St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FLUOXETINE HCL 10 MG PO CAPS

Facility

$2.60

Service Code	NDC 6233202231
Hospital Charge Code	6233202231
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$1.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.30

FLUOXETINE HCL 10 MG PO CAPS

Facility

$2.60

Service Code	NDC 6586219201
Hospital Charge Code	6586219201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$2.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.30
Rate for Payer: Aetna Government	$1.30
Rate for Payer: Brighton Health Commercial	$1.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.77
Rate for Payer: EmblemHealth Commercial	$1.30
Rate for Payer: Group Health Inc Commercial	$1.30
Rate for Payer: Group Health Inc Medicare	$0.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.30
Rate for Payer: Hamaspik Choice Inc Medicare	$1.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.69

FLUOXETINE HCL 10 MG PO CAPS

Facility

$2.60

Service Code	NDC 6233202231
Hospital Charge Code	6233202231
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$2.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.30
Rate for Payer: Aetna Government	$1.30
Rate for Payer: Brighton Health Commercial	$1.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.77
Rate for Payer: EmblemHealth Commercial	$1.30
Rate for Payer: Group Health Inc Commercial	$1.30
Rate for Payer: Group Health Inc Medicare	$0.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.30
Rate for Payer: Hamaspik Choice Inc Medicare	$1.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.69

FLUOXETINE HCL 10 MG PO CAPS

Facility

$0.14

Service Code	NDC 0904734561
Hospital Charge Code	0904734561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

FLUOXETINE HCL 10 MG PO CAPS

Facility

$0.14

Service Code	NDC 0904734561
Hospital Charge Code	0904734561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: EmblemHealth Commercial	$0.07
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

FLUOXETINE HCL 20 MG/5ML PO SOLN

Facility

$1.37

Service Code	NDC 0121472105
Hospital Charge Code	0121472105
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.68
Rate for Payer: Aetna Government	$0.68
Rate for Payer: Brighton Health Commercial	$1.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.93
Rate for Payer: EmblemHealth Commercial	$0.68
Rate for Payer: Group Health Inc Commercial	$0.68
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68
Rate for Payer: Hamaspik Choice Inc Medicare	$0.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.89

FLUOXETINE HCL 20 MG/5ML PO SOLN

Facility

$1.37

Service Code	NDC 0121472105
Hospital Charge Code	0121472105
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68

FLUOXETINE HCL 20 MG/5ML PO SOLN

Facility

$0.98

Service Code	NDC 5483852340
Hospital Charge Code	5483852340
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.49
Rate for Payer: Aetna Government	$0.49
Rate for Payer: Brighton Health Commercial	$0.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.67
Rate for Payer: EmblemHealth Commercial	$0.49
Rate for Payer: Group Health Inc Commercial	$0.49
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49
Rate for Payer: Hamaspik Choice Inc Medicare	$0.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.64

FLUOXETINE HCL 20 MG/5ML PO SOLN

Facility

$1.39

Service Code	NDC 6068784577
Hospital Charge Code	6068784577
Hospital Revenue Code	250
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$1.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.70
Rate for Payer: Aetna Government	$0.70
Rate for Payer: Brighton Health Commercial	$1.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.95
Rate for Payer: EmblemHealth Commercial	$0.70
Rate for Payer: Group Health Inc Commercial	$0.70
Rate for Payer: Group Health Inc Medicare	$0.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.70
Rate for Payer: Hamaspik Choice Inc Medicare	$0.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.90

FLUOXETINE HCL 20 MG/5ML PO SOLN

Facility

$0.98

Service Code	NDC 5483852340
Hospital Charge Code	5483852340
Hospital Revenue Code	250
Min. Negotiated Rate	$0.49
Max. Negotiated Rate	$0.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49

FLUOXETINE HCL 20 MG/5ML PO SOLN

Facility

$1.39

Service Code	NDC 6068784577
Hospital Charge Code	6068784577
Hospital Revenue Code	250
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$0.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.70

FLUOXETINE HCL 20 MG PO CAPS

Facility

$2.48

Service Code	NDC 0904578561
Hospital Charge Code	0904578561
Hospital Revenue Code	250
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$1.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.24

FLUOXETINE HCL 20 MG PO CAPS

Facility

$2.62

Service Code	NDC 6586219399
Hospital Charge Code	6586219399
Hospital Revenue Code	250
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$1.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.31

FLUOXETINE HCL 20 MG PO CAPS

Facility

$0.10

Service Code	NDC 0904734661
Hospital Charge Code	0904734661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05

FLUOXETINE HCL 20 MG PO CAPS

Facility

$2.62

Service Code	NDC 6586219399
Hospital Charge Code	6586219399
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$2.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.31
Rate for Payer: Aetna Government	$1.31
Rate for Payer: Brighton Health Commercial	$1.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.78
Rate for Payer: EmblemHealth Commercial	$1.31
Rate for Payer: Group Health Inc Commercial	$1.31
Rate for Payer: Group Health Inc Medicare	$0.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.31
Rate for Payer: Hamaspik Choice Inc Medicare	$1.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.70

