St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FE FUMARATE-B12-VIT C-FA-IFC PO CAPS

Facility

$0.39

Service Code	NDC 6304463510
Hospital Charge Code	6304463510
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: EmblemHealth Commercial	$0.20
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.25

FE FUMARATE-B12-VIT C-FA-IFC PO CAPS

Facility

$0.44

Service Code	NDC 5199163501
Hospital Charge Code	5199163501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22

FE FUMARATE-B12-VIT C-FA-IFC PO CAPS

Facility

$0.39

Service Code	NDC 6304463510
Hospital Charge Code	6304463510
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20

Female reproductive system infections

Facility

$52,400.54

Service Code	APR-DRG 5313
Min. Negotiated Rate	$11,377.00
Max. Negotiated Rate	$52,400.54
Rate for Payer: Affinity Essential Plan 1&2	$52,400.54
Rate for Payer: Affinity Essential Plan 3&4	$52,400.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$23,289.13
Rate for Payer: Amida Care Medicaid	$23,289.13
Rate for Payer: EmblemHealth Essential Plan 1&2	$52,400.54
Rate for Payer: EmblemHealth Essential Plan 3&4	$23,289.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$23,289.13
Rate for Payer: Fidelis Qualified Health Plan	$27,946.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$23,289.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$23,289.13
Rate for Payer: Healthfirst Commercial	$20,491.00
Rate for Payer: Healthfirst Essential Plan	$52,400.54
Rate for Payer: Healthfirst QHP	$11,377.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23,289.13
Rate for Payer: SOMOS Essential	$52,400.54
Rate for Payer: United Healthcare Essential Plan 1&2	$52,400.54
Rate for Payer: United Healthcare Essential Plan 3&4	$52,400.54
Rate for Payer: United Healthcare Medicaid	$23,289.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$23,289.13

Female reproductive system infections

Facility

$41,513.89

Service Code	APR-DRG 5311
Min. Negotiated Rate	$6,223.00
Max. Negotiated Rate	$41,513.89
Rate for Payer: Affinity Essential Plan 1&2	$41,513.89
Rate for Payer: Affinity Essential Plan 3&4	$41,513.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,450.62
Rate for Payer: Amida Care Medicaid	$18,450.62
Rate for Payer: EmblemHealth Essential Plan 1&2	$41,513.89
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,450.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,450.62
Rate for Payer: Fidelis Qualified Health Plan	$22,140.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,450.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,450.62
Rate for Payer: Healthfirst Commercial	$10,390.00
Rate for Payer: Healthfirst Essential Plan	$41,513.89
Rate for Payer: Healthfirst QHP	$6,223.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,450.62
Rate for Payer: SOMOS Essential	$41,513.89
Rate for Payer: United Healthcare Essential Plan 1&2	$41,513.89
Rate for Payer: United Healthcare Essential Plan 3&4	$41,513.89
Rate for Payer: United Healthcare Medicaid	$18,450.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,450.62

Female reproductive system infections

Facility

$54,913.79

Service Code	APR-DRG 5314
Min. Negotiated Rate	$11,825.00
Max. Negotiated Rate	$54,913.79
Rate for Payer: Affinity Essential Plan 1&2	$54,913.79
Rate for Payer: Affinity Essential Plan 3&4	$54,913.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$24,406.13
Rate for Payer: Amida Care Medicaid	$24,406.13
Rate for Payer: EmblemHealth Essential Plan 1&2	$54,913.79
Rate for Payer: EmblemHealth Essential Plan 3&4	$24,406.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$24,406.13
Rate for Payer: Fidelis Qualified Health Plan	$29,287.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$24,406.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$24,406.13
Rate for Payer: Healthfirst Commercial	$21,124.00
Rate for Payer: Healthfirst Essential Plan	$54,913.79
Rate for Payer: Healthfirst QHP	$11,825.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$24,406.13
Rate for Payer: SOMOS Essential	$54,913.79
Rate for Payer: United Healthcare Essential Plan 1&2	$54,913.79
Rate for Payer: United Healthcare Essential Plan 3&4	$54,913.79
Rate for Payer: United Healthcare Medicaid	$24,406.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$24,406.13

