St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

NICOTINE PATCH 21 MG/24 HR

Facility

$2.83

Hospital Charge Code	41651836
Hospital Revenue Code	250
Min. Negotiated Rate	$0.99
Max. Negotiated Rate	$2.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.42
Rate for Payer: Aetna Government	$1.42
Rate for Payer: Brighton Health Commercial	$2.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.26
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.92
Rate for Payer: Group Health Inc Commercial	$1.42
Rate for Payer: Group Health Inc Medicare	$0.99
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.42
Rate for Payer: Hamaspik Choice Inc Medicare	$1.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.84

NICOTINE POLACRILEX 2 MG MT GUM [10717]

Facility

$0.43

Service Code	NDC 00536136206
Hospital Charge Code	00536136206
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.21
Rate for Payer: Aetna Government	$0.21
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.29
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.28

NICOTINE POLACRILEX 2 MG MT GUM [10717]

Facility

$0.28

Service Code	NDC 00536136223
Hospital Charge Code	00536136223
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.19
Rate for Payer: Group Health Inc Commercial	$0.14
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.18

NICPTP 57MM 2-1/4 FLG 44MM 1-3/4

Facility

$9.60

Service Code	HCPCS A4409
Hospital Charge Code	40005160
Hospital Revenue Code	272
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$7.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.78
Rate for Payer: Aetna Government	$3.78
Rate for Payer: Brighton Health Commercial	$7.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.53
Rate for Payer: Group Health Inc Commercial	$4.80
Rate for Payer: Group Health Inc Medicare	$3.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.80
Rate for Payer: Hamaspik Choice Inc Medicare	$4.80

NICPTP 70MM 2-3/4 FLG 57MM 2-1/4

Facility

$15.98

Service Code	HCPCS A4407
Hospital Charge Code	40005161
Hospital Revenue Code	272
Min. Negotiated Rate	$5.32
Max. Negotiated Rate	$12.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.32
Rate for Payer: Aetna Government	$5.32
Rate for Payer: Brighton Health Commercial	$11.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.78
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.87
Rate for Payer: Group Health Inc Commercial	$7.99
Rate for Payer: Group Health Inc Medicare	$5.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.99
Rate for Payer: Hamaspik Choice Inc Medicare	$7.99

NI CVXCP TP70MM2-2/4FLG51MM2CTF

Facility

$5,526.00

Service Code	HCPCS Q4116
Hospital Charge Code	40005194
Hospital Revenue Code	272
Min. Negotiated Rate	$21.47
Max. Negotiated Rate	$4,420.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3,039.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$21.47
Rate for Payer: Aetna Government	$21.47
Rate for Payer: Brighton Health Commercial	$4,144.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4,420.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$3,757.68
Rate for Payer: Group Health Inc Commercial	$2,763.00
Rate for Payer: Group Health Inc Medicare	$1,934.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$2,763.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2,763.00

NI DRNPCH UCLR LNR 102MM 4 FLG

Facility

$11.82

Service Code	HCPCS A5063
Hospital Charge Code	40005179
Hospital Revenue Code	274
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$12.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.64
Rate for Payer: Aetna Government	$1.64
Rate for Payer: Brighton Health Commercial	$7.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.80
Rate for Payer: EmblemHealth Commercial	$5.91
Rate for Payer: Fidelis Medicare Advantage	$12.41
Rate for Payer: Group Health Inc Commercial	$5.91
Rate for Payer: Group Health Inc Medicare	$4.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.91
Rate for Payer: Hamaspik Choice Inc Medicare	$5.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.68

NI DRNPCH UCLR LNR 57MM 2-1/4FLG

Facility

$9.68

Service Code	HCPCS A5063
Hospital Charge Code	40005162
Hospital Revenue Code	274
Min. Negotiated Rate	$1.64
Max. Negotiated Rate	$10.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.64
Rate for Payer: Aetna Government	$1.64
Rate for Payer: Brighton Health Commercial	$5.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.57
Rate for Payer: EmblemHealth Commercial	$4.84
Rate for Payer: Fidelis Medicare Advantage	$10.16
Rate for Payer: Group Health Inc Commercial	$4.84
Rate for Payer: Group Health Inc Medicare	$3.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.84
Rate for Payer: Hamaspik Choice Inc Medicare	$4.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.29

