St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZOLPIDEM TARTRATE 5 MG PO TABS

Facility

$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

$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

ZONISAMIDE 100 MG/5ML PO SUSP

Facility

$2.97

Service Code	NDC 5265280011
Hospital Charge Code	5265280011
Hospital Revenue Code	250
Min. Negotiated Rate	$1.04
Max. Negotiated Rate	$2.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.48
Rate for Payer: Aetna Government	$1.48
Rate for Payer: Brighton Health Commercial	$2.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.02
Rate for Payer: EmblemHealth Commercial	$1.48
Rate for Payer: Group Health Inc Commercial	$1.48
Rate for Payer: Group Health Inc Medicare	$1.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.48
Rate for Payer: Hamaspik Choice Inc Medicare	$1.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.93

ZONISAMIDE 100 MG/5ML PO SUSP

Facility

$2.97

Service Code	NDC 5265280011
Hospital Charge Code	5265280011
Hospital Revenue Code	250
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$1.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.48

ZONISAMIDE 100 MG PO CAPS

Facility

$1.72

Service Code	NDC 5026881611
Hospital Charge Code	5026881611
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.86

ZONISAMIDE 100 MG PO CAPS

Facility

$1.72

Service Code	NDC 5026881611
Hospital Charge Code	5026881611
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.86
Rate for Payer: Aetna Government	$0.86
Rate for Payer: Brighton Health Commercial	$1.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.17
Rate for Payer: EmblemHealth Commercial	$0.86
Rate for Payer: Group Health Inc Commercial	$0.86
Rate for Payer: Group Health Inc Medicare	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.86
Rate for Payer: Hamaspik Choice Inc Medicare	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.12

ZONISAMIDE 100 MG PO CAPS

Facility

$1.72

Service Code	NDC 5026881615
Hospital Charge Code	5026881615
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.86

ZONISAMIDE 100 MG PO CAPS

Facility

$0.90

Service Code	NDC 6068723001
Hospital Charge Code	6068723001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$0.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.61
Rate for Payer: EmblemHealth Commercial	$0.45
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.59

ZONISAMIDE 100 MG PO CAPS

Facility

$2.19

Service Code	NDC 6909786107
Hospital Charge Code	6909786107
Hospital Revenue Code	250
Min. Negotiated Rate	$1.10
Max. Negotiated Rate	$1.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.10

ZONISAMIDE 100 MG PO CAPS

Facility

$1.72

Service Code	NDC 5026881615
Hospital Charge Code	5026881615
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.86
Rate for Payer: Aetna Government	$0.86
Rate for Payer: Brighton Health Commercial	$1.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.17
Rate for Payer: EmblemHealth Commercial	$0.86
Rate for Payer: Group Health Inc Commercial	$0.86
Rate for Payer: Group Health Inc Medicare	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.86
Rate for Payer: Hamaspik Choice Inc Medicare	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.12

ZONISAMIDE 100 MG PO CAPS

Facility

$0.90

Service Code	NDC 6068723001
Hospital Charge Code	6068723001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45

ZONISAMIDE 100 MG PO CAPS

Facility

$2.19

Service Code	NDC 6909786107
Hospital Charge Code	6909786107
Hospital Revenue Code	250
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$1.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.10
Rate for Payer: Aetna Government	$1.10
Rate for Payer: Brighton Health Commercial	$1.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.49
Rate for Payer: EmblemHealth Commercial	$1.10
Rate for Payer: Group Health Inc Commercial	$1.10
Rate for Payer: Group Health Inc Medicare	$0.77
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.10
Rate for Payer: Hamaspik Choice Inc Medicare	$1.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.42

ZONISAMIDE 25 MG PO CAPS

Facility

$0.55

Service Code	NDC 6846212801
Hospital Charge Code	6846212801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.37
Rate for Payer: EmblemHealth Commercial	$0.27
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.36

ZONISAMIDE 25 MG PO CAPS

Facility

$0.55

Service Code	NDC 6275625802
Hospital Charge Code	6275625802
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27

ZONISAMIDE 25 MG PO CAPS

Facility

$0.55

Service Code	NDC 6275625802
Hospital Charge Code	6275625802
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.27
Rate for Payer: Aetna Government	$0.27
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.37
Rate for Payer: EmblemHealth Commercial	$0.27
Rate for Payer: Group Health Inc Commercial	$0.27
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27
Rate for Payer: Hamaspik Choice Inc Medicare	$0.27
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.36

ZONISAMIDE 25 MG PO CAPS

Facility

$0.55

Service Code	NDC 6846212801
Hospital Charge Code	6846212801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.27

ZOSTER VAC RECOMB ADJUVANTED 50 MCG/0.5ML IM SUSR

Facility

$237.47

Service Code	HCPCS 90750
Hospital Charge Code	5816082311
Hospital Revenue Code	250
Min. Negotiated Rate	$83.12
Max. Negotiated Rate	$14,140.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$130.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$165.25
Rate for Payer: Aetna Government	$165.25
Rate for Payer: Affinity Essential Plan 1&2	$318.15
Rate for Payer: Affinity Essential Plan 3&4	$318.15
Rate for Payer: Affinity Medicaid/CHP/HARP	$141.40
Rate for Payer: Amida Care Medicaid	$141.40
Rate for Payer: Brighton Health Commercial	$178.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$189.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$161.48
Rate for Payer: EmblemHealth Commercial	$118.74
Rate for Payer: EmblemHealth Essential Plan 1&2	$318.15
Rate for Payer: EmblemHealth Essential Plan 3&4	$141.40
Rate for Payer: Fidelis CHP/HARP/Medicaid	$141.40
Rate for Payer: Fidelis Essential Plan Aliesa	$318.15
Rate for Payer: Fidelis Essential Plan QHP	$318.15
Rate for Payer: Fidelis Qualified Health Plan	$148.47
Rate for Payer: Group Health Inc Commercial	$118.74
Rate for Payer: Group Health Inc Medicare	$83.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$141.40
Rate for Payer: Hamaspik Choice Inc Medicare	$118.74
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$14,140.00
Rate for Payer: Healthfirst Essential Plan	$318.15
Rate for Payer: Healthfirst QHP	$230.48
Rate for Payer: SOMOS CHP/HARP/Medicaid	$141.40
Rate for Payer: SOMOS Essential	$318.15
Rate for Payer: United Healthcare Essential Plan 1&2	$318.15
Rate for Payer: United Healthcare Essential Plan 3&4	$155.54
Rate for Payer: United Healthcare Medicaid	$141.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$154.36
Rate for Payer: Wellcare CHP/FHP/Medicaid	$141.40

ZOSTER VAC RECOMB ADJUVANTED 50 MCG/0.5ML IM SUSR

Facility

$237.47

Service Code	HCPCS 90750
Hospital Charge Code	5816082311
Hospital Revenue Code	250
Min. Negotiated Rate	$118.74
Max. Negotiated Rate	$118.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$118.74

Know your out-of-pocket cost for care.

All Charges