Female reproductive system infections

Facility

$44,860.79

Service Code	APR-DRG 5312
Min. Negotiated Rate	$7,761.00
Max. Negotiated Rate	$44,860.79
Rate for Payer: Affinity Essential Plan 1&2	$44,860.79
Rate for Payer: Affinity Essential Plan 3&4	$44,860.79
Rate for Payer: Affinity Medicaid/CHP/HARP	$19,938.13
Rate for Payer: Amida Care Medicaid	$19,938.13
Rate for Payer: EmblemHealth Essential Plan 1&2	$44,860.79
Rate for Payer: EmblemHealth Essential Plan 3&4	$19,938.13
Rate for Payer: Fidelis CHP/HARP/Medicaid	$19,938.13
Rate for Payer: Fidelis Qualified Health Plan	$23,925.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$19,938.13
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$19,938.13
Rate for Payer: Healthfirst Commercial	$13,038.00
Rate for Payer: Healthfirst Essential Plan	$44,860.79
Rate for Payer: Healthfirst QHP	$7,761.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19,938.13
Rate for Payer: SOMOS Essential	$44,860.79
Rate for Payer: United Healthcare Essential Plan 1&2	$44,860.79
Rate for Payer: United Healthcare Essential Plan 3&4	$44,860.79
Rate for Payer: United Healthcare Medicaid	$19,938.13
Rate for Payer: Wellcare CHP/FHP/Medicaid	$19,938.13

FEMALE REPRODUCTIVE SYSTEM INFECTIONS

Facility

$230.40

Service Code	EAPG 00751
Min. Negotiated Rate	$166.63
Max. Negotiated Rate	$230.40
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$166.63
Rate for Payer: Healthfirst Commercial	$230.40

Female reproductive system malignancy

Facility

$76,110.19

Service Code	APR-DRG 5304
Min. Negotiated Rate	$30,107.00
Max. Negotiated Rate	$76,110.19
Rate for Payer: Affinity Essential Plan 1&2	$76,110.19
Rate for Payer: Affinity Essential Plan 3&4	$76,110.19
Rate for Payer: Affinity Medicaid/CHP/HARP	$33,826.75
Rate for Payer: Amida Care Medicaid	$33,826.75
Rate for Payer: EmblemHealth Essential Plan 1&2	$76,110.19
Rate for Payer: EmblemHealth Essential Plan 3&4	$33,826.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$33,826.75
Rate for Payer: Fidelis Qualified Health Plan	$40,592.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$33,826.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$33,826.75
Rate for Payer: Healthfirst Commercial	$45,153.00
Rate for Payer: Healthfirst Essential Plan	$76,110.19
Rate for Payer: Healthfirst QHP	$30,107.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$33,826.75
Rate for Payer: SOMOS Essential	$76,110.19
Rate for Payer: United Healthcare Essential Plan 1&2	$76,110.19
Rate for Payer: United Healthcare Essential Plan 3&4	$76,110.19
Rate for Payer: United Healthcare Medicaid	$33,826.75
Rate for Payer: Wellcare CHP/FHP/Medicaid	$33,826.75

Female reproductive system malignancy

Facility

$42,748.54

Service Code	APR-DRG 5301
Min. Negotiated Rate	$6,044.00
Max. Negotiated Rate	$42,748.54
Rate for Payer: Affinity Essential Plan 1&2	$42,748.54
Rate for Payer: Affinity Essential Plan 3&4	$42,748.54
Rate for Payer: Affinity Medicaid/CHP/HARP	$18,999.35
Rate for Payer: Amida Care Medicaid	$18,999.35
Rate for Payer: EmblemHealth Essential Plan 1&2	$42,748.54
Rate for Payer: EmblemHealth Essential Plan 3&4	$18,999.35
Rate for Payer: Fidelis CHP/HARP/Medicaid	$18,999.35
Rate for Payer: Fidelis Qualified Health Plan	$22,799.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$18,999.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$18,999.35
Rate for Payer: Healthfirst Commercial	$11,729.00
Rate for Payer: Healthfirst Essential Plan	$42,748.54
Rate for Payer: Healthfirst QHP	$6,044.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$18,999.35
Rate for Payer: SOMOS Essential	$42,748.54
Rate for Payer: United Healthcare Essential Plan 1&2	$42,748.54
Rate for Payer: United Healthcare Essential Plan 3&4	$42,748.54
Rate for Payer: United Healthcare Medicaid	$18,999.35
Rate for Payer: Wellcare CHP/FHP/Medicaid	$18,999.35

