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Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

FLUOROURACIL 2500 MG/50 ML INJ

Facility

OP

$13.00

Service Code	HCPCS J9190
Hospital Charge Code	41642373
Hospital Revenue Code	636
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$8.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$7.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$6.50
Rate for Payer: Group Health Inc Medicare	$4.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50
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	$8.45

FLUOROURACIL 2500 MG/50 ML INJ

Facility

IP

$13.00

Service Code	HCPCS J9190
Hospital Charge Code	41652373
Hospital Revenue Code	636
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$6.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50

FLUOROURACIL 2500 MG/50 ML INJ

Facility

OP

$13.00

Service Code	HCPCS J9190
Hospital Charge Code	41652373
Hospital Revenue Code	636
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$8.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$7.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.48
Rate for Payer: Group Health Inc Commercial	$6.50
Rate for Payer: Group Health Inc Medicare	$4.55
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50
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	$8.45

FLUOROURACIL 2500 MG/50 ML INJ

Facility

IP

$13.00

Service Code	HCPCS J9190
Hospital Charge Code	41642373
Hospital Revenue Code	636
Min. Negotiated Rate	$6.50
Max. Negotiated Rate	$6.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.50
Rate for Payer: Hamaspik Choice Inc Medicare	$6.50

FLUOROURACIL 2.5 GM/50ML IV SOLN [82180]

Facility

OP

$0.66

Service Code	HCPCS J9190
Hospital Charge Code	25021021598
Hospital Revenue Code	278
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$1.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$0.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.33
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.38
Rate for Payer: EmblemHealth Commercial	$0.33
Rate for Payer: Fidelis Medicare Advantage	$0.69
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.43

FLUOROURACIL 2.5 GM/50ML IV SOLN [82180]

Facility

IP

$0.69

Service Code	HCPCS J9190
Hospital Charge Code	16729027611
Hospital Revenue Code	278
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.34
Rate for Payer: Hamaspik Choice Inc Medicare	$0.34

FLUOROURACIL 2.5 GM/50ML IV SOLN [82180]

Facility

IP

$0.35

Service Code	HCPCS J9190
Hospital Charge Code	63323011751
Hospital Revenue Code	278
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.18
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18
Rate for Payer: Hamaspik Choice Inc Medicare	$0.18

FLUOROURACIL 2.5 GM/50ML IV SOLN [82180]

Facility

OP

$0.35

Service Code	HCPCS J9190
Hospital Charge Code	63323011751
Hospital Revenue Code	278
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$1.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$0.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.18
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.20
Rate for Payer: EmblemHealth Commercial	$0.18
Rate for Payer: Fidelis Medicare Advantage	$0.37
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

FLUOROURACIL 2.5 GM/50ML IV SOLN [82180]

Facility

IP

$0.66

Service Code	HCPCS J9190
Hospital Charge Code	25021021598
Hospital Revenue Code	278
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33

FLUOROURACIL 2.5 GM/50ML IV SOLN [82180]

Facility

OP

$0.69

Service Code	HCPCS J9190
Hospital Charge Code	70700018822
Hospital Revenue Code	278
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$1.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.40
Rate for Payer: EmblemHealth Commercial	$0.34
Rate for Payer: Fidelis Medicare Advantage	$0.72
Rate for Payer: Group Health Inc Commercial	$0.34
Rate for Payer: Group Health Inc Medicare	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.34
Rate for Payer: Hamaspik Choice Inc Medicare	$0.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.45

FLUOROURACIL 2.5 GM/50ML IV SOLN [82180]

Facility

IP

$0.69

Service Code	HCPCS J9190
Hospital Charge Code	70700018822
Hospital Revenue Code	278
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.34
Rate for Payer: Hamaspik Choice Inc Medicare	$0.34

FLUOROURACIL 2.5 GM/50ML IV SOLN [82180]

Facility

OP

$0.69

Service Code	HCPCS J9190
Hospital Charge Code	16729027611
Hospital Revenue Code	278
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$1.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$0.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.40
Rate for Payer: EmblemHealth Commercial	$0.34
Rate for Payer: Fidelis Medicare Advantage	$0.72
Rate for Payer: Group Health Inc Commercial	$0.34
Rate for Payer: Group Health Inc Medicare	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.34
Rate for Payer: Hamaspik Choice Inc Medicare	$0.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.45

