|
AMLODIPINE BESYLATE 10 MG PO TABS
|
Facility
|
IP
|
$2.38
|
|
|
Service Code
|
NDC 6787719990
|
| Hospital Charge Code |
6787719990
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.19
|
|
|
AMLODIPINE BESYLATE 10 MG PO TABS
|
Facility
|
OP
|
$2.26
|
|
|
Service Code
|
NDC 0904637161
|
| Hospital Charge Code |
0904637161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.13
|
| Rate for Payer: Aetna Government |
$1.13
|
| Rate for Payer: Brighton Health Commercial |
$1.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.53
|
| Rate for Payer: EmblemHealth Commercial |
$1.13
|
| Rate for Payer: Group Health Inc Commercial |
$1.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.79
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.47
|
|
|
AMLODIPINE BESYLATE 10 MG PO TABS
|
Facility
|
OP
|
$2.38
|
|
|
Service Code
|
NDC 6787719990
|
| Hospital Charge Code |
6787719990
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.19
|
| Rate for Payer: Aetna Government |
$1.19
|
| Rate for Payer: Brighton Health Commercial |
$1.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.62
|
| Rate for Payer: EmblemHealth Commercial |
$1.19
|
| Rate for Payer: Group Health Inc Commercial |
$1.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.55
|
|
|
AMLODIPINE BESYLATE 10 MG PO TABS
|
Facility
|
OP
|
$2.38
|
|
|
Service Code
|
NDC 6787719910
|
| Hospital Charge Code |
6787719910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.19
|
| Rate for Payer: Aetna Government |
$1.19
|
| Rate for Payer: Brighton Health Commercial |
$1.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.62
|
| Rate for Payer: EmblemHealth Commercial |
$1.19
|
| Rate for Payer: Group Health Inc Commercial |
$1.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.55
|
|
|
AMLODIPINE BESYLATE 10 MG PO TABS
|
Facility
|
IP
|
$2.38
|
|
|
Service Code
|
NDC 6787719910
|
| Hospital Charge Code |
6787719910
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.19
|
|
|
AMLODIPINE BESYLATE 10 MG PO TABS
|
Facility
|
OP
|
$2.38
|
|
|
Service Code
|
NDC 6787719905
|
| Hospital Charge Code |
6787719905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.31
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.19
|
| Rate for Payer: Aetna Government |
$1.19
|
| Rate for Payer: Brighton Health Commercial |
$1.79
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.91
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.62
|
| Rate for Payer: EmblemHealth Commercial |
$1.19
|
| Rate for Payer: Group Health Inc Commercial |
$1.19
|
| Rate for Payer: Group Health Inc Medicare |
$0.83
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.19
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.19
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.55
|
|
|
AMLODIPINE BESYLATE 10 MG PO TABS
|
Facility
|
IP
|
$2.38
|
|
|
Service Code
|
NDC 6787719905
|
| Hospital Charge Code |
6787719905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.19
|
|
|
AMLODIPINE BESYLATE 2.5 MG PO TABS
|
Facility
|
IP
|
$1.59
|
|
|
Service Code
|
NDC 0904636961
|
| Hospital Charge Code |
0904636961
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.80
|
|
|
AMLODIPINE BESYLATE 2.5 MG PO TABS
|
Facility
|
OP
|
$1.73
|
|
|
Service Code
|
NDC 6909712605
|
| Hospital Charge Code |
6909712605
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.87
|
| Rate for Payer: Aetna Government |
$0.87
|
| Rate for Payer: Brighton Health Commercial |
$1.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.18
|
| Rate for Payer: EmblemHealth Commercial |
$0.87
|
| Rate for Payer: Group Health Inc Commercial |
$0.87
|
| Rate for Payer: Group Health Inc Medicare |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.12
|
|
|
AMLODIPINE BESYLATE 2.5 MG PO TABS
|
Facility
|
OP
|
$1.59
|
|
|
Service Code
|
NDC 0904636961
|
| Hospital Charge Code |
0904636961
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$1.27 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.88
|
| 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: EmblemHealth Commercial |
$0.80
|
| 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 |
$1.04
|
|
|
AMLODIPINE BESYLATE 2.5 MG PO TABS
|
Facility
|
IP
|
$1.73
|
|
|
Service Code
|
NDC 6909712605
|
| Hospital Charge Code |
6909712605
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.87
|
|
|
AMLODIPINE BESYLATE 5 MG PO TABS
|
Facility
|
OP
|
$1.79
|
|
|
Service Code
|
NDC 6787719810
|
| Hospital Charge Code |
6787719810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Government |
$0.89
|
| Rate for Payer: Brighton Health Commercial |
$1.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.22
|
| Rate for Payer: EmblemHealth Commercial |
$0.89
|
| Rate for Payer: Group Health Inc Commercial |
$0.89
|
| Rate for Payer: Group Health Inc Medicare |
$0.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.16
|
|
|
AMLODIPINE BESYLATE 5 MG PO TABS
|
Facility
|
IP
|
$1.79
|
|
|
Service Code
|
NDC 6787719890
|
| Hospital Charge Code |
6787719890
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.89
|
|
|
AMLODIPINE BESYLATE 5 MG PO TABS
|
Facility
|
OP
|
$0.19
|
|
|
Service Code
|
NDC 6068748801
|
| Hospital Charge Code |
