St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FLUARIX QUAD 0.5ML SYR

Facility

$32.00

Service Code	HCPCS 90686
Hospital Charge Code	41658165
Hospital Revenue Code	636
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$16.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16.00

FLUARIX QUAD 0.5ML SYR

Facility

$32.00

Service Code	HCPCS 90686
Hospital Charge Code	41658165
Hospital Revenue Code	636
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$23.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.53
Rate for Payer: Aetna Government	$20.53
Rate for Payer: Brighton Health Commercial	$19.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$16.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$18.40
Rate for Payer: Group Health Inc Commercial	$16.00
Rate for Payer: Group Health Inc Medicare	$11.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.00
Rate for Payer: Hamaspik Choice Inc Medicare	$16.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23.69
Rate for Payer: SOMOS Essential	$23.69
Rate for Payer: United Healthcare Commercial	$21.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$20.80

FLUARIX QUAD (VFC) 0.5ML SYR

Facility

$0.01

Service Code	HCPCS 90686
Hospital Charge Code	41658155
Hospital Revenue Code	636
Max. Negotiated Rate	$23.69
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$20.53
Rate for Payer: Aetna Government	$20.53
Rate for Payer: Brighton Health Commercial	$0.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.01
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.01
Rate for Payer: Group Health Inc Commercial	$0.01
Rate for Payer: Group Health Inc Medicare	$0.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: SOMOS CHP/HARP/Medicaid	$23.69
Rate for Payer: SOMOS Essential	$23.69
Rate for Payer: United Healthcare Commercial	$21.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

FLUARIX QUAD (VFC) 0.5ML SYR

Facility

$0.01

Service Code	HCPCS 90686
Hospital Charge Code	41658155
Hospital Revenue Code	636
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01

FLUCONAZOLE 100 MG/50 ML IVPB PREMIX

Facility

$24.88

Hospital Charge Code	41645351
Hospital Revenue Code	250
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$19.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.44
Rate for Payer: Aetna Government	$12.44
Rate for Payer: Brighton Health Commercial	$18.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.92
Rate for Payer: Group Health Inc Commercial	$12.44
Rate for Payer: Group Health Inc Medicare	$8.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.44
Rate for Payer: Hamaspik Choice Inc Medicare	$12.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.17

FLUCONAZOLE 100 MG/50 ML IVPB PREMIX

Facility

$24.88

Hospital Charge Code	41655351
Hospital Revenue Code	250
Min. Negotiated Rate	$8.71
Max. Negotiated Rate	$19.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.44
Rate for Payer: Aetna Government	$12.44
Rate for Payer: Brighton Health Commercial	$18.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.90
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.92
Rate for Payer: Group Health Inc Commercial	$12.44
Rate for Payer: Group Health Inc Medicare	$8.71
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.44
Rate for Payer: Hamaspik Choice Inc Medicare	$12.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$16.17

FLUCONAZOLE 100 MG PO TABS [10044]

Facility

$8.75

Service Code	NDC 70710113803
Hospital Charge Code	70710113803
Hospital Revenue Code	250
Min. Negotiated Rate	$3.06
Max. Negotiated Rate	$7.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.38
Rate for Payer: Aetna Government	$4.38
Rate for Payer: Brighton Health Commercial	$6.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.95
Rate for Payer: Group Health Inc Commercial	$4.38
Rate for Payer: Group Health Inc Medicare	$3.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.38
Rate for Payer: Hamaspik Choice Inc Medicare	$4.38
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.69

FLUCONAZOLE 100 MG PO TABS [10044]

Facility

$9.53

Service Code	NDC 50268033715
Hospital Charge Code	50268033715
Hospital Revenue Code	250
Min. Negotiated Rate	$3.34
Max. Negotiated Rate	$7.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.77
Rate for Payer: Aetna Government	$4.77
Rate for Payer: Brighton Health Commercial	$7.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.48
Rate for Payer: Group Health Inc Commercial	$4.77
Rate for Payer: Group Health Inc Medicare	$3.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.77
Rate for Payer: Hamaspik Choice Inc Medicare	$4.77
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.20

FLUCONAZOLE 100 MG PO TABS [10044]

Facility

$9.71

Service Code	NDC 00904650061
Hospital Charge Code	00904650061
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$7.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.85
Rate for Payer: Aetna Government	$4.85
Rate for Payer: Brighton Health Commercial	$7.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.60
Rate for Payer: Group Health Inc Commercial	$4.85
Rate for Payer: Group Health Inc Medicare	$3.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.85
Rate for Payer: Hamaspik Choice Inc Medicare	$4.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.31

FLUCONAZOLE 100 MG TAB

Facility

$0.25

Hospital Charge Code	41653754
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.20
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	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
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	$0.16

FLUCONAZOLE 100 MG TAB

Facility

$0.25

Hospital Charge Code	41643754
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.20
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	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
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	$0.16

FLUCONAZOLE 10 MG/ML PO SUSR [14232]

Facility

$1.03

Service Code	NDC 57237014935
Hospital Charge Code	57237014935
Hospital Revenue Code	250
Min. Negotiated Rate	$0.36
Max. Negotiated Rate	$0.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.51
Rate for Payer: Aetna Government	$0.51
Rate for Payer: Brighton Health Commercial	$0.77
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.70
Rate for Payer: Group Health Inc Commercial	$0.51
Rate for Payer: Group Health Inc Medicare	$0.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.51
Rate for Payer: Hamaspik Choice Inc Medicare	$0.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.67

FLUCONAZOLE 10 MG/ML PO SUSR [14232]