FLUOROURACIL 5000 MG/100 ML INJ

Facility

OP

$25.00

Service Code	HCPCS J9190
Hospital Charge Code	41653616
Hospital Revenue Code	636
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$16.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$15.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.38
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	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50
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	$16.25

FLUOROURACIL 5000 MG/100 ML INJ

Facility

OP

$25.00

Service Code	HCPCS J9190
Hospital Charge Code	41643616
Hospital Revenue Code	636
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$16.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$13.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$15.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$14.38
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	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50
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	$16.25

FLUOROURACIL 5000 MG/100 ML INJ

Facility

IP

$25.00

Service Code	HCPCS J9190
Hospital Charge Code	41653616
Hospital Revenue Code	636
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$12.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50

FLUOROURACIL 5000 MG/100 ML INJ

Facility

IP

$25.00

Service Code	HCPCS J9190
Hospital Charge Code	41643616
Hospital Revenue Code	636
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$12.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$12.50
Rate for Payer: Hamaspik Choice Inc Medicare	$12.50

FLUOROURACIL 500 MG/10 ML INJ

Facility

OP

$12.00

Service Code	HCPCS J9190
Hospital Charge Code	41652875
Hospital Revenue Code	636
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$7.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$7.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.90
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
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	$7.80

FLUOROURACIL 500 MG/10 ML INJ

Facility

OP

$12.00

Service Code	HCPCS J9190
Hospital Charge Code	41642875
Hospital Revenue Code	636
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$7.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$7.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.90
Rate for Payer: Group Health Inc Commercial	$6.00
Rate for Payer: Group Health Inc Medicare	$4.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00
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	$7.80

FLUOROURACIL 500 MG/10 ML INJ

Facility

IP

$12.00

Service Code	HCPCS J9190
Hospital Charge Code	41642875
Hospital Revenue Code	636
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00

FLUOROURACIL 500 MG/10 ML INJ

Facility

IP

$12.00

Service Code	HCPCS J9190
Hospital Charge Code	41652875
Hospital Revenue Code	636
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$6.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$6.00
Rate for Payer: Hamaspik Choice Inc Medicare	$6.00

FLUOROURACIL 500 MG/10ML IV SOLN [82200]

Facility

OP

$1.59

Service Code	HCPCS J9190
Hospital Charge Code	70700018622
Hospital Revenue Code	278
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$0.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.92
Rate for Payer: EmblemHealth Commercial	$0.80
Rate for Payer: Fidelis Medicare Advantage	$1.67
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

FLUOROURACIL 500 MG/10ML IV SOLN [82200]

Facility

IP

$1.59

Service Code	HCPCS J9190
Hospital Charge Code	70700018622
Hospital Revenue Code	278
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80
Rate for Payer: Hamaspik Choice Inc Medicare	$0.80

FLUOROURACIL 500 MG/10ML IV SOLN [82200]

Facility

OP

$1.59

Service Code	HCPCS J9190
Hospital Charge Code	16729027603
Hospital Revenue Code	278
Min. Negotiated Rate	$0.56
Max. Negotiated Rate	$1.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$0.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.92
Rate for Payer: EmblemHealth Commercial	$0.80
Rate for Payer: Fidelis Medicare Advantage	$1.67
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

FLUOROURACIL 500 MG/10ML IV SOLN [82200]

Facility

IP

$1.59

Service Code	HCPCS J9190
Hospital Charge Code	70700018623
Hospital Revenue Code	278
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$0.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.80
Rate for Payer: Hamaspik Choice Inc Medicare	$0.80

FLUOROURACIL 500 MG/10ML IV SOLN [82200]

Facility

OP

$0.41

Service Code	HCPCS J9190
Hospital Charge Code	63323011710
Hospital Revenue Code	278
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$1.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Aetna Government	$1.70
Rate for Payer: Brighton Health Commercial	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.21
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.24
Rate for Payer: EmblemHealth Commercial	$0.21
Rate for Payer: Fidelis Medicare Advantage	$0.43
Rate for Payer: Group Health Inc Commercial	$0.21
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.27

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