St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

NITROFURANTOIN MACROCRYSTAL 50 MG PO CAPS [5595]

Facility

$2.13

Service Code	NDC 00115164301
Hospital Charge Code	00115164301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$1.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.07
Rate for Payer: Aetna Government	$1.07
Rate for Payer: Brighton Health Commercial	$1.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.45
Rate for Payer: Group Health Inc Commercial	$1.07
Rate for Payer: Group Health Inc Medicare	$0.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.07
Rate for Payer: Hamaspik Choice Inc Medicare	$1.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.39

NITROFURANTOIN MONOHYD MACRO 100 MG PO CAPS [10724]

Facility

$4.29

Service Code	NDC 50268062511
Hospital Charge Code	50268062511
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$3.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.14
Rate for Payer: Aetna Government	$2.14
Rate for Payer: Brighton Health Commercial	$3.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.91
Rate for Payer: Group Health Inc Commercial	$2.14
Rate for Payer: Group Health Inc Medicare	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.14
Rate for Payer: Hamaspik Choice Inc Medicare	$2.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.79

NITROFURANTOIN MONO MACR 100MG CA

Facility

$4.00

Hospital Charge Code	41647273
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

NITROFURANTOIN MONO MICR 100MG CA

Facility

$4.00

Hospital Charge Code	41657273
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

NITROGLYCERIN 0.1 MG/HR TD PT24 [27471]

Facility

$1.86

Service Code	NDC 00378910216
Hospital Charge Code	00378910216
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$1.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.93
Rate for Payer: Aetna Government	$0.93
Rate for Payer: Brighton Health Commercial	$1.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.26
Rate for Payer: Group Health Inc Commercial	$0.93
Rate for Payer: Group Health Inc Medicare	$0.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.93
Rate for Payer: Hamaspik Choice Inc Medicare	$0.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.21

NITROGLYCERIN 0.1 MG/HR TD PT24 [27471]

Facility

$1.86

Service Code	NDC 00378910293
Hospital Charge Code	00378910293
Hospital Revenue Code	250
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$1.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.93
Rate for Payer: Aetna Government	$0.93
Rate for Payer: Brighton Health Commercial	$1.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.26
Rate for Payer: Group Health Inc Commercial	$0.93
Rate for Payer: Group Health Inc Medicare	$0.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.93
Rate for Payer: Hamaspik Choice Inc Medicare	$0.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.21

NITROGLYCERIN 0.2 MG/HR TD PT24 [27472]

Facility

$1.90

Service Code	NDC 00378910493
Hospital Charge Code	00378910493
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$1.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.95
Rate for Payer: Aetna Government	$0.95
Rate for Payer: Brighton Health Commercial	$1.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.29
Rate for Payer: Group Health Inc Commercial	$0.95
Rate for Payer: Group Health Inc Medicare	$0.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.95
Rate for Payer: Hamaspik Choice Inc Medicare	$0.95
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.24

NITROGLYCERIN 0.3 MG/HR TD PT24 [27473]

Facility

$63.59

Service Code	NDC 50742051530
Hospital Charge Code	50742051530
Hospital Revenue Code	250
Min. Negotiated Rate	$22.26
Max. Negotiated Rate	$50.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$34.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$31.79
Rate for Payer: Aetna Government	$31.79
Rate for Payer: Brighton Health Commercial	$47.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$50.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$43.24
Rate for Payer: Group Health Inc Commercial	$31.79
Rate for Payer: Group Health Inc Medicare	$22.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$31.79
Rate for Payer: Hamaspik Choice Inc Medicare	$31.79
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$41.33

NITROGLYCERIN 0.4 MG SL SUBL [5604]

Facility

$1.02

Service Code	NDC 43598043611
Hospital Charge Code	43598043611
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.51
Rate for Payer: Aetna Government	$0.51
Rate for Payer: Brighton Health Commercial	$0.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.69
Rate for Payer: Group Health Inc Commercial	$0.51
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51
Rate for Payer: Hamaspik Choice Inc Medicare	$0.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.66

NITROGLYCERIN 0.4 MG SL SUBL [5604]

Facility

$0.47

Service Code	NDC 59762330401
Hospital Charge Code	59762330401
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.24
Rate for Payer: Aetna Government	$0.24
Rate for Payer: Brighton Health Commercial	$0.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.32
Rate for Payer: Group Health Inc Commercial	$0.24
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.24
Rate for Payer: Hamaspik Choice Inc Medicare	$0.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.31

NITROGLYCERIN 0.4 MG SL SUBL [5604]

Facility

$1.03

Service Code	NDC 68462063945
Hospital Charge Code	68462063945
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.51
Rate for Payer: Aetna Government	$0.51
Rate for Payer: Brighton Health Commercial	$0.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.70
Rate for Payer: Group Health Inc Commercial	$0.51
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51
Rate for Payer: Hamaspik Choice Inc Medicare	$0.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.67

NITROGLYCERIN 0.4 MG SL SUBL [5604]

Facility

$1.94

Service Code	NDC 00071041813
Hospital Charge Code	00071041813
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$1.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.97
Rate for Payer: Aetna Government	$0.97
Rate for Payer: Brighton Health Commercial	$1.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.32
Rate for Payer: Group Health Inc Commercial	$0.97
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97
Rate for Payer: Hamaspik Choice Inc Medicare	$0.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.26