NI DRNPCH UCLR LNR 70MM 2-3/4FLG

Facility

$9.68

Service Code	HCPCS A5062
Hospital Charge Code	40005163
Hospital Revenue Code	274
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$10.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.35
Rate for Payer: Aetna Government	$1.35
Rate for Payer: Brighton Health Commercial	$5.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.57
Rate for Payer: EmblemHealth Commercial	$4.84
Rate for Payer: Fidelis Medicare Advantage	$10.16
Rate for Payer: Group Health Inc Commercial	$4.84
Rate for Payer: Group Health Inc Medicare	$3.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.84
Rate for Payer: Hamaspik Choice Inc Medicare	$4.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.29

NIEMANN-PICK DISEASE

Facility

$117.50

Service Code	HCPCS 81330
Hospital Charge Code	40603052
Hospital Revenue Code	300
Min. Negotiated Rate	$32.90
Max. Negotiated Rate	$94.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$64.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$47.00
Rate for Payer: Aetna Government	$47.00
Rate for Payer: Affinity Essential Plan 1&2	$32.90
Rate for Payer: Affinity Essential Plan 3&4	$32.90
Rate for Payer: Affinity Medicaid/CHP/HARP	$32.90
Rate for Payer: Brighton Health Commercial	$88.12
Rate for Payer: Cash Price	$47.00
Rate for Payer: Cash Price	$47.00
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$47.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$94.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$79.90
Rate for Payer: Elderplan Medicare Advantage	$47.00
Rate for Payer: EmblemHealth Commercial	$47.00
Rate for Payer: Fidelis Essential Plan Aliesa	$39.95
Rate for Payer: Fidelis Essential Plan QHP	$41.83
Rate for Payer: Fidelis Medicare Advantage	$47.00
Rate for Payer: Fidelis Qualified Health Plan	$41.83
Rate for Payer: Group Health Inc Commercial	$47.00
Rate for Payer: Group Health Inc Medicare	$47.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$58.75
Rate for Payer: Hamaspik Choice Inc Medicare	$47.00
Rate for Payer: Healthfirst Medicare Advantage	$47.00
Rate for Payer: Healthfirst QHP	$47.00
Rate for Payer: Humana Medicare	$47.94
Rate for Payer: Senior Whole Health Medicare Advantage	$47.00
Rate for Payer: United Healthcare Commercial	$42.30
Rate for Payer: United Healthcare Medicare Advantage	$47.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$47.00
Rate for Payer: Wellcare CHP/FHP/Medicaid	$37.60
Rate for Payer: Wellcare Medicare	$42.30

NIEMANN-PICK DISEASE

Facility

$117.50

Service Code	HCPCS 81330
Hospital Charge Code	40603052
Hospital Revenue Code	300
Rate for Payer: Cash Price	$47.00

NIFEDIPINE 10 MG CAP

Facility

$1.38

Hospital Charge Code	41644715
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.69
Rate for Payer: Aetna Government	$0.69
Rate for Payer: Brighton Health Commercial	$1.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.94
Rate for Payer: Group Health Inc Commercial	$0.69
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.69
Rate for Payer: Hamaspik Choice Inc Medicare	$0.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.90

NIFEDIPINE 10 MG CAP

Facility

$1.38

Hospital Charge Code	41654715
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.69
Rate for Payer: Aetna Government	$0.69
Rate for Payer: Brighton Health Commercial	$1.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.94
Rate for Payer: Group Health Inc Commercial	$0.69
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.69
Rate for Payer: Hamaspik Choice Inc Medicare	$0.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.90

NIFEDIPINE 10 MG PO CAPS [5558]

Facility

$0.46

Service Code	NDC 23155019401
Hospital Charge Code	23155019401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.37
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
Rate for Payer: Brighton Health Commercial	$0.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.37
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.30

NIFEDIPINE 30 MG TAB CR

Facility

$1.23

Hospital Charge Code	41644011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.62
Rate for Payer: Aetna Government	$0.62
Rate for Payer: Brighton Health Commercial	$0.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.84
Rate for Payer: Group Health Inc Commercial	$0.62
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.62
Rate for Payer: Hamaspik Choice Inc Medicare	$0.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.80

NIFEDIPINE 30 MG TAB CR

Facility

$1.23

Hospital Charge Code	41654011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.62
Rate for Payer: Aetna Government	$0.62
Rate for Payer: Brighton Health Commercial	$0.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.84
Rate for Payer: Group Health Inc Commercial	$0.62
Rate for Payer: Group Health Inc Medicare	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.62
Rate for Payer: Hamaspik Choice Inc Medicare	$0.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.80

