|
ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK
|
Facility
|
OP
|
$874.40
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
81434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.90 |
| Max. Negotiated Rate |
$874.40 |
| Rate for Payer: Aetna Commercial |
$786.96
|
| Rate for Payer: Aetna Commercial |
$126.36
|
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Commercial |
$157.32
|
| Rate for Payer: Aetna Commercial |
$279.36
|
| Rate for Payer: Aetna Commercial |
$1,000.80
|
| Rate for Payer: Aetna Commercial |
$175.68
|
| Rate for Payer: Aetna Medicare |
$70.20
|
| Rate for Payer: Aetna Medicare |
$155.20
|
| Rate for Payer: Aetna Medicare |
$97.60
|
| Rate for Payer: Aetna Medicare |
$437.20
|
| Rate for Payer: Aetna Medicare |
$87.40
|
| Rate for Payer: Aetna Medicare |
$66.00
|
| Rate for Payer: Aetna Medicare |
$556.00
|
| Rate for Payer: ASR ASR |
$301.09
|
| Rate for Payer: ASR ASR |
$169.56
|
| Rate for Payer: ASR ASR |
$136.19
|
| Rate for Payer: ASR ASR |
$1,078.64
|
| Rate for Payer: ASR ASR |
$128.04
|
| Rate for Payer: ASR ASR |
$848.17
|
| Rate for Payer: ASR ASR |
$189.34
|
| Rate for Payer: ASR Commercial |
$1,078.64
|
| Rate for Payer: ASR Commercial |
$169.56
|
| Rate for Payer: ASR Commercial |
$128.04
|
| Rate for Payer: ASR Commercial |
$136.19
|
| Rate for Payer: ASR Commercial |
$848.17
|
| Rate for Payer: ASR Commercial |
$301.09
|
| Rate for Payer: ASR Commercial |
$189.34
|
| Rate for Payer: BCBS Complete |
$56.16
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS Complete |
$444.80
|
| Rate for Payer: BCBS Complete |
$349.76
|
| Rate for Payer: BCBS Complete |
$124.16
|
| Rate for Payer: BCBS Complete |
$78.08
|
| Rate for Payer: BCBS Complete |
$69.92
|
| Rate for Payer: BCBS Trust/PPO |
$114.97
|
| Rate for Payer: BCBS Trust/PPO |
$910.62
|
| Rate for Payer: BCBS Trust/PPO |
$716.05
|
| Rate for Payer: BCBS Trust/PPO |
$108.09
|
| Rate for Payer: BCBS Trust/PPO |
$254.19
|
| Rate for Payer: BCBS Trust/PPO |
$143.14
|
| Rate for Payer: BCBS Trust/PPO |
$159.85
|
| Rate for Payer: BCN Commercial |
$677.92
|
| Rate for Payer: BCN Commercial |
$102.34
|
| Rate for Payer: BCN Commercial |
$151.34
|
| Rate for Payer: BCN Commercial |
$862.13
|
| Rate for Payer: BCN Commercial |
$108.85
|
| Rate for Payer: BCN Commercial |
$135.52
|
| Rate for Payer: BCN Commercial |
$240.65
|
| Rate for Payer: Cash Price |
$139.84
|
| Rate for Payer: Cash Price |
$112.32
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$889.60
|
| 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 |
$156.16
|
| Rate for Payer: Cash Price |
$248.32
|
| Rate for Payer: Cash Price |
$248.32
|
| Rate for Payer: Cash Price |
$699.52
|
| Rate for Payer: Cash Price |
$699.52
|
| Rate for Payer: Cofinity Commercial |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$821.94
|
| Rate for Payer: Cofinity Commercial |
$131.98
|
| Rate for Payer: Cofinity Commercial |
$291.78
|
| 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: Encore Health Key Benefits Commercial |
$889.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.16
|
| Rate for Payer: Healthscope Commercial |
$174.80
|
| Rate for Payer: Healthscope Commercial |
$1,112.00
|
| Rate for Payer: Healthscope Commercial |
$132.00
|
| Rate for Payer: Healthscope Commercial |
$310.40
|
| Rate for Payer: Healthscope Commercial |
$195.20
|
| Rate for Payer: Healthscope Commercial |
$140.40
|
| Rate for Payer: Healthscope Commercial |
$874.40
|
| Rate for Payer: Healthscope Whirlpool |
$169.56
|
| Rate for Payer: Healthscope Whirlpool |
$136.19
|
| Rate for Payer: Healthscope Whirlpool |
$128.04
|
| Rate for Payer: Healthscope Whirlpool |
$189.34
|
| Rate for Payer: Healthscope Whirlpool |
$301.09
|
| Rate for Payer: Healthscope Whirlpool |
$848.17
|
| Rate for Payer: Healthscope Whirlpool |
$1,078.64
|
| Rate for Payer: Mclaren Commercial |
$279.36
|
| Rate for Payer: Mclaren Commercial |
$157.32
|
| Rate for Payer: Mclaren Commercial |
$126.36
|
| Rate for Payer: Mclaren Commercial |
$786.96
|
| Rate for Payer: Mclaren Commercial |
$175.68
|
| Rate for Payer: Mclaren Commercial |
$118.80
|
| Rate for Payer: Mclaren Commercial |
$1,000.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$119.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.20
|
| 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 |
$165.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.84
