St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ZINC OXIDE 40 % EX OINT [19672]

Facility

$0.06

Service Code	NDC 00363714201
Hospital Charge Code	00363714201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.05
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	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
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	$0.04

ZINC OXIDE 40 % EX PSTE [111153]

Facility

$0.11

Service Code	NDC 69968006101
Hospital Charge Code	69968006101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.09
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	$0.09
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

ZINC OXIDE-COD LIVER OIL-VIT A OINT 30 G

Facility

$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: Brighton Health Commercial	$5.32
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

$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: Brighton Health Commercial	$5.32
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

$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: Brighton Health Commercial	$6.00
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

$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: Brighton Health Commercial	$6.00
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

$28.48

Service Code	HCPCS 84630
Hospital Charge Code	40609131
Hospital Revenue Code	300
Rate for Payer: Cash Price	$11.39

ZINC, PLASMA OR SERUM

Facility

$28.48

Service Code	HCPCS 84630
Hospital Charge Code	40609131
Hospital Revenue Code	300
Min. Negotiated Rate	$9.11
Max. Negotiated Rate	$21.36
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: Brighton Health Commercial	$21.36
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 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 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

$35.88

Service Code	HCPCS 84202
Hospital Charge Code	40609834
Hospital Revenue Code	301
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$26.91
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: Brighton Health Commercial	$26.91
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 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 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 PROTOPORPHYRIN (ZPP)

Facility

$35.88

Service Code	HCPCS 84202
Hospital Charge Code	40609834
Hospital Revenue Code	301
Rate for Payer: Cash Price	$14.35

ZINC SULFATE 220 MG CAP

Facility

$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: Brighton Health Commercial	$0.03
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

$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: Brighton Health Commercial	$0.03
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

$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: Brighton Health Commercial	$3.75
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

$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: Brighton Health Commercial	$3.75
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

$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: Brighton Health Commercial	$11.32
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

$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: Brighton Health Commercial	$11.32
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

$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: Brighton Health Commercial	$11.32
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

$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: Brighton Health Commercial	$11.32
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

$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: Brighton Health Commercial	$14.95
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

$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: Brighton Health Commercial	$14.95
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

$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: Brighton Health Commercial	$6.38
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

$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: Brighton Health Commercial	$6.38
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 HCL 20 MG PO CAPS [29778]

Facility

$8.96

Service Code	NDC 00904626908
Hospital Charge Code	00904626908
Hospital Revenue Code	250
Min. Negotiated Rate	$3.14
Max. Negotiated Rate	$7.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.48
Rate for Payer: Aetna Government	$4.48
Rate for Payer: Brighton Health Commercial	$6.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.10
Rate for Payer: Group Health Inc Commercial	$4.48
Rate for Payer: Group Health Inc Medicare	$3.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.48
Rate for Payer: Hamaspik Choice Inc Medicare	$4.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.83

ZIPRASIDONE HCL 20 MG PO CAPS [29778]

Facility

$8.00

Service Code	NDC 33342014409
Hospital Charge Code	33342014409
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: Brighton Health Commercial	$6.00
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

ZIPRASIDONE HCL 20 MG PO CAPS [29778]

Facility

$3.34

Service Code	NDC 63739098832
Hospital Charge Code	63739098832
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$2.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.67
Rate for Payer: Aetna Government	$1.67
Rate for Payer: Brighton Health Commercial	$2.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.67
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.27
Rate for Payer: Group Health Inc Commercial	$1.67
Rate for Payer: Group Health Inc Medicare	$1.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.67
Rate for Payer: Hamaspik Choice Inc Medicare	$1.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.17

Know your out-of-pocket cost for care.

All Charges