Female reproductive system malignancy

Facility

$45,775.35

Service Code	APR-DRG 5302
Min. Negotiated Rate	$8,372.00
Max. Negotiated Rate	$45,775.35
Rate for Payer: Affinity Essential Plan 1&2	$45,775.35
Rate for Payer: Affinity Essential Plan 3&4	$45,775.35
Rate for Payer: Affinity Medicaid/CHP/HARP	$20,344.60
Rate for Payer: Amida Care Medicaid	$20,344.60
Rate for Payer: EmblemHealth Essential Plan 1&2	$45,775.35
Rate for Payer: EmblemHealth Essential Plan 3&4	$20,344.60
Rate for Payer: Fidelis CHP/HARP/Medicaid	$20,344.60
Rate for Payer: Fidelis Qualified Health Plan	$24,413.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$20,344.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$20,344.60
Rate for Payer: Healthfirst Commercial	$14,091.00
Rate for Payer: Healthfirst Essential Plan	$45,775.35
Rate for Payer: Healthfirst QHP	$8,372.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$20,344.60
Rate for Payer: SOMOS Essential	$45,775.35
Rate for Payer: United Healthcare Essential Plan 1&2	$45,775.35
Rate for Payer: United Healthcare Essential Plan 3&4	$45,775.35
Rate for Payer: United Healthcare Medicaid	$20,344.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$20,344.60

Female reproductive system malignancy

Facility

$57,551.89

Service Code	APR-DRG 5303
Min. Negotiated Rate	$15,788.00
Max. Negotiated Rate	$57,551.89
Rate for Payer: Affinity Essential Plan 1&2	$57,551.89
Rate for Payer: Affinity Essential Plan 3&4	$57,551.89
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,578.62
Rate for Payer: Amida Care Medicaid	$25,578.62
Rate for Payer: EmblemHealth Essential Plan 1&2	$57,551.89
Rate for Payer: EmblemHealth Essential Plan 3&4	$25,578.62
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,578.62
Rate for Payer: Fidelis Qualified Health Plan	$30,694.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,578.62
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,578.62
Rate for Payer: Healthfirst Commercial	$25,697.00
Rate for Payer: Healthfirst Essential Plan	$57,551.89
Rate for Payer: Healthfirst QHP	$15,788.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,578.62
Rate for Payer: SOMOS Essential	$57,551.89
Rate for Payer: United Healthcare Essential Plan 1&2	$57,551.89
Rate for Payer: United Healthcare Essential Plan 3&4	$57,551.89
Rate for Payer: United Healthcare Medicaid	$25,578.62
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,578.62

FEMALE REPRODUCTIVE SYSTEM MALIGNANCY

Facility

$209.72

Service Code	EAPG 00750
Min. Negotiated Rate	$152.74
Max. Negotiated Rate	$209.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$152.74
Rate for Payer: Healthfirst Commercial	$209.72

