St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

$8.93

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 40 MG PO TABS [35136]

Facility

$8.95

Service Code	NDC 72205000590
Hospital Charge Code	72205000590
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 40 MG PO TABS [35136]

Facility

$8.95

Service Code	NDC 68462026405
Hospital Charge Code	68462026405
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 40 MG PO TABS [35136]

Facility

$8.95

Service Code	NDC 57237017190
Hospital Charge Code	57237017190
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 40 MG PO TABS [35136]

Facility

$8.95

Service Code	NDC 16729028715
Hospital Charge Code	16729028715
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 40 MG PO TABS [35136]

Facility

$1.59

Service Code	NDC 50268071115
Hospital Charge Code	50268071115
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	$0.79
Rate for Payer: Aetna Government	$0.79
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	$0.79
Rate for Payer: Group Health Inc Medicare	$0.56
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 CALCIUM 40 MG PO TABS [35136]

Facility

$8.95

Service Code	NDC 47335058583
Hospital Charge Code	47335058583
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 40 MG PO TABS [35136]

Facility

$8.95

Service Code	NDC 16729028710
Hospital Charge Code	16729028710
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 40 MG PO TABS [35136]

Facility

$8.95

Service Code	NDC 57237017105
Hospital Charge Code	57237017105
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 40 MG PO TABS [35136]

Facility

$8.94

Service Code	NDC 31722088530
Hospital Charge Code	31722088530
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 40 MG PO TABS [35136]

Facility

$1.44

Service Code	NDC 00781540331
Hospital Charge Code	00781540331
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 5 MG PO TABS [36612]

Facility

$8.95

Service Code	NDC 47335058281
Hospital Charge Code	47335058281
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 5 MG PO TABS [36612]

Facility

$8.95

Service Code	NDC 72205002790
Hospital Charge Code	72205002790
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 5 MG PO TABS [36612]

Facility

$8.95

Service Code	NDC 68462026190
Hospital Charge Code	68462026190
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 5 MG PO TABS [36612]

Facility

$1.20

Service Code	NDC 00904677861
Hospital Charge Code	00904677861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.60
Rate for Payer: Aetna Government	$0.60
Rate for Payer: Brighton Health Commercial	$0.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.82
Rate for Payer: Group Health Inc Commercial	$0.60
Rate for Payer: Group Health Inc Medicare	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.60
Rate for Payer: Hamaspik Choice Inc Medicare	$0.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.78

ROSUVASTATIN CALCIUM 5 MG PO TABS [36612]

Facility

$8.95

Service Code	NDC 27808015501
Hospital Charge Code	27808015501
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 5 MG PO TABS [36612]

Facility

$8.95

Service Code	NDC 65862029390
Hospital Charge Code	65862029390
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

ROTATABLE SNARE 13MM

Facility

$770.00

Hospital Charge Code	40209775
Hospital Revenue Code	270
Min. Negotiated Rate	$269.50
Max. Negotiated Rate	$616.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$423.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$385.00
Rate for Payer: Aetna Government	$385.00
Rate for Payer: Brighton Health Commercial	$577.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$616.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$523.60
Rate for Payer: Group Health Inc Commercial	$385.00
Rate for Payer: Group Health Inc Medicare	$269.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$385.00
Rate for Payer: Hamaspik Choice Inc Medicare	$385.00

ROTATOR CUFF REPAIR SHOULDER

Facility

$18,117.83

Service Code	HCPCS 23420
Hospital Charge Code	40024294
Hospital Revenue Code	360
Rate for Payer: Cash Price	$8,273.12

ROTATOR CUFF REPAIR SHOULDER

Facility

$18,117.83

Service Code	HCPCS 23420
Hospital Charge Code	40024294
Hospital Revenue Code	360
Min. Negotiated Rate	$1,505.00
Max. Negotiated Rate	$13,588.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4,065.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8,273.12
Rate for Payer: Aetna Government	$8,273.12
Rate for Payer: Affinity Essential Plan 1&2	$5,791.18
Rate for Payer: Affinity Essential Plan 3&4	$5,791.18
Rate for Payer: Affinity Medicaid/CHP/HARP	$5,791.18
Rate for Payer: Brighton Health Commercial	$13,588.37
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Cash Price	$8,273.12
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$8,273.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$8,273.12
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$7,032.15
Rate for Payer: Fidelis Essential Plan QHP	$7,363.08
Rate for Payer: Fidelis Medicare Advantage	$8,273.12
Rate for Payer: Fidelis Qualified Health Plan	$7,363.08
Rate for Payer: Group Health Inc Commercial	$8,273.12
Rate for Payer: Group Health Inc Medicare	$8,273.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$9,058.92
Rate for Payer: Hamaspik Choice Inc Medicare	$8,273.12
Rate for Payer: Healthfirst Medicare Advantage	$7,032.15
Rate for Payer: Healthfirst QHP	$8,273.12
Rate for Payer: Humana Medicare	$8,438.58
Rate for Payer: Senior Whole Health Medicare Advantage	$8,273.12
Rate for Payer: United Healthcare Commercial	$2,683.00
Rate for Payer: United Healthcare Medicare Advantage	$8,273.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8,273.12
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6,618.50
Rate for Payer: Wellcare Medicare	$7,859.46