FLUOXETINE HCL 20 MG PO CAPS

Facility

$0.10

Service Code	NDC 0904734661
Hospital Charge Code	0904734661
Hospital Revenue Code	250
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$0.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.05
Rate for Payer: Aetna Government	$0.05
Rate for Payer: Brighton Health Commercial	$0.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.07
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.06

FLUOXETINE HCL 20 MG PO CAPS

Facility

$2.48

Service Code	NDC 0904578561
Hospital Charge Code	0904578561
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$1.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.24
Rate for Payer: Aetna Government	$1.24
Rate for Payer: Brighton Health Commercial	$1.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.99
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.69
Rate for Payer: EmblemHealth Commercial	$1.24
Rate for Payer: Group Health Inc Commercial	$1.24
Rate for Payer: Group Health Inc Medicare	$0.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.24
Rate for Payer: Hamaspik Choice Inc Medicare	$1.24
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.61

FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN

Facility

$36.00

Service Code	HCPCS J2680
Hospital Charge Code	5515026705
Hospital Revenue Code	250
Min. Negotiated Rate	$7.31
Max. Negotiated Rate	$28.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$19.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.30
Rate for Payer: Aetna Government	$10.30
Rate for Payer: Brighton Health Commercial	$27.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$28.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$24.48
Rate for Payer: EmblemHealth Commercial	$18.00
Rate for Payer: Group Health Inc Commercial	$18.00
Rate for Payer: Group Health Inc Medicare	$12.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.00
Rate for Payer: Hamaspik Choice Inc Medicare	$18.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$23.40

FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN

Facility

$18.72

Service Code	HCPCS J2680
Hospital Charge Code	4202312901
Hospital Revenue Code	250
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$9.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.36

FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN

Facility

$29.04

Service Code	HCPCS J2680
Hospital Charge Code	0143952901
Hospital Revenue Code	250
Min. Negotiated Rate	$7.31
Max. Negotiated Rate	$23.23
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$15.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.30
Rate for Payer: Aetna Government	$10.30
Rate for Payer: Brighton Health Commercial	$21.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$23.23
Rate for Payer: Cigna LocalPlus Benefit Plan	$19.75
Rate for Payer: EmblemHealth Commercial	$14.52
Rate for Payer: Group Health Inc Commercial	$14.52
Rate for Payer: Group Health Inc Medicare	$10.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.52
Rate for Payer: Hamaspik Choice Inc Medicare	$14.52
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$18.88

FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN

Facility

$32.34

Service Code	HCPCS J2680
Hospital Charge Code	4202312989
Hospital Revenue Code	250
Min. Negotiated Rate	$7.31
Max. Negotiated Rate	$25.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.30
Rate for Payer: Aetna Government	$10.30
Rate for Payer: Brighton Health Commercial	$24.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$25.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$21.99
Rate for Payer: EmblemHealth Commercial	$16.17
Rate for Payer: Group Health Inc Commercial	$16.17
Rate for Payer: Group Health Inc Medicare	$11.32
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.17
Rate for Payer: Hamaspik Choice Inc Medicare	$16.17
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$21.02

FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN

Facility

$18.72

Service Code	HCPCS J2680
Hospital Charge Code	4202312901
Hospital Revenue Code	250
Min. Negotiated Rate	$6.55
Max. Negotiated Rate	$14.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.30
Rate for Payer: Aetna Government	$10.30
Rate for Payer: Brighton Health Commercial	$14.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.73
Rate for Payer: EmblemHealth Commercial	$9.36
Rate for Payer: Group Health Inc Commercial	$9.36
Rate for Payer: Group Health Inc Medicare	$6.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.36
Rate for Payer: Hamaspik Choice Inc Medicare	$9.36
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.17

FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN

Facility

$32.34

Service Code	HCPCS J2680
Hospital Charge Code	4202312989
Hospital Revenue Code	250
Min. Negotiated Rate	$16.17
Max. Negotiated Rate	$16.17
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.17

FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN

Facility

$37.19

Service Code	HCPCS J2680
Hospital Charge Code	6745735959
Hospital Revenue Code	250
Min. Negotiated Rate	$7.31
Max. Negotiated Rate	$29.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$20.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$10.30
Rate for Payer: Aetna Government	$10.30
Rate for Payer: Brighton Health Commercial	$27.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$29.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$25.29
Rate for Payer: EmblemHealth Commercial	$18.60
Rate for Payer: Group Health Inc Commercial	$18.60
Rate for Payer: Group Health Inc Medicare	$13.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$18.60
Rate for Payer: Hamaspik Choice Inc Medicare	$18.60
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$7.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$24.17

FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN

Facility

$29.04

Service Code	HCPCS J2680
Hospital Charge Code	0143952901
Hospital Revenue Code	250
Min. Negotiated Rate	$14.52
Max. Negotiated Rate	$14.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$14.52

Know your out-of-pocket cost for care.

All Charges