St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FULVESTRANT 250 MG/5ML IM SOSY

Facility

$232.69

Service Code	HCPCS J9395
Hospital Charge Code	0310072010
Hospital Revenue Code	250
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$186.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$127.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.73
Rate for Payer: Aetna Government	$6.73
Rate for Payer: Affinity Essential Plan 1&2	$4.71
Rate for Payer: Affinity Essential Plan 3&4	$4.71
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.71
Rate for Payer: Brighton Health Commercial	$174.51
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$186.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$158.23
Rate for Payer: Elderplan Medicare Advantage	$6.73
Rate for Payer: EmblemHealth Commercial	$6.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.06
Rate for Payer: Fidelis Essential Plan Aliesa	$5.72
Rate for Payer: Fidelis Essential Plan QHP	$5.99
Rate for Payer: Fidelis Medicare Advantage	$6.73
Rate for Payer: Fidelis Qualified Health Plan	$5.99
Rate for Payer: Group Health Inc Commercial	$6.73
Rate for Payer: Group Health Inc Medicare	$6.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.73
Rate for Payer: Hamaspik Choice Inc Medicare	$6.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$6.73
Rate for Payer: Healthfirst Medicare Advantage	$5.72
Rate for Payer: Healthfirst QHP	$6.73
Rate for Payer: Humana Medicare	$6.86
Rate for Payer: Senior Whole Health Medicare Advantage	$6.73
Rate for Payer: United Healthcare Medicare Advantage	$6.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$151.25
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.39
Rate for Payer: Wellcare Medicare	$6.39

FULVESTRANT 250 MG/5ML IM SOSY

Facility

$18.00

Service Code	HCPCS J9395
Hospital Charge Code	0143902202
Hospital Revenue Code	250
Min. Negotiated Rate	$4.71
Max. Negotiated Rate	$14.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.73
Rate for Payer: Aetna Government	$6.73
Rate for Payer: Affinity Essential Plan 1&2	$4.71
Rate for Payer: Affinity Essential Plan 3&4	$4.71
Rate for Payer: Affinity Medicaid/CHP/HARP	$4.71
Rate for Payer: Brighton Health Commercial	$13.50
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$6.73
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.24
Rate for Payer: Elderplan Medicare Advantage	$6.73
Rate for Payer: EmblemHealth Commercial	$6.73
Rate for Payer: Fidelis CHP/HARP/Medicaid	$6.06
Rate for Payer: Fidelis Essential Plan Aliesa	$5.72
Rate for Payer: Fidelis Essential Plan QHP	$5.99
Rate for Payer: Fidelis Medicare Advantage	$6.73
Rate for Payer: Fidelis Qualified Health Plan	$5.99
Rate for Payer: Group Health Inc Commercial	$6.73
Rate for Payer: Group Health Inc Medicare	$6.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.73
Rate for Payer: Hamaspik Choice Inc Medicare	$6.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$6.73
Rate for Payer: Healthfirst Medicare Advantage	$5.72
Rate for Payer: Healthfirst QHP	$6.73
Rate for Payer: Humana Medicare	$6.86
Rate for Payer: Senior Whole Health Medicare Advantage	$6.73
Rate for Payer: United Healthcare Medicare Advantage	$6.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.70
Rate for Payer: Wellcare CHP/FHP/Medicaid	$6.39
Rate for Payer: Wellcare Medicare	$6.39

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$2.51

Service Code	HCPCS J1938
Hospital Charge Code	0409610219
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$2.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.25
Rate for Payer: Aetna Government	$1.25
Rate for Payer: Brighton Health Commercial	$1.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.71
Rate for Payer: EmblemHealth Commercial	$1.25
Rate for Payer: Group Health Inc Commercial	$1.25
Rate for Payer: Group Health Inc Medicare	$0.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.25
Rate for Payer: Hamaspik Choice Inc Medicare	$1.25
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.63

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$0.37

Service Code	HCPCS J1938
Hospital Charge Code	3600028425
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.19
Rate for Payer: Aetna Government	$0.19
Rate for Payer: Brighton Health Commercial	$0.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.25
Rate for Payer: EmblemHealth Commercial	$0.19
Rate for Payer: Group Health Inc Commercial	$0.19
Rate for Payer: Group Health Inc Medicare	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19
Rate for Payer: Hamaspik Choice Inc Medicare	$0.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.24

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$0.60

Service Code	HCPCS J1938
Hospital Charge Code	7128820302
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.30
Rate for Payer: Aetna Government	$0.30
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: EmblemHealth Commercial	$0.30
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: Healthfirst CHP/FHP/Medicaid	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.39

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$2.51

Service Code	HCPCS J1938
Hospital Charge Code	0409610219
Hospital Revenue Code	250
Min. Negotiated Rate	$1.25
Max. Negotiated Rate	$1.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.25

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$0.94

Service Code	HCPCS J1938
Hospital Charge Code	3600028325
Hospital Revenue Code	250
Min. Negotiated Rate	$0.47
Max. Negotiated Rate	$0.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$0.60

