|
WHITE PETROLATUM-MINERAL OIL 83 %-15 % EYE OINTMENT
|
Facility
|
IP
|
$22.10
|
|
|
Service Code
|
NDC 00904648838
|
| Hospital Charge Code |
117765
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$14.36 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Aetna Commercial |
$19.89
|
| Rate for Payer: ASR ASR |
$21.44
|
| Rate for Payer: ASR Commercial |
$21.44
|
| Rate for Payer: BCBS Trust/PPO |
$18.01
|
| Rate for Payer: BCN Commercial |
$17.13
|
| Rate for Payer: Cash Price |
$17.68
|
| Rate for Payer: Cofinity Commercial |
$20.77
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17.68
|
| Rate for Payer: Healthscope Commercial |
$22.10
|
| Rate for Payer: Healthscope Whirlpool |
$21.44
|
| Rate for Payer: Mclaren Commercial |
$19.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18.78
|
| Rate for Payer: Nomi Health Commercial |
$18.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.45
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$493.06
|
|
|
Service Code
|
NDC 55111062660
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$320.49 |
| Max. Negotiated Rate |
$493.06 |
| Rate for Payer: Aetna Commercial |
$443.75
|
| Rate for Payer: ASR ASR |
$478.27
|
| Rate for Payer: ASR Commercial |
$478.27
|
| Rate for Payer: BCBS Trust/PPO |
$401.79
|
| 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 Commercial |
$419.10
|
| Rate for Payer: Nomi Health Commercial |
$404.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$433.89
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
OP
|
$9.88
|
|
|
Service Code
|
NDC 68084005911
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$9.88 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna Medicare |
$4.94
|
| Rate for Payer: ASR ASR |
$9.58
|
| Rate for Payer: ASR Commercial |
$9.58
|
| Rate for Payer: BCBS Complete |
$3.95
|
| Rate for Payer: BCBS Trust/PPO |
$8.09
|
| Rate for Payer: BCN Commercial |
$7.66
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.90
|
| Rate for Payer: Healthscope Commercial |
$9.88
|
| Rate for Payer: Healthscope Whirlpool |
$9.58
|
| Rate for Payer: Mclaren Commercial |
$8.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.40
|
| Rate for Payer: Nomi Health Commercial |
$8.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.66
|
| Rate for Payer: Priority Health Narrow Network |
$6.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.69
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
OP
|
$296.26
|
|
|
Service Code
|
NDC 68084005921
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$118.50 |
| Max. Negotiated Rate |
$296.26 |
| Rate for Payer: Aetna Commercial |
$266.63
|
| Rate for Payer: Aetna Medicare |
$148.13
|
| Rate for Payer: ASR ASR |
$287.37
|
| Rate for Payer: ASR Commercial |
$287.37
|
| Rate for Payer: BCBS Complete |
$118.50
|
| Rate for Payer: BCBS Trust/PPO |
$242.61
|
| Rate for Payer: BCN Commercial |
$229.69
|
| Rate for Payer: Cash Price |
$237.01
|
| Rate for Payer: Cofinity Commercial |
$278.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.01
|
| Rate for Payer: Healthscope Commercial |
$296.26
|
| Rate for Payer: Healthscope Whirlpool |
$287.37
|
| Rate for Payer: Mclaren Commercial |
$266.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.82
|
| Rate for Payer: Nomi Health Commercial |
$242.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.57
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$259.58
|
| Rate for Payer: Priority Health Narrow Network |
$207.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.71
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$9.88
|
|
|
Service Code
|
NDC 68084005911
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$9.88 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: ASR ASR |
$9.58
|
| Rate for Payer: ASR Commercial |
$9.58
|
| Rate for Payer: BCBS Trust/PPO |
$8.05
|
| Rate for Payer: BCN Commercial |
$7.66
|
| Rate for Payer: Cash Price |
$7.90
|
| Rate for Payer: Cofinity Commercial |
$9.29
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$7.90
|
| Rate for Payer: Healthscope Commercial |
