St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

NITROGLYCERIN 0.4 MG SL SUBL

Facility

$1.03

Service Code	NDC 6846263945
Hospital Charge Code	6846263945
Hospital Revenue Code	250
Min. Negotiated Rate	$0.51
Max. Negotiated Rate	$0.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51

NITROGLYCERIN 0.4 MG SL SUBL

Facility

$0.47

Service Code	NDC 7075601411
Hospital Charge Code	7075601411
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: EmblemHealth Commercial	$0.24
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 2 % TD OINT

Facility

$1.42

Service Code	NDC 0281032630
Hospital Charge Code	0281032630
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$0.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.71

NITROGLYCERIN 2 % TD OINT

Facility

$1.42

Service Code	NDC 0281032630
Hospital Charge Code	0281032630
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: EmblemHealth Commercial	$0.71
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

Facility

$1.42

Service Code	NDC 0281032660
Hospital Charge Code	0281032660
Hospital Revenue Code	250
Min. Negotiated Rate	$0.71
Max. Negotiated Rate	$0.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.71

NITROGLYCERIN 2 % TD OINT

Facility

$2.76

Service Code	NDC 0281032608
Hospital Charge Code	0281032608
Hospital Revenue Code	250
Min. Negotiated Rate	$1.38
Max. Negotiated Rate	$1.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.38

NITROGLYCERIN 2 % TD OINT

Facility

$1.42

Service Code	NDC 0281032660
Hospital Charge Code	0281032660
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: EmblemHealth Commercial	$0.71
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

Facility

$2.76

Service Code	NDC 0281032608
Hospital Charge Code	0281032608
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: EmblemHealth Commercial	$1.38
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 5 MG/ML IV SOLN

Facility

$1.87

Service Code	HCPCS J2305
Hospital Charge Code	0517481025
Hospital Revenue Code	258
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$0.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.93

NITROGLYCERIN 5 MG/ML IV SOLN

Facility

$1.87

Service Code	HCPCS J2305
Hospital Charge Code	0517481025
Hospital Revenue Code	258
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$1.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.93
Rate for Payer: Aetna Government	$0.93
Rate for Payer: Brighton Health Commercial	$1.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.49
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.27
Rate for Payer: EmblemHealth Commercial	$0.93
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: Healthfirst CHP/FHP/Medicaid	$1.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.21

NITROGLYCERIN BOLUS FROM BAG

Facility

$0.10

Service Code	NDC 9999123481
Hospital Charge Code	9999123481
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

NITROGLYCERIN BOLUS FROM BAG

Facility

$0.10

Service Code	NDC 9999123481
Hospital Charge Code	9999123481
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

NITROGLYCERIN IN D5W 100-5 MCG/ML-% IV SOLN

Facility

$0.10

Service Code	HCPCS J2305
Hospital Charge Code	0338104702
Hospital Revenue Code	258
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$1.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

NITROGLYCERIN IN D5W 100-5 MCG/ML-% IV SOLN

Facility

$0.10

Service Code	HCPCS J2305
Hospital Charge Code	0338104702
Hospital Revenue Code	258
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

NITROGLYCERIN IN D5W 200-5 MCG/ML-% IV SOLN

Facility

$0.11

Service Code	HCPCS J2305
Hospital Charge Code	0338104902
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$1.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.07

NITROGLYCERIN IN D5W 200-5 MCG/ML-% IV SOLN

Facility

$0.11

Service Code	HCPCS J2305
Hospital Charge Code	0338104902
Hospital Revenue Code	258
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

NITROGLYCERIN IN D5W 400-5 MCG/ML-% IV SOLN

Facility

$0.12

Service Code	HCPCS J2305
Hospital Charge Code	0338105102
Hospital Revenue Code	258
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06

NITROGLYCERIN IN D5W 400-5 MCG/ML-% IV SOLN

Facility

$0.12

Service Code	HCPCS J2305
Hospital Charge Code	0338105102
Hospital Revenue Code	258
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$1.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.06
Rate for Payer: Aetna Government	$0.06
Rate for Payer: Brighton Health Commercial	$0.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.08
Rate for Payer: EmblemHealth Commercial	$0.06
Rate for Payer: Group Health Inc Commercial	$0.06
Rate for Payer: Group Health Inc Medicare	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.06
Rate for Payer: Hamaspik Choice Inc Medicare	$0.06
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.08

NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN

Facility

$14.70

Service Code	NDC 7012111891
Hospital Charge Code	7012111891
Hospital Revenue Code	258
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$7.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.35

NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN

Facility

$161.82

Service Code	NDC 6745783902
Hospital Charge Code	6745783902
Hospital Revenue Code	258
Min. Negotiated Rate	$56.64
Max. Negotiated Rate	$129.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$80.91
Rate for Payer: Aetna Government	$80.91
Rate for Payer: Brighton Health Commercial	$121.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$129.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$110.04
Rate for Payer: EmblemHealth Commercial	$80.91
Rate for Payer: Group Health Inc Commercial	$80.91
Rate for Payer: Group Health Inc Medicare	$56.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.91
Rate for Payer: Hamaspik Choice Inc Medicare	$80.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$105.18

NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN

Facility

$12.50

Service Code	NDC 7043602880
Hospital Charge Code	7043602880
Hospital Revenue Code	258
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$10.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.25
Rate for Payer: Aetna Government	$6.25
Rate for Payer: Brighton Health Commercial	$9.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.50
Rate for Payer: EmblemHealth Commercial	$6.25
Rate for Payer: Group Health Inc Commercial	$6.25
Rate for Payer: Group Health Inc Medicare	$4.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.25
Rate for Payer: Hamaspik Choice Inc Medicare	$6.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.12

NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN

Facility

$12.50

Service Code	NDC 7043602880
Hospital Charge Code	7043602880
Hospital Revenue Code	258
Min. Negotiated Rate	$6.25
Max. Negotiated Rate	$6.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.25

NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN

Facility

$161.82

Service Code	NDC 6745783902
Hospital Charge Code	6745783902
Hospital Revenue Code	258
Min. Negotiated Rate	$80.91
Max. Negotiated Rate	$80.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$80.91

NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN

Facility

$14.70

Service Code	NDC 7012111891
Hospital Charge Code	7012111891
Hospital Revenue Code	258
Min. Negotiated Rate	$5.14
Max. Negotiated Rate	$11.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.35
Rate for Payer: Aetna Government	$7.35
Rate for Payer: Brighton Health Commercial	$11.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.76
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.00
Rate for Payer: EmblemHealth Commercial	$7.35
Rate for Payer: Group Health Inc Commercial	$7.35
Rate for Payer: Group Health Inc Medicare	$5.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.35
Rate for Payer: Hamaspik Choice Inc Medicare	$7.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.55

NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN

Facility

$12.50

Service Code	NDC 7006926101
Hospital Charge Code	7006926101
Hospital Revenue Code	258
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$10.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.25
Rate for Payer: Aetna Government	$6.25
Rate for Payer: Brighton Health Commercial	$9.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.50
Rate for Payer: EmblemHealth Commercial	$6.25
Rate for Payer: Group Health Inc Commercial	$6.25
Rate for Payer: Group Health Inc Medicare	$4.38
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.25
Rate for Payer: Hamaspik Choice Inc Medicare	$6.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.12

Know your out-of-pocket cost for care.

All Charges