St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FLUORESCEIN SODIUM

Facility

$0.21

Hospital Charge Code	41658828
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

FLUORESCEIN SODIUM

Facility

$0.21

Hospital Charge Code	41648828
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.11
Rate for Payer: Aetna Government	$0.11
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: Group Health Inc Commercial	$0.11
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.11
Rate for Payer: Hamaspik Choice Inc Medicare	$0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

FLUORESCEIN SODIUM 10 % IV SOLN [137870]

Facility

$17.28

Service Code	NDC 17478025310
Hospital Charge Code	17478025310
Hospital Revenue Code	278
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$8.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.64
Rate for Payer: Hamaspik Choice Inc Medicare	$8.64

FLUORESCEIN SODIUM 10 % IV SOLN [137870]

Facility

$13.13

Service Code	NDC 00065009265
Hospital Charge Code	00065009265
Hospital Revenue Code	278
Min. Negotiated Rate	$4.59
Max. Negotiated Rate	$13.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$6.56
Rate for Payer: Aetna Government	$6.56
Rate for Payer: Brighton Health Commercial	$7.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.56
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.55
Rate for Payer: EmblemHealth Commercial	$6.56
Rate for Payer: Fidelis Medicare Advantage	$13.78
Rate for Payer: Group Health Inc Commercial	$6.56
Rate for Payer: Group Health Inc Medicare	$4.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.56
Rate for Payer: Hamaspik Choice Inc Medicare	$6.56
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$8.53

FLUORESCEIN SODIUM 10 % IV SOLN [137870]

Facility

$13.13

Service Code	NDC 00065009265
Hospital Charge Code	00065009265
Hospital Revenue Code	278
Min. Negotiated Rate	$6.56
Max. Negotiated Rate	$6.56
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.56
Rate for Payer: Hamaspik Choice Inc Medicare	$6.56

FLUORESCEIN SODIUM 10 % IV SOLN [137870]

Facility

$17.28

Service Code	NDC 17478025310
Hospital Charge Code	17478025310
Hospital Revenue Code	278
Min. Negotiated Rate	$6.05
Max. Negotiated Rate	$18.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.64
Rate for Payer: Aetna Government	$8.64
Rate for Payer: Brighton Health Commercial	$10.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.94
Rate for Payer: EmblemHealth Commercial	$8.64
Rate for Payer: Fidelis Medicare Advantage	$18.14
Rate for Payer: Group Health Inc Commercial	$8.64
Rate for Payer: Group Health Inc Medicare	$6.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.64
Rate for Payer: Hamaspik Choice Inc Medicare	$8.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.23

FLUORESCEIN SODIUM 1 MG OP STRP [27663]

Facility

$0.26

Service Code	NDC 17238090011
Hospital Charge Code	17238090011
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.21
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	$0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.18
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	$0.17

FLUORESCEIN SODIUM 1 MG OP STRP [27663]

Facility

$0.21

Service Code	NDC 17238090030
Hospital Charge Code	17238090030
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.10
Rate for Payer: Aetna Government	$0.10
Rate for Payer: Brighton Health Commercial	$0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.14
Rate for Payer: Group Health Inc Commercial	$0.10
Rate for Payer: Group Health Inc Medicare	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.10
Rate for Payer: Hamaspik Choice Inc Medicare	$0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.14