$9.88
|
| Rate for Payer: Healthscope Whirlpool |
$9.58
|
| Rate for Payer: Mclaren Commercial |
$8.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$8.40
|
| Rate for Payer: Nomi Health Commercial |
$8.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$8.69
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
OP
|
$493.06
|
|
|
Service Code
|
NDC 55111062660
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$197.22 |
| Max. Negotiated Rate |
$493.06 |
| Rate for Payer: Aetna Commercial |
$443.75
|
| Rate for Payer: Aetna Medicare |
$246.53
|
| Rate for Payer: ASR ASR |
$478.27
|
| Rate for Payer: ASR Commercial |
$478.27
|
| Rate for Payer: BCBS Complete |
$197.22
|
| Rate for Payer: BCBS Trust/PPO |
$403.77
|
| 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 Commercial |
$419.10
|
| Rate for Payer: Nomi Health Commercial |
$404.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$320.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$432.02
|
| Rate for Payer: Priority Health Narrow Network |
$345.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$433.89
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$329.18
|
|
|
Service Code
|
NDC 31722000860
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.97 |
| Max. Negotiated Rate |
$329.18 |
| Rate for Payer: Aetna Commercial |
$296.26
|
| Rate for Payer: ASR ASR |
$319.30
|
| Rate for Payer: ASR Commercial |
$319.30
|
| Rate for Payer: BCBS Trust/PPO |
$268.25
|
| Rate for Payer: BCN Commercial |
$255.21
|
| Rate for Payer: Cash Price |
$263.35
|
| Rate for Payer: Cofinity Commercial |
$309.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.34
|
| Rate for Payer: Healthscope Commercial |
$329.18
|
| Rate for Payer: Healthscope Whirlpool |
$319.30
|
| Rate for Payer: Mclaren Commercial |
$296.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.80
|
| Rate for Payer: Nomi Health Commercial |
$269.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.68
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
OP
|
$329.18
|
|
|
Service Code
|
NDC 31722000860
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$131.67 |
| Max. Negotiated Rate |
$329.18 |
| Rate for Payer: Aetna Commercial |
$296.26
|
| Rate for Payer: Aetna Medicare |
$164.59
|
| Rate for Payer: ASR ASR |
$319.30
|
| Rate for Payer: ASR Commercial |
$319.30
|
| Rate for Payer: BCBS Complete |
$131.67
|
| Rate for Payer: BCBS Trust/PPO |
$269.57
|
| Rate for Payer: BCN Commercial |
$255.21
|
| Rate for Payer: Cash Price |
$263.35
|
| Rate for Payer: Cofinity Commercial |
$309.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$263.34
|
| Rate for Payer: Healthscope Commercial |
$329.18
|
| Rate for Payer: Healthscope Whirlpool |
$319.30
|
| Rate for Payer: Mclaren Commercial |
$296.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$279.80
|
| Rate for Payer: Nomi Health Commercial |
$269.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$213.97
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.43
|
| Rate for Payer: Priority Health Narrow Network |
$230.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.68
|
|
|
ZAFIRLUKAST 20 MG TABLET
|
Facility
|
IP
|
$296.26
|
|
|
Service Code
|
NDC 68084005921
|
| Hospital Charge Code |
17960
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$192.57 |
| Max. Negotiated Rate |
$296.26 |
| Rate for Payer: Aetna Commercial |
$266.63
|
| Rate for Payer: ASR ASR |
$287.37
|
| Rate for Payer: ASR Commercial |
$287.37
|
| Rate for Payer: BCBS Trust/PPO |
$241.42
|
| Rate for Payer: BCN Commercial |
$229.69
|
| Rate for Payer: Cash Price |
$237.01
|
| Rate for Payer: Cofinity Commercial |
$278.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$237.01
|
| Rate for Payer: Healthscope Commercial |
$296.26
|
| Rate for Payer: Healthscope Whirlpool |
$287.37
|
| Rate for Payer: Mclaren Commercial |
$266.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$251.82
|
| Rate for Payer: Nomi Health Commercial |
$242.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.71
|
|
|
