St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FENTANYL 12 MCG/HR TD PT72

Facility

$20.30

Service Code	NDC 0406911276
Hospital Charge Code	0406911276
Hospital Revenue Code	250
Min. Negotiated Rate	$7.11
Max. Negotiated Rate	$16.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.15
Rate for Payer: Aetna Government	$10.15
Rate for Payer: Brighton Health Commercial	$15.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.81
Rate for Payer: EmblemHealth Commercial	$10.15
Rate for Payer: Group Health Inc Commercial	$10.15
Rate for Payer: Group Health Inc Medicare	$7.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.15
Rate for Payer: Hamaspik Choice Inc Medicare	$10.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.20

FENTANYL 12 MCG/HR TD PT72

Facility

$20.30

Service Code	NDC 4778142347
Hospital Charge Code	4778142347
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 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

FENTANYL 12 MCG/HR TD PT72

Facility

$20.30

Service Code	NDC 0378911998
Hospital Charge Code	0378911998
Hospital Revenue Code	250
Min. Negotiated Rate	$7.11
Max. Negotiated Rate	$16.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.15
Rate for Payer: Aetna Government	$10.15
Rate for Payer: Brighton Health Commercial	$15.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.24
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.81
Rate for Payer: EmblemHealth Commercial	$10.15
Rate for Payer: Group Health Inc Commercial	$10.15
Rate for Payer: Group Health Inc Medicare	$7.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.15
Rate for Payer: Hamaspik Choice Inc Medicare	$10.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.20

FENTANYL 12 MCG/HR TD PT72

Facility

$20.30

Service Code	NDC 0378911916
Hospital Charge Code	0378911916
Hospital Revenue Code	250
Min. Negotiated Rate	$10.15
Max. Negotiated Rate	$10.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.15

FENTANYL 25 MCG/HR TD PT72

Facility

$21.27

Service Code	NDC 4778142411
Hospital Charge Code	4778142411
Hospital Revenue Code	250
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$10.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.63

FENTANYL 25 MCG/HR TD PT72

Facility

$21.27

Service Code	NDC 4778142447
Hospital Charge Code	4778142447
Hospital Revenue Code	250
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$17.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.63
Rate for Payer: Aetna Government	$10.63
Rate for Payer: Brighton Health Commercial	$15.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.46
Rate for Payer: EmblemHealth Commercial	$10.63
Rate for Payer: Group Health Inc Commercial	$10.63
Rate for Payer: Group Health Inc Medicare	$7.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.63
Rate for Payer: Hamaspik Choice Inc Medicare	$10.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.82

FENTANYL 25 MCG/HR TD PT72

Facility

$7.00

Service Code	NDC 5074255001
Hospital Charge Code	5074255001
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: EmblemHealth Commercial	$3.50
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

FENTANYL 25 MCG/HR TD PT72

Facility

$21.27

Service Code	NDC 4778142447
Hospital Charge Code	4778142447
Hospital Revenue Code	250
Min. Negotiated Rate	$10.63
Max. Negotiated Rate	$10.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.63

FENTANYL 25 MCG/HR TD PT72

Facility

$7.00

Service Code	NDC 5074255001
Hospital Charge Code	5074255001
Hospital Revenue Code	250
Min. Negotiated Rate	$3.50
Max. Negotiated Rate	$3.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50

FENTANYL 25 MCG/HR TD PT72

Facility

$21.27

Service Code	NDC 4778142411
Hospital Charge Code	4778142411
Hospital Revenue Code	250
Min. Negotiated Rate	$7.44
Max. Negotiated Rate	$17.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$11.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.63
Rate for Payer: Aetna Government	$10.63
Rate for Payer: Brighton Health Commercial	$15.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$17.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.46
Rate for Payer: EmblemHealth Commercial	$10.63
Rate for Payer: Group Health Inc Commercial	$10.63
Rate for Payer: Group Health Inc Medicare	$7.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$10.63
Rate for Payer: Hamaspik Choice Inc Medicare	$10.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$13.82

FENTANYL 50 MCG/HR TD PT72

Facility

$38.88

Service Code	NDC 6050570822
Hospital Charge Code	6050570822
Hospital Revenue Code	250
Min. Negotiated Rate	$13.61
Max. Negotiated Rate	$31.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.44
Rate for Payer: Aetna Government	$19.44
Rate for Payer: Brighton Health Commercial	$29.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.44
Rate for Payer: EmblemHealth Commercial	$19.44
Rate for Payer: Group Health Inc Commercial	$19.44
Rate for Payer: Group Health Inc Medicare	$13.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.44
Rate for Payer: Hamaspik Choice Inc Medicare	$19.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.27

FENTANYL 50 MCG/HR TD PT72

Facility

$26.36

Service Code	NDC 0378912298
Hospital Charge Code	0378912298
Hospital Revenue Code	250
Min. Negotiated Rate	$9.23
Max. Negotiated Rate	$21.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$14.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$13.18
Rate for Payer: Aetna Government	$13.18
Rate for Payer: Brighton Health Commercial	$19.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$21.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$17.92
Rate for Payer: EmblemHealth Commercial	$13.18
Rate for Payer: Group Health Inc Commercial	$13.18
Rate for Payer: Group Health Inc Medicare	$9.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.18
Rate for Payer: Hamaspik Choice Inc Medicare	$13.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$17.13