Female reproductive system reconstructive procedures

Facility

$49,502.11

Service Code	APR-DRG 5142
Min. Negotiated Rate	$9,670.00
Max. Negotiated Rate	$49,502.11
Rate for Payer: Affinity Essential Plan 1&2	$49,502.11
Rate for Payer: Affinity Essential Plan 3&4	$49,502.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,000.94
Rate for Payer: Amida Care Medicaid	$22,000.94
Rate for Payer: EmblemHealth Essential Plan 1&2	$49,502.11
Rate for Payer: EmblemHealth Essential Plan 3&4	$22,000.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,000.94
Rate for Payer: Fidelis Qualified Health Plan	$26,401.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,000.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,000.94
Rate for Payer: Healthfirst Commercial	$17,202.00
Rate for Payer: Healthfirst Essential Plan	$49,502.11
Rate for Payer: Healthfirst QHP	$9,670.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,000.94
Rate for Payer: SOMOS Essential	$49,502.11
Rate for Payer: United Healthcare Essential Plan 1&2	$49,502.11
Rate for Payer: United Healthcare Essential Plan 3&4	$49,502.11
Rate for Payer: United Healthcare Medicaid	$22,000.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,000.94

Female reproductive system reconstructive procedures

Facility

$86,979.24

Service Code	APR-DRG 5144
Min. Negotiated Rate	$14,617.00
Max. Negotiated Rate	$86,979.24
Rate for Payer: Affinity Essential Plan 1&2	$86,979.24
Rate for Payer: Affinity Essential Plan 3&4	$86,979.24
Rate for Payer: Affinity Medicaid/CHP/HARP	$38,657.44
Rate for Payer: Amida Care Medicaid	$38,657.44
Rate for Payer: EmblemHealth Essential Plan 1&2	$86,979.24
Rate for Payer: EmblemHealth Essential Plan 3&4	$38,657.44
Rate for Payer: Fidelis CHP/HARP/Medicaid	$38,657.44
Rate for Payer: Fidelis Qualified Health Plan	$46,388.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$38,657.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$38,657.44
Rate for Payer: Healthfirst Commercial	$31,762.00
Rate for Payer: Healthfirst Essential Plan	$86,979.24
Rate for Payer: Healthfirst QHP	$14,617.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$38,657.44
Rate for Payer: SOMOS Essential	$86,979.24
Rate for Payer: United Healthcare Essential Plan 1&2	$86,979.24
Rate for Payer: United Healthcare Essential Plan 3&4	$86,979.24
Rate for Payer: United Healthcare Medicaid	$38,657.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$38,657.44

Female reproductive system reconstructive procedures

Facility

$49,502.11

Service Code	APR-DRG 5143
Min. Negotiated Rate	$13,411.00
Max. Negotiated Rate	$49,502.11
Rate for Payer: Affinity Essential Plan 1&2	$49,502.11
Rate for Payer: Affinity Essential Plan 3&4	$49,502.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,000.94
Rate for Payer: Amida Care Medicaid	$22,000.94
Rate for Payer: EmblemHealth Essential Plan 1&2	$49,502.11
Rate for Payer: EmblemHealth Essential Plan 3&4	$22,000.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,000.94
Rate for Payer: Fidelis Qualified Health Plan	$26,401.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,000.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,000.94
Rate for Payer: Healthfirst Commercial	$17,357.00
Rate for Payer: Healthfirst Essential Plan	$49,502.11
Rate for Payer: Healthfirst QHP	$13,411.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,000.94
Rate for Payer: SOMOS Essential	$49,502.11
Rate for Payer: United Healthcare Essential Plan 1&2	$49,502.11
Rate for Payer: United Healthcare Essential Plan 3&4	$49,502.11
Rate for Payer: United Healthcare Medicaid	$22,000.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,000.94

Female reproductive system reconstructive procedures

Facility

$49,502.11

Service Code	APR-DRG 5141
Min. Negotiated Rate	$7,516.00
Max. Negotiated Rate	$49,502.11
Rate for Payer: Affinity Essential Plan 1&2	$49,502.11
Rate for Payer: Affinity Essential Plan 3&4	$49,502.11
Rate for Payer: Affinity Medicaid/CHP/HARP	$22,000.94
Rate for Payer: Amida Care Medicaid	$22,000.94
Rate for Payer: EmblemHealth Essential Plan 1&2	$49,502.11
Rate for Payer: EmblemHealth Essential Plan 3&4	$22,000.94
Rate for Payer: Fidelis CHP/HARP/Medicaid	$22,000.94
Rate for Payer: Fidelis Qualified Health Plan	$26,401.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$22,000.94
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$22,000.94
Rate for Payer: Healthfirst Commercial	$13,621.00
Rate for Payer: Healthfirst Essential Plan	$49,502.11
Rate for Payer: Healthfirst QHP	$7,516.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$22,000.94
Rate for Payer: SOMOS Essential	$49,502.11
Rate for Payer: United Healthcare Essential Plan 1&2	$49,502.11
Rate for Payer: United Healthcare Essential Plan 3&4	$49,502.11
Rate for Payer: United Healthcare Medicaid	$22,000.94
Rate for Payer: Wellcare CHP/FHP/Medicaid	$22,000.94

