|
ZINC GLUCONATE 50 MG ORAL TAB
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 93295013588
|
| Hospital Charge Code |
8872
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.36
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Centivo All Commercial |
$0.51
|
| Rate for Payer: Cigna All Commercial |
$0.86
|
| Rate for Payer: CORVEL All Commercial |
$0.93
|
| Rate for Payer: Coventry All Commercial |
$0.88
|
| Rate for Payer: Encore All Commercial |
$0.92
|
| Rate for Payer: Frontpath All Commercial |
$0.92
|
| Rate for Payer: Humana ChoiceCare |
$0.86
|
| Rate for Payer: Humana Medicare |
$0.51
|
| Rate for Payer: Lucent All Commercial |
$0.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.90
|
| Rate for Payer: PHCS All Commercial |
$0.75
|
| Rate for Payer: PHP All Commercial |
$0.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.39
|
| Rate for Payer: Sagamore Health Network All Products |
$0.77
|
| Rate for Payer: Signature Care EPO |
$0.83
|
| Rate for Payer: Signature Care PPO |
$0.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
| Rate for Payer: United Healthcare Medicare |
$0.33
|
|
|
ZINC GLUCONATE 50 MG ORAL TAB
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 93295013588
|
| Hospital Charge Code |
8872
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cigna All Commercial |
$0.86
|
| Rate for Payer: CORVEL All Commercial |
$0.93
|
| Rate for Payer: Coventry All Commercial |
$0.88
|
| Rate for Payer: Encore All Commercial |
$0.92
|
| Rate for Payer: Frontpath All Commercial |
$0.92
|
| Rate for Payer: Humana ChoiceCare |
$0.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.90
|
| Rate for Payer: PHCS All Commercial |
$0.75
|
| Rate for Payer: PHP All Commercial |
$0.76
|
| Rate for Payer: Sagamore Health Network All Products |
$0.77
|
| Rate for Payer: Signature Care EPO |
$0.83
|
| Rate for Payer: Signature Care PPO |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
|
|
ZINC OXIDE 20 % TOP OINT
|
Facility
|
OP
|
$38.97
|
|
|
Service Code
|
NDC 75834017001
|
| Hospital Charge Code |
8874
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$36.24 |
| Rate for Payer: Aetna Commercial |
$32.89
|
| Rate for Payer: Aetna Medicare |
$12.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.14
|
| Rate for Payer: Cash Price |
$24.16
|
| Rate for Payer: Centivo All Commercial |
$19.87
|
| Rate for Payer: Cigna All Commercial |
$33.63
|
| Rate for Payer: CORVEL All Commercial |
$36.24
|
| Rate for Payer: Coventry All Commercial |
$34.29
|
| Rate for Payer: Encore All Commercial |
$35.87
|
| Rate for Payer: Frontpath All Commercial |
$35.85
|
| Rate for Payer: Humana ChoiceCare |
$33.65
|
| Rate for Payer: Humana Medicare |
$19.87
|
| Rate for Payer: Lucent All Commercial |
$19.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.07
|
| Rate for Payer: PHCS All Commercial |
$29.22
|
| Rate for Payer: PHP All Commercial |
$29.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.20
|
| Rate for Payer: Sagamore Health Network All Products |
$30.08
|
| Rate for Payer: Signature Care EPO |
$32.34
|
| Rate for Payer: Signature Care PPO |
$34.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.12
|
| Rate for Payer: United Healthcare Commercial |
$30.70
|
| Rate for Payer: United Healthcare Medicare |
$12.86
|
|
|
ZINC OXIDE 20 % TOP OINT
|
Facility
|
IP
|
$38.97
|
|
|
Service Code
|
NDC 75834017001
|
| Hospital Charge Code |
8874
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.22 |
| Max. Negotiated Rate |
$36.24 |
| Rate for Payer: Aetna Commercial |
$33.67
|
| Rate for Payer: Cash Price |
$24.16
|
| Rate for Payer: Cigna All Commercial |
$33.63
|
| Rate for Payer: CORVEL All Commercial |
$36.24
|
| Rate for Payer: Coventry All Commercial |
$34.29
|
| Rate for Payer: Encore All Commercial |
$35.87
|
| Rate for Payer: Frontpath All Commercial |
$35.85
|
| Rate for Payer: Humana ChoiceCare |
$33.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.07
|
| Rate for Payer: PHCS All Commercial |
$29.22
|
| Rate for Payer: PHP All Commercial |
$29.55