FENTANYL 50 MCG/HR TD PT72

Facility

$38.88

Service Code	NDC 4778142647
Hospital Charge Code	4778142647
Hospital Revenue Code	250
Min. Negotiated Rate	$19.44
Max. Negotiated Rate	$19.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.44

FENTANYL 50 MCG/HR TD PT72

Facility

$38.88

Service Code	NDC 4778142647
Hospital Charge Code	4778142647
Hospital Revenue Code	250
Min. Negotiated Rate	$13.61
Max. Negotiated Rate	$31.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$21.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$19.44
Rate for Payer: Aetna Government	$19.44
Rate for Payer: Brighton Health Commercial	$29.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$31.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$26.44
Rate for Payer: EmblemHealth Commercial	$19.44
Rate for Payer: Group Health Inc Commercial	$19.44
Rate for Payer: Group Health Inc Medicare	$13.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.44
Rate for Payer: Hamaspik Choice Inc Medicare	$19.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$25.27

FENTANYL 50 MCG/HR TD PT72

Facility

$38.88

Service Code	NDC 6050570822
Hospital Charge Code	6050570822
Hospital Revenue Code	250
Min. Negotiated Rate	$19.44
Max. Negotiated Rate	$19.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$19.44

FENTANYL 50 MCG/HR TD PT72

Facility

$26.36

Service Code	NDC 0378912298
Hospital Charge Code	0378912298
Hospital Revenue Code	250
Min. Negotiated Rate	$13.18
Max. Negotiated Rate	$13.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$13.18

FENTANYL 75 MCG/HR TD PT72

Facility

$59.31

Service Code	NDC 6050570830
Hospital Charge Code	6050570830
Hospital Revenue Code	250
Min. Negotiated Rate	$20.76
Max. Negotiated Rate	$47.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.66
Rate for Payer: Aetna Government	$29.66
Rate for Payer: Brighton Health Commercial	$44.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.45
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.33
Rate for Payer: EmblemHealth Commercial	$29.66
Rate for Payer: Group Health Inc Commercial	$29.66
Rate for Payer: Group Health Inc Medicare	$20.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.66
Rate for Payer: Hamaspik Choice Inc Medicare	$29.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.55

FENTANYL 75 MCG/HR TD PT72

Facility

$59.31

Service Code	NDC 4778142747
Hospital Charge Code	4778142747
Hospital Revenue Code	250
Min. Negotiated Rate	$20.76
Max. Negotiated Rate	$47.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.65
Rate for Payer: Aetna Government	$29.65
Rate for Payer: Brighton Health Commercial	$44.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.33
Rate for Payer: EmblemHealth Commercial	$29.65
Rate for Payer: Group Health Inc Commercial	$29.65
Rate for Payer: Group Health Inc Medicare	$20.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.65
Rate for Payer: Hamaspik Choice Inc Medicare	$29.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.55

FENTANYL 75 MCG/HR TD PT72

Facility

$40.21

Service Code	NDC 0406917576
Hospital Charge Code	0406917576
Hospital Revenue Code	250
Min. Negotiated Rate	$14.07
Max. Negotiated Rate	$32.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.11
Rate for Payer: Aetna Government	$20.11
Rate for Payer: Brighton Health Commercial	$30.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.34
Rate for Payer: EmblemHealth Commercial	$20.11
Rate for Payer: Group Health Inc Commercial	$20.11
Rate for Payer: Group Health Inc Medicare	$14.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.11
Rate for Payer: Hamaspik Choice Inc Medicare	$20.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.14

FENTANYL 75 MCG/HR TD PT72

Facility

$59.31

Service Code	NDC 6050570832
Hospital Charge Code	6050570832
Hospital Revenue Code	250
Min. Negotiated Rate	$20.76
Max. Negotiated Rate	$47.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$32.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.65
Rate for Payer: Aetna Government	$29.65
Rate for Payer: Brighton Health Commercial	$44.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$47.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$40.33
Rate for Payer: EmblemHealth Commercial	$29.65
Rate for Payer: Group Health Inc Commercial	$29.65
Rate for Payer: Group Health Inc Medicare	$20.76
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.65
Rate for Payer: Hamaspik Choice Inc Medicare	$29.65
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$38.55

FENTANYL 75 MCG/HR TD PT72

Facility

$59.31

Service Code	NDC 6050570832
Hospital Charge Code	6050570832
Hospital Revenue Code	250
Min. Negotiated Rate	$29.65
Max. Negotiated Rate	$29.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$29.65

FENTANYL 75 MCG/HR TD PT72

Facility

$40.21

Service Code	NDC 0378912398
Hospital Charge Code	0378912398
Hospital Revenue Code	250
Min. Negotiated Rate	$20.11
Max. Negotiated Rate	$20.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.11

FENTANYL 75 MCG/HR TD PT72

Facility

$40.21

Service Code	NDC 0378912398
Hospital Charge Code	0378912398
Hospital Revenue Code	250
Min. Negotiated Rate	$14.07
Max. Negotiated Rate	$32.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$22.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.11
Rate for Payer: Aetna Government	$20.11
Rate for Payer: Brighton Health Commercial	$30.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$32.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$27.34
Rate for Payer: EmblemHealth Commercial	$20.11
Rate for Payer: Group Health Inc Commercial	$20.11
Rate for Payer: Group Health Inc Medicare	$14.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.11
Rate for Payer: Hamaspik Choice Inc Medicare	$20.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.14

Know your out-of-pocket cost for care.

All Charges