St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

AZTREONAM IVP < 2000MG

Facility

$33.80

Service Code	HCPCS S0073
Hospital Charge Code	41647824
Hospital Revenue Code	636
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$16.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.90
Rate for Payer: Hamaspik Choice Inc Medicare	$16.90

AZTREONAM IVP < 2000MG

Facility

$33.80

Service Code	HCPCS S0073
Hospital Charge Code	41657824
Hospital Revenue Code	636
Min. Negotiated Rate	$11.83
Max. Negotiated Rate	$21.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.01
Rate for Payer: Aetna Government	$12.01
Rate for Payer: Brighton Health Commercial	$20.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.44
Rate for Payer: Group Health Inc Commercial	$16.90
Rate for Payer: Group Health Inc Medicare	$11.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.90
Rate for Payer: Hamaspik Choice Inc Medicare	$16.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.97

AZTREONAM IVP < 2000MG

Facility

$33.80

Service Code	HCPCS S0073
Hospital Charge Code	41657824
Hospital Revenue Code	636
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$16.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.90
Rate for Payer: Hamaspik Choice Inc Medicare	$16.90

AZTREONAM IVP < 2000MG

Facility

$33.80

Service Code	HCPCS S0073
Hospital Charge Code	41647825
Hospital Revenue Code	636
Min. Negotiated Rate	$11.83
Max. Negotiated Rate	$21.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.01
Rate for Payer: Aetna Government	$12.01
Rate for Payer: Brighton Health Commercial	$20.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.44
Rate for Payer: Group Health Inc Commercial	$16.90
Rate for Payer: Group Health Inc Medicare	$11.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.90
Rate for Payer: Hamaspik Choice Inc Medicare	$16.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.97

B12 RIA

Facility

$37.70

Service Code	HCPCS 82607
Hospital Charge Code	40602365
Hospital Revenue Code	301
Min. Negotiated Rate	$10.56
Max. Negotiated Rate	$28.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$15.08
Rate for Payer: Aetna Government	$15.08
Rate for Payer: Affinity Essential Plan 1&2	$10.56
Rate for Payer: Affinity Essential Plan 3&4	$10.56
Rate for Payer: Affinity Medicaid/CHP/HARP	$10.56
Rate for Payer: Brighton Health Commercial	$28.28
Rate for Payer: Cash Price	$15.08
Rate for Payer: Cash Price	$15.08
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$15.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.28
Rate for Payer: Elderplan Medicare Advantage	$15.08
Rate for Payer: EmblemHealth Commercial	$15.08
Rate for Payer: Fidelis Essential Plan Aliesa	$12.82
Rate for Payer: Fidelis Essential Plan QHP	$13.42
Rate for Payer: Fidelis Medicare Advantage	$15.08
Rate for Payer: Fidelis Qualified Health Plan	$13.42
Rate for Payer: Group Health Inc Commercial	$15.08
Rate for Payer: Group Health Inc Medicare	$15.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.85
Rate for Payer: Hamaspik Choice Inc Medicare	$15.08
Rate for Payer: Healthfirst Medicare Advantage	$15.08
Rate for Payer: Healthfirst QHP	$15.08
Rate for Payer: Humana Medicare	$15.38
Rate for Payer: Senior Whole Health Medicare Advantage	$15.08
Rate for Payer: United Healthcare Commercial	$19.09
Rate for Payer: United Healthcare Medicare Advantage	$15.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.08
Rate for Payer: Wellcare CHP/FHP/Medicaid	$12.06
Rate for Payer: Wellcare Medicare	$13.57

B12 RIA

Facility

$37.70

Service Code	HCPCS 82607
Hospital Charge Code	40602365
Hospital Revenue Code	301
Rate for Payer: Cash Price	$15.08

B2-GLYCOPROTEIN I AB (IGG)

Facility

$63.63

Service Code	HCPCS 86146
Hospital Charge Code	40728345
Hospital Revenue Code	302
Rate for Payer: Cash Price	$25.45

