|
ZIM TRILY ALFIT AETABLR SYS LG 36
|
Facility
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40202637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$850.00 |
| Max. Negotiated Rate |
$850.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$850.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$850.00
|
|
|
ZIM VRSY FEM HD 12/14-28+0MM NK
|
Facility
IP
|
$2,550.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,275.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,275.00
|
|
|
ZIM VRSY FEM HD 12/14-28+0MM NK
|
Facility
OP
|
$2,550.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204219
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$2,677.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,402.50
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,275.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,466.25
|
| Rate for Payer: Fidelis Medicare Advantage |
$2,677.50
|
| Rate for Payer: Group Health Inc Commercial |
$1,275.00
|
| Rate for Payer: Group Health Inc Medicare |
$892.50
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,275.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,275.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1,657.50
|
|
|
ZIM VRZY END-FEM HD 12/14 TP 43MM
|
Facility
IP
|
$3,324.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,662.00 |
| Max. Negotiated Rate |
$1,662.00 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,662.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,662.00
|
|
|
ZIM VRZY END-FEM HD 12/14 TP 43MM
|
Facility
OP
|
$3,324.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
40204218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.17 |
| Max. Negotiated Rate |
$3,490.20 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1,828.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$339.17
|
| Rate for Payer: Aetna Government |
$339.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,662.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1,911.30
|
| Rate for Payer: Fidelis Medicare Advantage |
$3,490.20
|
| Rate for Payer: Group Health Inc Commercial |
$1,662.00
|
| Rate for Payer: Group Health Inc Medicare |
$1,163.40
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1,662.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1,662.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2,160.60
|
|
|
ZINC OXIDE 20% OINT 30 GRAMS
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
41640023
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
ZINC OXIDE 20% OINT 30 GRAMS
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
41650023
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
ZINC OXIDE-COD LIVER OIL-VIT A OINT 30 G
|
Facility
OP
|
$7.10
|
|
| Hospital Charge Code |
41651713
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.55
|
| Rate for Payer: Aetna Government |
$3.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.83
|
| Rate for Payer: Group Health Inc Commercial |
$3.55
|
| Rate for Payer: Group Health Inc Medicare |
$2.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.62
|
|
|
ZINC OXIDE-COD LIVER OIL-VIT A OINT 30 G
|
Facility
OP
|
$7.10
|
|
| Hospital Charge Code |
41641713
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.55
|
| Rate for Payer: Aetna Government |
$3.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$5.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.83
|
| Rate for Payer: Group Health Inc Commercial |
$3.55
|
| Rate for Payer: Group Health Inc Medicare |
$2.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.55
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.55
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.62
|
|
|
ZINC OXIDE OINT 40%
|
Facility
OP
|
$8.00
|
|
| Hospital Charge Code |
41656803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.00
|
| Rate for Payer: Aetna Government |
$4.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.20
|
|
|
ZINC OXIDE OINT 40%
|
Facility
OP
|
$8.00
|
|
| Hospital Charge Code |
41646803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$6.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.40
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.00
|
| Rate for Payer: Aetna Government |
$4.00
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.44
|
| Rate for Payer: Group Health Inc Commercial |
$4.00
|
| Rate for Payer: Group Health Inc Medicare |
$2.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.00
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.20
|
|
|
ZINC, PLASMA OR SERUM
|
Facility
OP
|
$28.48
|
|
|
Service Code
|
HCPCS 84630
|
| Hospital Charge Code |
40609131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$18.08 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$15.66
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$11.39
|
| Rate for Payer: Aetna Government |
$11.39
|
| Rate for Payer: Cash Price |
$11.39
|
| Rate for Payer: Cash Price |
$11.39
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$11.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$18.08
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$15.30
|
| Rate for Payer: Elderplan Medicare Advantage |
$11.39
|
| Rate for Payer: EmblemHealth Commercial |
$11.39
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$10.25
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$9.68
|
| Rate for Payer: Fidelis Essential Plan QHP |
$10.14
|
| Rate for Payer: Fidelis Medicare Advantage |
$11.39
|
| Rate for Payer: Fidelis Qualified Health Plan |
$10.14
|
| Rate for Payer: Group Health Inc Commercial |
$11.39
|
| Rate for Payer: Group Health Inc Medicare |
$11.39
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$14.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$11.39
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$11.39
|
| Rate for Payer: Healthfirst Medicare Advantage |
$11.39
|
| Rate for Payer: Healthfirst QHP |
$11.39
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$11.39
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.39
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$9.11
|
| Rate for Payer: Wellcare Medicare |
$10.25
|
|
|
ZINC PROTOPORPHYRIN (ZPP)
|
Facility
OP
|
$35.88
|
|
|
Service Code
|
HCPCS 84202
|
| Hospital Charge Code |
40609834
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.48 |
| Max. Negotiated Rate |
$22.79 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$19.73
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.35
|
| Rate for Payer: Aetna Government |
$14.35
|
| Rate for Payer: Cash Price |
$14.35
|
| Rate for Payer: Cash Price |
$14.35
