St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

ISOSORBIDE DINITRATE 10 MG PO TABS

Facility

$1.25

Service Code	NDC 6808408211
Hospital Charge Code	6808408211
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.63

ISOSORBIDE DINITRATE 10 MG PO TABS

Facility

$0.73

Service Code	NDC 0904661961
Hospital Charge Code	0904661961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.37

ISOSORBIDE DINITRATE 20 MG PO TABS

Facility

$0.86

Service Code	NDC 0904662061
Hospital Charge Code	0904662061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.43
Rate for Payer: Aetna Government	$0.43
Rate for Payer: Brighton Health Commercial	$0.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.58
Rate for Payer: EmblemHealth Commercial	$0.43
Rate for Payer: Group Health Inc Commercial	$0.43
Rate for Payer: Group Health Inc Medicare	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.43
Rate for Payer: Hamaspik Choice Inc Medicare	$0.43
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.56

ISOSORBIDE DINITRATE 20 MG PO TABS

Facility

$1.19

Service Code	NDC 0143177201
Hospital Charge Code	0143177201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.95
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	$0.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.95
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.81
Rate for Payer: EmblemHealth Commercial	$0.60
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	$0.77

ISOSORBIDE DINITRATE 20 MG PO TABS

Facility

$1.19

Service Code	NDC 0143177201
Hospital Charge Code	0143177201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.60

ISOSORBIDE DINITRATE 20 MG PO TABS

Facility

$0.86

Service Code	NDC 0904662061
Hospital Charge Code	0904662061
Hospital Revenue Code	250
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$0.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.43

ISOSORBIDE DINITRATE 5 MG PO TABS

Facility

$1.06

Service Code	NDC 5026844715
Hospital Charge Code	5026844715
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.53

ISOSORBIDE DINITRATE 5 MG PO TABS

Facility

$1.06

Service Code	NDC 5026844715
Hospital Charge Code	5026844715
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$0.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.72
Rate for Payer: EmblemHealth Commercial	$0.53
Rate for Payer: Group Health Inc Commercial	$0.53
Rate for Payer: Group Health Inc Medicare	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.53
Rate for Payer: Hamaspik Choice Inc Medicare	$0.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.69

ISOSORBIDE MONONITRATE ER 120 MG PO TB24

Facility

$2.93

Service Code	NDC 6838265201
Hospital Charge Code	6838265201
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$1.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.47

ISOSORBIDE MONONITRATE ER 120 MG PO TB24

Facility

$8.80

Service Code	NDC 1366810601
Hospital Charge Code	1366810601
Hospital Revenue Code	250
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$4.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.40

ISOSORBIDE MONONITRATE ER 120 MG PO TB24

Facility

$8.80

Service Code	NDC 1366810601
Hospital Charge Code	1366810601
Hospital Revenue Code	250
Min. Negotiated Rate	$3.08
Max. Negotiated Rate	$7.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.40
Rate for Payer: Aetna Government	$4.40
Rate for Payer: Brighton Health Commercial	$6.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.99
Rate for Payer: EmblemHealth Commercial	$4.40
Rate for Payer: Group Health Inc Commercial	$4.40
Rate for Payer: Group Health Inc Medicare	$3.08
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.40
Rate for Payer: Hamaspik Choice Inc Medicare	$4.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.72

ISOSORBIDE MONONITRATE ER 120 MG PO TB24

Facility

$2.93

Service Code	NDC 6838265201
Hospital Charge Code	6838265201
Hospital Revenue Code	250
Min. Negotiated Rate	$1.03
Max. Negotiated Rate	$2.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.47
Rate for Payer: Aetna Government	$1.47
Rate for Payer: Brighton Health Commercial	$2.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.00
Rate for Payer: EmblemHealth Commercial	$1.47
Rate for Payer: Group Health Inc Commercial	$1.47
Rate for Payer: Group Health Inc Medicare	$1.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.47
Rate for Payer: Hamaspik Choice Inc Medicare	$1.47
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.91

ISOSORBIDE MONONITRATE ER 120 MG PO TB24

Facility

$2.32

Service Code	NDC 5026845315
Hospital Charge Code	5026845315
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$1.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.16
Rate for Payer: Aetna Government	$1.16
Rate for Payer: Brighton Health Commercial	$1.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.58
Rate for Payer: EmblemHealth Commercial	$1.16
Rate for Payer: Group Health Inc Commercial	$1.16
Rate for Payer: Group Health Inc Medicare	$0.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.16
Rate for Payer: Hamaspik Choice Inc Medicare	$1.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.51

