St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FLUOCINONIDE 0.05 % EX OINT

Facility

$4.72

Service Code	NDC 5167212641
Hospital Charge Code	5167212641
Hospital Revenue Code	250
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$3.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.36
Rate for Payer: Aetna Government	$2.36
Rate for Payer: Brighton Health Commercial	$3.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.21
Rate for Payer: EmblemHealth Commercial	$2.36
Rate for Payer: Group Health Inc Commercial	$2.36
Rate for Payer: Group Health Inc Medicare	$1.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.36
Rate for Payer: Hamaspik Choice Inc Medicare	$2.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.07

FLUOCINONIDE 0.05 % EX SOLN

Facility

$1.78

Service Code	NDC 6498045206
Hospital Charge Code	6498045206
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$1.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.89
Rate for Payer: Aetna Government	$0.89
Rate for Payer: Brighton Health Commercial	$1.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.21
Rate for Payer: EmblemHealth Commercial	$0.89
Rate for Payer: Group Health Inc Commercial	$0.89
Rate for Payer: Group Health Inc Medicare	$0.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.89
Rate for Payer: Hamaspik Choice Inc Medicare	$0.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.15

FLUOCINONIDE 0.05 % EX SOLN

Facility

$1.78

Service Code	NDC 6498045206
Hospital Charge Code	6498045206
Hospital Revenue Code	250
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.89

FLUOCINONIDE 0.05 % EX SOLN

Facility

$1.93

Service Code	NDC 7071012843
Hospital Charge Code	7071012843
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$1.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.97
Rate for Payer: Aetna Government	$0.97
Rate for Payer: Brighton Health Commercial	$1.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.31
Rate for Payer: EmblemHealth Commercial	$0.97
Rate for Payer: Group Health Inc Commercial	$0.97
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97
Rate for Payer: Hamaspik Choice Inc Medicare	$0.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.26

FLUOCINONIDE 0.05 % EX SOLN

Facility

$1.93

Service Code	NDC 5167212734
Hospital Charge Code	5167212734
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$1.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.97
Rate for Payer: Aetna Government	$0.97
Rate for Payer: Brighton Health Commercial	$1.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.31
Rate for Payer: EmblemHealth Commercial	$0.97
Rate for Payer: Group Health Inc Commercial	$0.97
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97
Rate for Payer: Hamaspik Choice Inc Medicare	$0.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.26

FLUOCINONIDE 0.05 % EX SOLN

Facility

$0.80

Service Code	NDC 0168013460
Hospital Charge Code	0168013460
Hospital Revenue Code	250
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.40

FLUOCINONIDE 0.05 % EX SOLN

Facility

$0.80

Service Code	NDC 0168013460
Hospital Charge Code	0168013460
Hospital Revenue Code	250
Min. Negotiated Rate	$0.28
Max. Negotiated Rate	$0.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.40
Rate for Payer: Aetna Government	$0.40
Rate for Payer: Brighton Health Commercial	$0.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.54
Rate for Payer: EmblemHealth Commercial	$0.40
Rate for Payer: Group Health Inc Commercial	$0.40
Rate for Payer: Group Health Inc Medicare	$0.28
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.40
Rate for Payer: Hamaspik Choice Inc Medicare	$0.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.52

FLUOCINONIDE 0.05 % EX SOLN

Facility

$1.93

Service Code	NDC 7071012843
Hospital Charge Code	7071012843
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$0.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97

FLUOCINONIDE 0.05 % EX SOLN

Facility

$1.93

Service Code	NDC 5167212734
Hospital Charge Code	5167212734
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$0.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97

FLUORESCEIN-BENOXINATE 0.25-0.4 % OP SOLN

Facility

$7.68

Service Code	NDC 5939021805
Hospital Charge Code	5939021805
Hospital Revenue Code	250
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$3.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.84

FLUORESCEIN-BENOXINATE 0.25-0.4 % OP SOLN

Facility

$7.68

Service Code	NDC 5939021805
Hospital Charge Code	5939021805
Hospital Revenue Code	250
Min. Negotiated Rate	$2.69
Max. Negotiated Rate	$6.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.84
Rate for Payer: Aetna Government	$3.84
Rate for Payer: Brighton Health Commercial	$5.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.14
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.22
Rate for Payer: EmblemHealth Commercial	$3.84
Rate for Payer: Group Health Inc Commercial	$3.84
Rate for Payer: Group Health Inc Medicare	$2.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.84
Rate for Payer: Hamaspik Choice Inc Medicare	$3.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.99