Facility

$0.99

Service Code	NDC 59762502901
Hospital Charge Code	59762502901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.35
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: Group Health Inc Commercial	$0.49
Rate for Payer: Group Health Inc Medicare	$0.35
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

FLUCONAZOLE 10 MG/ML SUSP

Facility

$0.45

Hospital Charge Code	41654987
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
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	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.29

FLUCONAZOLE 10 MG/ML SUSP

Facility

$0.45

Hospital Charge Code	41644987
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.23
Rate for Payer: Aetna Government	$0.23
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	$0.31
Rate for Payer: Group Health Inc Commercial	$0.23
Rate for Payer: Group Health Inc Medicare	$0.16
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.23
Rate for Payer: Hamaspik Choice Inc Medicare	$0.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.29

FLUCONAZOLE 150 MG PO TABS [13577]

Facility

$13.93

Service Code	NDC 57237000511
Hospital Charge Code	57237000511
Hospital Revenue Code	250
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$11.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.97
Rate for Payer: Aetna Government	$6.97
Rate for Payer: Brighton Health Commercial	$10.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.47
Rate for Payer: Group Health Inc Commercial	$6.97
Rate for Payer: Group Health Inc Medicare	$4.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.97
Rate for Payer: Hamaspik Choice Inc Medicare	$6.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.06

FLUCONAZOLE 150 MG PO TABS [13577]

Facility

$14.01

Service Code	NDC 68462011944
Hospital Charge Code	68462011944
Hospital Revenue Code	250
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$11.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.71
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.01
Rate for Payer: Aetna Government	$7.01
Rate for Payer: Brighton Health Commercial	$10.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.53
Rate for Payer: Group Health Inc Commercial	$7.01
Rate for Payer: Group Health Inc Medicare	$4.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.01
Rate for Payer: Hamaspik Choice Inc Medicare	$7.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.11

FLUCONAZOLE 150 MG PO TABS [13577]

Facility

$73.05

Service Code	NDC 00049350079
Hospital Charge Code	00049350079
Hospital Revenue Code	250
Min. Negotiated Rate	$25.57
Max. Negotiated Rate	$58.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.53
Rate for Payer: Aetna Government	$36.53
Rate for Payer: Brighton Health Commercial	$54.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.44
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.68
Rate for Payer: Group Health Inc Commercial	$36.53
Rate for Payer: Group Health Inc Medicare	$25.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.53
Rate for Payer: Hamaspik Choice Inc Medicare	$36.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$47.48

FLUCONAZOLE 150 MG PO TABS [13577]

Facility

$13.98

Service Code	NDC 62559099212
Hospital Charge Code	62559099212
Hospital Revenue Code	250
Min. Negotiated Rate	$4.89
Max. Negotiated Rate	$11.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.99
Rate for Payer: Aetna Government	$6.99
Rate for Payer: Brighton Health Commercial	$10.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.50
Rate for Payer: Group Health Inc Commercial	$6.99
Rate for Payer: Group Health Inc Medicare	$4.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.99
Rate for Payer: Hamaspik Choice Inc Medicare	$6.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.08

FLUCONAZOLE 150 MG PO TABS [13577]

Facility

$13.93

Service Code	NDC 70710113908
Hospital Charge Code	70710113908
Hospital Revenue Code	250
Min. Negotiated Rate	$4.88
Max. Negotiated Rate	$11.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.97
Rate for Payer: Aetna Government	$6.97
Rate for Payer: Brighton Health Commercial	$10.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.47
Rate for Payer: Group Health Inc Commercial	$6.97
Rate for Payer: Group Health Inc Medicare	$4.88
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.97
Rate for Payer: Hamaspik Choice Inc Medicare	$6.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.06

FLUCONAZOLE 150 MG TAB

Facility

$0.89

Hospital Charge Code	41643755
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.61
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.58

FLUCONAZOLE 150 MG TAB

Facility

$0.89

Hospital Charge Code	41653755
Hospital Revenue Code	250
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$0.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.45
Rate for Payer: Aetna Government	$0.45
Rate for Payer: Brighton Health Commercial	$0.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.71
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.61
Rate for Payer: Group Health Inc Commercial	$0.45
Rate for Payer: Group Health Inc Medicare	$0.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.45
Rate for Payer: Hamaspik Choice Inc Medicare	$0.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.58

FLUCONAZOLE 200 MG/100 ML IVPB PREMIX

Facility

$7.64

Service Code	HCPCS J1450
Hospital Charge Code	41654547
Hospital Revenue Code	636
Min. Negotiated Rate	$2.67
Max. Negotiated Rate	$5.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.57
Rate for Payer: Aetna Government	$5.57
Rate for Payer: Brighton Health Commercial	$4.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.82
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.39
Rate for Payer: Group Health Inc Commercial	$3.82
Rate for Payer: Group Health Inc Medicare	$2.67
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.82
Rate for Payer: Hamaspik Choice Inc Medicare	$3.82
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	$4.97

FLUCONAZOLE 200 MG/100 ML IVPB PREMIX

Facility

$7.64

Service Code	HCPCS J1450
Hospital Charge Code	41644547
Hospital Revenue Code	636
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$3.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.82
Rate for Payer: Hamaspik Choice Inc Medicare	$3.82

FLUCONAZOLE 200 MG/100 ML IVPB PREMIX

Facility

$7.64

Service Code	HCPCS J1450
Hospital Charge Code	41654547
Hospital Revenue Code	636
Min. Negotiated Rate	$3.82
Max. Negotiated Rate	$3.82
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.82
Rate for Payer: Hamaspik Choice Inc Medicare	$3.82

Know your out-of-pocket cost for care.

All Charges