St. Barnabas Hospital

All Charges

Charge

Type

Price

FLUCONAZOLE 2 MG/ML INJ NEONATAL

Facility OP

$11.00

Hospital Charge Code	41641288
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: 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

FLUCONAZOLE 2 MG/ML INJ NEONATAL

Facility OP

$11.00

Hospital Charge Code	41651288
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: 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

FLUCONAZOLE 2MG/ML NS

Facility OP

$0.17

Service Code	HCPCS J1450
Hospital Charge Code	41650330
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$5.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.57
Rate for Payer: Aetna Government	$5.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.41
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.94
Rate for Payer: SOMOS Essential	$2.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

FLUCONAZOLE 2MG/ML NS

Facility IP

$0.17

Service Code	HCPCS J1450
Hospital Charge Code	41640330
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09

FLUCONAZOLE 2MG/ML NS

Facility IP

$0.17

Service Code	HCPCS J1450
Hospital Charge Code	41650330
Hospital Revenue Code	636
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09

FLUCONAZOLE 2MG/ML NS

Facility OP

$0.17

Service Code	HCPCS J1450
Hospital Charge Code	41640330
Hospital Revenue Code	636
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$5.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.57
Rate for Payer: Aetna Government	$5.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.41
Rate for Payer: Group Health Inc Commercial	$0.09
Rate for Payer: Group Health Inc Medicare	$0.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.09
Rate for Payer: Hamaspik Choice Inc Medicare	$0.09
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.94
Rate for Payer: SOMOS Essential	$2.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.11

FLUCONAZOLE 400 MG/200 ML IVPB PREMIX

Facility IP

$6.96

Service Code	HCPCS J1450
Hospital Charge Code	41644557
Hospital Revenue Code	636
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$3.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.48
Rate for Payer: Hamaspik Choice Inc Medicare	$3.48

FLUCONAZOLE 400 MG/200 ML IVPB PREMIX

Facility IP

$6.96

Service Code	HCPCS J1450
Hospital Charge Code	41654557
Hospital Revenue Code	636
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$3.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.48
Rate for Payer: Hamaspik Choice Inc Medicare	$3.48

FLUCONAZOLE 400 MG/200 ML IVPB PREMIX

Facility OP

$6.96

Service Code	HCPCS J1450
Hospital Charge Code	41654557
Hospital Revenue Code	636
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$5.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.57
Rate for Payer: Aetna Government	$5.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.41
Rate for Payer: Group Health Inc Commercial	$3.48
Rate for Payer: Group Health Inc Medicare	$2.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.48
Rate for Payer: Hamaspik Choice Inc Medicare	$3.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.94
Rate for Payer: SOMOS Essential	$2.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.52

FLUCONAZOLE 400 MG/200 ML IVPB PREMIX

Facility OP

$6.96

Service Code	HCPCS J1450
Hospital Charge Code	41644557
Hospital Revenue Code	636
Min. Negotiated Rate	$2.41
Max. Negotiated Rate	$5.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.57
Rate for Payer: Aetna Government	$5.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.00
Rate for Payer: Fidelis CHP/HARP/Medicaid	$2.41
Rate for Payer: Group Health Inc Commercial	$3.48
Rate for Payer: Group Health Inc Medicare	$2.44
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.48
Rate for Payer: Hamaspik Choice Inc Medicare	$3.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.68
Rate for Payer: SOMOS CHP/HARP/Medicaid	$2.94
Rate for Payer: SOMOS Essential	$2.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.52

FLUCONAZOLE 50 MG TAB

Facility OP

$0.14

Hospital Charge Code	41643753
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: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
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

FLUCONAZOLE 50 MG TAB

Facility OP

$0.14

Hospital Charge Code	41653753
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: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
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

FLUCONAZOLE SUSPENSION

Facility OP

$1.87

Service Code	HCPCS J3490
Hospital Charge Code	41640391
Hospital Revenue Code	636
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$1.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.94
Rate for Payer: Aetna Government	$0.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.08
Rate for Payer: Group Health Inc Commercial	$0.94
Rate for Payer: Group Health Inc Medicare	$0.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.94
Rate for Payer: Hamaspik Choice Inc Medicare	$0.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.22

FLUCONAZOLE SUSPENSION

Facility IP

$1.87

Service Code	HCPCS J3490
Hospital Charge Code	41650391
Hospital Revenue Code	636
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$0.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.94
Rate for Payer: Hamaspik Choice Inc Medicare	$0.94

FLUCONAZOLE SUSPENSION

Facility OP

$1.87

Service Code	HCPCS J3490
Hospital Charge Code	41650391
Hospital Revenue Code	636
Min. Negotiated Rate	$0.65
Max. Negotiated Rate	$1.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.94
Rate for Payer: Aetna Government	$0.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.08
Rate for Payer: Group Health Inc Commercial	$0.94
Rate for Payer: Group Health Inc Medicare	$0.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.94
Rate for Payer: Hamaspik Choice Inc Medicare	$0.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.22

FLUCONAZOLE SUSPENSION

Facility IP

$1.87

Service Code	HCPCS J3490
Hospital Charge Code	41640391
Hospital Revenue Code	636
Min. Negotiated Rate	$0.94
Max. Negotiated Rate	$0.94
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.94
Rate for Payer: Hamaspik Choice Inc Medicare	$0.94

FLUCYTOSINE 250 MG CAP - NF

Facility OP

$72.53

Hospital Charge Code	41652531
Hospital Revenue Code	250
Min. Negotiated Rate	$25.39
Max. Negotiated Rate	$58.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.26
Rate for Payer: Aetna Government	$36.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.32
Rate for Payer: Group Health Inc Commercial	$36.26
Rate for Payer: Group Health Inc Medicare	$25.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.26
Rate for Payer: Hamaspik Choice Inc Medicare	$36.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$47.14

