St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$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 PO TABS [10045]

Facility

$1.74

Service Code	NDC 00904650106
Hospital Charge Code	00904650106
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.39
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.87
Rate for Payer: Aetna Government	$0.87
Rate for Payer: Brighton Health Commercial	$1.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.39
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.19
Rate for Payer: Group Health Inc Commercial	$0.87
Rate for Payer: Group Health Inc Medicare	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.87
Rate for Payer: Hamaspik Choice Inc Medicare	$0.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.13

FLUCONAZOLE 200 MG PO TABS [10045]

Facility

$75.11

Service Code	NDC 00049343030
Hospital Charge Code	00049343030
Hospital Revenue Code	250
Min. Negotiated Rate	$26.29
Max. Negotiated Rate	$60.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$41.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$37.56
Rate for Payer: Aetna Government	$37.56
Rate for Payer: Brighton Health Commercial	$56.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$60.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$51.08
Rate for Payer: Group Health Inc Commercial	$37.56
Rate for Payer: Group Health Inc Medicare	$26.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$37.56
Rate for Payer: Hamaspik Choice Inc Medicare	$37.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$48.82

FLUCONAZOLE 200 MG PO TABS [10045]

Facility

$16.35

Service Code	NDC 00904650161
Hospital Charge Code	00904650161
Hospital Revenue Code	250
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$13.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.99
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.17
Rate for Payer: Aetna Government	$8.17
Rate for Payer: Brighton Health Commercial	$12.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.11
Rate for Payer: Group Health Inc Commercial	$8.17
Rate for Payer: Group Health Inc Medicare	$5.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.17
Rate for Payer: Hamaspik Choice Inc Medicare	$8.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.62

FLUCONAZOLE 200 MG PO TABS [10045]

Facility

$14.41

Service Code	NDC 68462010430
Hospital Charge Code	68462010430
Hospital Revenue Code	250
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$11.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.20
Rate for Payer: Aetna Government	$7.20
Rate for Payer: Brighton Health Commercial	$10.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.80
Rate for Payer: Group Health Inc Commercial	$7.20
Rate for Payer: Group Health Inc Medicare	$5.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.20
Rate for Payer: Hamaspik Choice Inc Medicare	$7.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.36

FLUCONAZOLE 200 MG PO TABS [10045]

Facility

$14.33

Service Code	NDC 70710114003
Hospital Charge Code	70710114003
Hospital Revenue Code	250
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$11.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.16
Rate for Payer: Aetna Government	$7.16
Rate for Payer: Brighton Health Commercial	$10.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.74
Rate for Payer: Group Health Inc Commercial	$7.16
Rate for Payer: Group Health Inc Medicare	$5.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.16
Rate for Payer: Hamaspik Choice Inc Medicare	$7.16
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.31

FLUCONAZOLE 200 MG TAB

Facility

$0.35

Hospital Charge Code	41653756
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.18
Rate for Payer: Aetna Government	$0.18
Rate for Payer: Brighton Health Commercial	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: Group Health Inc Commercial	$0.18
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18
Rate for Payer: Hamaspik Choice Inc Medicare	$0.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.23

FLUCONAZOLE 200 MG TAB

Facility

$0.35

Hospital Charge Code	41643756
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.18
Rate for Payer: Aetna Government	$0.18
Rate for Payer: Brighton Health Commercial	$0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: Group Health Inc Commercial	$0.18
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18
Rate for Payer: Hamaspik Choice Inc Medicare	$0.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.23

FLUCONAZOLE 2 MG/ML INJ NEONATAL

Facility

$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: Brighton Health Commercial	$8.25
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

$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: Brighton Health Commercial	$8.25
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

$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

$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: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
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: 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

$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

$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: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
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: 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

$6.96

Service Code	HCPCS J1450
Hospital Charge Code	41654557
Hospital Revenue Code	636
Min. Negotiated Rate	$2.44
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: Brighton Health Commercial	$4.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.00
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: 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

$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

$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

$6.96

Service Code	HCPCS J1450
Hospital Charge Code	41644557
Hospital Revenue Code	636
Min. Negotiated Rate	$2.44
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: Brighton Health Commercial	$4.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.00
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: 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 40 MG/ML PO SUSR [14233]

Facility

$3.73

Service Code	NDC 57237015035
Hospital Charge Code	57237015035
Hospital Revenue Code	250
Min. Negotiated Rate	$1.30
Max. Negotiated Rate	$2.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.86
Rate for Payer: Aetna Government	$1.86
Rate for Payer: Brighton Health Commercial	$2.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.98
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.53
Rate for Payer: Group Health Inc Commercial	$1.86
Rate for Payer: Group Health Inc Medicare	$1.30
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.86
Rate for Payer: Hamaspik Choice Inc Medicare	$1.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.42

FLUCONAZOLE 50 MG PO TABS [10046]

Facility

$5.60

Service Code	NDC 68462010130
Hospital Charge Code	68462010130
Hospital Revenue Code	250
Min. Negotiated Rate	$1.96
Max. Negotiated Rate	$4.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.80
Rate for Payer: Aetna Government	$2.80
Rate for Payer: Brighton Health Commercial	$4.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.48
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.81
Rate for Payer: Group Health Inc Commercial	$2.80
Rate for Payer: Group Health Inc Medicare	$1.96
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.80
Rate for Payer: Hamaspik Choice Inc Medicare	$2.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.64

FLUCONAZOLE 50 MG TAB

Facility

$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: Brighton Health Commercial	$0.11
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

$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: Brighton Health Commercial	$0.11
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 IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN [10049]

Facility

$0.09

Service Code	HCPCS J1450
Hospital Charge Code	00409468818
Hospital Revenue Code	278
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.05
Rate for Payer: Hamaspik Choice Inc Medicare	$0.05

FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN [10049]

Facility

$0.09

Service Code	HCPCS J1450
Hospital Charge Code	00409468818
Hospital Revenue Code	278
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$5.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.57
Rate for Payer: Aetna Government	$5.57
Rate for Payer: Brighton Health Commercial	$0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.05
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Fidelis Medicare Advantage	$0.09
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

FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN [10049]

Facility

$0.07

Service Code	HCPCS J1450
Hospital Charge Code	69784000206
Hospital Revenue Code	278
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$0.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04

Know your out-of-pocket cost for care.

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