|
ZIPRASIDONE HCL 80 MG PO CAPS
|
Facility
|
OP
|
$3.23
|
|
|
Service Code
|
NDC 5026881412
|
| Hospital Charge Code |
5026881412
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.78
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.61
|
| Rate for Payer: Aetna Government |
$1.61
|
| Rate for Payer: Brighton Health Commercial |
$2.42
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.20
|
| Rate for Payer: EmblemHealth Commercial |
$1.61
|
| Rate for Payer: Group Health Inc Commercial |
$1.61
|
| Rate for Payer: Group Health Inc Medicare |
$1.13
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.61
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.61
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.10
|
|
|
ZIPRASIDONE MESYLATE 20 MG IM SOLR
|
Facility
|
IP
|
$56.40
|
|
|
Service Code
|
HCPCS J3486
|
| Hospital Charge Code |
4359884858
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$28.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.20
|
|
|
ZIPRASIDONE MESYLATE 20 MG IM SOLR
|
Facility
|
OP
|
$56.40
|
|
|
Service Code
|
HCPCS J3486
|
| Hospital Charge Code |
4359884858
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$45.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.85
|
| Rate for Payer: Aetna Government |
$14.85
|
| Rate for Payer: Brighton Health Commercial |
$42.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.35
|
| Rate for Payer: EmblemHealth Commercial |
$28.20
|
| Rate for Payer: Group Health Inc Commercial |
$28.20
|
| Rate for Payer: Group Health Inc Medicare |
$19.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.66
|
|
|
ZIPRASIDONE MESYLATE 20 MG IM SOLR
|
Facility
|
IP
|
$56.40
|
|
|
Service Code
|
HCPCS J3486
|
| Hospital Charge Code |
4359884811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$28.20 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.20
|
|
|
ZIPRASIDONE MESYLATE 20 MG IM SOLR
|
Facility
|
OP
|
$56.40
|
|
|
Service Code
|
HCPCS J3486
|
| Hospital Charge Code |
4359884811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.83 |
| Max. Negotiated Rate |
$45.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$31.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.85
|
| Rate for Payer: Aetna Government |
$14.85
|
| Rate for Payer: Brighton Health Commercial |
$42.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$45.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$38.35
|
| Rate for Payer: EmblemHealth Commercial |
$28.20
|
| Rate for Payer: Group Health Inc Commercial |
$28.20
|
| Rate for Payer: Group Health Inc Medicare |
$19.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$28.20
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$28.20
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$6.83
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$36.66
|
|
|
ZOLEDRONIC ACID 4 MG/5ML IV CONC
|
Facility
|
IP
|
$10.72
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
0409421501
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.36
|
|
|
ZOLEDRONIC ACID 4 MG/5ML IV CONC
|
Facility
|
IP
|
$10.56
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
6745739054
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$5.28 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.28
|
|
|
ZOLEDRONIC ACID 4 MG/5ML IV CONC
|
Facility
|
OP
|
$43.20
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
2502180166
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$3,256.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$23.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.25
|
| Rate for Payer: Aetna Government |
$8.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$73.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$73.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$32.56
|
| Rate for Payer: Amida Care Medicaid |
$32.56
|
| Rate for Payer: Brighton Health Commercial |
$32.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$34.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$29.38
|
| Rate for Payer: EmblemHealth Commercial |
$21.60
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$73.26
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$32.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.19
|
| Rate for Payer: Group Health Inc Commercial |
$21.60
|
| Rate for Payer: Group Health Inc Medicare |
$15.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.60
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,256.00
|
| Rate for Payer: Healthfirst Essential Plan |
$73.26
|
| Rate for Payer: Healthfirst QHP |
$53.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.56
|
| Rate for Payer: SOMOS Essential |
$73.26
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$73.26
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$35.82
|
| Rate for Payer: United Healthcare Medicaid |
$32.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$28.08
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32.56
|
|
|
ZOLEDRONIC ACID 4 MG/5ML IV CONC
|
Facility
|
IP
|
$43.20
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
