St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FENTANYL 50 MCG/ML INJ 2 ML VIAL

Facility

$44.20

Hospital Charge Code	41655566
Hospital Revenue Code	636
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$22.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.10
Rate for Payer: Hamaspik Choice Inc Medicare	$22.10

FENTANYL 50 MCG/ML INJ 2 ML VIAL

Facility

$44.20

Hospital Charge Code	41655566
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

FENTANYL 50 MCG/ML INJ 2 ML VIAL

Facility

$44.20

Hospital Charge Code	41645566
Hospital Revenue Code	636
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$22.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$22.10
Rate for Payer: Hamaspik Choice Inc Medicare	$22.10

FENTANYL 75 MCG/HR TD PT72 [27907]

Facility

$40.21

Service Code	NDC 00378912398
Hospital Charge Code	00378912398
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	$20.10
Rate for Payer: Aetna Government	$20.10
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: Group Health Inc Commercial	$20.10
Rate for Payer: Group Health Inc Medicare	$14.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.10
Rate for Payer: Hamaspik Choice Inc Medicare	$20.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.14

FENTANYL 75 MCG/HR TD PT72 [27907]

Facility

$59.31

Service Code	NDC 60505708302
Hospital Charge Code	60505708302
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: 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 [27907]

Facility

$59.31

Service Code	NDC 47781042747
Hospital Charge Code	47781042747
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: 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 [27907]

Facility

$59.31

Service Code	NDC 60505708300
Hospital Charge Code	60505708300
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: 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 [27907]

Facility

$40.21

Service Code	NDC 00406917576
Hospital Charge Code	00406917576
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	$20.10
Rate for Payer: Aetna Government	$20.10
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: Group Health Inc Commercial	$20.10
Rate for Payer: Group Health Inc Medicare	$14.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$20.10
Rate for Payer: Hamaspik Choice Inc Medicare	$20.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$26.14

FENTANYL AND ANALOGUES

Facility

$87.50

Service Code	HCPCS 80354
Hospital Charge Code	40609880
Hospital Revenue Code	301
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$70.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$48.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$65.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$70.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$59.50
Rate for Payer: Group Health Inc Commercial	$43.75
Rate for Payer: Group Health Inc Medicare	$30.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$43.75
Rate for Payer: Hamaspik Choice Inc Medicare	$43.75
Rate for Payer: United Healthcare Commercial	$21.99

FENTANYL-BUPIVACAINE-NACL 0.5-0.0625-0.9 MG/250ML-% EP SOLN [136896]

Facility

$0.12

Service Code	NDC 69374052525
Hospital Charge Code	69374052525
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: 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 100MCG/2ML

Facility

$2.40

Service Code	HCPCS J3010
Hospital Charge Code	41646092
Hospital Revenue Code	636
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.20
Rate for Payer: Hamaspik Choice Inc Medicare	$1.20

FENTANYL CITRATE 100MCG/2ML

Facility

$2.40

Service Code	HCPCS J3010
Hospital Charge Code	41646092
Hospital Revenue Code	636
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Brighton Health Commercial	$1.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.38
Rate for Payer: Group Health Inc Commercial	$1.20
Rate for Payer: Group Health Inc Medicare	$0.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.20
Rate for Payer: Hamaspik Choice Inc Medicare	$1.20
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	$1.56

FENTANYL CITRATE 100MCG/2ML

Facility

$2.40

Service Code	HCPCS J3010
Hospital Charge Code	41656092
Hospital Revenue Code	636
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.20
Rate for Payer: Hamaspik Choice Inc Medicare	$1.20

FENTANYL CITRATE 100MCG/2ML

Facility

$2.40

Service Code	HCPCS J3010
Hospital Charge Code	41656092
Hospital Revenue Code	636
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$1.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
Rate for Payer: Brighton Health Commercial	$1.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.38
Rate for Payer: Group Health Inc Commercial	$1.20
Rate for Payer: Group Health Inc Medicare	$0.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.20
Rate for Payer: Hamaspik Choice Inc Medicare	$1.20
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	$1.56

FENTANYL CITRATE INJ 50MCG/ML

Facility

$0.28

Service Code	HCPCS J3010
Hospital Charge Code	41646038
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 CITRATE INJ 50MCG/ML

Facility

$0.28

Service Code	HCPCS J3010
Hospital Charge Code	41646038
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$1.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
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: 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	$0.18

FENTANYL CITRATE INJ 50MCG/ML

Facility

$0.28

Service Code	HCPCS J3010
Hospital Charge Code	41656038
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 CITRATE INJ 50MCG/ML

Facility

$0.28

Service Code	HCPCS J3010
Hospital Charge Code	41656038
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$1.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.63
Rate for Payer: Aetna Government	$0.63
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: 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	$0.18

FENTANYL CITRATE-NACL 1.3-0.9 MG/130ML-% IV SOLN [401216]

Facility

$0.31

Service Code	HCPCS J3010
Hospital Charge Code	63323013099
Hospital Revenue Code	278
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.16
Rate for Payer: Hamaspik Choice Inc Medicare	$0.16

FENTANYL CITRATE-NACL 1.3-0.9 MG/130ML-% IV SOLN [401216]

Facility

$0.31

Service Code	HCPCS J3010
Hospital Charge Code	63323013099
Hospital Revenue Code	278
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$0.63
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	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: EmblemHealth Commercial	$0.16
Rate for Payer: Fidelis Medicare Advantage	$0.33
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.20

FENTANYL CITRATE (PF) 1000 MCG/20ML IJ SOLN [131634]

Facility

$0.47

Service Code	HCPCS J3010
Hospital Charge Code	00409909431
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$1.05
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: 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.99
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.05
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.05
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.30

FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN [131632]

Facility

$0.92

Service Code	HCPCS J3010
Hospital Charge Code	00409909422
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.05
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: 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.99
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.05
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.05
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.05
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 [131632]

Facility

$1.38

Service Code	HCPCS J3010
Hospital Charge Code	63323080612
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: 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.99
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.05
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.05
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.05
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 [131632]

Facility

$1.27

Service Code	HCPCS J3010
Hospital Charge Code	00641602725
Hospital Revenue Code	250
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$1.05
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: 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.99
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.05
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.05
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.05
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 [131632]

Facility

$0.93

Service Code	HCPCS J3010
Hospital Charge Code	00409909412
Hospital Revenue Code	250
Min. Negotiated Rate	$0.32
Max. Negotiated Rate	$1.05
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: 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.99
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.05
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.05
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.60

Know your out-of-pocket cost for care.

All Charges