St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FLUMAZENIL 0.5 MG/5ML IV SOLN [39744]

Facility

$1.70

Service Code	NDC 36000014801
Hospital Charge Code	36000014801
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

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	$0.60
Max. Negotiated Rate	$1.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.85
Rate for Payer: Aetna Government	$0.85
Rate for Payer: Brighton Health Commercial	$1.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.98
Rate for Payer: EmblemHealth Commercial	$0.85
Rate for Payer: Fidelis Medicare Advantage	$1.78
Rate for Payer: Group Health Inc Commercial	$0.85
Rate for Payer: Group Health Inc Medicare	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.85
Rate for Payer: Hamaspik Choice Inc Medicare	$0.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.10

FLUMAZENIL 0.5 MG/5ML IV SOLN [39744]

Facility

$1.70

Service Code	NDC 36000014801
Hospital Charge Code	36000014801
Hospital Revenue Code	278
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.94
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.85
Rate for Payer: Aetna Government	$0.85
Rate for Payer: Brighton Health Commercial	$1.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.98
Rate for Payer: EmblemHealth Commercial	$0.85
Rate for Payer: Fidelis Medicare Advantage	$1.79
Rate for Payer: Group Health Inc Commercial	$0.85
Rate for Payer: Group Health Inc Medicare	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.85
Rate for Payer: Hamaspik Choice Inc Medicare	$0.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.11

FLUMAZENIL 0.5 MG/5ML IV SOLN [39744]

Facility

$1.78

Service Code	NDC 63323042405
Hospital Charge Code	63323042405
Hospital Revenue Code	278
Min. Negotiated Rate	$0.89
Max. Negotiated Rate	$0.89
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.89
Rate for Payer: Hamaspik Choice Inc Medicare	$0.89

FLUMAZENIL 0.5 MG/5ML IV SOLN [39744]

Facility

$1.78

Service Code	NDC 63323042405
Hospital Charge Code	63323042405
Hospital Revenue Code	278
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$1.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.89
Rate for Payer: Aetna Government	$0.89
Rate for Payer: Brighton Health Commercial	$1.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.02
Rate for Payer: EmblemHealth Commercial	$0.89
Rate for Payer: Fidelis Medicare Advantage	$1.87
Rate for Payer: Group Health Inc Commercial	$0.89
Rate for Payer: Group Health Inc Medicare	$0.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.89
Rate for Payer: Hamaspik Choice Inc Medicare	$0.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.16

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	$0.81
Max. Negotiated Rate	$0.81
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.81
Rate for Payer: Hamaspik Choice Inc Medicare	$0.81

FLUMAZENIL 1 MG/10 ML INJ

Facility

$19.13

Hospital Charge Code	41651574
Hospital Revenue Code	250
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$15.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.56
Rate for Payer: Aetna Government	$9.56
Rate for Payer: Brighton Health Commercial	$14.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.01
Rate for Payer: Group Health Inc Commercial	$9.56
Rate for Payer: Group Health Inc Medicare	$6.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.56
Rate for Payer: Hamaspik Choice Inc Medicare	$9.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.43

FLUMAZENIL 1 MG/10 ML INJ

Facility

$19.13

Hospital Charge Code	41641574
Hospital Revenue Code	250
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$15.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.56
Rate for Payer: Aetna Government	$9.56
Rate for Payer: Brighton Health Commercial	$14.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$15.30
Rate for Payer: Cigna LocalPlus Benefit Plan	$13.01
Rate for Payer: Group Health Inc Commercial	$9.56
Rate for Payer: Group Health Inc Medicare	$6.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.56
Rate for Payer: Hamaspik Choice Inc Medicare	$9.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.43

FLUMAZENIL 1 MG/10ML IV SOLN [39745]

Facility

$1.63

Service Code	NDC 00143978310
Hospital Charge Code	00143978310
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 1 MG/10ML IV SOLN [39745]

Facility

$1.63

Service Code	NDC 00143978310
Hospital Charge Code	00143978310
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

FLUMIST QUAD (VFC) 0.2ML INTRANAS

Facility

$0.01

Service Code	HCPCS 90672
Hospital Charge Code	41655959
Hospital Revenue Code	636
Max. Negotiated Rate	$29.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$26.88
Rate for Payer: Aetna Government	$26.88
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	$29.46
Rate for Payer: SOMOS Essential	$29.46
Rate for Payer: United Healthcare Commercial	$26.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

FLUMIST QUAD (VFC) 0.2ML INTRANAS

Facility

$0.01

Service Code	HCPCS 90672
Hospital Charge Code	41655959
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

FLUMIST QUAD (VFC) 0.2ML NASAL

Facility

$0.01

Hospital Charge Code	41645959
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

FLUMIST QUAD (VFC) 0.2ML NASAL

Facility

$0.01

Hospital Charge Code	41645959
Hospital Revenue Code	636
Max. Negotiated Rate	$0.01
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	$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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.01