2502180166
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.60
|
|
|
ZOLEDRONIC ACID 4 MG/5ML IV CONC
|
Facility
|
OP
|
$10.72
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
0409421501
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.75 |
| Max. Negotiated Rate |
$3,256.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.89
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.25
|
| Rate for Payer: Aetna Government |
$8.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$73.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$73.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$32.56
|
| Rate for Payer: Amida Care Medicaid |
$32.56
|
| Rate for Payer: Brighton Health Commercial |
$8.04
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.29
|
| Rate for Payer: EmblemHealth Commercial |
$5.36
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$73.26
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$32.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.19
|
| Rate for Payer: Group Health Inc Commercial |
$5.36
|
| Rate for Payer: Group Health Inc Medicare |
$3.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.36
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,256.00
|
| Rate for Payer: Healthfirst Essential Plan |
$73.26
|
| Rate for Payer: Healthfirst QHP |
$53.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.56
|
| Rate for Payer: SOMOS Essential |
$73.26
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$73.26
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$35.82
|
| Rate for Payer: United Healthcare Medicaid |
$32.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.97
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32.56
|
|
|
ZOLEDRONIC ACID 4 MG/5ML IV CONC
|
Facility
|
OP
|
$10.56
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
6745739054
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$3.70 |
| Max. Negotiated Rate |
$3,256.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.81
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.25
|
| Rate for Payer: Aetna Government |
$8.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$73.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$73.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$32.56
|
| Rate for Payer: Amida Care Medicaid |
$32.56
|
| Rate for Payer: Brighton Health Commercial |
$7.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.45
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$7.18
|
| Rate for Payer: EmblemHealth Commercial |
$5.28
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$73.26
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$32.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.19
|
| Rate for Payer: Group Health Inc Commercial |
$5.28
|
| Rate for Payer: Group Health Inc Medicare |
$3.70
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.28
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,256.00
|
| Rate for Payer: Healthfirst Essential Plan |
$73.26
|
| Rate for Payer: Healthfirst QHP |
$53.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.56
|
| Rate for Payer: SOMOS Essential |
$73.26
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$73.26
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$35.82
|
| Rate for Payer: United Healthcare Medicaid |
$32.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32.56
|
|
|
ZOLEDRONIC ACID 5 MG/100ML IV SOLN
|
Facility
|
IP
|
$1.32
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
6745779410
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.66
|
|
|
ZOLEDRONIC ACID 5 MG/100ML IV SOLN
|
Facility
|
OP
|
$1.32
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
6745779410
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$3,256.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.25
|
| Rate for Payer: Aetna Government |
$8.25
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$73.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$73.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$32.56
|
| Rate for Payer: Amida Care Medicaid |
$32.56
|
| Rate for Payer: Brighton Health Commercial |
$0.99
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.90
|
| Rate for Payer: EmblemHealth Commercial |
$0.66
|
| Rate for Payer: EmblemHealth Essential Plan 1&2 |
$73.26
|
| Rate for Payer: EmblemHealth Essential Plan 3&4 |
$32.56
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$32.56
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$73.26
|
| Rate for Payer: Fidelis Essential Plan QHP |
$73.26
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.66
|
| Rate for Payer: Group Health Inc Medicare |
$0.46
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.66
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$3,256.00
|
| Rate for Payer: Healthfirst Essential Plan |
$73.26
|
| Rate for Payer: Healthfirst QHP |
$53.07
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.56
|
| Rate for Payer: SOMOS Essential |
$73.26
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$73.26