|
| Rate for Payer: Sagamore Health Network All Products |
$30.08
|
| Rate for Payer: Signature Care EPO |
$32.34
|
| Rate for Payer: Signature Care PPO |
$34.29
|
| Rate for Payer: United Healthcare Commercial |
$30.70
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) ORAL CAP
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
NDC 68585000801
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Aetna Commercial |
$0.62
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cigna All Commercial |
$0.62
|
| Rate for Payer: CORVEL All Commercial |
$0.67
|
| Rate for Payer: Coventry All Commercial |
$0.63
|
| Rate for Payer: Encore All Commercial |
$0.66
|
| Rate for Payer: Frontpath All Commercial |
$0.66
|
| Rate for Payer: Humana ChoiceCare |
$0.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.65
|
| Rate for Payer: PHCS All Commercial |
$0.54
|
| Rate for Payer: PHP All Commercial |
$0.55
|
| Rate for Payer: Sagamore Health Network All Products |
$0.56
|
| Rate for Payer: Signature Care EPO |
$0.60
|
| Rate for Payer: Signature Care PPO |
$0.63
|
| Rate for Payer: United Healthcare Commercial |
$0.57
|
|
|
ZINC SULFATE 50 MG ZINC (220 MG) ORAL CAP
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 68585000801
|
| Hospital Charge Code |
8880
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.67 |
| Rate for Payer: Aetna Commercial |
$0.61
|
| Rate for Payer: Aetna Medicare |
$0.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.26
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Centivo All Commercial |
$0.37
|
| Rate for Payer: Cigna All Commercial |
$0.62
|
| Rate for Payer: CORVEL All Commercial |
$0.67
|
| Rate for Payer: Coventry All Commercial |
$0.63
|
| Rate for Payer: Encore All Commercial |
$0.66
|
| Rate for Payer: Frontpath All Commercial |
$0.66
|
| Rate for Payer: Humana ChoiceCare |
$0.62
|
| Rate for Payer: Humana Medicare |
$0.37
|
| Rate for Payer: Lucent All Commercial |
$0.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.65
|
| Rate for Payer: PHCS All Commercial |
$0.54
|
| Rate for Payer: PHP All Commercial |
$0.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.28
|
| Rate for Payer: Sagamore Health Network All Products |
$0.56
|
| Rate for Payer: Signature Care EPO |
$0.60
|
| Rate for Payer: Signature Care PPO |
$0.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.61
|
| Rate for Payer: United Healthcare Commercial |
$0.57
|
| Rate for Payer: United Healthcare Medicare |
$0.24
|
|
|
ZIPRASIDONE HCL 20 MG ORAL CAP
|
Facility
|
IP
|
$11.59
|
|
|
Service Code
|
NDC 00904626908
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.69 |
| Max. Negotiated Rate |
$10.77 |
| Rate for Payer: Aetna Commercial |
$10.01
|
| Rate for Payer: Cash Price |
$7.18
|
| Rate for Payer: Cigna All Commercial |
$10.00
|
| Rate for Payer: CORVEL All Commercial |
$10.77
|
| Rate for Payer: Coventry All Commercial |
$10.19
|
| Rate for Payer: Encore All Commercial |
$10.66
|
| Rate for Payer: Frontpath All Commercial |
$10.66
|
| Rate for Payer: Humana ChoiceCare |
$10.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.43
|
| Rate for Payer: PHCS All Commercial |
$8.69
|
| Rate for Payer: PHP All Commercial |
$8.79
|
| Rate for Payer: Sagamore Health Network All Products |
$8.94
|
| Rate for Payer: Signature Care EPO |
$9.62
|
| Rate for Payer: Signature Care PPO |
$10.19
|
| Rate for Payer: United Healthcare Commercial |
$9.13
|
|
|
ZIPRASIDONE HCL 20 MG ORAL CAP
|
Facility
|
OP
|
$11.59
|
|
|
Service Code
|
NDC 00904626908
|
| Hospital Charge Code |
29778
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$10.77 |
| Rate for Payer: Aetna Commercial |
$9.78
|
| Rate for Payer: Aetna Medicare |
$3.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.21
|
| Rate for Payer: Cash Price |
$7.18
|
| Rate for Payer: Centivo All Commercial |
$5.91
|
| Rate for Payer: Cigna All Commercial |
$10.00
|
| Rate for Payer: CORVEL All Commercial |
$10.77
|
| Rate for Payer: Coventry All Commercial |
$10.19
|
| Rate for Payer: Encore All Commercial |
$10.66
|