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 |
$1.26 |
| Max. Negotiated Rate |
$126.65 |
| Rate for Payer: Aetna Commercial |
$113.98
|
| Rate for Payer: Aetna Medicare |
$63.32
|
| Rate for Payer: ASR ASR |
$122.85
|
| Rate for Payer: ASR Commercial |
$122.85
|
| Rate for Payer: BCBS Complete |
$50.66
|
| Rate for Payer: BCBS Trust/PPO |
$103.71
|
| Rate for Payer: BCN Commercial |
$98.19
|
| 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: 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 Commercial |
$107.65
|
| Rate for Payer: Nomi Health Commercial |
$103.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.57
|
| Rate for Payer: Priority Health Narrow Network |
$1.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.45
|
|
|
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 |
$82.32 |
| Max. Negotiated Rate |
$126.65 |
| Rate for Payer: Aetna Commercial |
$113.98
|
| Rate for Payer: ASR ASR |
$122.85
|
| Rate for Payer: ASR Commercial |
$122.85
|
| Rate for Payer: BCBS Trust/PPO |
$103.21
|
| 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 Commercial |
$107.65
|
| Rate for Payer: Nomi Health Commercial |
$103.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$82.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.45
|
|
|
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 |
$9.49 |
| Max. Negotiated Rate |
$23.73 |
| Rate for Payer: Aetna Commercial |
$21.36
|
| Rate for Payer: Aetna Medicare |
$11.86
|
| Rate for Payer: ASR ASR |
$23.02
|
| Rate for Payer: ASR Commercial |
$23.02
|
| Rate for Payer: BCBS Complete |
$9.49
|
| Rate for Payer: BCBS Trust/PPO |
$19.43
|
| 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 Commercial |
$20.17
|
| Rate for Payer: Nomi Health Commercial |
$19.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.42
|
| Rate for Payer: 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 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 |
$15.42 |
| Max. Negotiated Rate |
$23.73 |
| Rate for Payer: Aetna Commercial |
$21.36
|
| Rate for Payer: ASR ASR |
$23.02
|
| Rate for Payer: ASR Commercial |
$23.02
|
| Rate for Payer: BCBS Trust/PPO |
$19.34
|
| 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 Commercial |
$20.17
|
| Rate for Payer: Nomi Health Commercial |
$19.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$20.88
|
|
|
ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE
|
Facility
|
OP
|
$39.19
|
|
|
Service Code
|
NDC 11701005033
|
| Hospital Charge Code |
11378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$39.19 |
| Rate for Payer: Aetna Commercial |
$35.27
|
| Rate for Payer: Aetna Medicare |
$19.60
|
| Rate for Payer: ASR ASR |
$38.01
|
| Rate for Payer: ASR Commercial |
$38.01
|
| Rate for Payer: BCBS Complete |
$15.68
|
| Rate for Payer: BCBS Trust/PPO |
$32.09
|
| 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 Commercial |
$33.31
|
| Rate for Payer: Nomi Health Commercial |
$32.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.34
|
| Rate for Payer: Priority Health Narrow Network |
$27.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.49
|
|
|
ZINC OXIDE-PETROLATUM 20 %-51 % TOPICAL PASTE
|
Facility
|
IP
|
$39.19
|
|
|
Service Code
|
NDC 11701005033
|
| Hospital Charge Code |
11378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.47 |
| Max. Negotiated Rate |
$39.19 |
| Rate for Payer: Aetna Commercial |
$35.27
|
| Rate for Payer: ASR ASR |
$38.01
|
| Rate for Payer: ASR Commercial |
$38.01
|
| Rate for Payer: BCBS Trust/PPO |
$31.94
|
| 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 Commercial |
$33.31
|
| Rate for Payer: Nomi Health Commercial |
$32.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$34.49
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
IP
|
$168.30
|
|
|
Service Code
|
NDC 77333098310
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$109.40 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Aetna Commercial |
$151.47
|
| Rate for Payer: ASR ASR |
$163.25
|
| Rate for Payer: ASR Commercial |
$163.25
|
| Rate for Payer: BCBS Trust/PPO |
$137.15
|
