St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

AMLODIPINE BESYLATE 10 MG PO TABS

Facility

$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

$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

$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

$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

$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

$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 10 MG PO TABS

Facility

$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 2.5 MG PO TABS

Facility

$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

$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

$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 2.5 MG PO TABS

Facility

$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 5 MG PO TABS

Facility

$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

$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

$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

$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

$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

$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

$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

$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

AMLODIPINE BESYLATE 5 MG PO TABS

Facility

$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

$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

$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

$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

AMMONIA AROMATIC IN INHA

Facility

$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

AMMONIA AROMATIC IN INHA

Facility

$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

Know your out-of-pocket cost for care.

All Charges