| Rate for Payer: Frontpath All Commercial |
$10.66
|
| Rate for Payer: Humana ChoiceCare |
$10.01
|
| Rate for Payer: Humana Medicare |
$5.91
|
| Rate for Payer: Lucent All Commercial |
$5.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.43
|
| Rate for Payer: PHCS All Commercial |
$8.69
|
| Rate for Payer: PHP All Commercial |
$8.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.52
|
| Rate for Payer: Sagamore Health Network All Products |
$8.94
|
| Rate for Payer: Signature Care EPO |
$9.62
|
| Rate for Payer: Signature Care PPO |
$10.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.85
|
| Rate for Payer: United Healthcare Commercial |
$9.13
|
| Rate for Payer: United Healthcare Medicare |
$3.82
|
|
|
ZIPRASIDONE MESYLATE 20 MG/ML (FINAL CONC.) IM SOLR
|
Facility
|
IP
|
$98.11
|
|
|
Service Code
|
HCPCS J3486
|
| Hospital Charge Code |
33175
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.58 |
| Max. Negotiated Rate |
$91.24 |
| Rate for Payer: Aetna Commercial |
$84.77
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Cigna All Commercial |
$84.67
|
| Rate for Payer: CORVEL All Commercial |
$91.24
|
| Rate for Payer: Coventry All Commercial |
$86.34
|
| Rate for Payer: Encore All Commercial |
$90.31
|
| Rate for Payer: Frontpath All Commercial |
$90.26
|
| Rate for Payer: Humana ChoiceCare |
$84.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.30
|
| Rate for Payer: PHCS All Commercial |
$73.58
|
| Rate for Payer: PHP All Commercial |
$74.41
|
| Rate for Payer: Sagamore Health Network All Products |
$75.74
|
| Rate for Payer: Signature Care EPO |
$81.43
|
| Rate for Payer: Signature Care PPO |
$86.34
|
| Rate for Payer: United Healthcare Commercial |
$77.31
|
|
|
ZIPRASIDONE MESYLATE 20 MG/ML (FINAL CONC.) IM SOLR
|
Facility
|
OP
|
$98.11
|
|
|
Service Code
|
HCPCS J3486
|
| Hospital Charge Code |
33175
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$91.24 |
| Rate for Payer: Aetna Commercial |
$82.81
|
| Rate for Payer: Aetna Medicare |
$32.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$56.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$10.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.61
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Centivo All Commercial |
$50.04
|
| Rate for Payer: Cigna All Commercial |
$84.67
|
| Rate for Payer: CORVEL All Commercial |
$91.24
|
| Rate for Payer: Coventry All Commercial |
$86.34
|
| Rate for Payer: Encore All Commercial |
$90.31
|
| Rate for Payer: Frontpath All Commercial |
$90.26
|
| Rate for Payer: Humana ChoiceCare |
$84.74
|
| Rate for Payer: Humana Medicare |
$50.04
|
| Rate for Payer: Lucent All Commercial |
$50.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.30
|
| Rate for Payer: Managed Health Services Medicaid |
$10.45
|
| Rate for Payer: MDWise Medicaid |
$10.45
|
| Rate for Payer: PHCS All Commercial |
$73.58
|
| Rate for Payer: PHP All Commercial |
$74.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.26
|
| Rate for Payer: Sagamore Health Network All Products |
$75.74
|
| Rate for Payer: Signature Care EPO |
$81.43
|
| Rate for Payer: Signature Care PPO |
$86.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$83.40
|
| Rate for Payer: United Healthcare Commercial |
$77.31
|
| Rate for Payer: United Healthcare Medicare |
$32.38
|
|
|
ZOLEDRONIC ACID 4 MG/5 ML IV SOLN
|
Facility
|
IP
|
$53.20
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
35640
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$49.48 |
| Rate for Payer: Aetna Commercial |
$45.96
|
| Rate for Payer: Cash Price |
$32.98
|
| Rate for Payer: Cigna All Commercial |
$45.91
|
| Rate for Payer: CORVEL All Commercial |
$49.48
|
| Rate for Payer: Coventry All Commercial |
$46.82
|
| Rate for Payer: Encore All Commercial |
$48.97
|
| Rate for Payer: Frontpath All Commercial |
$48.94
|
| Rate for Payer: Humana ChoiceCare |
$45.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.88
|
| Rate for Payer: PHCS All Commercial |
$39.90
|
| Rate for Payer: PHP All Commercial |
$40.35
|