| Rate for Payer: BCN Commercial |
$130.48
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cofinity Commercial |
$158.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.64
|
| Rate for Payer: Healthscope Commercial |
$168.30
|
| Rate for Payer: Healthscope Whirlpool |
$163.25
|
| Rate for Payer: Mclaren Commercial |
$151.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.06
|
| Rate for Payer: Nomi Health Commercial |
$138.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.10
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
OP
|
$144.10
|
|
|
Service Code
|
NDC 20555004000
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.64 |
| Max. Negotiated Rate |
$144.10 |
| Rate for Payer: Aetna Commercial |
$129.69
|
| Rate for Payer: Aetna Medicare |
$72.05
|
| Rate for Payer: ASR ASR |
$139.78
|
| Rate for Payer: ASR Commercial |
$139.78
|
| Rate for Payer: BCBS Complete |
$57.64
|
| Rate for Payer: BCBS Trust/PPO |
$118.00
|
| Rate for Payer: BCN Commercial |
$111.72
|
| Rate for Payer: Cash Price |
$115.28
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.28
|
| Rate for Payer: Healthscope Commercial |
$144.10
|
| Rate for Payer: Healthscope Whirlpool |
$139.78
|
| Rate for Payer: Mclaren Commercial |
$129.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.48
|
| Rate for Payer: Nomi Health Commercial |
$118.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.26
|
| Rate for Payer: Priority Health Narrow Network |
$101.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.81
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
IP
|
$1.68
|
|
|
Service Code
|
NDC 77333098325
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Aetna Commercial |
$1.51
|
| Rate for Payer: ASR ASR |
$1.63
|
| Rate for Payer: ASR Commercial |
$1.63
|
| Rate for Payer: BCBS Trust/PPO |
$1.37
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cofinity Commercial |
$1.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.34
|
| Rate for Payer: Healthscope Commercial |
$1.68
|
| Rate for Payer: Healthscope Whirlpool |
$1.63
|
| Rate for Payer: Mclaren Commercial |
$1.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.43
|
| Rate for Payer: Nomi Health Commercial |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.48
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
OP
|
$168.30
|
|
|
Service Code
|
NDC 77333098310
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$67.32 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Aetna Commercial |
$151.47
|
| Rate for Payer: Aetna Medicare |
$84.15
|
| Rate for Payer: ASR ASR |
$163.25
|
| Rate for Payer: ASR Commercial |
$163.25
|
| Rate for Payer: BCBS Complete |
$67.32
|
| Rate for Payer: BCBS Trust/PPO |
$137.82
|
| Rate for Payer: BCN Commercial |
$130.48
|
| Rate for Payer: Cash Price |
$134.64
|
| Rate for Payer: Cofinity Commercial |
$158.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.64
|
| Rate for Payer: Healthscope Commercial |
$168.30
|
| Rate for Payer: Healthscope Whirlpool |
$163.25
|
| Rate for Payer: Mclaren Commercial |
$151.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.06
|
| Rate for Payer: Nomi Health Commercial |
$138.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.46
|
| Rate for Payer: Priority Health Narrow Network |
$117.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.10
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
IP
|
$144.10
|
|
|
Service Code
|
NDC 20555004000
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$93.66 |
| Max. Negotiated Rate |
$144.10 |
| Rate for Payer: Aetna Commercial |
$129.69
|
| Rate for Payer: ASR ASR |
$139.78
|
| Rate for Payer: ASR Commercial |
$139.78
|
| Rate for Payer: BCBS Trust/PPO |
$117.43
|
| Rate for Payer: BCN Commercial |
$111.72
|
| Rate for Payer: Cash Price |
$115.28
|
| Rate for Payer: Cofinity Commercial |
$135.45
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$115.28
|
| Rate for Payer: Healthscope Commercial |
$144.10
|
| Rate for Payer: Healthscope Whirlpool |
$139.78
|
| Rate for Payer: Mclaren Commercial |