FLUORESCENT ANTIBODY TITER

Facility

$30.13

Service Code	HCPCS 86256
Hospital Charge Code	40609604
Hospital Revenue Code	300
Min. Negotiated Rate	$8.44
Max. Negotiated Rate	$22.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$16.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$12.05
Rate for Payer: Aetna Government	$12.05
Rate for Payer: Affinity Essential Plan 1&2	$8.44
Rate for Payer: Affinity Essential Plan 3&4	$8.44
Rate for Payer: Affinity Medicaid/CHP/HARP	$8.44
Rate for Payer: Brighton Health Commercial	$22.60
Rate for Payer: Cash Price	$12.05
Rate for Payer: Cash Price	$12.05
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$12.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$19.15
Rate for Payer: Cigna LocalPlus Benefit Plan	$16.20
Rate for Payer: Elderplan Medicare Advantage	$12.05
Rate for Payer: EmblemHealth Commercial	$12.05
Rate for Payer: Fidelis Essential Plan Aliesa	$10.24
Rate for Payer: Fidelis Essential Plan QHP	$10.72
Rate for Payer: Fidelis Medicare Advantage	$12.05
Rate for Payer: Fidelis Qualified Health Plan	$10.72
Rate for Payer: Group Health Inc Commercial	$12.05
Rate for Payer: Group Health Inc Medicare	$12.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$15.06
Rate for Payer: Hamaspik Choice Inc Medicare	$12.05
Rate for Payer: Healthfirst Medicare Advantage	$12.05
Rate for Payer: Healthfirst QHP	$12.05
Rate for Payer: Humana Medicare	$12.29
Rate for Payer: Senior Whole Health Medicare Advantage	$12.05
Rate for Payer: United Healthcare Commercial	$15.26
Rate for Payer: United Healthcare Medicare Advantage	$12.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.05
Rate for Payer: Wellcare CHP/FHP/Medicaid	$9.64
Rate for Payer: Wellcare Medicare	$10.84

FLUORESCENT ANTIBODY TITER

Facility

$30.13

Service Code	HCPCS 86256
Hospital Charge Code	40609604
Hospital Revenue Code	300
Rate for Payer: Cash Price	$12.05

FLUORIDE GEL CARRIER

Facility

$25.00

Service Code	HCPCS D5986
Hospital Charge Code	42301395
Hospital Revenue Code	361
Min. Negotiated Rate	$8.75
Max. Negotiated Rate	$9,760.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.67
Rate for Payer: Aetna Government	$36.67
Rate for Payer: Affinity Essential Plan 1&2	$219.60
Rate for Payer: Affinity Essential Plan 3&4	$219.60
Rate for Payer: Affinity Medicaid/CHP/HARP	$97.60
Rate for Payer: Amida Care Medicaid	$97.60
Rate for Payer: Brighton Health Commercial	$18.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Fidelis CHP/HARP/Medicaid	$9,760.00
Rate for Payer: Fidelis Essential Plan Aliesa	$97.60
Rate for Payer: Fidelis Essential Plan QHP	$97.60
Rate for Payer: Fidelis Qualified Health Plan	$102.48
Rate for Payer: Group Health Inc Commercial	$12.50
Rate for Payer: Group Health Inc Medicare	$8.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$97.60
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$97.60
Rate for Payer: Healthfirst Essential Plan	$219.60
Rate for Payer: Healthfirst QHP	$97.60
Rate for Payer: SOMOS CHP/HARP/Medicaid	$97.60
Rate for Payer: SOMOS Essential	$219.60
Rate for Payer: United Healthcare Essential Plan 1&2	$219.60
Rate for Payer: United Healthcare Essential Plan 3&4	$107.36
Rate for Payer: United Healthcare Medicaid	$97.60
Rate for Payer: Wellcare CHP/FHP/Medicaid	$97.60

FLUORODEOXYGLUCOSE F-18

Facility

$275.00

Service Code	HCPCS A9552
Hospital Charge Code	41656582
Hospital Revenue Code	343
Min. Negotiated Rate	$96.25
Max. Negotiated Rate	$260.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$151.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$260.79
Rate for Payer: Aetna Government	$260.79
Rate for Payer: Brighton Health Commercial	$206.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$220.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$187.00
Rate for Payer: Group Health Inc Commercial	$137.50
Rate for Payer: Group Health Inc Medicare	$96.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.50
Rate for Payer: Hamaspik Choice Inc Medicare	$137.50