ROTAVIRUS

Facility

$29.95

Service Code	HCPCS 87425
Hospital Charge Code	40728145
Hospital Revenue Code	300
Rate for Payer: Cash Price	$11.98

ROTAVIRUS

Facility

$29.95

Service Code	HCPCS 87425
Hospital Charge Code	40728145
Hospital Revenue Code	300
Min. Negotiated Rate	$8.39
Max. Negotiated Rate	$22.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.98
Rate for Payer: Aetna Government	$11.98
Rate for Payer: Affinity Essential Plan 1&2	$8.39
Rate for Payer: Affinity Essential Plan 3&4	$8.39
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.39
Rate for Payer: Brighton Health Commercial	$22.46
Rate for Payer: Cash Price	$11.98
Rate for Payer: Cash Price	$11.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$11.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.13
Rate for Payer: Elderplan Medicare Advantage	$11.98
Rate for Payer: EmblemHealth Commercial	$11.98
Rate for Payer: Fidelis Essential Plan Aliesa	$10.18
Rate for Payer: Fidelis Essential Plan QHP	$10.66
Rate for Payer: Fidelis Medicare Advantage	$11.98
Rate for Payer: Fidelis Qualified Health Plan	$10.66
Rate for Payer: Group Health Inc Commercial	$11.98
Rate for Payer: Group Health Inc Medicare	$11.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.98
Rate for Payer: Hamaspik Choice Inc Medicare	$11.98
Rate for Payer: Healthfirst Medicare Advantage	$11.98
Rate for Payer: Healthfirst QHP	$11.98
Rate for Payer: Humana Medicare	$12.22
Rate for Payer: Senior Whole Health Medicare Advantage	$11.98
Rate for Payer: United Healthcare Commercial	$15.19
Rate for Payer: United Healthcare Medicare Advantage	$11.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.58
Rate for Payer: Wellcare Medicare	$10.78

ROTAVIRUS AG EIA

Facility

$29.95

Service Code	HCPCS 87425
Hospital Charge Code	40619710
Hospital Revenue Code	306
Rate for Payer: Cash Price	$11.98

ROTAVIRUS AG EIA

Facility

$29.95

Service Code	HCPCS 87425
Hospital Charge Code	40619710
Hospital Revenue Code	306
Min. Negotiated Rate	$8.39
Max. Negotiated Rate	$22.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.98
Rate for Payer: Aetna Government	$11.98
Rate for Payer: Affinity Essential Plan 1&2	$8.39
Rate for Payer: Affinity Essential Plan 3&4	$8.39
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.39
Rate for Payer: Brighton Health Commercial	$22.46
Rate for Payer: Cash Price	$11.98
Rate for Payer: Cash Price	$11.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$11.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.13
Rate for Payer: Elderplan Medicare Advantage	$11.98
Rate for Payer: EmblemHealth Commercial	$11.98
Rate for Payer: Fidelis Essential Plan Aliesa	$10.18
Rate for Payer: Fidelis Essential Plan QHP	$10.66
Rate for Payer: Fidelis Medicare Advantage	$11.98
Rate for Payer: Fidelis Qualified Health Plan	$10.66
Rate for Payer: Group Health Inc Commercial	$11.98
Rate for Payer: Group Health Inc Medicare	$11.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.98
Rate for Payer: Hamaspik Choice Inc Medicare	$11.98
Rate for Payer: Healthfirst Medicare Advantage	$11.98
Rate for Payer: Healthfirst QHP	$11.98
Rate for Payer: Humana Medicare	$12.22
Rate for Payer: Senior Whole Health Medicare Advantage	$11.98
Rate for Payer: United Healthcare Commercial	$15.19
Rate for Payer: United Healthcare Medicare Advantage	$11.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.58
Rate for Payer: Wellcare Medicare	$10.78

Know your out-of-pocket cost for care.

All Charges