|
ZOLEDRONIC ACID 4 MG/5 ML INJ
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
41653263
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$3,256.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.25
|
| Rate for Payer: Aetna Government |
$8.25
|
| Rate for Payer: Amida Care Medicaid |
$32.56
|
| Rate for Payer: Brighton Health Commercial |
$67.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$64.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,256.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.19
|
| Rate for Payer: Group Health Inc Commercial |
$56.50
|
| Rate for Payer: Group Health Inc Medicare |
$39.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.56
|
| Rate for Payer: Healthfirst Essential Plan |
$73.26
|
| Rate for Payer: Healthfirst QHP |
$32.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.56
|
| Rate for Payer: SOMOS Essential |
$32.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32.56
|
|
|
ZOLEDRONIC ACID 4 MG/5 ML INJ
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
41643263
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.50 |
| Max. Negotiated Rate |
$56.50 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$56.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.50
|
|
|
ZOLEDRONIC ACID 4 MG/5 ML INJ
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
41643263
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$3,256.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$62.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.25
|
| Rate for Payer: Aetna Government |
$8.25
|
| Rate for Payer: Amida Care Medicaid |
$32.56
|
| Rate for Payer: Brighton Health Commercial |
$67.80
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$56.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$64.98
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,256.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.19
|
| Rate for Payer: Group Health Inc Commercial |
$56.50
|
| Rate for Payer: Group Health Inc Medicare |
$39.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$56.50
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.56
|
| Rate for Payer: Healthfirst Essential Plan |
$73.26
|
| Rate for Payer: Healthfirst QHP |
$32.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.56
|
| Rate for Payer: SOMOS Essential |
$32.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$73.45
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32.56
|
|
|
ZOLEDRONIC ACID 4 MG/5ML IV CONC [35640]
|
Facility
|
OP
|
$10.56
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
67457039054
|
|
Hospital Revenue Code
|
278
|
| 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: Amida Care Medicaid |
$32.56
|
| Rate for Payer: Brighton Health Commercial |
$6.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.28
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.07
|
| Rate for Payer: EmblemHealth Commercial |
$5.28
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,256.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.09
|
| 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 |
$32.56
|
| Rate for Payer: Healthfirst Essential Plan |
$73.26
|
| Rate for Payer: Healthfirst QHP |
$32.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.56
|
| Rate for Payer: SOMOS Essential |
$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 4 MG/5ML IV CONC [35640]
|
Facility
|
OP
|
$43.20
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
25021080166
|
|
Hospital Revenue Code
|
278
|
| 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: Amida Care Medicaid |
$32.56
|
| Rate for Payer: Brighton Health Commercial |
$25.92
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$21.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$24.84
|
| Rate for Payer: EmblemHealth Commercial |
$21.60
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,256.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$45.36
|
| 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 |
$32.56
|
| Rate for Payer: Healthfirst Essential Plan |
$73.26
|
| Rate for Payer: Healthfirst QHP |
$32.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.56
|
| Rate for Payer: SOMOS Essential |
$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 [35640]
|
Facility
|
OP
|
$10.72
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
00409421501
|
|
Hospital Revenue Code
|
278
|
| 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: Amida Care Medicaid |
$32.56
|
| Rate for Payer: Brighton Health Commercial |
$6.43
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.16
|
| Rate for Payer: EmblemHealth Commercial |
$5.36
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,256.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.25
|
| 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 |
$32.56
|
| Rate for Payer: Healthfirst Essential Plan |
$73.26
|
| Rate for Payer: Healthfirst QHP |
$32.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.56
|
| Rate for Payer: SOMOS Essential |
$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 [35640]
|
Facility
|
IP
|
$43.20
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
25021080166
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$21.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$21.60
|
|
|
ZOLEDRONIC ACID 4 MG/5ML IV CONC [35640]
|
Facility
|
IP
|
$10.72
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
00409421501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.36
|
|
|
ZOLEDRONIC ACID 4 MG/5ML IV CONC [35640]
|
Facility
|
IP
|
$10.56
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
67457039054
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$5.28 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.28
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.28
|
|
|
ZOLEDRONIC ACID 5MG/100 ML INJ
|
Facility
|
OP
|
$107.50
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
41646564
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$3,256.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$59.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.25
|
| Rate for Payer: Aetna Government |
$8.25
|
| Rate for Payer: Amida Care Medicaid |
$32.56
|
| Rate for Payer: Brighton Health Commercial |
$64.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$53.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$61.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,256.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.19
|
| Rate for Payer: Group Health Inc Commercial |
$53.75
|
| Rate for Payer: Group Health Inc Medicare |
$37.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.56
|
| Rate for Payer: Healthfirst Essential Plan |
$73.26
|
| Rate for Payer: Healthfirst QHP |
$32.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.56
|
| Rate for Payer: SOMOS Essential |
$32.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32.56
|
|
|
ZOLEDRONIC ACID 5MG/100 ML INJ
|
Facility
|
IP
|
$107.50
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
41646564
