St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FLUDEOXYGLUCOSE F 18 20-300 MCI/ML IV SOLN [160130]

Facility

$222.00

Service Code	HCPCS A9552
Hospital Charge Code	49609010101
Hospital Revenue Code	278
Min. Negotiated Rate	$77.70
Max. Negotiated Rate	$260.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$122.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$260.79
Rate for Payer: Aetna Government	$260.79
Rate for Payer: Brighton Health Commercial	$133.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$111.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$127.65
Rate for Payer: EmblemHealth Commercial	$111.00
Rate for Payer: Fidelis Medicare Advantage	$233.10
Rate for Payer: Group Health Inc Commercial	$111.00
Rate for Payer: Group Health Inc Medicare	$77.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.00
Rate for Payer: Hamaspik Choice Inc Medicare	$111.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$144.30

FLUDEOXYGLUCOSE F 18 20-300 MCI/ML IV SOLN [160130]

Facility

$222.00

Service Code	HCPCS A9552
Hospital Charge Code	49609010101
Hospital Revenue Code	278
Min. Negotiated Rate	$111.00
Max. Negotiated Rate	$111.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$111.00
Rate for Payer: Hamaspik Choice Inc Medicare	$111.00

FLUDROCORTISONE 0.1 MG TAB

Facility

$1.32

Hospital Charge Code	41654015
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$1.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.66
Rate for Payer: Aetna Government	$0.66
Rate for Payer: Brighton Health Commercial	$0.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.90
Rate for Payer: Group Health Inc Commercial	$0.66
Rate for Payer: Group Health Inc Medicare	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.66
Rate for Payer: Hamaspik Choice Inc Medicare	$0.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.86

FLUDROCORTISONE 0.1 MG TAB

Facility

$1.32

Hospital Charge Code	41644015
Hospital Revenue Code	250
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$1.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.66
Rate for Payer: Aetna Government	$0.66
Rate for Payer: Brighton Health Commercial	$0.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.06
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.90
Rate for Payer: Group Health Inc Commercial	$0.66
Rate for Payer: Group Health Inc Medicare	$0.46
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.66
Rate for Payer: Hamaspik Choice Inc Medicare	$0.66
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.86

FLUDROCORTISONE ACETATE 0.1 MG PO TABS [10054]

Facility

$1.60

Service Code	NDC 50268033011
Hospital Charge Code	50268033011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.80
Rate for Payer: Aetna Government	$0.80
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.09
Rate for Payer: Group Health Inc Commercial	$0.80
Rate for Payer: Group Health Inc Medicare	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80
Rate for Payer: Hamaspik Choice Inc Medicare	$0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.04

FLUDROCORTISONE ACETATE 0.1 MG PO TABS [10054]

Facility

$1.60

Service Code	NDC 50268033015
Hospital Charge Code	50268033015
Hospital Revenue Code	250
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.80
Rate for Payer: Aetna Government	$0.80
Rate for Payer: Brighton Health Commercial	$1.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.09
Rate for Payer: Group Health Inc Commercial	$0.80
Rate for Payer: Group Health Inc Medicare	$0.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80
Rate for Payer: Hamaspik Choice Inc Medicare	$0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.04

FLUDROCORTISONE ACETATE 0.1 MG PO TABS [10054]

Facility

$0.75

Service Code	NDC 00115703301
Hospital Charge Code	00115703301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.26
Max. Negotiated Rate	$0.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.37
Rate for Payer: Aetna Government	$0.37
Rate for Payer: Brighton Health Commercial	$0.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.51
Rate for Payer: Group Health Inc Commercial	$0.37
Rate for Payer: Group Health Inc Medicare	$0.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.37
Rate for Payer: Hamaspik Choice Inc Medicare	$0.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.49

FLUID AIR ELITE BED

Facility

$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: Brighton Health Commercial	$150.00
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

FLUID AIR II BED

Facility

$200.00

Hospital Charge Code	40209305
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: Brighton Health Commercial	$150.00
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

FLUIDAIR WITH SIT UP BED

Facility

$200.00

Hospital Charge Code	40209302
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: Brighton Health Commercial	$150.00
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

FLU IMMUNIZE ORDER/ADMIN

Facility

$0.01

Service Code	HCPCS G8482
Hospital Charge Code	30307867
Hospital Revenue Code	510
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$250.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.01
Rate for Payer: Aetna Government	$0.01
Rate for Payer: Brighton Health Commercial	$233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$204.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$173.89
Rate for Payer: Group Health Inc Commercial	$250.00
Rate for Payer: Group Health Inc Medicare	$250.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.01
Rate for Payer: Hamaspik Choice Inc Medicare	$0.01
Rate for Payer: United Healthcare Commercial	$222.00

FLULAVAL 5ML

Facility

$16.72

Service Code	HCPCS Q2036
Hospital Charge Code	41655563
Hospital Revenue Code	636
Min. Negotiated Rate	$8.36
Max. Negotiated Rate	$8.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.36
Rate for Payer: Hamaspik Choice Inc Medicare	$8.36