FLUORODEOXYGLUCOSE F-18

Facility

$275.00

Service Code	HCPCS A9552
Hospital Charge Code	41646582
Hospital Revenue Code	343
Min. Negotiated Rate	$96.25
Max. Negotiated Rate	$260.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$151.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$260.79
Rate for Payer: Aetna Government	$260.79
Rate for Payer: Brighton Health Commercial	$206.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$220.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$187.00
Rate for Payer: Group Health Inc Commercial	$137.50
Rate for Payer: Group Health Inc Medicare	$96.25
Rate for Payer: Hamaspik Choice Inc Medicaid	$137.50
Rate for Payer: Hamaspik Choice Inc Medicare	$137.50

FLUORO EXAM OF G/COLON TUI

Facility

$705.83

Service Code	HCPCS 49465
Hospital Charge Code	30304004
Hospital Revenue Code	750
Min. Negotiated Rate	$198.36
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$283.37
Rate for Payer: Aetna Government	$283.37
Rate for Payer: Affinity Essential Plan 1&2	$198.36
Rate for Payer: Affinity Essential Plan 3&4	$198.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$198.36
Rate for Payer: Brighton Health Commercial	$529.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$283.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$283.37
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$240.86
Rate for Payer: Fidelis Essential Plan QHP	$252.20
Rate for Payer: Fidelis Medicare Advantage	$283.37
Rate for Payer: Fidelis Qualified Health Plan	$252.20
Rate for Payer: Group Health Inc Commercial	$283.37
Rate for Payer: Group Health Inc Medicare	$283.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.92
Rate for Payer: Hamaspik Choice Inc Medicare	$283.37
Rate for Payer: Healthfirst Medicare Advantage	$240.86
Rate for Payer: Healthfirst QHP	$283.37
Rate for Payer: Humana Medicare	$289.04
Rate for Payer: Senior Whole Health Medicare Advantage	$283.37
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$283.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$283.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$226.70
Rate for Payer: Wellcare Medicare	$269.20

FLUORO EXAM OF G/COLON TUI

Facility

$705.83

Service Code	HCPCS 49465
Hospital Charge Code	30304004
Hospital Revenue Code	750
Rate for Payer: Cash Price	$283.37

FLUORO EXAM OF G/COLON TUI

Facility

$705.83

Service Code	HCPCS 49465
Hospital Charge Code	30104004
Hospital Revenue Code	360
Min. Negotiated Rate	$198.36
Max. Negotiated Rate	$2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$283.37
Rate for Payer: Aetna Government	$283.37
Rate for Payer: Affinity Essential Plan 1&2	$198.36
Rate for Payer: Affinity Essential Plan 3&4	$198.36
Rate for Payer: Affinity Medicaid/CHP/HARP	$198.36
Rate for Payer: Brighton Health Commercial	$529.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Cash Price	$283.37
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$283.37
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2,477.75
Rate for Payer: Elderplan Medicare Advantage	$283.37
Rate for Payer: EmblemHealth Commercial	$1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa	$240.86
Rate for Payer: Fidelis Essential Plan QHP	$252.20
Rate for Payer: Fidelis Medicare Advantage	$283.37
Rate for Payer: Fidelis Qualified Health Plan	$252.20
Rate for Payer: Group Health Inc Commercial	$283.37
Rate for Payer: Group Health Inc Medicare	$283.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$352.92
Rate for Payer: Hamaspik Choice Inc Medicare	$283.37
Rate for Payer: Healthfirst Medicare Advantage	$240.86
Rate for Payer: Healthfirst QHP	$283.37
Rate for Payer: Humana Medicare	$289.04
Rate for Payer: Senior Whole Health Medicare Advantage	$283.37
Rate for Payer: United Healthcare Commercial	$1,113.00
Rate for Payer: United Healthcare Medicare Advantage	$283.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$283.37
Rate for Payer: Wellcare CHP/FHP/Medicaid	$226.70
Rate for Payer: Wellcare Medicare	$269.20