NITROGLYCERIN 0.4 MG SL SUBL [5604]

Facility

$1.03

Service Code	NDC 59762330403
Hospital Charge Code	59762330403
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.51
Rate for Payer: Aetna Government	$0.51
Rate for Payer: Brighton Health Commercial	$0.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.70
Rate for Payer: Group Health Inc Commercial	$0.51
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51
Rate for Payer: Hamaspik Choice Inc Medicare	$0.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.67

NITROGLYCERIN 0.4 MG SUBLINGUAL TAB

Facility

$1.00

Hospital Charge Code	41652534
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
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	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
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	$0.65

NITROGLYCERIN 0.4 MG SUBLINGUAL TAB

Facility

$1.00

Hospital Charge Code	41642534
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$0.80
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	$0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.68
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	$0.65

NITROGLYCERIN 100 MG/D5W 250 ML

Facility

$10.30

Hospital Charge Code	41642294
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.15
Rate for Payer: Aetna Government	$5.15
Rate for Payer: Brighton Health Commercial	$7.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.00
Rate for Payer: Group Health Inc Commercial	$5.15
Rate for Payer: Group Health Inc Medicare	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.15
Rate for Payer: Hamaspik Choice Inc Medicare	$5.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.70

NITROGLYCERIN 100 MG/D5W 250 ML

Facility

$10.30

Hospital Charge Code	41652294
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$8.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.15
Rate for Payer: Aetna Government	$5.15
Rate for Payer: Brighton Health Commercial	$7.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.00
Rate for Payer: Group Health Inc Commercial	$5.15
Rate for Payer: Group Health Inc Medicare	$3.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.15
Rate for Payer: Hamaspik Choice Inc Medicare	$5.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.70

NITROGLYCERIN 25 MG/D5W 250 ML

Facility

$10.75

Hospital Charge Code	41642141
Hospital Revenue Code	250
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$8.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.38
Rate for Payer: Aetna Government	$5.38
Rate for Payer: Brighton Health Commercial	$8.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.31
Rate for Payer: Group Health Inc Commercial	$5.38
Rate for Payer: Group Health Inc Medicare	$3.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.38
Rate for Payer: Hamaspik Choice Inc Medicare	$5.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.99

NITROGLYCERIN 25 MG/D5W 250 ML

Facility

$10.75

Hospital Charge Code	41652141
Hospital Revenue Code	250
Min. Negotiated Rate	$3.76
Max. Negotiated Rate	$8.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.38
Rate for Payer: Aetna Government	$5.38
Rate for Payer: Brighton Health Commercial	$8.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.31
Rate for Payer: Group Health Inc Commercial	$5.38
Rate for Payer: Group Health Inc Medicare	$3.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.38
Rate for Payer: Hamaspik Choice Inc Medicare	$5.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.99

NITROGLYCERIN 2% OINT 1 GRAM

Facility

$2.00

Hospital Charge Code	41642449
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

NITROGLYCERIN 2% OINT 1 GRAM

Facility

$2.00

Hospital Charge Code	41652449
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.00
Rate for Payer: Aetna Government	$1.00
Rate for Payer: Brighton Health Commercial	$1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.36
Rate for Payer: Group Health Inc Commercial	$1.00
Rate for Payer: Group Health Inc Medicare	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.00
Rate for Payer: Hamaspik Choice Inc Medicare	$1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.30

NITROGLYCERIN 2 % TD OINT [5606]

Facility

$2.76

Service Code	NDC 00281032608
Hospital Charge Code	00281032608
Hospital Revenue Code	250
Min. Negotiated Rate	$0.96
Max. Negotiated Rate	$2.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.38
Rate for Payer: Aetna Government	$1.38
Rate for Payer: Brighton Health Commercial	$2.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.87
Rate for Payer: Group Health Inc Commercial	$1.38
Rate for Payer: Group Health Inc Medicare	$0.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38
Rate for Payer: Hamaspik Choice Inc Medicare	$1.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.79

NITROGLYCERIN 2 % TD OINT [5606]

Facility

$1.42

Service Code	NDC 00281032660
Hospital Charge Code	00281032660
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.71
Rate for Payer: Aetna Government	$0.71
Rate for Payer: Brighton Health Commercial	$1.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.97
Rate for Payer: Group Health Inc Commercial	$0.71
Rate for Payer: Group Health Inc Medicare	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.71
Rate for Payer: Hamaspik Choice Inc Medicare	$0.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.92

NITROGLYCERIN 2 % TD OINT [5606]

Facility

$1.42

Service Code	NDC 00281032630
Hospital Charge Code	00281032630
Hospital Revenue Code	250
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$1.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.71
Rate for Payer: Aetna Government	$0.71
Rate for Payer: Brighton Health Commercial	$1.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.97
Rate for Payer: Group Health Inc Commercial	$0.71
Rate for Payer: Group Health Inc Medicare	$0.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.71
Rate for Payer: Hamaspik Choice Inc Medicare	$0.71
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.92

NITROGLYCERIN 50 MG/10 ML INJ

Facility

$8.00

Hospital Charge Code	41643534
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

Know your out-of-pocket cost for care.

All Charges