St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN

Facility

$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

FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN

Facility

$0.60

Service Code	HCPCS J3010
Hospital Charge Code	6332380650
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$1.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Brighton Health Commercial	$0.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.41
Rate for Payer: EmblemHealth Commercial	$0.30
Rate for Payer: Group Health Inc Commercial	$0.30
Rate for Payer: Group Health Inc Medicare	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30
Rate for Payer: Hamaspik Choice Inc Medicare	$0.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.39

FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN

Facility

$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

$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) 250 MCG/5ML IJ SOLN

Facility

$0.68

Service Code	HCPCS J3010
Hospital Charge Code	6332380613
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$1.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Brighton Health Commercial	$0.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.47
Rate for Payer: EmblemHealth Commercial	$0.34
Rate for Payer: Group Health Inc Commercial	$0.34
Rate for Payer: Group Health Inc Medicare	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.34
Rate for Payer: Hamaspik Choice Inc Medicare	$0.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.44

FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN

Facility

$0.68

Service Code	HCPCS J3010
Hospital Charge Code	6332380613
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.34

FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN

Facility

$0.55

Service Code	HCPCS J3010
Hospital Charge Code	0409909425
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$1.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Brighton Health Commercial	$0.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.38
Rate for Payer: EmblemHealth Commercial	$0.28
Rate for Payer: Group Health Inc Commercial	$0.28
Rate for Payer: Group Health Inc Medicare	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28
Rate for Payer: Hamaspik Choice Inc Medicare	$0.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.36

FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN

Facility

$0.55

Service Code	HCPCS J3010
Hospital Charge Code	0409909425
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.28

FENTANYL CITRATE (PF) 500 MCG/10ML IJ SOLN

Facility

$0.45

Service Code	HCPCS J3010
Hospital Charge Code	0409909428
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22

FENTANYL CITRATE (PF) 500 MCG/10ML IJ SOLN

Facility

$0.45

Service Code	HCPCS J3010
Hospital Charge Code	0409909428
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$1.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.30
Rate for Payer: EmblemHealth Commercial	$0.22
Rate for Payer: Group Health Inc Commercial	$0.22
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22
Rate for Payer: Hamaspik Choice Inc Medicare	$0.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.29

FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN (WRAPPED)

Facility

$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) 50 MCG/ML IJ SOLN (WRAPPED)

Facility

$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 PCA 1300 MCG/130 ML NS (PREMIX)

Facility

$0.31

Service Code	HCPCS J3010
Hospital Charge Code	6332313099
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16

FENTANYL PCA 1300 MCG/130 ML NS (PREMIX)

Facility

$0.31

Service Code	HCPCS J3010
Hospital Charge Code	6332313099
Hospital Revenue Code	250
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

FERRIC CARBOXYMALTOSE 750 MG/15ML IV SOLN

Facility

$115.67

Service Code	HCPCS J1439
Hospital Charge Code	0517065001
Hospital Revenue Code	258
Min. Negotiated Rate	$0.78
Max. Negotiated Rate	$92.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$63.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.11
Rate for Payer: Aetna Government	$1.11
Rate for Payer: Affinity Essential Plan 1&2	$0.78
Rate for Payer: Affinity Essential Plan 3&4	$0.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$0.78
Rate for Payer: Brighton Health Commercial	$86.75
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$1.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$92.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$78.66
Rate for Payer: Elderplan Medicare Advantage	$1.11
Rate for Payer: EmblemHealth Commercial	$1.11
Rate for Payer: Fidelis CHP/HARP/Medicaid	$1.00
Rate for Payer: Fidelis Essential Plan Aliesa	$0.94
Rate for Payer: Fidelis Essential Plan QHP	$0.99
Rate for Payer: Fidelis Medicare Advantage	$1.11
Rate for Payer: Fidelis Qualified Health Plan	$0.99
Rate for Payer: Group Health Inc Commercial	$1.11
Rate for Payer: Group Health Inc Medicare	$1.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.11
Rate for Payer: Hamaspik Choice Inc Medicare	$1.11
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.11
Rate for Payer: Healthfirst Medicare Advantage	$0.94
Rate for Payer: Healthfirst QHP	$1.11
Rate for Payer: Humana Medicare	$1.13
Rate for Payer: Senior Whole Health Medicare Advantage	$1.11
Rate for Payer: United Healthcare Medicare Advantage	$1.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$75.19
Rate for Payer: Wellcare CHP/FHP/Medicaid	$1.05
Rate for Payer: Wellcare Medicare	$1.05

FERRIC CARBOXYMALTOSE 750 MG/15ML IV SOLN

Facility

$115.67

Service Code	HCPCS J1439
Hospital Charge Code	0517065001
Hospital Revenue Code	258
Min. Negotiated Rate	$57.84
Max. Negotiated Rate	$57.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$57.84

FERRIC SUBSULFATE 259 MG/GM EX SOLN

Facility

$2.46

Service Code	NDC 5936560651
Hospital Charge Code	5936560651
Hospital Revenue Code	250
Min. Negotiated Rate	$1.23
Max. Negotiated Rate	$1.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.23

FERRIC SUBSULFATE 259 MG/GM EX SOLN

Facility

$2.46

Service Code	NDC 5936560651
Hospital Charge Code	5936560651
Hospital Revenue Code	250
Min. Negotiated Rate	$0.86
Max. Negotiated Rate	$1.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.23
Rate for Payer: Aetna Government	$1.23
Rate for Payer: Brighton Health Commercial	$1.84
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.96
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.67
Rate for Payer: EmblemHealth Commercial	$1.23
Rate for Payer: Group Health Inc Commercial	$1.23
Rate for Payer: Group Health Inc Medicare	$0.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.23
Rate for Payer: Hamaspik Choice Inc Medicare	$1.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.60

FERROUS GLUCONATE 324 (37.5 FE) MG PO TABS

Facility

$0.07

Service Code	NDC 0904213761
Hospital Charge Code	0904213761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.04
Rate for Payer: Aetna Government	$0.04
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: EmblemHealth Commercial	$0.04
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

FERROUS GLUCONATE 324 (37.5 FE) MG PO TABS

Facility

$0.04

Service Code	NDC 2055501900
Hospital Charge Code	2055501900
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02

FERROUS GLUCONATE 324 (37.5 FE) MG PO TABS

Facility

$0.04

Service Code	NDC 2055501900
Hospital Charge Code	2055501900
Hospital Revenue Code	250
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.02
Rate for Payer: Aetna Government	$0.02
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.03
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.03
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

FERROUS GLUCONATE 324 (37.5 FE) MG PO TABS

Facility

$0.07

Service Code	NDC 0904213761
Hospital Charge Code	0904213761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04

FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN

Facility

$0.52

Service Code	NDC 0904727770
Hospital Charge Code	0904727770
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26

FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN

Facility

$0.52

Service Code	NDC 0904727770
Hospital Charge Code	0904727770
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.26
Rate for Payer: Aetna Government	$0.26
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	$0.36
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.34

FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN

Facility

$0.52

Service Code	NDC 0904727741
Hospital Charge Code	0904727741
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.26

Know your out-of-pocket cost for care.

All Charges