B2-GLYCOPROTEIN I AB (IGG)

Facility

$63.63

Service Code	HCPCS 86146
Hospital Charge Code	40728345
Hospital Revenue Code	302
Min. Negotiated Rate	$17.82
Max. Negotiated Rate	$47.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$35.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$25.45
Rate for Payer: Aetna Government	$25.45
Rate for Payer: Affinity Essential Plan 1&2	$17.82
Rate for Payer: Affinity Essential Plan 3&4	$17.82
Rate for Payer: Affinity Medicaid/CHP/HARP	$17.82
Rate for Payer: Brighton Health Commercial	$47.72
Rate for Payer: Cash Price	$25.45
Rate for Payer: Cash Price	$25.45
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$25.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.21
Rate for Payer: Elderplan Medicare Advantage	$25.45
Rate for Payer: EmblemHealth Commercial	$25.45
Rate for Payer: Fidelis Essential Plan Aliesa	$21.63
Rate for Payer: Fidelis Essential Plan QHP	$22.65
Rate for Payer: Fidelis Medicare Advantage	$25.45
Rate for Payer: Fidelis Qualified Health Plan	$22.65
Rate for Payer: Group Health Inc Commercial	$25.45
Rate for Payer: Group Health Inc Medicare	$25.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.82
Rate for Payer: Hamaspik Choice Inc Medicare	$25.45
Rate for Payer: Healthfirst Medicare Advantage	$25.45
Rate for Payer: Healthfirst QHP	$25.45
Rate for Payer: Humana Medicare	$25.96
Rate for Payer: Senior Whole Health Medicare Advantage	$25.45
Rate for Payer: United Healthcare Commercial	$32.22
Rate for Payer: United Healthcare Medicare Advantage	$25.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.45
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20.36
Rate for Payer: Wellcare Medicare	$22.90

BACITRACIN

Facility

$28.35

Hospital Charge Code	40200602
Hospital Revenue Code	270
Min. Negotiated Rate	$9.92
Max. Negotiated Rate	$22.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.18
Rate for Payer: Aetna Government	$14.18
Rate for Payer: Brighton Health Commercial	$21.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.28
Rate for Payer: Group Health Inc Commercial	$14.18
Rate for Payer: Group Health Inc Medicare	$9.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.18
Rate for Payer: Hamaspik Choice Inc Medicare	$14.18

BACITRACIN 50,000 UNITS INJ

Facility

$9.00

Hospital Charge Code	41653123
Hospital Revenue Code	250
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$7.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.50
Rate for Payer: Aetna Government	$4.50
Rate for Payer: Brighton Health Commercial	$6.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.12
Rate for Payer: Group Health Inc Commercial	$4.50
Rate for Payer: Group Health Inc Medicare	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85

BACITRACIN 50,000 UNITS INJ

Facility

$9.00

Service Code	HCPCS J3490
Hospital Charge Code	41643123
Hospital Revenue Code	636
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$5.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.50
Rate for Payer: Aetna Government	$4.50
Rate for Payer: Brighton Health Commercial	$5.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.18
Rate for Payer: Group Health Inc Commercial	$4.50
Rate for Payer: Group Health Inc Medicare	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85

BACITRACIN 50,000 UNITS INJ

Facility

$9.00

Service Code	HCPCS J3490
Hospital Charge Code	41643123
Hospital Revenue Code	636
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50

BACITRACIN 500 UNIT/GM EX OINT [850]

Facility

$0.12

Service Code	NDC 00713028031
Hospital Charge Code	00713028031
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.08
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

BACITRACIN 500 UNIT/GM OP OINT [852]

Facility

$37.05

Service Code	NDC 00574402235
Hospital Charge Code	00574402235
Hospital Revenue Code	250
Min. Negotiated Rate	$12.97
Max. Negotiated Rate	$29.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$18.53
Rate for Payer: Aetna Government	$18.53
Rate for Payer: Brighton Health Commercial	$27.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.20
Rate for Payer: Group Health Inc Commercial	$18.53
Rate for Payer: Group Health Inc Medicare	$12.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.53
Rate for Payer: Hamaspik Choice Inc Medicare	$18.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$24.09