|
| Rate for Payer: Nomi Health Commercial |
$911.84
|
| Rate for Payer: Nomi Health Commercial |
$143.34
|
| Rate for Payer: Nomi Health Commercial |
$115.13
|
| Rate for Payer: Nomi Health Commercial |
$108.24
|
| Rate for Payer: Nomi Health Commercial |
$160.06
|
| Rate for Payer: Nomi Health Commercial |
$717.01
|
| Rate for Payer: Nomi Health Commercial |
$254.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.88
|
| Rate for Payer: Priority Health Narrow Network |
$7.90
|
| Rate for Payer: Priority Health Narrow Network |
$7.90
|
| Rate for Payer: Priority Health Narrow Network |
$7.90
|
| Rate for Payer: Priority Health Narrow Network |
$7.90
|
| Rate for Payer: Priority Health Narrow Network |
$7.90
|
| Rate for Payer: Priority Health Narrow Network |
$7.90
|
| Rate for Payer: Priority Health Narrow Network |
$7.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$978.56
|
| 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 |
$273.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.16
|
|
|
ZOLEDRONIC ACID 5 MG/100 ML IN MANNITOL 5 %-WATER INTRAVENOUS PIGGYBCK
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
81434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Commercial |
$157.32
|
| 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 |
$1,000.80
|
| Rate for Payer: Aetna Commercial |
$279.36
|
| 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 |
$128.04
|
| Rate for Payer: ASR ASR |
$1,078.64
|
| Rate for Payer: ASR ASR |
$301.09
|
| Rate for Payer: ASR Commercial |
$848.17
|
| Rate for Payer: ASR Commercial |
$301.09
|
| Rate for Payer: ASR Commercial |
$136.19
|
| Rate for Payer: ASR Commercial |
$189.34
|
| Rate for Payer: ASR Commercial |
$169.56
|
| Rate for Payer: ASR Commercial |
$128.04
|
| Rate for Payer: ASR Commercial |
$1,078.64
|
| Rate for Payer: BCBS Trust/PPO |
$252.94
|
| Rate for Payer: BCBS Trust/PPO |
$159.07
|
| Rate for Payer: BCBS Trust/PPO |
$906.17
|
| Rate for Payer: BCBS Trust/PPO |
$107.57
|
| Rate for Payer: BCBS Trust/PPO |
$142.44
|
| Rate for Payer: BCBS Trust/PPO |
$114.41
|
| Rate for Payer: BCBS Trust/PPO |
$712.55
|
| Rate for Payer: BCN Commercial |
$108.85
|
| Rate for Payer: BCN Commercial |
$677.92
|
| Rate for Payer: BCN Commercial |
$151.34
|
| Rate for Payer: BCN Commercial |
$862.13
|
| Rate for Payer: BCN Commercial |
$102.34
|
| Rate for Payer: BCN Commercial |
$240.65
|
| Rate for Payer: BCN Commercial |
$135.52
|
| Rate for Payer: Cash Price |
$248.32
|
| Rate for Payer: Cash Price |
$139.84
|
| Rate for Payer: Cash Price |
$889.60
|
| Rate for Payer: Cash Price |
$112.32
|
| Rate for Payer: Cash Price |
$156.16
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$699.52
|
| Rate for Payer: Cofinity Commercial |
$183.49
|
| Rate for Payer: Cofinity Commercial |
$131.98
|
| Rate for Payer: Cofinity Commercial |
$1,045.28
|
| Rate for Payer: Cofinity Commercial |
$164.31
|
| Rate for Payer: Cofinity Commercial |
$124.08
|
| Rate for Payer: Cofinity Commercial |
$291.78
|
| Rate for Payer: Cofinity Commercial |
$821.94
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$699.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$889.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$105.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$156.16
|
| Rate for Payer: Healthscope Commercial |
$195.20
|
| Rate for Payer: Healthscope Commercial |
$874.40
|
| Rate for Payer: Healthscope Commercial |
$140.40
|
| Rate for Payer: Healthscope Commercial |
$174.80
|
| Rate for Payer: Healthscope Commercial |
$310.40
|
| Rate for Payer: Healthscope Commercial |
$132.00
|
| Rate for Payer: Healthscope Commercial |
$1,112.00
|
| Rate for Payer: Healthscope Whirlpool |
$301.09
|
| Rate for Payer: Healthscope Whirlpool |
$189.34
|
| Rate for Payer: Healthscope Whirlpool |
$169.56
|
| Rate for Payer: Healthscope Whirlpool |
$128.04
|
| Rate for Payer: Healthscope Whirlpool |
$136.19
|
| Rate for Payer: Healthscope Whirlpool |
$1,078.64
|
| Rate for Payer: Healthscope Whirlpool |
$848.17
|
| Rate for Payer: Mclaren Commercial |
$175.68
|
| Rate for Payer: Mclaren Commercial |
$786.96
|
| Rate for Payer: Mclaren Commercial |
$1,000.80
|
| Rate for Payer: Mclaren Commercial |
$279.36
|
| Rate for Payer: Mclaren Commercial |
$126.36
|
| Rate for Payer: Mclaren Commercial |
$118.80
|
| Rate for Payer: Mclaren Commercial |