FLUORESCEIN SODIUM 10 % IV SOLN

Facility

$17.28

Service Code	HCPCS A9612
Hospital Charge Code	1747825310
Hospital Revenue Code	258
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$13.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.64
Rate for Payer: Aetna Government	$8.64
Rate for Payer: Brighton Health Commercial	$12.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.75
Rate for Payer: EmblemHealth Commercial	$8.64
Rate for Payer: Group Health Inc Commercial	$8.64
Rate for Payer: Group Health Inc Medicare	$6.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.64
Rate for Payer: Hamaspik Choice Inc Medicare	$8.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.23

FLUORESCEIN SODIUM 10 % IV SOLN

Facility

$13.13

Service Code	HCPCS A9612
Hospital Charge Code	0065009265
Hospital Revenue Code	258
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$10.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.56
Rate for Payer: Aetna Government	$6.56
Rate for Payer: Brighton Health Commercial	$9.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$10.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.93
Rate for Payer: EmblemHealth Commercial	$6.56
Rate for Payer: Group Health Inc Commercial	$6.56
Rate for Payer: Group Health Inc Medicare	$4.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.56
Rate for Payer: Hamaspik Choice Inc Medicare	$6.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.53

FLUORESCEIN SODIUM 10 % IV SOLN

Facility

$17.28

Service Code	HCPCS A9612
Hospital Charge Code	1747825310
Hospital Revenue Code	258
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$8.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.64

FLUORESCEIN SODIUM 10 % IV SOLN

Facility

$13.13

Service Code	HCPCS A9612
Hospital Charge Code	0065009265
Hospital Revenue Code	258
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$6.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.56

FLUORESCEIN SODIUM 1 MG OP STRP

Facility

$0.21

Service Code	NDC 1723890030
Hospital Charge Code	1723890030
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$0.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10

FLUORESCEIN SODIUM 1 MG OP STRP

Facility

$0.26

Service Code	NDC 1723890011
Hospital Charge Code	1723890011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13

FLUORESCEIN SODIUM 1 MG OP STRP

Facility

$0.21

Service Code	NDC 1723890030
Hospital Charge Code	1723890030
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: EmblemHealth Commercial	$0.10
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

FLUORESCEIN SODIUM 1 MG OP STRP

Facility

$0.26

Service Code	NDC 1723890011
Hospital Charge Code	1723890011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.13
Rate for Payer: Aetna Government	$0.13
Rate for Payer: Brighton Health Commercial	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
Rate for Payer: EmblemHealth Commercial	$0.13
Rate for Payer: Group Health Inc Commercial	$0.13
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.13
Rate for Payer: Hamaspik Choice Inc Medicare	$0.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.17

FLUOROMETHOLONE 0.1 % OP SUSP

Facility

$18.59

Service Code	NDC 6075888005
Hospital Charge Code	6075888005
Hospital Revenue Code	250
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$14.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.29
Rate for Payer: Aetna Government	$9.29
Rate for Payer: Brighton Health Commercial	$13.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.64
Rate for Payer: EmblemHealth Commercial	$9.29
Rate for Payer: Group Health Inc Commercial	$9.29
Rate for Payer: Group Health Inc Medicare	$6.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.29
Rate for Payer: Hamaspik Choice Inc Medicare	$9.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.08

FLUOROMETHOLONE 0.1 % OP SUSP

Facility

$18.59

Service Code	NDC 6075888005
Hospital Charge Code	6075888005
Hospital Revenue Code	250
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$9.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.29

FLUOROURACIL 1 GM/20ML IV SOLN

Facility

$0.33

Service Code	HCPCS J9190
Hospital Charge Code	6332311728
Hospital Revenue Code	258
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17

FLUOROURACIL 1 GM/20ML IV SOLN

Facility

$0.33

Service Code	HCPCS J9190
Hospital Charge Code	6332311728
Hospital Revenue Code	258
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$1.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.23
Rate for Payer: EmblemHealth Commercial	$0.17
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.22

FLUOROURACIL 1 GM/20ML IV SOLN

Facility

$0.41

Service Code	HCPCS J9190
Hospital Charge Code	6332311720
Hospital Revenue Code	258
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21

FLUOROURACIL 1 GM/20ML IV SOLN

Facility

$0.33

Service Code	HCPCS J9190
Hospital Charge Code	6332311741
Hospital Revenue Code	258
Min. Negotiated Rate	$0.17
Max. Negotiated Rate	$0.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17

Know your out-of-pocket cost for care.

All Charges