|
FENTANYL 75 MCG/HR TD PT72
|
Facility
|
IP
|
$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
|
IP
|
$40.21
|
|
|
Service Code
|
NDC 0406917576
|
| Hospital Charge Code |
0406917576
|
|
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
|
OP
|
$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-BUPIVACAINE-NACL 0.5-0.0625-0.9 MG/250ML-% EP SOLN
|
Facility
|
IP
|
$0.12
|
|
|
Service Code
|
NDC 6937452525
|
| Hospital Charge Code |
6937452525
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
|
|
FENTANYL-BUPIVACAINE-NACL 0.5-0.0625-0.9 MG/250ML-% EP SOLN
|
Facility
|
OP
|
$0.12
|
|
|
Service Code
|
NDC 6937452525
|
| Hospital Charge Code |
6937452525
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.09 |
| 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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.07
|
|
|
FENTANYL CITRATE-NACL 1.3-0.9 MG/130ML-% IV SOLN
|
Facility
|
IP
|
$0.31
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
6332313099
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.16
|
|
|
FENTANYL CITRATE-NACL 1.3-0.9 MG/130ML-% IV SOLN
|
Facility
|
OP
|
$0.31
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
6332313099
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.63
|
| Rate for Payer: Aetna Government |
$0.63
|
| Rate for Payer: Brighton Health Commercial |
$0.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.21
|
| Rate for Payer: EmblemHealth Commercial |
$0.16
|
| Rate for Payer: Group Health Inc Commercial |
$0.16
|
| Rate for Payer: Group Health Inc Medicare |
$0.11
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.16
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.20
|
|
|
FENTANYL CITRATE (PF) 1000 MCG/20ML IJ SOLN
|
Facility
|
OP
|
$0.47
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
0409909431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.63
|
| Rate for Payer: Aetna Government |
$0.63
|
| Rate for Payer: Brighton Health Commercial |
$0.35
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.37
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.32
|
| Rate for Payer: EmblemHealth Commercial |
$0.23
|
| Rate for Payer: Group Health Inc Commercial |
$0.23
|
| Rate for Payer: Group Health Inc Medicare |
$0.16
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.23
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.30
|
|
|
FENTANYL CITRATE (PF) 1000 MCG/20ML IJ SOLN
|
Facility
|
IP
|
$0.47
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
0409909431
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.23 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.23
|
|
|
FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN
|
Facility
|
IP
|
$1.37
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
6332380602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.69
|
|
|
FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN
|
Facility
|
OP
|
$1.37
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
6332380602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.63
|
| Rate for Payer: Aetna Government |
$0.63
|
| Rate for Payer: Brighton Health Commercial |
$1.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.93
|
| Rate for Payer: EmblemHealth Commercial |
$0.69
|
| Rate for Payer: Group Health Inc Commercial |
$0.69
|
| Rate for Payer: Group Health Inc Medicare |
$0.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.89
|
|
|
FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN
|
Facility
|
OP
|
$1.27
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
0641602701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.63
|
| Rate for Payer: Aetna Government |
$0.63
|
| Rate for Payer: Brighton Health Commercial |
$0.95
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.86
|
| Rate for Payer: EmblemHealth Commercial |
$0.64
|
| Rate for Payer: Group Health Inc Commercial |
$0.64
|
| Rate for Payer: Group Health Inc Medicare |
$0.44
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.83
|
|
|
FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN
|
Facility
|
IP
|
$1.38
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
6332380612
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$0.69 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.69
|
|
|
FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN
|
Facility
|
OP
|
$0.92
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
0409909422
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.63
|
| Rate for Payer: Aetna Government |
$0.63
|
| Rate for Payer: Brighton Health Commercial |
$0.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.63
|
| Rate for Payer: EmblemHealth Commercial |
$0.46
|
| Rate for Payer: Group Health Inc Commercial |
$0.46
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.60
|
|
|
FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN
|
Facility
|
OP
|
$1.27
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
0641602725
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.70
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.63
|
| Rate for Payer: Aetna Government |
$0.63
|
| Rate for Payer: Brighton Health Commercial |
$0.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.02
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.87
|
| Rate for Payer: EmblemHealth Commercial |
$0.64
|
| Rate for Payer: Group Health Inc Commercial |
$0.64
|
| Rate for Payer: Group Health Inc Medicare |
$0.45
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.64
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.64
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.83
|
|
|
FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN
|
Facility
|
IP
|
$1.27
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
0641602725
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.64
|
|
|
FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN
|
Facility
|
IP
|
$1.27
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
0641602701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$0.64 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.64
|
|
|
FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN
|
Facility
|
OP
|
$0.93
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
0409909412
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.51
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.63
|
| Rate for Payer: Aetna Government |
$0.63
|
| Rate for Payer: Brighton Health Commercial |
$0.69
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.63
|
| Rate for Payer: EmblemHealth Commercial |
$0.46
|
| Rate for Payer: Group Health Inc Commercial |
$0.46
|
| Rate for Payer: Group Health Inc Medicare |
$0.32
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.46
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.60
|
|
|
FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN
|
Facility
|
IP
|
$0.93
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
0409909412
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.46
|
|
|
FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN
|
Facility
|
IP
|
$0.92
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
0409909422
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.46
|
|
|
FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN
|
Facility
|
OP
|
$1.38
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
6332380612
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.76
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.63
|
| Rate for Payer: Aetna Government |
$0.63
|
| Rate for Payer: Brighton Health Commercial |
$1.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.94
|
| Rate for Payer: EmblemHealth Commercial |
$0.69
|
| Rate for Payer: Group Health Inc Commercial |
$0.69
|
| Rate for Payer: Group Health Inc Medicare |
$0.48
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.69
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.69
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.89
|
|
|
FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN
|
Facility
|
OP
|
$0.52
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
0409909441
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.63
|
| Rate for Payer: Aetna Government |
$0.63
|
| Rate for Payer: Brighton Health Commercial |
$0.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
| Rate for Payer: EmblemHealth Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.34
|
|
|
FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN
|
Facility
|
OP
|
$0.52
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
0409909461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.63
|
| Rate for Payer: Aetna Government |
$0.63
|
| Rate for Payer: Brighton Health Commercial |
$0.39
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
| Rate for Payer: EmblemHealth Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Commercial |
$0.26
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.26
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.26
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$1.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.34
|
|
|
FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
0641603001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.30
|
|
|
FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN
|
Facility
|
IP
|
$0.60
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
6332380650
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.30
|
|