| Rate for Payer: Sagamore Health Network All Products |
$41.07
|
| Rate for Payer: Signature Care EPO |
$44.16
|
| Rate for Payer: Signature Care PPO |
$46.82
|
| Rate for Payer: United Healthcare Commercial |
$41.92
|
|
|
ZOLEDRONIC ACID 4 MG/5 ML IV SOLN
|
Facility
|
OP
|
$53.20
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
35640
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$49.48 |
| Rate for Payer: Aetna Commercial |
$44.90
|
| Rate for Payer: Aetna Medicare |
$17.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$30.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.31
|
| Rate for Payer: Cash Price |
$32.98
|
| Rate for Payer: Cash Price |
$32.98
|
| Rate for Payer: Centivo All Commercial |
$27.13
|
| Rate for Payer: Cigna All Commercial |
$45.91
|
| Rate for Payer: CORVEL All Commercial |
$49.48
|
| Rate for Payer: Coventry All Commercial |
$46.82
|
| Rate for Payer: Encore All Commercial |
$48.97
|
| Rate for Payer: Frontpath All Commercial |
$48.94
|
| Rate for Payer: Humana ChoiceCare |
$45.95
|
| Rate for Payer: Humana Medicare |
$27.13
|
| Rate for Payer: Lucent All Commercial |
$27.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.88
|
| Rate for Payer: Managed Health Services Medicaid |
$11.55
|
| Rate for Payer: MDWise Medicaid |
$11.55
|
| Rate for Payer: PHCS All Commercial |
$39.90
|
| Rate for Payer: PHP All Commercial |
$40.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.75
|
| Rate for Payer: Sagamore Health Network All Products |
$41.07
|
| Rate for Payer: Signature Care EPO |
$44.16
|
| Rate for Payer: Signature Care PPO |
$46.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.22
|
| Rate for Payer: United Healthcare Commercial |
$41.92
|
| Rate for Payer: United Healthcare Medicare |
$17.56
|
|
|
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK
|
Facility
|
IP
|
$519.60
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
81434
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$389.70 |
| Max. Negotiated Rate |
$483.23 |
| Rate for Payer: Aetna Commercial |
$448.93
|
| Rate for Payer: Cash Price |
$322.15
|
| Rate for Payer: Cigna All Commercial |
$448.41
|
| Rate for Payer: CORVEL All Commercial |
$483.23
|
| Rate for Payer: Coventry All Commercial |
$457.25
|
| Rate for Payer: Encore All Commercial |
$478.29
|
| Rate for Payer: Frontpath All Commercial |
$478.03
|
| Rate for Payer: Humana ChoiceCare |
$448.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$467.64
|
| Rate for Payer: PHCS All Commercial |
$389.70
|
| Rate for Payer: PHP All Commercial |
$394.06
|
| Rate for Payer: Sagamore Health Network All Products |
$401.13
|
| Rate for Payer: Signature Care EPO |
$431.27
|
| Rate for Payer: Signature Care PPO |
$457.25
|
| Rate for Payer: United Healthcare Commercial |
$409.44
|
|
|
ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK
|
Facility
|
OP
|
$519.60
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
81434
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$483.23 |
| Rate for Payer: Aetna Commercial |
$438.54
|
| Rate for Payer: Aetna Medicare |
$171.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$171.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$298.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$324.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$197.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$188.61
|
| Rate for Payer: Cash Price |
$322.15
|
| Rate for Payer: Cash Price |
$322.15
|
| Rate for Payer: Centivo All Commercial |
$265.00
|
| Rate for Payer: Cigna All Commercial |
$448.41
|
| Rate for Payer: CORVEL All Commercial |
$483.23
|
| Rate for Payer: Coventry All Commercial |
$457.25
|
| Rate for Payer: Encore All Commercial |
$478.29
|
| Rate for Payer: Frontpath All Commercial |
$478.03
|
| Rate for Payer: Humana ChoiceCare |
$448.78
|
| Rate for Payer: Humana Medicare |
$265.00
|
| Rate for Payer: Lucent All Commercial |
$265.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$467.64
|
| Rate for Payer: Managed Health Services Medicaid |
$11.55
|
| Rate for Payer: MDWise Medicaid |