FLULAVAL 5ML

Facility

$16.72

Service Code	HCPCS Q2036
Hospital Charge Code	41655563
Hospital Revenue Code	636
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$10.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.03
Rate for Payer: Aetna Government	$9.03
Rate for Payer: Brighton Health Commercial	$10.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.61
Rate for Payer: Group Health Inc Commercial	$8.36
Rate for Payer: Group Health Inc Medicare	$5.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.36
Rate for Payer: Hamaspik Choice Inc Medicare	$8.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.87

FLULAVAL 5ML

Facility

$16.72

Service Code	HCPCS Q2036
Hospital Charge Code	41645563
Hospital Revenue Code	636
Min. Negotiated Rate	$8.36
Max. Negotiated Rate	$8.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.36
Rate for Payer: Hamaspik Choice Inc Medicare	$8.36

FLULAVAL 5ML

Facility

$16.72

Service Code	HCPCS Q2036
Hospital Charge Code	41645563
Hospital Revenue Code	636
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$10.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.03
Rate for Payer: Aetna Government	$9.03
Rate for Payer: Brighton Health Commercial	$10.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.61
Rate for Payer: Group Health Inc Commercial	$8.36
Rate for Payer: Group Health Inc Medicare	$5.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.36
Rate for Payer: Hamaspik Choice Inc Medicare	$8.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.87

FLULAVAL QUAD 0.5ML IM 3 YRS+

Facility

$32.00

Service Code	HCPCS 90686
Hospital Charge Code	41655971
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

FLULAVAL QUAD 0.5ML IM 3 YRS+

Facility

$32.00

Service Code	HCPCS 90686
Hospital Charge Code	41655971
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

FLULAVAL QUAD 0.5ML IM 3YRS+

Facility

$32.00

Service Code	HCPCS 90686
Hospital Charge Code	41645971
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

FLULAVAL QUAD 0.5ML IM 3YRS+

Facility

$32.00

Service Code	HCPCS 90686
Hospital Charge Code	41645971
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

FLUMAZENIL 0.5 MG/5 ML INJ

Facility

$8.00

Hospital Charge Code	41654424
Hospital Revenue Code	250
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$6.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.00
Rate for Payer: Aetna Government	$4.00
Rate for Payer: Brighton Health Commercial	$6.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.44
Rate for Payer: Group Health Inc Commercial	$4.00
Rate for Payer: Group Health Inc Medicare	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

FLUMAZENIL 0.5 MG/5 ML INJ

Facility

$8.00

Hospital Charge Code	41644424
Hospital Revenue Code	250
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$6.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.00
Rate for Payer: Aetna Government	$4.00
Rate for Payer: Brighton Health Commercial	$6.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.44
Rate for Payer: Group Health Inc Commercial	$4.00
Rate for Payer: Group Health Inc Medicare	$2.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.00
Rate for Payer: Hamaspik Choice Inc Medicare	$4.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.20

FLUMAZENIL 0.5 MG/5ML IV SOLN [39744]

Facility

$1.63

Service Code	NDC 00143978410
Hospital Charge Code	00143978410
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$1.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.81
Rate for Payer: Aetna Government	$0.81
Rate for Payer: Brighton Health Commercial	$0.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.93
Rate for Payer: EmblemHealth Commercial	$0.81
Rate for Payer: Fidelis Medicare Advantage	$1.71
Rate for Payer: Group Health Inc Commercial	$0.81
Rate for Payer: Group Health Inc Medicare	$0.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.81
Rate for Payer: Hamaspik Choice Inc Medicare	$0.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.06

FLUMAZENIL 0.5 MG/5ML IV SOLN [39744]

Facility

$1.63

Service Code	NDC 00143978410
Hospital Charge Code	00143978410
Hospital Revenue Code	278
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.81
Rate for Payer: Hamaspik Choice Inc Medicare	$0.81

FLUMAZENIL 0.5 MG/5ML IV SOLN [39744]

Facility

$1.63

Service Code	NDC 00143978401
Hospital Charge Code	00143978401
Hospital Revenue Code	278
Min. Negotiated Rate	$0.57
Max. Negotiated Rate	$1.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.89
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.81
Rate for Payer: Aetna Government	$0.81
Rate for Payer: Brighton Health Commercial	$0.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.81
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.93
Rate for Payer: EmblemHealth Commercial	$0.81
Rate for Payer: Fidelis Medicare Advantage	$1.71
Rate for Payer: Group Health Inc Commercial	$0.81
Rate for Payer: Group Health Inc Medicare	$0.57
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.81
Rate for Payer: Hamaspik Choice Inc Medicare	$0.81
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.06

FLUMAZENIL 0.5 MG/5ML IV SOLN [39744]

Facility

$1.70

Service Code	NDC 36000014810
Hospital Charge Code	36000014810
Hospital Revenue Code	278
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$0.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.85
Rate for Payer: Hamaspik Choice Inc Medicare	$0.85

Know your out-of-pocket cost for care.

All Charges