St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ROSUVASTATIN CALCIUM 5 MG PO TABS

Facility

$8.95

Service Code	NDC 6846226190
Hospital Charge Code	6846226190
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$7.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.47
Rate for Payer: Aetna Government	$4.47
Rate for Payer: Brighton Health Commercial	$6.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.08
Rate for Payer: EmblemHealth Commercial	$4.47
Rate for Payer: Group Health Inc Commercial	$4.47
Rate for Payer: Group Health Inc Medicare	$3.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.47
Rate for Payer: Hamaspik Choice Inc Medicare	$4.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.81

ROSUVASTATIN CALCIUM 5 MG PO TABS

Facility

$8.95

Service Code	NDC 6586229390
Hospital Charge Code	6586229390
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$7.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.47
Rate for Payer: Aetna Government	$4.47
Rate for Payer: Brighton Health Commercial	$6.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.08
Rate for Payer: EmblemHealth Commercial	$4.47
Rate for Payer: Group Health Inc Commercial	$4.47
Rate for Payer: Group Health Inc Medicare	$3.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.47
Rate for Payer: Hamaspik Choice Inc Medicare	$4.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.81

ROSUVASTATIN CALCIUM 5 MG PO TABS

Facility

$8.95

Service Code	NDC 6586229390
Hospital Charge Code	6586229390
Hospital Revenue Code	250
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$4.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.47

ROSUVASTATIN CALCIUM 5 MG PO TABS

Facility

$8.95

Service Code	NDC 7037700612
Hospital Charge Code	7037700612
Hospital Revenue Code	250
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$4.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.47

ROSUVASTATIN CALCIUM 5 MG PO TABS

Facility

$8.95

Service Code	NDC 4733558281
Hospital Charge Code	4733558281
Hospital Revenue Code	250
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$4.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.47

ROSUVASTATIN CALCIUM 5 MG PO TABS

Facility

$8.95

Service Code	NDC 6846226190
Hospital Charge Code	6846226190
Hospital Revenue Code	250
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$4.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.47

ROSUVASTATIN CALCIUM 5 MG PO TABS

Facility

$8.95

Service Code	NDC 7220502790
Hospital Charge Code	7220502790
Hospital Revenue Code	250
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$4.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.47

ROSUVASTATIN CALCIUM 5 MG PO TABS

Facility

$8.95

Service Code	NDC 2780815501
Hospital Charge Code	2780815501
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$7.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.47
Rate for Payer: Aetna Government	$4.47
Rate for Payer: Brighton Health Commercial	$6.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.08
Rate for Payer: EmblemHealth Commercial	$4.47
Rate for Payer: Group Health Inc Commercial	$4.47
Rate for Payer: Group Health Inc Medicare	$3.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.47
Rate for Payer: Hamaspik Choice Inc Medicare	$4.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.81

ROSUVASTATIN CALCIUM 5 MG PO TABS

Facility

$8.95

Service Code	NDC 7220502790
Hospital Charge Code	7220502790
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$7.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.47
Rate for Payer: Aetna Government	$4.47
Rate for Payer: Brighton Health Commercial	$6.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.08
Rate for Payer: EmblemHealth Commercial	$4.47
Rate for Payer: Group Health Inc Commercial	$4.47
Rate for Payer: Group Health Inc Medicare	$3.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.47
Rate for Payer: Hamaspik Choice Inc Medicare	$4.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.81

ROSUVASTATIN CALCIUM 5 MG PO TABS

Facility

$8.95

Service Code	NDC 4733558281
Hospital Charge Code	4733558281
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$7.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.47
Rate for Payer: Aetna Government	$4.47
Rate for Payer: Brighton Health Commercial	$6.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.08
Rate for Payer: EmblemHealth Commercial	$4.47
Rate for Payer: Group Health Inc Commercial	$4.47
Rate for Payer: Group Health Inc Medicare	$3.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.47
Rate for Payer: Hamaspik Choice Inc Medicare	$4.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.81

ROSUVASTATIN CALCIUM 5 MG PO TABS

Facility

$8.95

Service Code	NDC 7037700612
Hospital Charge Code	7037700612
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$7.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.47
Rate for Payer: Aetna Government	$4.47
Rate for Payer: Brighton Health Commercial	$6.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.08
Rate for Payer: EmblemHealth Commercial	$4.47
Rate for Payer: Group Health Inc Commercial	$4.47
Rate for Payer: Group Health Inc Medicare	$3.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.47
Rate for Payer: Hamaspik Choice Inc Medicare	$4.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.81

ROSUVASTATIN CALCIUM 5 MG PO TABS

Facility

$8.95

Service Code	NDC 2780815501
Hospital Charge Code	2780815501
Hospital Revenue Code	250
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$4.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.47

ROTAVIRUS VACCINE LIVE ORAL PO SUSP

Facility

$110.89

Service Code	NDC 5816074021
Hospital Charge Code	5816074021
Hospital Revenue Code	250
Min. Negotiated Rate	$55.45
Max. Negotiated Rate	$55.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.45