NIFEDIPINE 60 MG TAB CR

Facility

$2.36

Hospital Charge Code	41654012
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$1.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.18
Rate for Payer: Aetna Government	$1.18
Rate for Payer: Brighton Health Commercial	$1.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.60
Rate for Payer: Group Health Inc Commercial	$1.18
Rate for Payer: Group Health Inc Medicare	$0.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.18
Rate for Payer: Hamaspik Choice Inc Medicare	$1.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.53

NIFEDIPINE 60 MG TAB CR

Facility

$2.36

Hospital Charge Code	41644012
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$1.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.18
Rate for Payer: Aetna Government	$1.18
Rate for Payer: Brighton Health Commercial	$1.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.60
Rate for Payer: Group Health Inc Commercial	$1.18
Rate for Payer: Group Health Inc Medicare	$0.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.18
Rate for Payer: Hamaspik Choice Inc Medicare	$1.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.53

NIFEDIPINE 90 MG TAB CR

Facility

$3.64

Hospital Charge Code	41654013
Hospital Revenue Code	250
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$2.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.82
Rate for Payer: Aetna Government	$1.82
Rate for Payer: Brighton Health Commercial	$2.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.48
Rate for Payer: Group Health Inc Commercial	$1.82
Rate for Payer: Group Health Inc Medicare	$1.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.82
Rate for Payer: Hamaspik Choice Inc Medicare	$1.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.37

NIFEDIPINE 90 MG TAB CR

Facility

$3.64

Hospital Charge Code	41644013
Hospital Revenue Code	250
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$2.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.82
Rate for Payer: Aetna Government	$1.82
Rate for Payer: Brighton Health Commercial	$2.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.91
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.48
Rate for Payer: Group Health Inc Commercial	$1.82
Rate for Payer: Group Health Inc Medicare	$1.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.82
Rate for Payer: Hamaspik Choice Inc Medicare	$1.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.37

NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24 [28643]

Facility

$1.34

Service Code	NDC 62175026037
Hospital Charge Code	62175026037
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$1.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.67
Rate for Payer: Aetna Government	$0.67
Rate for Payer: Brighton Health Commercial	$1.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.07
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.91
Rate for Payer: Group Health Inc Commercial	$0.67
Rate for Payer: Group Health Inc Medicare	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.67
Rate for Payer: Hamaspik Choice Inc Medicare	$0.67
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.87

NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24 [28643]

Facility

$1.31

Service Code	NDC 50268059715
Hospital Charge Code	50268059715
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$1.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.66
Rate for Payer: Aetna Government	$0.66
Rate for Payer: Brighton Health Commercial	$0.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.89
Rate for Payer: Group Health Inc Commercial	$0.66
Rate for Payer: Group Health Inc Medicare	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.66
Rate for Payer: Hamaspik Choice Inc Medicare	$0.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.85

NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24 [28643]

Facility

$1.33

Service Code	NDC 50742026001
Hospital Charge Code	50742026001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$1.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.66
Rate for Payer: Aetna Government	$0.66
Rate for Payer: Brighton Health Commercial	$0.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.90
Rate for Payer: Group Health Inc Commercial	$0.66
Rate for Payer: Group Health Inc Medicare	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.66
Rate for Payer: Hamaspik Choice Inc Medicare	$0.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.86

NIFEDIPINE ER OSMOTIC RELEASE 30 MG PO TB24 [28643]

Facility

$1.31

Service Code	NDC 50742026003
Hospital Charge Code	50742026003
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$1.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.66
Rate for Payer: Aetna Government	$0.66
Rate for Payer: Brighton Health Commercial	$0.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.89
Rate for Payer: Group Health Inc Commercial	$0.66
Rate for Payer: Group Health Inc Medicare	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.66
Rate for Payer: Hamaspik Choice Inc Medicare	$0.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.85

NIFEDIPINE ER OSMOTIC RELEASE 60 MG PO TB24 [27659]

Facility

$3.50

Service Code	NDC 00904708161
Hospital Charge Code	00904708161
Hospital Revenue Code	250
Min. Negotiated Rate	$1.22
Max. Negotiated Rate	$2.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.75
Rate for Payer: Aetna Government	$1.75
Rate for Payer: Brighton Health Commercial	$2.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.38
Rate for Payer: Group Health Inc Commercial	$1.75
Rate for Payer: Group Health Inc Medicare	$1.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.75
Rate for Payer: Hamaspik Choice Inc Medicare	$1.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.27

Know your out-of-pocket cost for care.

All Charges