6068748801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.09
|
| Rate for Payer: Aetna Government |
$0.09
|
| Rate for Payer: Brighton Health Commercial |
$0.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.13
|
| Rate for Payer: EmblemHealth Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Commercial |
$0.09
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.09
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.12
|
|
|
AMLODIPINE BESYLATE 5 MG PO TABS
|
Facility
|
OP
|
$10.17
|
|
|
Service Code
|
NDC 0069153041
|
| Hospital Charge Code |
0069153041
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$8.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.59
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.08
|
| Rate for Payer: Aetna Government |
$5.08
|
| Rate for Payer: Brighton Health Commercial |
$7.62
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$8.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.91
|
| Rate for Payer: EmblemHealth Commercial |
$5.08
|
| Rate for Payer: Group Health Inc Commercial |
$5.08
|
| Rate for Payer: Group Health Inc Medicare |
$3.56
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.61
|
|
|
AMLODIPINE BESYLATE 5 MG PO TABS
|
Facility
|
OP
|
$1.64
|
|
|
Service Code
|
NDC 0904637061
|
| Hospital Charge Code |
0904637061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.82
|
| Rate for Payer: Aetna Government |
$0.82
|
| Rate for Payer: Brighton Health Commercial |
$1.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.31
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.12
|
| Rate for Payer: EmblemHealth Commercial |
$0.82
|
| Rate for Payer: Group Health Inc Commercial |
$0.82
|
| Rate for Payer: Group Health Inc Medicare |
$0.58
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.07
|
|
|
AMLODIPINE BESYLATE 5 MG PO TABS
|
Facility
|
IP
|
$1.64
|
|
|
Service Code
|
NDC 0904637061
|
| Hospital Charge Code |
0904637061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$0.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.82
|
|
|
AMLODIPINE BESYLATE 5 MG PO TABS
|
Facility
|
OP
|
$1.79
|
|
|
Service Code
|
NDC 6787719890
|
| Hospital Charge Code |
6787719890
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.98
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Government |
$0.89
|
| Rate for Payer: Brighton Health Commercial |
$1.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.22
|
| Rate for Payer: EmblemHealth Commercial |
$0.89
|
| Rate for Payer: Group Health Inc Commercial |
$0.89
|
| Rate for Payer: Group Health Inc Medicare |
$0.63
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.16
|
|
|
AMLODIPINE BESYLATE 5 MG PO TABS
|
Facility
|
IP
|
$0.19
|
|
|
Service Code
|
NDC 6068748801
|
| Hospital Charge Code |
6068748801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.09
|
|
|
AMLODIPINE BESYLATE 5 MG PO TABS
|
Facility
|
IP
|
$1.79
|
|
|
Service Code
|
NDC 6787719810
|
| Hospital Charge Code |
6787719810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$0.89 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.89
|
|
|
AMLODIPINE BESYLATE 5 MG PO TABS
|
Facility
|
IP
|
$1.73
|
|
|
Service Code
|
NDC 6909712715
|
| Hospital Charge Code |
6909712715
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$0.87 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.87
|
|
|
AMLODIPINE BESYLATE 5 MG PO TABS
|
Facility
|
IP
|
$10.17
|
|
|
Service Code
|
NDC 0069153041
|
| Hospital Charge Code |
0069153041
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$5.08 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.08
|
|
|
AMLODIPINE BESYLATE 5 MG PO TABS
|
Facility
|
OP
|
$1.73
|
|
|
Service Code
|
NDC 6909712715
|
| Hospital Charge Code |
6909712715
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$1.38 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.87
|
| Rate for Payer: Aetna Government |
$0.87
|
| Rate for Payer: Brighton Health Commercial |
$1.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.38
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.18
|
| Rate for Payer: EmblemHealth Commercial |
$0.87
|
| Rate for Payer: Group Health Inc Commercial |
$0.87
|
| Rate for Payer: Group Health Inc Medicare |
$0.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.87
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.12
|
|
|
AMMONIA AROMATIC IN INHA
|
Facility
|
OP
|
$0.27
|
|
|
Service Code
|
NDC 6777725101
|
| Hospital Charge Code |
6777725101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.15
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.13
|
| Rate for Payer: Aetna Government |
$0.13
|
| Rate for Payer: Brighton Health Commercial |
$0.20
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.22
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.18
|
| Rate for Payer: EmblemHealth Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Commercial |
$0.13
|
| Rate for Payer: Group Health Inc Medicare |
$0.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.13
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.17
|
|
|
AMMONIA AROMATIC IN INHA
|
Facility
|
IP
|
$0.27
|
|
|
Service Code
|
NDC 6777725101
|
| Hospital Charge Code |
6777725101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.13
|
|