$157.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$945.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$743.24
|
| 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 |
$148.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$112.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$263.84
|
| Rate for Payer: Nomi Health Commercial |
$911.84
|
| Rate for Payer: Nomi Health Commercial |
$254.53
|
| Rate for Payer: Nomi Health Commercial |
$717.01
|
| Rate for Payer: Nomi Health Commercial |
$143.34
|
| Rate for Payer: Nomi Health Commercial |
$115.13
|
| Rate for Payer: Nomi Health Commercial |
$108.24
|
| Rate for Payer: Nomi Health Commercial |
$160.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$568.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$722.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.76
|
| 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 |
$769.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$171.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$273.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$123.55
|
|
|
ZOLPIDEM 10 MG TABLET
|
Facility
|
OP
|
$1.86
|
|
|
Service Code
|
NDC 51079072501
|
| Hospital Charge Code |
11700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna Commercial |
$1.67
|
| Rate for Payer: Aetna Medicare |
$0.93
|
| Rate for Payer: ASR ASR |
$1.80
|
| Rate for Payer: ASR Commercial |
$1.80
|
| Rate for Payer: BCBS Complete |
$0.74
|
| Rate for Payer: BCBS Trust/PPO |
$1.52
|
| 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 Commercial |
$1.58
|
| Rate for Payer: Nomi Health Commercial |
$1.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.21
|
| Rate for Payer: 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 |
$1.64
|
|
|
ZOLPIDEM 10 MG TABLET
|
Facility
|
IP
|
$185.65
|
|
|
Service Code
|
NDC 51079072520
|
| Hospital Charge Code |
11700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$185.65 |
| Rate for Payer: Aetna Commercial |
$167.08
|
| Rate for Payer: ASR ASR |
$180.08
|
| Rate for Payer: ASR Commercial |
$180.08
|
| Rate for Payer: BCBS Trust/PPO |
$151.29
|
| 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 Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| 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 |
$1.21 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna Commercial |
$1.67
|
| Rate for Payer: ASR ASR |
$1.80
|
| Rate for Payer: ASR Commercial |
$1.80
|
| Rate for Payer: BCBS Trust/PPO |
$1.52
|
| 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 Commercial |
$1.58
|
| Rate for Payer: Nomi Health Commercial |
$1.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.64
|
|
|
ZOLPIDEM 10 MG TABLET
|
Facility
|
OP
|
$185.65
|
|
|
Service Code
|
NDC 51079072520
|
| Hospital Charge Code |
11700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.26 |
| Max. Negotiated Rate |
$185.65 |
| Rate for Payer: Aetna Commercial |
$167.08
|
| Rate for Payer: Aetna Medicare |
$92.82
|
| Rate for Payer: ASR ASR |
$180.08
|
| Rate for Payer: ASR Commercial |
$180.08
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCBS Trust/PPO |
$152.03
|
| 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 Commercial |
$157.80
|
| Rate for Payer: Nomi Health Commercial |
$152.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.67
|
| Rate for Payer: 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
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$6,594.06
|
|
|
Service Code
|
NDC 00024540131
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4,286.14 |
| 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: ASR Commercial |
$6,396.24
|
| Rate for Payer: BCBS Trust/PPO |
$5,373.50
|
| 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 Commercial |
$5,604.95
|
| Rate for Payer: Nomi Health Commercial |
$5,407.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,286.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5,802.77
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$134.75
|
|
|
Service Code
|
NDC 51079072420
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$134.75 |
| Rate for Payer: Aetna Commercial |
$121.28
|
| Rate for Payer: Aetna Medicare |
$67.38
|
| Rate for Payer: ASR ASR |
$130.71
|
| Rate for Payer: ASR Commercial |
$130.71
|
| Rate for Payer: BCBS Complete |
$53.90
|
| Rate for Payer: BCBS Trust/PPO |
$110.35
|
| 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 Commercial |