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$35.82
|
| Rate for Payer: United Healthcare Medicaid |
$32.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.86
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32.56
|
|
|
ZOLPIDEM TARTRATE 10 MG PO TABS
|
Facility
|
OP
|
$4.63
|
|
|
Service Code
|
NDC 0093007401
|
| Hospital Charge Code |
0093007401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.31
|
| Rate for Payer: Aetna Government |
$2.31
|
| Rate for Payer: Brighton Health Commercial |
$3.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.15
|
| Rate for Payer: EmblemHealth Commercial |
$2.31
|
| Rate for Payer: Group Health Inc Commercial |
$2.31
|
| Rate for Payer: Group Health Inc Medicare |
$1.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.01
|
|
|
ZOLPIDEM TARTRATE 10 MG PO TABS
|
Facility
|
IP
|
$4.63
|
|
|
Service Code
|
NDC 1366800801
|
| Hospital Charge Code |
1366800801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.31
|
|
|
ZOLPIDEM TARTRATE 10 MG PO TABS
|
Facility
|
IP
|
$4.63
|
|
|
Service Code
|
NDC 0093007401
|
| Hospital Charge Code |
0093007401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.31
|
|
|
ZOLPIDEM TARTRATE 10 MG PO TABS
|
Facility
|
OP
|
$4.63
|
|
|
Service Code
|
NDC 1366800801
|
| Hospital Charge Code |
1366800801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.31
|
| Rate for Payer: Aetna Government |
$2.31
|
| Rate for Payer: Brighton Health Commercial |
$3.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.15
|
| Rate for Payer: EmblemHealth Commercial |
$2.31
|
| Rate for Payer: Group Health Inc Commercial |
$2.31
|
| Rate for Payer: Group Health Inc Medicare |
$1.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.01
|
|
|
ZOLPIDEM TARTRATE 5 MG PO TABS
|
Facility
|
OP
|
$4.63
|
|
|
Service Code
|
NDC 0093007301
|
| Hospital Charge Code |
0093007301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.31
|
| Rate for Payer: Aetna Government |
$2.31
|
| Rate for Payer: Brighton Health Commercial |
$3.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.15
|
| Rate for Payer: EmblemHealth Commercial |
$2.31
|
| Rate for Payer: Group Health Inc Commercial |
$2.31
|
| Rate for Payer: Group Health Inc Medicare |
$1.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.01
|
|
|
ZOLPIDEM TARTRATE 5 MG PO TABS
|
Facility
|
OP
|
$0.10
|
|
|
Service Code
|
NDC 0904608261
|
| Hospital Charge Code |
0904608261
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.06
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.05
|
| Rate for Payer: Aetna Government |
$0.05
|
| Rate for Payer: Brighton Health Commercial |
$0.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.07
|
| Rate for Payer: EmblemHealth Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.05
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.05
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
ZOLPIDEM TARTRATE 5 MG PO TABS
|
Facility
|
IP
|
$5.14
|
|
|
Service Code
|
NDC 6586215901
|
| Hospital Charge Code |
6586215901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.57
|
|
|
ZOLPIDEM TARTRATE 5 MG PO TABS
|
Facility
|
OP
|
$4.63
|
|
|
Service Code
|
NDC 1366800701
|
| Hospital Charge Code |
1366800701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.54
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.31
|
| Rate for Payer: Aetna Government |
$2.31
|
| Rate for Payer: Brighton Health Commercial |
$3.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.70
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.15
|
| Rate for Payer: EmblemHealth Commercial |
$2.31
|
| Rate for Payer: Group Health Inc Commercial |
$2.31
|
| Rate for Payer: Group Health Inc Medicare |
$1.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.01
|
|
|
ZOLPIDEM TARTRATE 5 MG PO TABS
|
Facility
|
IP
|
$4.63
|
|
|
Service Code
|
NDC 0093007301
|
| Hospital Charge Code |
0093007301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.31
|
|
|
ZOLPIDEM TARTRATE 5 MG PO TABS
|
Facility
|
IP
|
$0.10
|
|
|
Service Code
|
NDC 0904608261
|
| Hospital Charge Code |
0904608261
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.05 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.05
|
|
|
ZOLPIDEM TARTRATE 5 MG PO TABS
|
Facility
|
IP
|
$1.29
|
|
|
Service Code
|
NDC 6068783811
|
| Hospital Charge Code |
6068783811
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$0.65 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.65
|
|
|
ZOLPIDEM TARTRATE 5 MG PO TABS
|
Facility
|
OP
|
$5.14
|
|
|
Service Code
|
NDC 6586215901
|
| Hospital Charge Code |
6586215901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.57
|
| Rate for Payer: Aetna Government |
$2.57
|
| Rate for Payer: Brighton Health Commercial |
$3.85
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.49
|
| Rate for Payer: EmblemHealth Commercial |
$2.57
|
| Rate for Payer: Group Health Inc Commercial |
$2.57
|
| Rate for Payer: Group Health Inc Medicare |
$1.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.34
|
|