FLUCYTOSINE 250 MG CAP - NF

Facility OP

$72.53

Hospital Charge Code	41642531
Hospital Revenue Code	250
Min. Negotiated Rate	$25.39
Max. Negotiated Rate	$58.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$39.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.26
Rate for Payer: Aetna Government	$36.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.32
Rate for Payer: Group Health Inc Commercial	$36.26
Rate for Payer: Group Health Inc Medicare	$25.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.26
Rate for Payer: Hamaspik Choice Inc Medicare	$36.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$47.14

FLUCYTOSINE 500 MG CAP - NF

Facility OP

$79.00

Hospital Charge Code	41642532
Hospital Revenue Code	250
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$63.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$43.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39.50
Rate for Payer: Aetna Government	$39.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$63.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.72
Rate for Payer: Group Health Inc Commercial	$39.50
Rate for Payer: Group Health Inc Medicare	$27.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.50
Rate for Payer: Hamaspik Choice Inc Medicare	$39.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$51.35

FLUCYTOSINE 500 MG CAP - NF

Facility OP

$79.00

Hospital Charge Code	41652532
Hospital Revenue Code	250
Min. Negotiated Rate	$27.65
Max. Negotiated Rate	$63.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$43.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$39.50
Rate for Payer: Aetna Government	$39.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$63.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$53.72
Rate for Payer: Group Health Inc Commercial	$39.50
Rate for Payer: Group Health Inc Medicare	$27.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$39.50
Rate for Payer: Hamaspik Choice Inc Medicare	$39.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$51.35

FLUDARABINE 50 MG INJ

Facility OP

$136.00

Service Code	HCPCS J9185
Hospital Charge Code	41650950
Hospital Revenue Code	636
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$604.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$173.97
Rate for Payer: Aetna Government	$173.97
Rate for Payer: Cash Price	$173.97
Rate for Payer: Cash Price	$173.97
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$173.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$68.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$78.20
Rate for Payer: Elderplan Medicare Advantage	$173.97
Rate for Payer: EmblemHealth Commercial	$173.97
Rate for Payer: Fidelis CHP/HARP/Medicaid	$173.97
Rate for Payer: Fidelis Essential Plan Aliesa	$173.97
Rate for Payer: Fidelis Essential Plan QHP	$182.67
Rate for Payer: Fidelis Medicare Advantage	$173.97
Rate for Payer: Fidelis Qualified Health Plan	$182.67
Rate for Payer: Group Health Inc Commercial	$173.97
Rate for Payer: Group Health Inc Medicare	$173.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.00
Rate for Payer: Hamaspik Choice Inc Medicare	$68.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$604.75
Rate for Payer: Healthfirst Medicare Advantage	$147.87
Rate for Payer: Healthfirst QHP	$173.97
Rate for Payer: Senior Whole Health Medicare Advantage	$173.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$202.35
Rate for Payer: SOMOS Essential	$202.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$88.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$139.18
Rate for Payer: Wellcare Medicare	$165.27

FLUDARABINE 50 MG INJ

Facility IP

$136.00

Service Code	HCPCS J9185
Hospital Charge Code	41640950
Hospital Revenue Code	636
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$68.00
Rate for Payer: Cash Price	$173.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.00
Rate for Payer: Hamaspik Choice Inc Medicare	$68.00

FLUDARABINE 50 MG INJ

Facility OP

$136.00

Service Code	HCPCS J9185
Hospital Charge Code	41640950
Hospital Revenue Code	636
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$604.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$74.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$173.97
Rate for Payer: Aetna Government	$173.97
Rate for Payer: Cash Price	$173.97
Rate for Payer: Cash Price	$173.97
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$173.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$68.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$78.20
Rate for Payer: Elderplan Medicare Advantage	$173.97
Rate for Payer: EmblemHealth Commercial	$173.97
Rate for Payer: Fidelis CHP/HARP/Medicaid	$173.97
Rate for Payer: Fidelis Essential Plan Aliesa	$173.97
Rate for Payer: Fidelis Essential Plan QHP	$182.67
Rate for Payer: Fidelis Medicare Advantage	$173.97
Rate for Payer: Fidelis Qualified Health Plan	$182.67
Rate for Payer: Group Health Inc Commercial	$173.97
Rate for Payer: Group Health Inc Medicare	$173.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.00
Rate for Payer: Hamaspik Choice Inc Medicare	$68.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$604.75
Rate for Payer: Healthfirst Medicare Advantage	$147.87
Rate for Payer: Healthfirst QHP	$173.97
Rate for Payer: Senior Whole Health Medicare Advantage	$173.97
Rate for Payer: SOMOS CHP/HARP/Medicaid	$202.35
Rate for Payer: SOMOS Essential	$202.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$88.40
Rate for Payer: Wellcare CHP/FHP/Medicaid	$139.18
Rate for Payer: Wellcare Medicare	$165.27

FLUDARABINE 50 MG INJ

Facility IP

$136.00

Service Code	HCPCS J9185
Hospital Charge Code	41650950
Hospital Revenue Code	636
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$68.00
Rate for Payer: Cash Price	$173.97
Rate for Payer: Hamaspik Choice Inc Medicaid	$68.00
Rate for Payer: Hamaspik Choice Inc Medicare	$68.00

FLUID AIR ELITE BED

Facility OP

$200.00

Hospital Charge Code	40209306
Hospital Revenue Code	270
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$160.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$110.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$100.00
Rate for Payer: Aetna Government	$100.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$160.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$136.00
Rate for Payer: Group Health Inc Commercial	$100.00
Rate for Payer: Group Health Inc Medicare	$70.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$100.00
Rate for Payer: Hamaspik Choice Inc Medicare	$100.00

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