St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

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	$0.03
Max. Negotiated Rate	$5.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.57
Rate for Payer: Aetna Government	$5.57
Rate for Payer: Brighton Health Commercial	$0.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.04
Rate for Payer: EmblemHealth Commercial	$0.04
Rate for Payer: Fidelis Medicare Advantage	$0.08
Rate for Payer: Group Health Inc Commercial	$0.04
Rate for Payer: Group Health Inc Medicare	$0.03
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.04
Rate for Payer: Hamaspik Choice Inc Medicare	$0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.05

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

Facility

$0.11

Service Code	HCPCS J1450
Hospital Charge Code	25021018482
Hospital Revenue Code	278
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$5.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.57
Rate for Payer: Aetna Government	$5.57
Rate for Payer: Brighton Health Commercial	$0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.05
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.06
Rate for Payer: EmblemHealth Commercial	$0.05
Rate for Payer: Fidelis Medicare Advantage	$0.11
Rate for Payer: Group Health Inc Commercial	$0.05
Rate for Payer: Group Health Inc Medicare	$0.04
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	$0.07

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

Facility

$0.11

Service Code	HCPCS J1450
Hospital Charge Code	25021018482
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 400-0.9 MG/200ML-% IV SOLN [10050]

Facility

$0.04

Service Code	HCPCS J1450
Hospital Charge Code	00409468812
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$5.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.57
Rate for Payer: Aetna Government	$5.57
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Fidelis Medicare Advantage	$0.05
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN [10050]

Facility

$0.04

Service Code	HCPCS J1450
Hospital Charge Code	69784000306
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02

FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN [10050]

Facility

$0.04

Service Code	HCPCS J1450
Hospital Charge Code	00409468812
Hospital Revenue Code	278
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02

FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN [10050]

Facility

$0.04

Service Code	HCPCS J1450
Hospital Charge Code	69784000306
Hospital Revenue Code	278
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$5.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.57
Rate for Payer: Aetna Government	$5.57
Rate for Payer: Brighton Health Commercial	$0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.02
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.02
Rate for Payer: EmblemHealth Commercial	$0.02
Rate for Payer: Fidelis Medicare Advantage	$0.04
Rate for Payer: Group Health Inc Commercial	$0.02
Rate for Payer: Group Health Inc Medicare	$0.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.02
Rate for Payer: Hamaspik Choice Inc Medicare	$0.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

FLUCONAZOLE SUSPENSION

Facility

$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: Brighton Health Commercial	$1.12
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

$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: Brighton Health Commercial	$1.12
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

$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

$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

$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: Brighton Health Commercial	$54.40
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

$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: Brighton Health Commercial	$54.40
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 PO CAPS [10051]

Facility

$82.07

Service Code	NDC 43386077101
Hospital Charge Code	43386077101
Hospital Revenue Code	250
Min. Negotiated Rate	$28.72
Max. Negotiated Rate	$65.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.03
Rate for Payer: Aetna Government	$41.03
Rate for Payer: Brighton Health Commercial	$61.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.81
Rate for Payer: Group Health Inc Commercial	$41.03
Rate for Payer: Group Health Inc Medicare	$28.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.03
Rate for Payer: Hamaspik Choice Inc Medicare	$41.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$53.34

FLUCYTOSINE 250 MG PO CAPS [10051]

Facility

$82.07

Service Code	NDC 59651033101
Hospital Charge Code	59651033101
Hospital Revenue Code	250
Min. Negotiated Rate	$28.72
Max. Negotiated Rate	$65.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.03
Rate for Payer: Aetna Government	$41.03
Rate for Payer: Brighton Health Commercial	$61.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$65.66
Rate for Payer: Cigna LocalPlus Benefit Plan	$55.81
Rate for Payer: Group Health Inc Commercial	$41.03
Rate for Payer: Group Health Inc Medicare	$28.72
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.03
Rate for Payer: Hamaspik Choice Inc Medicare	$41.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$53.34

FLUCYTOSINE 500 MG CAP - NF

Facility

$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: Brighton Health Commercial	$59.25
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

$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: Brighton Health Commercial	$59.25
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 PO CAPS [10052]

