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All Charges

Charge

Type

Setting

Price

ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE [8880]

Facility

IP

$0.23

Service Code	NDC 7733398325
Hospital Charge Code	1711267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of CA HMO/PPO	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE [8880]

Facility

IP

$0.23

Service Code	NDC 7733398310
Hospital Charge Code	1711267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of CA HMO/PPO	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.14
Rate for Payer: LLUH Dept of Risk Management WC	$0.13
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE [8880]

Facility

IP

$0.12

Service Code	NDC 6858500801
Hospital Charge Code	1711267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.10
Rate for Payer: Cash Price	$0.05
Rate for Payer: Cigna of CA HMO/PPO	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.09

ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE [8880]

Facility

IP

$0.22

Service Code	NDC 2055504000
Hospital Charge Code	1711267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.18
Rate for Payer: Cash Price	$0.10
Rate for Payer: Cigna of CA HMO/PPO	$0.18
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE [8880]

Facility

OP

$0.22

Service Code	NDC 2055504000
Hospital Charge Code	1711267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.17
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.13
Rate for Payer: Aetna of CA Government/Medicare	$0.13
Rate for Payer: Cash Price	$0.10
Rate for Payer: Health Smart Auto/Commercial	$0.13
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.13
Rate for Payer: LLUH Dept of Risk Management WC	$0.12
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.17

ZINC SULFATE 50 MG ZINC (220 MG) CAPSULE [8880]

Facility

OP

$0.12

Service Code	NDC 6858500801
Hospital Charge Code	1711267
Hospital Revenue Code	259
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.09
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.07
Rate for Payer: Aetna of CA Government/Medicare	$0.07
Rate for Payer: Cash Price	$0.05
Rate for Payer: Health Smart Auto/Commercial	$0.07
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.07
Rate for Payer: LLUH Dept of Risk Management WC	$0.07
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.09

ZINC SULFATE 50 MG ZINC (220 MG) TABLET [8881]

Facility

IP

$0.05

Service Code	NDC 1000673027
Hospital Charge Code	ERX8881
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cigna of CA HMO/PPO	$0.04
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.04

ZINC SULFATE 50 MG ZINC (220 MG) TABLET [8881]

Facility

OP

$0.05

Service Code	NDC 1000673027
Hospital Charge Code	ERX8881
Hospital Revenue Code	259
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.04
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.03
Rate for Payer: Aetna of CA Government/Medicare	$0.03
Rate for Payer: Cash Price	$0.02
Rate for Payer: Health Smart Auto/Commercial	$0.03
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.03
Rate for Payer: LLUH Dept of Risk Management WC	$0.03
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.04

ZIPRASIDONE 20 MG CAPSULE [29778]

Facility

IP

$0.60

Service Code	NDC 55111-256-60
Hospital Charge Code	1710933
Hospital Revenue Code	259
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.48
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of CA HMO/PPO	$0.48
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.45

ZIPRASIDONE 20 MG CAPSULE [29778]

Facility

IP

$5.79

Service Code	NDC 0904-6269-08
Hospital Charge Code	1710933
Hospital Revenue Code	259
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$4.63
Rate for Payer: Cash Price	$2.61
Rate for Payer: Cigna of CA HMO/PPO	$4.63
Rate for Payer: Health Smart Auto/Commercial	$3.47
Rate for Payer: LLUH Dept of Risk Management WC	$3.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.34

ZIPRASIDONE 20 MG CAPSULE [29778]

Facility

OP

$0.60

Service Code	NDC 55111-256-60
Hospital Charge Code	1710933
Hospital Revenue Code	259
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.36
Rate for Payer: Aetna of CA Government/Medicare	$0.36
Rate for Payer: Cash Price	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.36
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.45

ZIPRASIDONE 20 MG CAPSULE [29778]

Facility

OP

$5.79

Service Code	NDC 0904-6269-08
Hospital Charge Code	1710933
Hospital Revenue Code	259
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$4.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.47
Rate for Payer: Aetna of CA Government/Medicare	$3.47
Rate for Payer: Cash Price	$2.61
Rate for Payer: Health Smart Auto/Commercial	$3.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.47
Rate for Payer: LLUH Dept of Risk Management WC	$3.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.34

ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION [33175]

Facility

IP

$56.40

Service Code	CPT J3486
Hospital Charge Code	1722027
Hospital Revenue Code	636
Min. Negotiated Rate	$31.02
Max. Negotiated Rate	$45.12
Rate for Payer: Cash Price	$25.38
Rate for Payer: Cigna of CA HMO/PPO	$45.12
Rate for Payer: Health Smart Auto/Commercial	$33.84
Rate for Payer: LLUH Dept of Risk Management WC	$31.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$42.30

ZIPRASIDONE 20 MG/ML (FINAL CONCENTRATION) INTRAMUSCULAR SOLUTION [33175]

Facility

OP

$56.40

Service Code	CPT J3486
Hospital Charge Code	1722027
Hospital Revenue Code	636
Min. Negotiated Rate	$31.02
Max. Negotiated Rate	$42.30
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$33.84
Rate for Payer: Aetna of CA Government/Medicare	$33.84
Rate for Payer: Cash Price	$25.38
Rate for Payer: Health Smart Auto/Commercial	$33.84
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$33.84
Rate for Payer: LLUH Dept of Risk Management WC	$31.02
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$42.30

ZIPRASIDONE 40 MG CAPSULE [29779]