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.75 |
| Max. Negotiated Rate |
$53.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.75
|
|
|
ZOLEDRONIC ACID 5MG/100ML INJ
|
Facility
|
IP
|
$107.50
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
41656564
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.75 |
| Max. Negotiated Rate |
$53.75 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$53.75
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.75
|
|
|
ZOLEDRONIC ACID 5MG/100ML INJ
|
Facility
|
OP
|
$107.50
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
41656564
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$3,256.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$59.12
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$8.25
|
| Rate for Payer: Aetna Government |
$8.25
|
| Rate for Payer: Amida Care Medicaid |
$32.56
|
| Rate for Payer: Brighton Health Commercial |
$64.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$53.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$61.81
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,256.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.56
|
| Rate for Payer: Fidelis Qualified Health Plan |
$34.19
|
| Rate for Payer: Group Health Inc Commercial |
$53.75
|
| Rate for Payer: Group Health Inc Medicare |
$37.62
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$32.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$53.75
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$32.56
|
| Rate for Payer: Healthfirst Essential Plan |
$73.26
|
| Rate for Payer: Healthfirst QHP |
$32.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.56
|
| Rate for Payer: SOMOS Essential |
$32.56
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$69.88
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$32.56
|
|
|
ZOLEDRONIC ACID 5 MG/100ML IV SOLN [81434]
|
Facility
|
IP
|
$1.32
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
67457079410
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$0.66 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.66
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.66
|
|
|
ZOLEDRONIC ACID 5 MG/100ML IV SOLN [81434]
|
Facility
|
OP
|
$1.32
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
67457079410
|
|
Hospital Revenue Code
|
278
|
| 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: Amida Care Medicaid |
$32.56
|
| Rate for Payer: Brighton Health Commercial |
$0.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.66
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.76
|
| Rate for Payer: EmblemHealth Commercial |
$0.66
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$3,256.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$32.56
|
| Rate for Payer: Fidelis Essential Plan QHP |
$32.56
|
| Rate for Payer: Fidelis Medicare Advantage |
$1.39
|
| 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 |
$32.56
|
| Rate for Payer: Healthfirst Essential Plan |
$73.26
|
| Rate for Payer: Healthfirst QHP |
$32.56
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$32.56
|
| Rate for Payer: SOMOS Essential |
$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
|
|
|
ZOLL PADS
|
Facility
|
OP
|
$62.28
|
|
| Hospital Charge Code |
66520315
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$49.82 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$34.25
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$31.14
|
| Rate for Payer: Aetna Government |
$31.14
|
| Rate for Payer: Brighton Health Commercial |
$46.71
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$49.82
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$42.35
|
| Rate for Payer: Group Health Inc Commercial |
$31.14
|
| Rate for Payer: Group Health Inc Medicare |
$21.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$31.14
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$31.14
|
|
|
ZOLPIDEM 10 MG TAB
|
Facility
|
OP
|
$0.10
|
|
| Hospital Charge Code |
41652857
|
|
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: 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 10 MG TAB
|
Facility
|
OP
|
$0.10
|
|
| Hospital Charge Code |
41642857
|
|
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: 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 5 MG TAB
|
Facility
|
OP
|
$0.08
|
|
| Hospital Charge Code |
41652856
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Brighton Health Commercial |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
|
ZOLPIDEM 5 MG TAB
|
Facility
|
OP
|
$0.08
|
|
| Hospital Charge Code |
41642856
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.04
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.04
|
| Rate for Payer: Aetna Government |
$0.04
|
| Rate for Payer: Brighton Health Commercial |
$0.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.05
|
| Rate for Payer: Group Health Inc Commercial |
$0.04
|
| Rate for Payer: Group Health Inc Medicare |
$0.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.05
|
|
|
ZOLPIDEM TARTRATE 10 MG PO TABS [11700]
|
Facility
|
OP
|
$4.63
|
|
|
Service Code
|
NDC 13668000801
|
| Hospital Charge Code |
13668000801
|
|
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 |
$3.14
|
| 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 [11700]
|
Facility
|
OP
|
$4.65
|
|
|
Service Code
|
NDC 63739052610
|
| Hospital Charge Code |
63739052610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.32
|
| Rate for Payer: Aetna Government |
$2.32
|
| Rate for Payer: Brighton Health Commercial |
$3.48
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.72
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.16
|
| Rate for Payer: Group Health Inc Commercial |
$2.32
|
| Rate for Payer: Group Health Inc Medicare |
$1.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.32
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.02
|
|
|
ZOLPIDEM TARTRATE 10 MG PO TABS [11700]
|
Facility
|
OP
|
$4.63
|
|
|
Service Code
|
NDC 00093007401
|
| Hospital Charge Code |
00093007401
|
|
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 |
$3.14
|
| 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 [11701]
|
Facility
|
OP
|
$4.63
|
|
|
Service Code
|
NDC 00093007301
|
| Hospital Charge Code |
00093007301
|
|
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 |
$3.14
|
| 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 [11701]
|
Facility
|
OP
|
$1.76
|
|
|
Service Code
|
NDC 68084018901
|
| Hospital Charge Code |
68084018901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$1.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.88
|
| Rate for Payer: Aetna Government |
$0.88
|
| Rate for Payer: Brighton Health Commercial |
$1.32
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.19
|
| Rate for Payer: Group Health Inc Commercial |
$0.88
|
| Rate for Payer: Group Health Inc Medicare |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.88
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.88
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.14
|
|