ISOSORBIDE MONONITRATE ER 120 MG PO TB24

Facility

$2.32

Service Code	NDC 5026845315
Hospital Charge Code	5026845315
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$1.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.16

ISOSORBIDE MONONITRATE ER 30 MG PO TB24

Facility

$3.35

Service Code	NDC 1366810401
Hospital Charge Code	1366810401
Hospital Revenue Code	250
Min. Negotiated Rate	$1.68
Max. Negotiated Rate	$1.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.68

ISOSORBIDE MONONITRATE ER 30 MG PO TB24

Facility

$1.05

Service Code	NDC 6217512841
Hospital Charge Code	6217512841
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$0.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.84
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.71
Rate for Payer: EmblemHealth Commercial	$0.53
Rate for Payer: Group Health Inc Commercial	$0.53
Rate for Payer: Group Health Inc Medicare	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.53
Rate for Payer: Hamaspik Choice Inc Medicare	$0.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.68

ISOSORBIDE MONONITRATE ER 30 MG PO TB24

Facility

$1.06

Service Code	NDC 2315551905
Hospital Charge Code	2315551905
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.53

ISOSORBIDE MONONITRATE ER 30 MG PO TB24

Facility

$1.66

Service Code	NDC 0904644961
Hospital Charge Code	0904644961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.58
Max. Negotiated Rate	$1.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.83
Rate for Payer: Aetna Government	$0.83
Rate for Payer: Brighton Health Commercial	$1.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.13
Rate for Payer: EmblemHealth Commercial	$0.83
Rate for Payer: Group Health Inc Commercial	$0.83
Rate for Payer: Group Health Inc Medicare	$0.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.83
Rate for Payer: Hamaspik Choice Inc Medicare	$0.83
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.08

ISOSORBIDE MONONITRATE ER 30 MG PO TB24

Facility

$1.66

Service Code	NDC 0904644961
Hospital Charge Code	0904644961
Hospital Revenue Code	250
Min. Negotiated Rate	$0.83
Max. Negotiated Rate	$0.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.83

ISOSORBIDE MONONITRATE ER 30 MG PO TB24

Facility

$3.35

Service Code	NDC 1366810401
Hospital Charge Code	1366810401
Hospital Revenue Code	250
Min. Negotiated Rate	$1.17
Max. Negotiated Rate	$2.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.84
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.68
Rate for Payer: Aetna Government	$1.68
Rate for Payer: Brighton Health Commercial	$2.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.28
Rate for Payer: EmblemHealth Commercial	$1.68
Rate for Payer: Group Health Inc Commercial	$1.68
Rate for Payer: Group Health Inc Medicare	$1.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.68
Rate for Payer: Hamaspik Choice Inc Medicare	$1.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.18

ISOSORBIDE MONONITRATE ER 30 MG PO TB24

Facility

$1.06

Service Code	NDC 2315551905
Hospital Charge Code	2315551905
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$0.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.72
Rate for Payer: EmblemHealth Commercial	$0.53
Rate for Payer: Group Health Inc Commercial	$0.53
Rate for Payer: Group Health Inc Medicare	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.53
Rate for Payer: Hamaspik Choice Inc Medicare	$0.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.69

ISOSORBIDE MONONITRATE ER 30 MG PO TB24

Facility

$1.05

Service Code	NDC 6217512841
Hospital Charge Code	6217512841
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.53

ISOSORBIDE MONONITRATE ER 60 MG PO TB24

Facility

$4.28

Service Code	NDC 1366810501
Hospital Charge Code	1366810501
Hospital Revenue Code	250
Min. Negotiated Rate	$2.14
Max. Negotiated Rate	$2.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.14

ISOSORBIDE MONONITRATE ER 60 MG PO TB24

Facility

$4.28

Service Code	NDC 1366810501
Hospital Charge Code	1366810501
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$3.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.35
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	$3.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.91
Rate for Payer: EmblemHealth Commercial	$2.14
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	$2.78

ISOSORBIDE MONONITRATE ER 60 MG PO TB24

Facility

$1.43

Service Code	NDC 2315517801
Hospital Charge Code	2315517801
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$0.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.71

Know your out-of-pocket cost for care.

All Charges