St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FENTANYL 2500MCG/50ML - .1MG VIAL

Facility

$0.01

Service Code	HCPCS J3010
Hospital Charge Code	41648413
Hospital Revenue Code	636
Max. Negotiated Rate	$1.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.05
Rate for Payer: SOMOS Essential	$1.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

FENTANYL 2500MCG/50ML - .1MG VIAL

Facility

$0.01

Service Code	HCPCS J3010
Hospital Charge Code	41648413
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

FENTANYL 2500MCG/50ML - .1MG VIAL

Facility

$0.01

Service Code	HCPCS J3010
Hospital Charge Code	41658413
Hospital Revenue Code	636
Max. Negotiated Rate	$1.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.05
Rate for Payer: SOMOS Essential	$1.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

FENTANYL 250MG 50ML INF PEDS

Facility

$6.00

Hospital Charge Code	41647180
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

FENTANYL 250MG 50ML INF PEDS

Facility

$6.00

Hospital Charge Code	41657180
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

FENTANYL 25 MCG/HR TD PT72 [27905]

Facility

$21.27

Service Code	NDC 60505708102
Hospital Charge Code	60505708102
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: 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 [27905]

Facility

$21.27

Service Code	NDC 47781042447
Hospital Charge Code	47781042447
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: 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 [27905]

Facility

$21.27

Service Code	NDC 47781042411
Hospital Charge Code	60505708102
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: 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 [27905]

Facility

$21.27

Service Code	NDC 47781042411
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: 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 [27905]

Facility

$21.27

Service Code	NDC 47781042411
Hospital Charge Code	47781042447
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: 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 [27906]

Facility

$38.88

Service Code	NDC 47781042647
Hospital Charge Code	47781042647
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: 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 [27906]

Facility

$26.36

Service Code	NDC 00378912298
Hospital Charge Code	00378912298
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: 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 [27906]

Facility

$38.88

Service Code	NDC 60505708202
Hospital Charge Code	60505708202
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: 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/ML INJ 10 ML

Facility

$0.84

Hospital Charge Code	41644421
Hospital Revenue Code	636
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42

FENTANYL 50 MCG/ML INJ 10 ML

Facility

$0.84

Hospital Charge Code	41654421
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.48
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.55

FENTANYL 50 MCG/ML INJ 10 ML

Facility

$0.84

Hospital Charge Code	41654421
Hospital Revenue Code	636
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42

FENTANYL 50 MCG/ML INJ 10 ML

Facility

$0.84

Hospital Charge Code	41644421
Hospital Revenue Code	636
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.42
Rate for Payer: Aetna Government	$0.42
Rate for Payer: Brighton Health Commercial	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.48
Rate for Payer: Group Health Inc Commercial	$0.42
Rate for Payer: Group Health Inc Medicare	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42
Rate for Payer: Hamaspik Choice Inc Medicare	$0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.55

FENTANYL 50 MCG/ML INJ 20 ML

Facility

$0.28

Hospital Charge Code	41655599
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: Group Health Inc Commercial	$0.14
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.18

FENTANYL 50 MCG/ML INJ 20 ML

Facility

$0.28

Hospital Charge Code	41645599
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14

FENTANYL 50 MCG/ML INJ 20 ML

Facility

$0.28

Hospital Charge Code	41645599
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.14
Rate for Payer: Aetna Government	$0.14
Rate for Payer: Brighton Health Commercial	$0.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.16
Rate for Payer: Group Health Inc Commercial	$0.14
Rate for Payer: Group Health Inc Medicare	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.18

FENTANYL 50 MCG/ML INJ 20 ML

Facility

$0.28

Hospital Charge Code	41655599
Hospital Revenue Code	636
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.14
Rate for Payer: Hamaspik Choice Inc Medicare	$0.14

FENTANYL 50 MCG/ML INJ 2 ML AMP

Facility

$8.44

Hospital Charge Code	41644345
Hospital Revenue Code	250
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$6.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.22
Rate for Payer: Aetna Government	$4.22
Rate for Payer: Brighton Health Commercial	$6.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.74
Rate for Payer: Group Health Inc Commercial	$4.22
Rate for Payer: Group Health Inc Medicare	$2.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.22
Rate for Payer: Hamaspik Choice Inc Medicare	$4.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.49

FENTANYL 50 MCG/ML INJ 2 ML AMP

Facility

$8.44

Service Code	HCPCS J3010
Hospital Charge Code	41654345
Hospital Revenue Code	636
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$5.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Brighton Health Commercial	$5.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.22
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.85
Rate for Payer: Group Health Inc Commercial	$4.22
Rate for Payer: Group Health Inc Medicare	$2.95
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.22
Rate for Payer: Hamaspik Choice Inc Medicare	$4.22
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.05
Rate for Payer: SOMOS Essential	$1.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.49

FENTANYL 50 MCG/ML INJ 2 ML AMP

Facility

$8.44

Service Code	HCPCS J3010
Hospital Charge Code	41654345
Hospital Revenue Code	636
Min. Negotiated Rate	$4.22
Max. Negotiated Rate	$4.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.22
Rate for Payer: Hamaspik Choice Inc Medicare	$4.22

FENTANYL 50 MCG/ML INJ 2 ML VIAL

Facility

$44.20

Hospital Charge Code	41645566
Hospital Revenue Code	636
Min. Negotiated Rate	$15.47
Max. Negotiated Rate	$28.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$24.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$22.10
Rate for Payer: Aetna Government	$22.10
Rate for Payer: Brighton Health Commercial	$26.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$22.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.42
Rate for Payer: Group Health Inc Commercial	$22.10
Rate for Payer: Group Health Inc Medicare	$15.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.10
Rate for Payer: Hamaspik Choice Inc Medicare	$22.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$28.73

Know your out-of-pocket cost for care.

All Charges