$129.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$122.48
|
| Rate for Payer: Nomi Health Commercial |
$118.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.81
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE
|
Facility
|
OP
|
$1.68
|
|
|
Service Code
|
NDC 77333098325
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$1.68 |
| Rate for Payer: Aetna Commercial |
$1.51
|
| Rate for Payer: Aetna Medicare |
$0.84
|
| Rate for Payer: ASR ASR |
$1.63
|
| Rate for Payer: ASR Commercial |
$1.63
|
| Rate for Payer: BCBS Complete |
$0.67
|
| Rate for Payer: BCBS Trust/PPO |
$1.38
|
| Rate for Payer: BCN Commercial |
$1.30
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cofinity Commercial |
$1.58
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.34
|
| Rate for Payer: Healthscope Commercial |
$1.68
|
| Rate for Payer: Healthscope Whirlpool |
$1.63
|
| Rate for Payer: Mclaren Commercial |
$1.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.43
|
| Rate for Payer: Nomi Health Commercial |
$1.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.47
|
| Rate for Payer: Priority Health Narrow Network |
$1.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.48
|
|
|
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 |
$7.90 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Aetna Commercial |
$72.70
|
| Rate for Payer: Aetna Medicare |
$40.39
|
| Rate for Payer: ASR ASR |
$78.36
|
| Rate for Payer: ASR Commercial |
$78.36
|
| Rate for Payer: BCBS Complete |
$32.31
|
| Rate for Payer: BCBS Trust/PPO |
$66.15
|
| Rate for Payer: BCN Commercial |
$62.63
|
| Rate for Payer: Cash Price |
$64.63
|
| 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 Commercial |
$68.66
|
| Rate for Payer: Nomi Health Commercial |
$66.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.88
|
| Rate for Payer: Priority Health Narrow Network |
$7.90
|
| 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 |
$52.51 |
| Max. Negotiated Rate |
$80.78 |
| Rate for Payer: Aetna Commercial |
$72.70
|
| Rate for Payer: ASR ASR |
$78.36
|
| Rate for Payer: ASR Commercial |
$78.36
|
| Rate for Payer: BCBS Trust/PPO |
$65.83
|
| 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 Commercial |
$68.66
|
| Rate for Payer: Nomi Health Commercial |
$66.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$71.09
|
|
|
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 |
$68.56 |
| Max. Negotiated Rate |
$105.47 |
| Rate for Payer: Aetna Commercial |
$94.92
|
| Rate for Payer: ASR ASR |
$102.31
|
| Rate for Payer: ASR Commercial |
$102.31
|
| Rate for Payer: BCBS Trust/PPO |
$85.95
|
| Rate for Payer: BCN Commercial |
$81.77
|
| Rate for Payer: Cash Price |
$84.37
|
| Rate for Payer: Cofinity Commercial |
$99.14
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$84.38
|
| Rate for Payer: Healthscope Commercial |
$105.47
|
| Rate for Payer: Healthscope Whirlpool |
$102.31
|
| Rate for Payer: Mclaren Commercial |
$94.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.65
|
| Rate for Payer: Nomi Health Commercial |
$86.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.81
|
|
|
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 |
$7.90 |
| Max. Negotiated Rate |
$105.47 |
| Rate for Payer: Aetna Commercial |
$94.92
|
| Rate for Payer: Aetna Medicare |
$52.74
|
| Rate for Payer: ASR ASR |
$102.31
|
| Rate for Payer: ASR Commercial |
$102.31
|
| Rate for Payer: BCBS Complete |
$42.19
|
| Rate for Payer: BCBS Trust/PPO |
$86.37
|
| Rate for Payer: BCN Commercial |
$81.77
|
| 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 |
$84.38
|
| Rate for Payer: Healthscope Commercial |
$105.47
|
| Rate for Payer: Healthscope Whirlpool |
$102.31
|
| Rate for Payer: Mclaren Commercial |
$94.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.65
|
| Rate for Payer: Nomi Health Commercial |
$86.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.56
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.88
|
| Rate for Payer: Priority Health Narrow Network |
$7.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$92.81
|
|
