St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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

Facility

$1.27

Service Code	HCPCS J3010
Hospital Charge Code	00641602701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
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	$0.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.86
Rate for Payer: 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: 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

$1.37

Service Code	HCPCS J3010
Hospital Charge Code	63323080602
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: 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) 2500 MCG/50ML IJ SOLN [131635]

Facility

$0.60

Service Code	HCPCS J3010
Hospital Charge Code	00641603001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$1.05
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: 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: 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	$0.39

FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN [131635]

Facility

$0.52

Service Code	HCPCS J3010
Hospital Charge Code	00409909441
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$1.05
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: 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: 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	$0.34

FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN [131635]

Facility

$0.60

Service Code	HCPCS J3010
Hospital Charge Code	63323080650
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$1.05
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: 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: 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	$0.39

FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN [131635]

Facility

$0.52

Service Code	HCPCS J3010
Hospital Charge Code	00409909461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$1.05
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: 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: 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	$0.34

FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN [131633]

Facility

$0.68

Service Code	HCPCS J3010
Hospital Charge Code	63323080613
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$1.05
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: 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: 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	$0.44

FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN [131633]

Facility

$0.55

Service Code	HCPCS J3010
Hospital Charge Code	00409909425
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$1.05
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: 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: 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	$0.36

FENTANYL CITRATE (PF) 500 MCG/10ML IJ SOLN [131705]

Facility

$0.45

Service Code	HCPCS J3010
Hospital Charge Code	00409909428
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$1.05
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: 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: 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	$0.29

FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN (WRAPPED) [4080003037]

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 D5WW 100ML INF

Facility

$0.08

Hospital Charge Code	41657781
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	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
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

FENTANYL DRIP 500 MCG/D5W INFUSION 100 M

Facility

$7.00

Hospital Charge Code	41650088
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: 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 DRIP 500 MCG/D5W INFUSION 100 M

Facility

$7.00

Hospital Charge Code	41640088
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: 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 PATCH 100 MCG/HR

Facility

$22.65

Hospital Charge Code	41653946
Hospital Revenue Code	250
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$18.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.32
Rate for Payer: Aetna Government	$11.32
Rate for Payer: Brighton Health Commercial	$16.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.40
Rate for Payer: Group Health Inc Commercial	$11.32
Rate for Payer: Group Health Inc Medicare	$7.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.32
Rate for Payer: Hamaspik Choice Inc Medicare	$11.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.72

FENTANYL PATCH 100 MCG/HR

Facility

$22.65

Hospital Charge Code	41643946
Hospital Revenue Code	250
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$18.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.32
Rate for Payer: Aetna Government	$11.32
Rate for Payer: Brighton Health Commercial	$16.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.40
Rate for Payer: Group Health Inc Commercial	$11.32
Rate for Payer: Group Health Inc Medicare	$7.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.32
Rate for Payer: Hamaspik Choice Inc Medicare	$11.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.72

FENTANYL PATCH 12 MCG/HR

Facility

$29.68

Hospital Charge Code	41655319
Hospital Revenue Code	250
Min. Negotiated Rate	$10.39
Max. Negotiated Rate	$23.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.84
Rate for Payer: Aetna Government	$14.84
Rate for Payer: Brighton Health Commercial	$22.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.18
Rate for Payer: Group Health Inc Commercial	$14.84
Rate for Payer: Group Health Inc Medicare	$10.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.84
Rate for Payer: Hamaspik Choice Inc Medicare	$14.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.29

FENTANYL PATCH 12 MCG/HR

Facility

$29.68

Hospital Charge Code	41645319
Hospital Revenue Code	250
Min. Negotiated Rate	$10.39
Max. Negotiated Rate	$23.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.84
Rate for Payer: Aetna Government	$14.84
Rate for Payer: Brighton Health Commercial	$22.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$20.18
Rate for Payer: Group Health Inc Commercial	$14.84
Rate for Payer: Group Health Inc Medicare	$10.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.84
Rate for Payer: Hamaspik Choice Inc Medicare	$14.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$19.29

FENTANYL PATCH 25 MCG/HR

Facility

$6.48

Hospital Charge Code	41643943
Hospital Revenue Code	250
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$5.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.24
Rate for Payer: Aetna Government	$3.24
Rate for Payer: Brighton Health Commercial	$4.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.41
Rate for Payer: Group Health Inc Commercial	$3.24
Rate for Payer: Group Health Inc Medicare	$2.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.24
Rate for Payer: Hamaspik Choice Inc Medicare	$3.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.21

FENTANYL PATCH 25 MCG/HR

Facility

$6.48

Hospital Charge Code	41653943
Hospital Revenue Code	250
Min. Negotiated Rate	$2.27
Max. Negotiated Rate	$5.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.24
Rate for Payer: Aetna Government	$3.24
Rate for Payer: Brighton Health Commercial	$4.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.41
Rate for Payer: Group Health Inc Commercial	$3.24
Rate for Payer: Group Health Inc Medicare	$2.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.24
Rate for Payer: Hamaspik Choice Inc Medicare	$3.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.21

FENTANYL PATCH 50 MCG/HR

Facility

$11.00

Hospital Charge Code	41643944
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$8.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.50
Rate for Payer: Aetna Government	$5.50
Rate for Payer: Brighton Health Commercial	$8.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

FENTANYL PATCH 50 MCG/HR

Facility

$11.00

Hospital Charge Code	41653944
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$8.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.50
Rate for Payer: Aetna Government	$5.50
Rate for Payer: Brighton Health Commercial	$8.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

FENTANYL PATCH 75 MCG/HR

Facility

$19.11

Hospital Charge Code	41643945
Hospital Revenue Code	250
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$15.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.56
Rate for Payer: Aetna Government	$9.56
Rate for Payer: Brighton Health Commercial	$14.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.99
Rate for Payer: Group Health Inc Commercial	$9.56
Rate for Payer: Group Health Inc Medicare	$6.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.56
Rate for Payer: Hamaspik Choice Inc Medicare	$9.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.42

FENTANYL PATCH 75 MCG/HR

Facility

$19.11

Hospital Charge Code	41653945
Hospital Revenue Code	250
Min. Negotiated Rate	$6.69
Max. Negotiated Rate	$15.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.56
Rate for Payer: Aetna Government	$9.56
Rate for Payer: Brighton Health Commercial	$14.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.99
Rate for Payer: Group Health Inc Commercial	$9.56
Rate for Payer: Group Health Inc Medicare	$6.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.56
Rate for Payer: Hamaspik Choice Inc Medicare	$9.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.42

FENTANYL PCA 1000 MCG/D5W INFUSION 100 M

Facility

$11.00

Hospital Charge Code	41640619
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$8.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.50
Rate for Payer: Aetna Government	$5.50
Rate for Payer: Brighton Health Commercial	$8.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

FENTANYL PCA 1000 MCG/D5W INFUSION 100 M

Facility

$11.00

Hospital Charge Code	41650619
Hospital Revenue Code	250
Min. Negotiated Rate	$3.85
Max. Negotiated Rate	$8.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.50
Rate for Payer: Aetna Government	$5.50
Rate for Payer: Brighton Health Commercial	$8.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$5.50
Rate for Payer: Group Health Inc Medicare	$3.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.50
Rate for Payer: Hamaspik Choice Inc Medicare	$5.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.15

Know your out-of-pocket cost for care.

All Charges