FLUOCINONIDE 0.05 % EX CREA [3187]

Facility

$3.04

Service Code	NDC 00093026230
Hospital Charge Code	00093026230
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.52
Rate for Payer: Aetna Government	$1.52
Rate for Payer: Brighton Health Commercial	$2.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.07
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.97

FLUOCINONIDE 0.05 % EX CREA [3187]

Facility

$3.04

Service Code	NDC 51672138602
Hospital Charge Code	51672138602
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.52
Rate for Payer: Aetna Government	$1.52
Rate for Payer: Brighton Health Commercial	$2.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.07
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.97

FLUOCINONIDE 0.05 % EX CREA [3187]

Facility

$3.04

Service Code	NDC 00093026215
Hospital Charge Code	00093026215
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.52
Rate for Payer: Aetna Government	$1.52
Rate for Payer: Brighton Health Commercial	$2.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.07
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.97

FLUOCINONIDE 0.05 % EX CREA [3187]

Facility

$3.04

Service Code	NDC 51672138601
Hospital Charge Code	51672138601
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.52
Rate for Payer: Aetna Government	$1.52
Rate for Payer: Brighton Health Commercial	$2.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.07
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.97

FLUOCINONIDE 0.05 % EX CREA [3187]

Facility

$3.04

Service Code	NDC 51672138603
Hospital Charge Code	51672138603
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.52
Rate for Payer: Aetna Government	$1.52
Rate for Payer: Brighton Health Commercial	$2.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.07
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.97

FLUOCINONIDE 0.05 % EX CREA [3187]

Facility

$3.04

Service Code	NDC 00093026292
Hospital Charge Code	00093026292
Hospital Revenue Code	250
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.52
Rate for Payer: Aetna Government	$1.52
Rate for Payer: Brighton Health Commercial	$2.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.43
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.07
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.97

FLUOCINONIDE 0.05 % EX OINT [3189]

Facility

$4.72

Service Code	NDC 51672126402
Hospital Charge Code	51672126402
Hospital Revenue Code	250
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$3.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.36
Rate for Payer: Aetna Government	$2.36
Rate for Payer: Brighton Health Commercial	$3.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.21
Rate for Payer: Group Health Inc Commercial	$2.36
Rate for Payer: Group Health Inc Medicare	$1.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.36
Rate for Payer: Hamaspik Choice Inc Medicare	$2.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.07

FLUOCINONIDE 0.05 % EX OINT [3189]

Facility

$4.72

Service Code	NDC 51672126403
Hospital Charge Code	51672126403
Hospital Revenue Code	250
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$3.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.36
Rate for Payer: Aetna Government	$2.36
Rate for Payer: Brighton Health Commercial	$3.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.21
Rate for Payer: Group Health Inc Commercial	$2.36
Rate for Payer: Group Health Inc Medicare	$1.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.36
Rate for Payer: Hamaspik Choice Inc Medicare	$2.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.07

FLUOCINONIDE 0.05 % EX OINT [3189]

Facility

$4.72

Service Code	NDC 51672126401
Hospital Charge Code	51672126401
Hospital Revenue Code	250
Min. Negotiated Rate	$1.65
Max. Negotiated Rate	$3.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.36
Rate for Payer: Aetna Government	$2.36
Rate for Payer: Brighton Health Commercial	$3.54
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.21
Rate for Payer: Group Health Inc Commercial	$2.36
Rate for Payer: Group Health Inc Medicare	$1.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.36
Rate for Payer: Hamaspik Choice Inc Medicare	$2.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.07

FLUOCINONIDE 0.05 % EX SOLN [3190]

Facility

$1.93

Service Code	NDC 51672127304
Hospital Charge Code	51672127304
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$1.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.97
Rate for Payer: Aetna Government	$0.97
Rate for Payer: Brighton Health Commercial	$1.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.55
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.31
Rate for Payer: Group Health Inc Commercial	$0.97
Rate for Payer: Group Health Inc Medicare	$0.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.97
Rate for Payer: Hamaspik Choice Inc Medicare	$0.97
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.26

FLUOCINONIDE 0.05 % EX SOLN [3190]

Facility

$1.78

Service Code	NDC 64980045206
Hospital Charge Code	64980045206
Hospital Revenue Code	250
Min. Negotiated Rate	$0.62
Max. Negotiated Rate	$1.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.89
Rate for Payer: Aetna Government	$0.89
Rate for Payer: Brighton Health Commercial	$1.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.21
Rate for Payer: Group Health Inc Commercial	$0.89
Rate for Payer: Group Health Inc Medicare	$0.62
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.89
Rate for Payer: Hamaspik Choice Inc Medicare	$0.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.15

Know your out-of-pocket cost for care.

All Charges