FLUORO EXAM OF G/COLON TUI

Facility

$705.83

Service Code	HCPCS 49465
Hospital Charge Code	30104004
Hospital Revenue Code	360
Rate for Payer: Cash Price	$283.37

FLUOROGUIDE FOR SPINE INJECTION

Facility

$263.18

Service Code	HCPCS 77003 TC
Hospital Charge Code	41109862
Hospital Revenue Code	320
Min. Negotiated Rate	$43.38
Max. Negotiated Rate	$210.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$144.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$43.38
Rate for Payer: Aetna Government	$43.38
Rate for Payer: Brighton Health Commercial	$197.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$210.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$178.96
Rate for Payer: Group Health Inc Commercial	$131.59
Rate for Payer: Group Health Inc Medicare	$92.11
Rate for Payer: Hamaspik Choice Inc Medicaid	$131.59
Rate for Payer: Hamaspik Choice Inc Medicare	$131.59

FLUOROMETHOLONE 0.1% OPHTHALMIC SUSP

Facility

$16.68

Hospital Charge Code	41644083
Hospital Revenue Code	250
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$13.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.34
Rate for Payer: Aetna Government	$8.34
Rate for Payer: Brighton Health Commercial	$12.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.34
Rate for Payer: Group Health Inc Commercial	$8.34
Rate for Payer: Group Health Inc Medicare	$5.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.34
Rate for Payer: Hamaspik Choice Inc Medicare	$8.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.84

FLUOROMETHOLONE 0.1% OPHTHALMIC SUSP

Facility

$16.68

Hospital Charge Code	41654083
Hospital Revenue Code	250
Min. Negotiated Rate	$5.84
Max. Negotiated Rate	$13.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$8.34
Rate for Payer: Aetna Government	$8.34
Rate for Payer: Brighton Health Commercial	$12.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$13.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$11.34
Rate for Payer: Group Health Inc Commercial	$8.34
Rate for Payer: Group Health Inc Medicare	$5.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.34
Rate for Payer: Hamaspik Choice Inc Medicare	$8.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$10.84

FLUOROMETHOLONE 0.1 % OP SUSP [3208]

Facility

$18.59

Service Code	NDC 60758088005
Hospital Charge Code	60758088005
Hospital Revenue Code	250
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$14.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$10.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$9.29
Rate for Payer: Aetna Government	$9.29
Rate for Payer: Brighton Health Commercial	$13.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.64
Rate for Payer: Group Health Inc Commercial	$9.29
Rate for Payer: Group Health Inc Medicare	$6.51
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.29
Rate for Payer: Hamaspik Choice Inc Medicare	$9.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$12.08

FLUOROURACIL 1000 MG/20 ML INJ

Facility

$9.00

Service Code	HCPCS J9190
Hospital Charge Code	41653744
Hospital Revenue Code	636
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$5.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$5.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.18
Rate for Payer: Group Health Inc Commercial	$4.50
Rate for Payer: Group Health Inc Medicare	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.13
Rate for Payer: SOMOS Essential	$3.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85

FLUOROURACIL 1000 MG/20 ML INJ

Facility

$9.00

Service Code	HCPCS J9190
Hospital Charge Code	41643744
Hospital Revenue Code	636
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50

FLUOROURACIL 1000 MG/20 ML INJ

Facility

$9.00

Service Code	HCPCS J9190
Hospital Charge Code	41653744
Hospital Revenue Code	636
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$4.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50

FLUOROURACIL 1000 MG/20 ML INJ

Facility

$9.00

Service Code	HCPCS J9190
Hospital Charge Code	41643744
Hospital Revenue Code	636
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$5.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$5.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.18
Rate for Payer: Group Health Inc Commercial	$4.50
Rate for Payer: Group Health Inc Medicare	$3.15
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.50
Rate for Payer: Hamaspik Choice Inc Medicare	$4.50
Rate for Payer: SOMOS CHP/HARP/Medicaid	$3.13
Rate for Payer: SOMOS Essential	$3.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.85

Know your out-of-pocket cost for care.

All Charges