Facility

OP

$5.79

Service Code	NDC 0904-6270-08
Hospital Charge Code	1710934
Hospital Revenue Code	259
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$4.34
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$3.47
Rate for Payer: Aetna of CA Government/Medicare	$3.47
Rate for Payer: Cash Price	$2.61
Rate for Payer: Health Smart Auto/Commercial	$3.47
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$3.47
Rate for Payer: LLUH Dept of Risk Management WC	$3.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.34

ZIPRASIDONE 40 MG CAPSULE [29779]

Facility

OP

$1.60

Service Code	NDC 60505-2529-6
Hospital Charge Code	1710934
Hospital Revenue Code	259
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$1.20
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.96
Rate for Payer: Aetna of CA Government/Medicare	$0.96
Rate for Payer: Cash Price	$0.72
Rate for Payer: Health Smart Auto/Commercial	$0.96
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.96
Rate for Payer: LLUH Dept of Risk Management WC	$0.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.20

ZIPRASIDONE 40 MG CAPSULE [29779]

Facility

OP

$0.60

Service Code	NDC 0781-2166-60
Hospital Charge Code	1710934
Hospital Revenue Code	259
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.45
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.36
Rate for Payer: Aetna of CA Government/Medicare	$0.36
Rate for Payer: Cash Price	$0.27
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.36
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.45

ZIPRASIDONE 40 MG CAPSULE [29779]

Facility

IP

$0.60

Service Code	NDC 0781-2166-60
Hospital Charge Code	1710934
Hospital Revenue Code	259
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.48
Rate for Payer: Cash Price	$0.27
Rate for Payer: Cigna of CA HMO/PPO	$0.48
Rate for Payer: Health Smart Auto/Commercial	$0.36
Rate for Payer: LLUH Dept of Risk Management WC	$0.33
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.45

ZIPRASIDONE 40 MG CAPSULE [29779]

Facility

IP

$5.79

Service Code	NDC 0904-6270-08
Hospital Charge Code	1710934
Hospital Revenue Code	259
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$4.63
Rate for Payer: Cash Price	$2.61
Rate for Payer: Cigna of CA HMO/PPO	$4.63
Rate for Payer: Health Smart Auto/Commercial	$3.47
Rate for Payer: LLUH Dept of Risk Management WC	$3.18
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$4.34

ZIPRASIDONE 40 MG CAPSULE [29779]

Facility

IP

$1.60

Service Code	NDC 60505-2529-6
Hospital Charge Code	1710934
Hospital Revenue Code	259
Min. Negotiated Rate	$0.88
Max. Negotiated Rate	$1.28
Rate for Payer: Cash Price	$0.72
Rate for Payer: Cigna of CA HMO/PPO	$1.28
Rate for Payer: Health Smart Auto/Commercial	$0.96
Rate for Payer: LLUH Dept of Risk Management WC	$0.88
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$1.20

ZIPRASIDONE 60 MG CAPSULE [29780]

Facility

OP

$0.70

Service Code	NDC 55111-258-60
Hospital Charge Code	1712251
Hospital Revenue Code	259
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.53
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.42
Rate for Payer: Aetna of CA Government/Medicare	$0.42
Rate for Payer: Cash Price	$0.32
Rate for Payer: Health Smart Auto/Commercial	$0.42
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.42
Rate for Payer: LLUH Dept of Risk Management WC	$0.39
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.53

ZIPRASIDONE 60 MG CAPSULE [29780]

Facility

IP

$1.13

Service Code	NDC 68001-452-06
Hospital Charge Code	1712251
Hospital Revenue Code	259
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.90
Rate for Payer: Cash Price	$0.51
Rate for Payer: Cigna of CA HMO/PPO	$0.90
Rate for Payer: Health Smart Auto/Commercial	$0.68
Rate for Payer: LLUH Dept of Risk Management WC	$0.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.85

ZIPRASIDONE 60 MG CAPSULE [29780]

Facility

OP

$1.13

Service Code	NDC 68001-452-06
Hospital Charge Code	1712251
Hospital Revenue Code	259
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$0.85
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$0.68
Rate for Payer: Aetna of CA Government/Medicare	$0.68
Rate for Payer: Cash Price	$0.51
Rate for Payer: Health Smart Auto/Commercial	$0.68
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$0.68
Rate for Payer: LLUH Dept of Risk Management WC	$0.62
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.85

ZIPRASIDONE 60 MG CAPSULE [29780]

Facility

IP

$0.70

Service Code	NDC 55111-258-60
Hospital Charge Code	1712251
Hospital Revenue Code	259
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.56
Rate for Payer: Cash Price	$0.32
Rate for Payer: Cigna of CA HMO/PPO	$0.56
Rate for Payer: Health Smart Auto/Commercial	$0.42
Rate for Payer: LLUH Dept of Risk Management WC	$0.39
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$0.53

ZIPRASIDONE 80 MG CAPSULE [29781]

Facility

OP

$3.32

Service Code	NDC 68084-106-11
Hospital Charge Code	1712252
Hospital Revenue Code	259
Min. Negotiated Rate	$1.83
Max. Negotiated Rate	$2.49
Rate for Payer: Aetna of CA EPO/HMO/POS/PPO	$1.99
Rate for Payer: Aetna of CA Government/Medicare	$1.99
Rate for Payer: Cash Price	$1.49
Rate for Payer: Health Smart Auto/Commercial	$1.99
Rate for Payer: Kaiser Permanente of CA Medi-Cal/Medicare Advantage	$1.99
Rate for Payer: LLUH Dept of Risk Management WC	$1.83
Rate for Payer: Multiplan Beech St/Commercial/PHCS	$2.49

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