$11.55
|
| Rate for Payer: PHCS All Commercial |
$389.70
|
| Rate for Payer: PHP All Commercial |
$394.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$202.64
|
| Rate for Payer: Sagamore Health Network All Products |
$401.13
|
| Rate for Payer: Signature Care EPO |
$431.27
|
| Rate for Payer: Signature Care PPO |
$457.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$441.66
|
| Rate for Payer: United Healthcare Commercial |
$409.44
|
| Rate for Payer: United Healthcare Medicare |
$171.47
|
|
|
ZOLEDRONIC AC-MANNITOL-0.9NACL 4 MG/100 ML IV PGBK
|
Facility
|
OP
|
$265.30
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
165810
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$246.73 |
| Rate for Payer: Aetna Commercial |
$223.91
|
| Rate for Payer: Aetna Medicare |
$87.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$87.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$152.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$165.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.30
|
| Rate for Payer: Cash Price |
$164.49
|
| Rate for Payer: Cash Price |
$164.49
|
| Rate for Payer: Centivo All Commercial |
$135.30
|
| Rate for Payer: Cigna All Commercial |
$228.95
|
| Rate for Payer: CORVEL All Commercial |
$246.73
|
| Rate for Payer: Coventry All Commercial |
$233.46
|
| Rate for Payer: Encore All Commercial |
$244.21
|
| Rate for Payer: Frontpath All Commercial |
$244.08
|
| Rate for Payer: Humana ChoiceCare |
$229.14
|
| Rate for Payer: Humana Medicare |
$135.30
|
| Rate for Payer: Lucent All Commercial |
$135.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$238.77
|
| Rate for Payer: Managed Health Services Medicaid |
$11.55
|
| Rate for Payer: MDWise Medicaid |
$11.55
|
| Rate for Payer: PHCS All Commercial |
$198.98
|
| Rate for Payer: PHP All Commercial |
$201.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.47
|
| Rate for Payer: Sagamore Health Network All Products |
$204.81
|
| Rate for Payer: Signature Care EPO |
$220.20
|
| Rate for Payer: Signature Care PPO |
$233.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$225.50
|
| Rate for Payer: United Healthcare Commercial |
$209.06
|
| Rate for Payer: United Healthcare Medicare |
$87.55
|
|
|
ZOLEDRONIC AC-MANNITOL-0.9NACL 4 MG/100 ML IV PGBK
|
Facility
|
IP
|
$265.30
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
165810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$198.98 |
| Max. Negotiated Rate |
$246.73 |
| Rate for Payer: Aetna Commercial |
$229.22
|
| Rate for Payer: Cash Price |
$164.49
|
| Rate for Payer: Cigna All Commercial |
$228.95
|
| Rate for Payer: CORVEL All Commercial |
$246.73
|
| Rate for Payer: Coventry All Commercial |
$233.46
|
| Rate for Payer: Encore All Commercial |
$244.21
|
| Rate for Payer: Frontpath All Commercial |
$244.08
|
| Rate for Payer: Humana ChoiceCare |
$229.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$238.77
|
| Rate for Payer: PHCS All Commercial |
$198.98
|
| Rate for Payer: PHP All Commercial |
$201.20
|
| Rate for Payer: Sagamore Health Network All Products |
$204.81
|
| Rate for Payer: Signature Care EPO |
$220.20
|
| Rate for Payer: Signature Care PPO |
$233.46
|
| Rate for Payer: United Healthcare Commercial |
$209.06
|
|
|
ZOLPIDEM 5 MG ORAL TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904608261
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
|
|
ZOLPIDEM 5 MG ORAL TAB
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904608261
|
| Hospital Charge Code |
11701
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare |
$1.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.45
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Centivo All Commercial |
$2.04
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Humana Medicare |
$2.04
|
| Rate for Payer: Lucent All Commercial |
$2.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.56
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.40
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
| Rate for Payer: United Healthcare Medicare |
$1.32
|
|