BACITRACIN OPHTHALMIC OINT

Facility

$97.00

Hospital Charge Code	41640586
Hospital Revenue Code	250
Min. Negotiated Rate	$33.95
Max. Negotiated Rate	$77.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$48.50
Rate for Payer: Aetna Government	$48.50
Rate for Payer: Brighton Health Commercial	$72.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$77.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.96
Rate for Payer: Group Health Inc Commercial	$48.50
Rate for Payer: Group Health Inc Medicare	$33.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.50
Rate for Payer: Hamaspik Choice Inc Medicare	$48.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.05

BACITRACIN OPHTHALMIC OINT

Facility

$97.00

Hospital Charge Code	41650586
Hospital Revenue Code	250
Min. Negotiated Rate	$33.95
Max. Negotiated Rate	$77.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$53.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$48.50
Rate for Payer: Aetna Government	$48.50
Rate for Payer: Brighton Health Commercial	$72.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$77.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$65.96
Rate for Payer: Group Health Inc Commercial	$48.50
Rate for Payer: Group Health Inc Medicare	$33.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$48.50
Rate for Payer: Hamaspik Choice Inc Medicare	$48.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$63.05

BACITRACIN + POLYMYXIN B TOPICAL POWDER

Facility

$19.28

Hospital Charge Code	41642436
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$15.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.64
Rate for Payer: Aetna Government	$9.64
Rate for Payer: Brighton Health Commercial	$14.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.11
Rate for Payer: Group Health Inc Commercial	$9.64
Rate for Payer: Group Health Inc Medicare	$6.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.64
Rate for Payer: Hamaspik Choice Inc Medicare	$9.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.53

BACITRACIN + POLYMYXIN B TOPICAL POWDER

Facility

$19.28

Hospital Charge Code	41652436
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$15.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.64
Rate for Payer: Aetna Government	$9.64
Rate for Payer: Brighton Health Commercial	$14.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.11
Rate for Payer: Group Health Inc Commercial	$9.64
Rate for Payer: Group Health Inc Medicare	$6.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.64
Rate for Payer: Hamaspik Choice Inc Medicare	$9.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.53

BACITRACIN/POLYMYXIN OINT 0.94 G

Facility

$1.00

Hospital Charge Code	41655905
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

BACITRACIN/POLYMYXIN OINT 0.94G

Facility

$1.00

Hospital Charge Code	41645905
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.50
Rate for Payer: Aetna Government	$0.50
Rate for Payer: Brighton Health Commercial	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
Rate for Payer: Group Health Inc Commercial	$0.50
Rate for Payer: Group Health Inc Medicare	$0.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.50
Rate for Payer: Hamaspik Choice Inc Medicare	$0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.65

BACITRACIN TOPICAL OINTMENT

Facility

$0.05

Hospital Charge Code	41654311
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

BACITRACIN TOPICAL OINTMENT

Facility

$0.05

Hospital Charge Code	41644311
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

BACITRACIN TOP OINT 28.4G TUBE

Facility

$3.00

Hospital Charge Code	41645901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

BACITRACIN TOP OINT 28.4G TUBE

Facility

$3.00

Hospital Charge Code	41655901
Hospital Revenue Code	250
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.50
Rate for Payer: Aetna Government	$1.50
Rate for Payer: Brighton Health Commercial	$2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.04
Rate for Payer: Group Health Inc Commercial	$1.50
Rate for Payer: Group Health Inc Medicare	$1.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.95

BACITRACIN ZINC 500 UNIT/GM EX OINT [13818]

Facility

$0.13

Service Code	NDC 00904702367
Hospital Charge Code	00904702367
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

Know your out-of-pocket cost for care.

All Charges