$114.54
|
| Rate for Payer: Nomi Health Commercial |
$110.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.59
|
| Rate for Payer: 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
|
IP
|
$1.35
|
|
|
Service Code
|
NDC 51079072401
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Aetna Commercial |
$1.22
|
| Rate for Payer: ASR ASR |
$1.31
|
| Rate for Payer: ASR Commercial |
$1.31
|
| Rate for Payer: BCBS Trust/PPO |
$1.10
|
| 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 Commercial |
$1.15
|
| Rate for Payer: Nomi Health Commercial |
$1.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.19
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$6,594.06
|
|
|
Service Code
|
NDC 00024540131
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2,637.62 |
| Max. Negotiated Rate |
$6,594.06 |
| Rate for Payer: Aetna Commercial |
$5,934.65
|
| Rate for Payer: Aetna Medicare |
$3,297.03
|
| Rate for Payer: ASR ASR |
$6,396.24
|
| Rate for Payer: ASR Commercial |
$6,396.24
|
| Rate for Payer: BCBS Complete |
$2,637.62
|
| Rate for Payer: BCBS Trust/PPO |
$5,399.88
|
| 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 Commercial |
$5,604.95
|
| Rate for Payer: Nomi Health Commercial |
$5,407.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,286.14
|
| Rate for Payer: 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
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$134.75
|
|
|
Service Code
|
NDC 51079072420
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$87.59 |
| Max. Negotiated Rate |
$134.75 |
| Rate for Payer: Aetna Commercial |
$121.28
|
| Rate for Payer: ASR ASR |
$130.71
|
| Rate for Payer: ASR Commercial |
$130.71
|
| Rate for Payer: BCBS Trust/PPO |
$109.81
|
| 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 Commercial |
$114.54
|
| Rate for Payer: Nomi Health Commercial |
$110.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.58
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
IP
|
$13.12
|
|
|
Service Code
|
NDC 00904608261
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$13.12 |
| Rate for Payer: Aetna Commercial |
$11.81
|
| Rate for Payer: ASR ASR |
$12.73
|
| Rate for Payer: ASR Commercial |
$12.73
|
| Rate for Payer: BCBS Trust/PPO |
$10.69
|
| Rate for Payer: BCN Commercial |
$10.17
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$13.12
|
| Rate for Payer: Healthscope Whirlpool |
$12.73
|
| Rate for Payer: Mclaren Commercial |
$11.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.15
|
| Rate for Payer: Nomi Health Commercial |
$10.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.55
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$13.12
|
|
|
Service Code
|
NDC 00904608261
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$13.12 |
| Rate for Payer: Aetna Commercial |
$11.81
|
| Rate for Payer: Aetna Medicare |
$6.56
|
| Rate for Payer: ASR ASR |
$12.73
|
| Rate for Payer: ASR Commercial |
$12.73
|
| Rate for Payer: BCBS Complete |
$5.25
|
| Rate for Payer: BCBS Trust/PPO |
$10.74
|
| Rate for Payer: BCN Commercial |
$10.17
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cofinity Commercial |
$12.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$10.50
|
| Rate for Payer: Healthscope Commercial |
$13.12
|
| Rate for Payer: Healthscope Whirlpool |
$12.73
|
| Rate for Payer: Mclaren Commercial |
$11.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.15
|
| Rate for Payer: Nomi Health Commercial |
$10.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.50
|
| Rate for Payer: Priority Health Narrow Network |
$9.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$11.55
|
|
|
ZOLPIDEM 5 MG TABLET
|
Facility
|
OP
|
$1.35
|
|
|
Service Code
|
NDC 51079072401
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.35 |
| Rate for Payer: Aetna Commercial |
$1.22
|
| Rate for Payer: Aetna Medicare |
$0.68
|
| Rate for Payer: ASR ASR |
$1.31
|
| Rate for Payer: ASR Commercial |
$1.31
|
| Rate for Payer: BCBS Complete |
$0.54
|
| Rate for Payer: BCBS Trust/PPO |
$1.11
|
| 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 Commercial |
$1.15
|
| Rate for Payer: Nomi Health Commercial |
$1.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$0.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1.18
|
| Rate for Payer: Priority Health Narrow Network |
$0.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1.19
|
|
