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Charge
Type
Price
zoster vaccine, inactivated adjuvanted REC[CQCH]
Facility IP
$133.99
Service Code
NDC 58160082311
Hospital Charge Code
136004511
Hospital Revenue Code
250
Min. Negotiated Rate
$34.84
Max. Negotiated Rate
$120.59
Rate for Payer: Aetna of AZ Commercial
$120.59
Rate for Payer: Bisbee Police All Plans
$34.84
Rate for Payer: Cash Price
$107.19
Rate for Payer: Self Pay Self Pay
$107.19
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