St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ROSIGLITAZONE 2 MG TAB

Facility

$6.00

Hospital Charge Code	41642331
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

ROSIGLITAZONE 4 MG TAB

Facility

$8.00

Hospital Charge Code	41652328
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

ROSIGLITAZONE 4 MG TAB

Facility

$8.00

Hospital Charge Code	41642328
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

ROSIGLITAZONE 8 MG TAB

Facility

$15.00

Hospital Charge Code	41642332
Hospital Revenue Code	250
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$12.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.50
Rate for Payer: Aetna Government	$7.50
Rate for Payer: Brighton Health Commercial	$11.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.20
Rate for Payer: Group Health Inc Commercial	$7.50
Rate for Payer: Group Health Inc Medicare	$5.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.50
Rate for Payer: Hamaspik Choice Inc Medicare	$7.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.75

ROSIGLITAZONE 8 MG TAB

Facility

$15.00

Hospital Charge Code	41652332
Hospital Revenue Code	250
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$12.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.50
Rate for Payer: Aetna Government	$7.50
Rate for Payer: Brighton Health Commercial	$11.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.20
Rate for Payer: Group Health Inc Commercial	$7.50
Rate for Payer: Group Health Inc Medicare	$5.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.50
Rate for Payer: Hamaspik Choice Inc Medicare	$7.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.75

ROSUVASTATIN 10 MG TAB

Facility

$1.58

Hospital Charge Code	41655410
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$1.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Brighton Health Commercial	$1.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.07
Rate for Payer: Group Health Inc Commercial	$0.79
Rate for Payer: Group Health Inc Medicare	$0.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.79
Rate for Payer: Hamaspik Choice Inc Medicare	$0.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.03

ROSUVASTATIN 10 MG TAB

Facility

$1.58

Hospital Charge Code	41645410
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$1.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Brighton Health Commercial	$1.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.07
Rate for Payer: Group Health Inc Commercial	$0.79
Rate for Payer: Group Health Inc Medicare	$0.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.79
Rate for Payer: Hamaspik Choice Inc Medicare	$0.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.03

ROSUVASTATIN 20 MG TAB

Facility

$1.58

Hospital Charge Code	41655411
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$1.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Brighton Health Commercial	$1.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.07
Rate for Payer: Group Health Inc Commercial	$0.79
Rate for Payer: Group Health Inc Medicare	$0.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.79
Rate for Payer: Hamaspik Choice Inc Medicare	$0.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.03

ROSUVASTATIN 20 MG TAB

Facility

$1.58

Hospital Charge Code	41645411
Hospital Revenue Code	250
Min. Negotiated Rate	$0.55
Max. Negotiated Rate	$1.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.79
Rate for Payer: Aetna Government	$0.79
Rate for Payer: Brighton Health Commercial	$1.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.07
Rate for Payer: Group Health Inc Commercial	$0.79
Rate for Payer: Group Health Inc Medicare	$0.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.79
Rate for Payer: Hamaspik Choice Inc Medicare	$0.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.03

ROSUVASTATIN 40 MG TAB

Facility

$1.59

Hospital Charge Code	41645412
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.80
Rate for Payer: Aetna Government	$0.80
Rate for Payer: Brighton Health Commercial	$1.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.08
Rate for Payer: Group Health Inc Commercial	$0.80
Rate for Payer: Group Health Inc Medicare	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80
Rate for Payer: Hamaspik Choice Inc Medicare	$0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.03

ROSUVASTATIN 40 MG TAB

Facility

$1.59

Hospital Charge Code	41655412
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.80
Rate for Payer: Aetna Government	$0.80
Rate for Payer: Brighton Health Commercial	$1.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.08
Rate for Payer: Group Health Inc Commercial	$0.80
Rate for Payer: Group Health Inc Medicare	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80
Rate for Payer: Hamaspik Choice Inc Medicare	$0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.03

ROSUVASTATIN 5 MG TAB

Facility

$1.59

Hospital Charge Code	41655409
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.80
Rate for Payer: Aetna Government	$0.80
Rate for Payer: Brighton Health Commercial	$1.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.08
Rate for Payer: Group Health Inc Commercial	$0.80
Rate for Payer: Group Health Inc Medicare	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80
Rate for Payer: Hamaspik Choice Inc Medicare	$0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.03

ROSUVASTATIN 5 MG TAB

Facility

$1.59

Hospital Charge Code	41645409
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.80
Rate for Payer: Aetna Government	$0.80
Rate for Payer: Brighton Health Commercial	$1.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.08
Rate for Payer: Group Health Inc Commercial	$0.80
Rate for Payer: Group Health Inc Medicare	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80
Rate for Payer: Hamaspik Choice Inc Medicare	$0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.03

ROSUVASTATIN CALCIUM 10 MG PO TABS [35134]

Facility

$8.95

Service Code	NDC 16729028515
Hospital Charge Code	16729028515
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: 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 10 MG PO TABS [35134]

Facility

$1.44

Service Code	NDC 00781540192
Hospital Charge Code	00781540192
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$1.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.72
Rate for Payer: Aetna Government	$0.72
Rate for Payer: Brighton Health Commercial	$1.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.98
Rate for Payer: Group Health Inc Commercial	$0.72
Rate for Payer: Group Health Inc Medicare	$0.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.72
Rate for Payer: Hamaspik Choice Inc Medicare	$0.72
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.94

ROSUVASTATIN CALCIUM 10 MG PO TABS [35134]

Facility

$8.95

Service Code	NDC 47335058381
Hospital Charge Code	47335058381
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: 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 10 MG PO TABS [35134]

Facility

$8.95

Service Code	NDC 57237016999
Hospital Charge Code	57237016999
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: 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 10 MG PO TABS [35134]

Facility

$8.95

Service Code	NDC 68462026290
Hospital Charge Code	68462026290
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: 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 20 MG PO TABS [35135]

Facility

$8.95

Service Code	NDC 27808015701
Hospital Charge Code	27808015701
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: 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 20 MG PO TABS [35135]

Facility

$8.95

Service Code	NDC 72205000490
Hospital Charge Code	72205000490
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: 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 20 MG PO TABS [35135]

Facility

$8.95

Service Code	NDC 72205000499
Hospital Charge Code	72205000499
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: 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 20 MG PO TABS [35135]

Facility

$8.93

Service Code	NDC 70377000812
Hospital Charge Code	70377000812
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$7.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.47
Rate for Payer: Aetna Government	$4.47
Rate for Payer: Brighton Health Commercial	$6.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.08
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 20 MG PO TABS [35135]

Facility

$8.95

Service Code	NDC 65862029590
Hospital Charge Code	65862029590
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: 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 20 MG PO TABS [35135]

Facility

$8.95

Service Code	NDC 68462026390
Hospital Charge Code	68462026390
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: 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 20 MG PO TABS [35135]

Facility

$8.95

Service Code	NDC 47335058481
Hospital Charge Code	47335058481
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: 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

Know your out-of-pocket cost for care.

All Charges