Service Code	HCPCS J1938
Hospital Charge Code	7128820302
Hospital Revenue Code	250
Min. Negotiated Rate	$0.30
Max. Negotiated Rate	$0.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.30

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$1.26

Service Code	HCPCS J1938
Hospital Charge Code	3600028225
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$1.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.69
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	$1.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.86
Rate for Payer: EmblemHealth Commercial	$0.63
Rate for Payer: Group Health Inc Commercial	$0.63
Rate for Payer: Group Health Inc Medicare	$0.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.63
Rate for Payer: Hamaspik Choice Inc Medicare	$0.63
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.82

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$0.88

Service Code	HCPCS J1938
Hospital Charge Code	0409610218
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.44
Rate for Payer: Aetna Government	$0.44
Rate for Payer: Brighton Health Commercial	$0.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.70
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.60
Rate for Payer: EmblemHealth Commercial	$0.44
Rate for Payer: Group Health Inc Commercial	$0.44
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.44
Rate for Payer: Hamaspik Choice Inc Medicare	$0.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.57

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$0.38

Service Code	HCPCS J1938
Hospital Charge Code	2502131110
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.19
Rate for Payer: Aetna Government	$0.19
Rate for Payer: Brighton Health Commercial	$0.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.26
Rate for Payer: EmblemHealth Commercial	$0.19
Rate for Payer: Group Health Inc Commercial	$0.19
Rate for Payer: Group Health Inc Medicare	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19
Rate for Payer: Hamaspik Choice Inc Medicare	$0.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.25

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$1.26

Service Code	HCPCS J1938
Hospital Charge Code	6332328002
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.63

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$0.38

Service Code	HCPCS J1938
Hospital Charge Code	6332328010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$0.38

Service Code	HCPCS J1938
Hospital Charge Code	6332328010
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.19
Rate for Payer: Aetna Government	$0.19
Rate for Payer: Brighton Health Commercial	$0.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.26
Rate for Payer: EmblemHealth Commercial	$0.19
Rate for Payer: Group Health Inc Commercial	$0.19
Rate for Payer: Group Health Inc Medicare	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19
Rate for Payer: Hamaspik Choice Inc Medicare	$0.19
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.25

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$0.42

Service Code	HCPCS J1938
Hospital Charge Code	1672950243
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.21
Rate for Payer: Aetna Government	$0.21
Rate for Payer: Brighton Health Commercial	$0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.29
Rate for Payer: EmblemHealth Commercial	$0.21
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$0.37

Service Code	HCPCS J1938
Hospital Charge Code	3600028425
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$0.38

Service Code	HCPCS J1938
Hospital Charge Code	6332328005
Hospital Revenue Code	250
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$0.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$0.84

Service Code	HCPCS J1938
Hospital Charge Code	6332328004
Hospital Revenue Code	250
Min. Negotiated Rate	$0.42
Max. Negotiated Rate	$0.42
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.42

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$0.42

Service Code	HCPCS J1938
Hospital Charge Code	1672950243
Hospital Revenue Code	250
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$0.94

Service Code	HCPCS J1938
Hospital Charge Code	1672950143
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.47
Rate for Payer: Aetna Government	$0.47
Rate for Payer: Brighton Health Commercial	$0.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.64
Rate for Payer: EmblemHealth Commercial	$0.47
Rate for Payer: Group Health Inc Commercial	$0.47
Rate for Payer: Group Health Inc Medicare	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47
Rate for Payer: Hamaspik Choice Inc Medicare	$0.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.61

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$0.30

Service Code	HCPCS J1938
Hospital Charge Code	6332328026
Hospital Revenue Code	250
Min. Negotiated Rate	$0.15
Max. Negotiated Rate	$0.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.15

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$0.88

Service Code	HCPCS J1938
Hospital Charge Code	0409610218
Hospital Revenue Code	250
Min. Negotiated Rate	$0.44
Max. Negotiated Rate	$0.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.44

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$1.26

Service Code	HCPCS J1938
Hospital Charge Code	3600028225
Hospital Revenue Code	250
Min. Negotiated Rate	$0.63
Max. Negotiated Rate	$0.63
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.63

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$0.41

Service Code	HCPCS J1938
Hospital Charge Code	7128820304
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.28
Rate for Payer: EmblemHealth Commercial	$0.20
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.26

FUROSEMIDE 10 MG/ML IJ SOLN

Facility

$0.94

Service Code	HCPCS J1938
Hospital Charge Code	3600028325
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.47
Rate for Payer: Aetna Government	$0.47
Rate for Payer: Brighton Health Commercial	$0.71
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.75
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.64
Rate for Payer: EmblemHealth Commercial	$0.47
Rate for Payer: Group Health Inc Commercial	$0.47
Rate for Payer: Group Health Inc Medicare	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.47
Rate for Payer: Hamaspik Choice Inc Medicare	$0.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.61

Know your out-of-pocket cost for care.

All Charges