Facility

$158.81

Service Code	NDC 59651033201
Hospital Charge Code	59651033201
Hospital Revenue Code	250
Min. Negotiated Rate	$55.58
Max. Negotiated Rate	$127.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$87.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$79.40
Rate for Payer: Aetna Government	$79.40
Rate for Payer: Brighton Health Commercial	$119.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$127.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$107.99
Rate for Payer: Group Health Inc Commercial	$79.40
Rate for Payer: Group Health Inc Medicare	$55.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.40
Rate for Payer: Hamaspik Choice Inc Medicare	$79.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$103.22

FLUCYTOSINE 500 MG PO CAPS [10052]

Facility

$158.81

Service Code	NDC 43386077001
Hospital Charge Code	43386077001
Hospital Revenue Code	250
Min. Negotiated Rate	$55.58
Max. Negotiated Rate	$127.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$87.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$79.40
Rate for Payer: Aetna Government	$79.40
Rate for Payer: Brighton Health Commercial	$119.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$127.04
Rate for Payer: Cigna LocalPlus Benefit Plan	$107.99
Rate for Payer: Group Health Inc Commercial	$79.40
Rate for Payer: Group Health Inc Medicare	$55.58
Rate for Payer: Hamaspik Choice Inc Medicaid	$79.40
Rate for Payer: Hamaspik Choice Inc Medicare	$79.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$103.22

FLUDARABINE 50 MG INJ

Facility

$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

$136.00

Service Code	HCPCS J9185
Hospital Charge Code	41650950
Hospital Revenue Code	636
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$202.35
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: Affinity Essential Plan 1&2	$121.78
Rate for Payer: Affinity Essential Plan 3&4	$121.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$121.78
Rate for Payer: Brighton Health Commercial	$81.60
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 Medicare Advantage	$147.87
Rate for Payer: Healthfirst QHP	$173.97
Rate for Payer: Humana Medicare	$177.45
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: United Healthcare Commercial	$105.60
Rate for Payer: United Healthcare Medicare Advantage	$173.97
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

$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

FLUDARABINE 50 MG INJ

Facility

$136.00

Service Code	HCPCS J9185
Hospital Charge Code	41640950
Hospital Revenue Code	636
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$202.35
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: Affinity Essential Plan 1&2	$121.78
Rate for Payer: Affinity Essential Plan 3&4	$121.78
Rate for Payer: Affinity Medicaid/CHP/HARP	$121.78
Rate for Payer: Brighton Health Commercial	$81.60
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 Medicare Advantage	$147.87
Rate for Payer: Healthfirst QHP	$173.97
Rate for Payer: Humana Medicare	$177.45
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: United Healthcare Commercial	$105.60
Rate for Payer: United Healthcare Medicare Advantage	$173.97
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 PHOSPHATE 50 MG/2ML IV SOLN [41294]

Facility

$163.13

Service Code	HCPCS J9185
Hospital Charge Code	63323019202
Hospital Revenue Code	278
Min. Negotiated Rate	$81.56
Max. Negotiated Rate	$81.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$81.56
Rate for Payer: Hamaspik Choice Inc Medicare	$81.56

FLUDARABINE PHOSPHATE 50 MG/2ML IV SOLN [41294]

Facility

$163.13

Service Code	HCPCS J9185
Hospital Charge Code	63323019202
Hospital Revenue Code	278
Min. Negotiated Rate	$81.56
Max. Negotiated Rate	$177.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$89.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$173.97
Rate for Payer: Aetna Government	$173.97
Rate for Payer: Brighton Health Commercial	$97.88
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	$81.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$93.80
Rate for Payer: Elderplan Medicare Advantage	$173.97
Rate for Payer: EmblemHealth Commercial	$81.56
Rate for Payer: Fidelis Medicare Advantage	$173.97
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	$81.56
Rate for Payer: Hamaspik Choice Inc Medicare	$81.56
Rate for Payer: Healthfirst Medicare Advantage	$147.87
Rate for Payer: Healthfirst QHP	$173.97
Rate for Payer: Humana Medicare	$177.45
Rate for Payer: Senior Whole Health Medicare Advantage	$173.97
Rate for Payer: United Healthcare Medicare Advantage	$173.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$106.03
Rate for Payer: Wellcare CHP/FHP/Medicaid	$139.18

Know your out-of-pocket cost for care.

All Charges