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$14.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$22.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$19.28
|
| Rate for Payer: Elderplan Medicare Advantage |
$14.35
|
| Rate for Payer: EmblemHealth Commercial |
$14.35
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$12.92
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$12.20
|
| Rate for Payer: Fidelis Essential Plan QHP |
$12.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$14.35
|
| Rate for Payer: Fidelis Qualified Health Plan |
$12.77
|
| Rate for Payer: Group Health Inc Commercial |
$14.35
|
| Rate for Payer: Group Health Inc Medicare |
$14.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$17.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$14.35
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$14.35
|
| Rate for Payer: Healthfirst Medicare Advantage |
$14.35
|
| Rate for Payer: Healthfirst QHP |
$14.35
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$14.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$14.35
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$11.48
|
| Rate for Payer: Wellcare Medicare |
$12.92
|
|
|
ZINC SULFATE 220 MG CAP
|
Facility
OP
|
$0.04
|
|
| Hospital Charge Code |
41641233
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
ZINC SULFATE 220 MG CAP
|
Facility
OP
|
$0.04
|
|
| Hospital Charge Code |
41651233
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$0.03 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.02
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.02
|
| Rate for Payer: Aetna Government |
$0.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.03
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.03
|
| Rate for Payer: Group Health Inc Commercial |
$0.02
|
| Rate for Payer: Group Health Inc Medicare |
$0.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.02
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.03
|
|
|
ZINC SULFATE 25MG/5ML INJ
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
41645867
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
ZINC SULFATE 25MG/5ML INJ
|
Facility
OP
|
$5.00
|
|
| Hospital Charge Code |
41655867
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.75
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.50
|
| Rate for Payer: Aetna Government |
$2.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.40
|
| Rate for Payer: Group Health Inc Commercial |
$2.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.75
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.25
|
|
|
ZIPRASIDONE 20 MG CAP
|
Facility
OP
|
$15.09
|
|
| Hospital Charge Code |
41642824
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$12.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.54
|
| Rate for Payer: Aetna Government |
$7.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$7.54
|
| Rate for Payer: Group Health Inc Medicare |
$5.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.81
|
|
|
ZIPRASIDONE 20 MG CAP
|
Facility
OP
|
$15.09
|
|
| Hospital Charge Code |
41652824
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$12.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.54
|
| Rate for Payer: Aetna Government |
$7.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$7.54
|
| Rate for Payer: Group Health Inc Medicare |
$5.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.81
|
|
|
ZIPRASIDONE 40 MG CAP
|
Facility
OP
|
$15.09
|
|
| Hospital Charge Code |
41652825
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$12.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.54
|
| Rate for Payer: Aetna Government |
$7.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$7.54
|
| Rate for Payer: Group Health Inc Medicare |
$5.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.81
|
|
|
ZIPRASIDONE 40 MG CAP
|
Facility
OP
|
$15.09
|
|
| Hospital Charge Code |
41642825
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$12.07 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$8.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$7.54
|
| Rate for Payer: Aetna Government |
$7.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$12.07
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$10.26
|
| Rate for Payer: Group Health Inc Commercial |
$7.54
|
| Rate for Payer: Group Health Inc Medicare |
$5.28
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$7.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$7.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$9.81
|
|
|
ZIPRASIDONE 60 MG CAP
|
Facility
OP
|
$19.93
|
|
| Hospital Charge Code |
41655304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$15.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.96
|
| Rate for Payer: Aetna Government |
$9.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.55
|
| Rate for Payer: Group Health Inc Commercial |
$9.96
|
| Rate for Payer: Group Health Inc Medicare |
$6.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.95
|
|
|
ZIPRASIDONE 60 MG CAP
|
Facility
OP
|
$19.93
|
|
| Hospital Charge Code |
41645304
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$15.94 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$10.96
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$9.96
|
| Rate for Payer: Aetna Government |
$9.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$15.94
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$13.55
|
| Rate for Payer: Group Health Inc Commercial |
$9.96
|
| Rate for Payer: Group Health Inc Medicare |
$6.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.96
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.96
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$12.95
|
|
|
ZIPRASIDONE 80MG CAP
|
Facility
OP
|
$8.50
|
|
| Hospital Charge Code |
41653790
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$6.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.25
|
| Rate for Payer: Aetna Government |
$4.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.78
|
| Rate for Payer: Group Health Inc Commercial |
$4.25
|
| Rate for Payer: Group Health Inc Medicare |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.52
|
|
|
ZIPRASIDONE 80MG CAP
|
Facility
OP
|
$8.50
|
|
| Hospital Charge Code |
41643790
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$6.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.25
|
| Rate for Payer: Aetna Government |
$4.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.78
|
| Rate for Payer: Group Health Inc Commercial |
$4.25
|
| Rate for Payer: Group Health Inc Medicare |
$2.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.52
|
|
