: BCBS Complete |
$0.74
|
| Rate for Payer: BCBS Trust/PPO |
$1.53
|
| Rate for Payer: BCN Commercial |
$1.53
|
| 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 |
$1.80
|
| Rate for Payer: Healthscope Whirlpool |
$1.86
|
| Rate for Payer: Mclaren Commercial |
$1.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.58
|
| Rate for Payer: Nomi Health Commercial |
$1.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.63
|
| Rate for Payer: Priority Health Narrow Network |
$1.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.63
|
|
|
ZOLPIDEM 10 MG TABLET
|
Facility
|
IP
|
$185.65
|
|
|
Service Code
|
NDC 51079072520
|
| Hospital Charge Code |
11700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$139.24 |
| Max. Negotiated Rate |
$185.65 |
| Rate for Payer: Aetna Commercial |
$167.09
|
| Rate for Payer: ASR ASR |
$180.08
|
| Rate for Payer: BCBS Trust/PPO |
$152.46
|
| Rate for Payer: BCN Commercial |
$152.46
|
| 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: 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: UHC All Payor (Choice/PPO) + Core |
$163.37
|
|
|
ZOLPIDEM 10 MG TABLET
|
Facility
|
IP
|
$1.86
|
|
|
Service Code
|
NDC 51079072501
|
| Hospital Charge Code |
11700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.39 |
| 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 |
$1.52
|
| Rate for Payer: BCN Commercial |
$1.52
|
| 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 |
$1.80
|
| Rate for Payer: Healthscope Whirlpool |
$1.86
|
| Rate for Payer: Mclaren Commercial |
$1.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.58
|
| Rate for Payer: Nomi Health Commercial |
$1.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.63
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$1.35
|
|
|
Service Code
|
NDC 51079072401
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Aetna Commercial |
$1.21
|
| Rate for Payer: Aetna Medicare |
$0.50
|
| Rate for Payer: ASR ASR |
$1.31
|
| Rate for Payer: BCBS Complete |
$0.54
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCN Commercial |
$1.11
|
| 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 |
$1.31
|
| Rate for Payer: Healthscope Whirlpool |
$1.35
|
| Rate for Payer: Mclaren Commercial |
$1.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.15
|
| Rate for Payer: Nomi Health Commercial |
$1.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.01
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1.18
|
| Rate for Payer: Priority Health Narrow Network |
$0.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.19
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$6,594.06
|
|
|
Service Code
|
NDC 24540131
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,945.55 |
| 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 |
$5,415.04
|
| Rate for Payer: BCN Commercial |
$5,415.04
|
| 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 |
$6,396.24
|
| Rate for Payer: Healthscope Whirlpool |
$6,594.06
|
| Rate for Payer: Mclaren Commercial |
$5,934.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,604.95
|
| Rate for Payer: Nomi Health Commercial |
$5,407.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,945.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,802.77
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$1.35
|
|
|
Service Code
|
NDC 51079072401
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Aetna Commercial |
$1.21
|
| Rate for Payer: ASR ASR |
$1.31
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| Rate for Payer: BCN Commercial |
$1.11
|
| 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 |
$1.31
|
| Rate for Payer: Healthscope Whirlpool |
$1.35
|
| Rate for Payer: Mclaren Commercial |
$1.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.15
|
| Rate for Payer: Nomi Health Commercial |
$1.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.19
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$14.18
|
|
|
Service Code
|
NDC 904608261
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$14.18 |
| Rate for Payer: Aetna Commercial |
$12.76
|
| Rate for Payer: Aetna Medicare |
$5.24
|
| Rate for Payer: ASR ASR |
$13.75
|
| Rate for Payer: BCBS Complete |
$5.67
|
| Rate for Payer: BCBS Trust/PPO |
$11.69
|
| Rate for Payer: BCN Commercial |
$11.69
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: Cofinity Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.34
|
| Rate for Payer: Healthscope Commercial |
$13.75
|
| Rate for Payer: Healthscope Whirlpool |
$14.18
|
| Rate for Payer: Mclaren Commercial |
$12.76
|
| Rate for Payer: MI Amish Medical Board Commercial |
$11.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.05
|
| Rate for Payer: Nomi Health Commercial |
$11.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.63
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$12.42
|
| Rate for Payer: Priority Health Narrow Network |
$9.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.47
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$14.18
|
|
|
Service Code
|
NDC 904608261
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.63 |
| Max. Negotiated Rate |
$14.18 |
| Rate for Payer: Aetna Commercial |
$12.76
|
| Rate for Payer: ASR ASR |
$13.75
|
| Rate for Payer: BCBS Trust/PPO |
$11.64
|
| Rate for Payer: BCN Commercial |
$11.64
|
| Rate for Payer: Cash Price |
$11.34
|
| Rate for Payer: Cofinity Commercial |
$13.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$11.34
|
| Rate for Payer: Healthscope Commercial |
$13.75
|
| Rate for Payer: Healthscope Whirlpool |
$14.18
|
| Rate for Payer: Mclaren Commercial |
$12.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.05
|
| Rate for Payer: Nomi Health Commercial |
$11.62
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$12.47
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$134.75
|
|
|
Service Code
|
NDC 51079072420
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.06 |
| 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 |
$110.66
|
| Rate for Payer: BCN Commercial |
$110.66
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cofinity Commercial |
$126.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.80
|
| Rate for Payer: Healthscope Commercial |
$130.71
|
| Rate for Payer: Healthscope Whirlpool |
$134.75
|
| Rate for Payer: Mclaren Commercial |
$121.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.54
|
| Rate for Payer: Nomi Health Commercial |
$110.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.58
|
|
|
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 |
$134.75 |
| Rate for Payer: Aetna Commercial |
$121.28
|
| Rate for Payer: Aetna Medicare |
$49.86
|
| Rate for Payer: ASR ASR |
$130.71
|
| Rate for Payer: BCBS Complete |
$53.90
|
| Rate for Payer: BCBS Trust/PPO |
$111.10
|
| Rate for Payer: BCN Commercial |
$111.10
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cofinity Commercial |
$126.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$107.80
|
| Rate for Payer: Healthscope Commercial |
$130.71
|
| Rate for Payer: Healthscope Whirlpool |
$134.75
|
| Rate for Payer: Mclaren Commercial |
$121.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$107.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$114.54
|
| Rate for Payer: Nomi Health Commercial |
$110.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$118.07
|
| Rate for Payer: Priority Health Narrow Network |
$94.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.58
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$6,594.06
|
|
|
Service Code
|
NDC 24540131
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,439.80 |
| Max. Negotiated Rate |
$6,594.06 |
| Rate for Payer: Aetna Commercial |
$5,934.65
|
| Rate for Payer: Aetna Medicare |
$2,439.80
|
| Rate for Payer: ASR ASR |
$6,396.24
|
| Rate for Payer: BCBS Complete |
$2,637.62
|
| Rate for Payer: BCBS Trust/PPO |
$5,436.80
|
| Rate for Payer: BCN Commercial |
$5,436.80
|
| 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 |
$6,396.24
|
| Rate for Payer: Healthscope Whirlpool |
$6,594.06
|
| Rate for Payer: Mclaren Commercial |
$5,934.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$5,275.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,604.95
|
| Rate for Payer: Nomi Health Commercial |
$5,407.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,945.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$5,777.72
|
| Rate for Payer: Priority Health Narrow Network |
$4,622.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,802.77
|
|