ROTAVIRUS VACCINE LIVE ORAL PO SUSP

Facility

$110.89

Service Code	NDC 5816074021
Hospital Charge Code	5816074021
Hospital Revenue Code	250
Min. Negotiated Rate	$38.81
Max. Negotiated Rate	$88.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$60.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$55.45
Rate for Payer: Aetna Government	$55.45
Rate for Payer: Brighton Health Commercial	$83.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$88.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$75.41
Rate for Payer: EmblemHealth Commercial	$55.45
Rate for Payer: Group Health Inc Commercial	$55.45
Rate for Payer: Group Health Inc Medicare	$38.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$55.45
Rate for Payer: Hamaspik Choice Inc Medicare	$55.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$72.08

ROTAVIRUS VAC LIVE PENTAVALENT PO SOLN

Facility

$57.50

Service Code	NDC 0006404741
Hospital Charge Code	0006404741
Hospital Revenue Code	250
Min. Negotiated Rate	$20.13
Max. Negotiated Rate	$46.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$31.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$28.75
Rate for Payer: Aetna Government	$28.75
Rate for Payer: Brighton Health Commercial	$43.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$46.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$39.10
Rate for Payer: EmblemHealth Commercial	$28.75
Rate for Payer: Group Health Inc Commercial	$28.75
Rate for Payer: Group Health Inc Medicare	$20.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.75
Rate for Payer: Hamaspik Choice Inc Medicare	$28.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$37.38

ROTAVIRUS VAC LIVE PENTAVALENT PO SOLN

Facility

$57.50

Service Code	NDC 0006404741
Hospital Charge Code	0006404741
Hospital Revenue Code	250
Min. Negotiated Rate	$28.75
Max. Negotiated Rate	$28.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$28.75

ROUTINE PRENATAL CARE

Facility

$234.61

Service Code	EAPG 00766
Min. Negotiated Rate	$171.26
Max. Negotiated Rate	$234.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$171.26
Rate for Payer: Healthfirst Commercial	$234.61

RSVPREF3 VAC RECOMB ADJUVANTED 120 MCG/0.5ML IM SUSR

Facility

$336.00

Service Code	NDC 5816084811
Hospital Charge Code	5816084811
Hospital Revenue Code	250
Min. Negotiated Rate	$117.60
Max. Negotiated Rate	$268.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$184.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$168.00
Rate for Payer: Aetna Government	$168.00
Rate for Payer: Brighton Health Commercial	$252.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$268.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$228.48
Rate for Payer: EmblemHealth Commercial	$168.00
Rate for Payer: Group Health Inc Commercial	$168.00
Rate for Payer: Group Health Inc Medicare	$117.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.00
Rate for Payer: Hamaspik Choice Inc Medicare	$168.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$218.40

RSVPREF3 VAC RECOMB ADJUVANTED 120 MCG/0.5ML IM SUSR

Facility

$336.00

Service Code	NDC 5816084811
Hospital Charge Code	5816084811
Hospital Revenue Code	250
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$168.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$168.00

RSV PRE-FUSION F A&B VAC RCMB 120 MCG/0.5ML IM SOLR

Facility

$354.00

Service Code	NDC 0069034405
Hospital Charge Code	0069034405
Hospital Revenue Code	250
Min. Negotiated Rate	$123.90
Max. Negotiated Rate	$283.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$194.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$177.00
Rate for Payer: Aetna Government	$177.00
Rate for Payer: Brighton Health Commercial	$265.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$283.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$240.72
Rate for Payer: EmblemHealth Commercial	$177.00
Rate for Payer: Group Health Inc Commercial	$177.00
Rate for Payer: Group Health Inc Medicare	$123.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.00
Rate for Payer: Hamaspik Choice Inc Medicare	$177.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$230.10

RSV PRE-FUSION F A&B VAC RCMB 120 MCG/0.5ML IM SOLR

Facility

$354.00

Service Code	NDC 0069034401
Hospital Charge Code	0069034401
Hospital Revenue Code	250
Min. Negotiated Rate	$123.90
Max. Negotiated Rate	$283.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$194.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$177.00
Rate for Payer: Aetna Government	$177.00
Rate for Payer: Brighton Health Commercial	$265.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$283.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$240.72
Rate for Payer: EmblemHealth Commercial	$177.00
Rate for Payer: Group Health Inc Commercial	$177.00
Rate for Payer: Group Health Inc Medicare	$123.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.00
Rate for Payer: Hamaspik Choice Inc Medicare	$177.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$230.10

RSV PRE-FUSION F A&B VAC RCMB 120 MCG/0.5ML IM SOLR

Facility

$354.00

Service Code	NDC 0069034401
Hospital Charge Code	0069034401
Hospital Revenue Code	250
Min. Negotiated Rate	$177.00
Max. Negotiated Rate	$177.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.00

RSV PRE-FUSION F A&B VAC RCMB 120 MCG/0.5ML IM SOLR

Facility

$354.00

Service Code	NDC 0069034405
Hospital Charge Code	0069034405
Hospital Revenue Code	250
Min. Negotiated Rate	$177.00
Max. Negotiated Rate	$177.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$177.00

SACCHAROMYCES BOULARDII 250 MG PO CAPS

Facility

$0.84

Service Code	NDC 0904723006
Hospital Charge Code	0904723006
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$0.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.57
Rate for Payer: EmblemHealth Commercial	$0.42
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.55

SACCHAROMYCES BOULARDII 250 MG PO CAPS

Facility

$0.99

Service Code	NDC 0414200007
Hospital Charge Code	0414200007
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.79
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	$0.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.67
Rate for Payer: EmblemHealth Commercial	$0.50
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	$0.64

Know your out-of-pocket cost for care.

All Charges