FENTANYL 100 MCG/HR TD PT72

Facility

$78.71

Service Code	NDC 6050570842
Hospital Charge Code	6050570842
Hospital Revenue Code	250
Min. Negotiated Rate	$39.36
Max. Negotiated Rate	$39.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.36

FENTANYL 100 MCG/HR TD PT72

Facility

$53.36

Service Code	NDC 0406910076
Hospital Charge Code	0406910076
Hospital Revenue Code	250
Min. Negotiated Rate	$26.68
Max. Negotiated Rate	$26.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.68

FENTANYL 100 MCG/HR TD PT72

Facility

$53.36

Service Code	NDC 0378912498
Hospital Charge Code	0378912498
Hospital Revenue Code	250
Min. Negotiated Rate	$26.68
Max. Negotiated Rate	$26.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.68

FENTANYL 100 MCG/HR TD PT72

Facility

$78.71

Service Code	NDC 6050570842
Hospital Charge Code	6050570842
Hospital Revenue Code	250
Min. Negotiated Rate	$27.55
Max. Negotiated Rate	$62.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$43.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39.36
Rate for Payer: Aetna Government	$39.36
Rate for Payer: Brighton Health Commercial	$59.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$62.97
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.52
Rate for Payer: EmblemHealth Commercial	$39.36
Rate for Payer: Group Health Inc Commercial	$39.36
Rate for Payer: Group Health Inc Medicare	$27.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.36
Rate for Payer: Hamaspik Choice Inc Medicare	$39.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$51.16

FENTANYL 100 MCG/HR TD PT72

Facility

$53.36

Service Code	NDC 0406910076
Hospital Charge Code	0406910076
Hospital Revenue Code	250
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$42.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.68
Rate for Payer: Aetna Government	$26.68
Rate for Payer: Brighton Health Commercial	$40.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$42.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$36.28
Rate for Payer: EmblemHealth Commercial	$26.68
Rate for Payer: Group Health Inc Commercial	$26.68
Rate for Payer: Group Health Inc Medicare	$18.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.68
Rate for Payer: Hamaspik Choice Inc Medicare	$26.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.68

FENTANYL 100 MCG/HR TD PT72

Facility

$53.36

Service Code	NDC 0378912498
Hospital Charge Code	0378912498
Hospital Revenue Code	250
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$42.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$29.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.68
Rate for Payer: Aetna Government	$26.68
Rate for Payer: Brighton Health Commercial	$40.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$42.69
Rate for Payer: Cigna LocalPlus Benefit Plan	$36.28
Rate for Payer: EmblemHealth Commercial	$26.68
Rate for Payer: Group Health Inc Commercial	$26.68
Rate for Payer: Group Health Inc Medicare	$18.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$26.68
Rate for Payer: Hamaspik Choice Inc Medicare	$26.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$34.68

FENTANYL 12 MCG/HR TD PT72

Facility

$20.30

Service Code	NDC 0406911276
Hospital Charge Code	0406911276
Hospital Revenue Code	250
Min. Negotiated Rate	$10.15
Max. Negotiated Rate	$10.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.15

FENTANYL 12 MCG/HR TD PT72

Facility

$20.30

Service Code	NDC 0378911998
Hospital Charge Code	0378911998
Hospital Revenue Code	250
Min. Negotiated Rate	$10.15
Max. Negotiated Rate	$10.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.15

Know your out-of-pocket cost for care.

All Charges