St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

FLUOROURACIL 500 MG/10ML IV SOLN [82200]

Facility

$1.59

Service Code	HCPCS J9190
Hospital Charge Code	16729027603
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

$0.41

Service Code	HCPCS J9190
Hospital Charge Code	63323011710
Hospital Revenue Code	278
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$0.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.21
Rate for Payer: Hamaspik Choice Inc Medicare	$0.21

FLUOROURACIL 500 MG/10ML IV SOLN [82200]

Facility

$1.59

Service Code	HCPCS J9190
Hospital Charge Code	70700018623
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

$1.70

Service Code	HCPCS J9190
Hospital Revenue Code	278
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$1.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.70
Rate for Payer: Aetna Government	$1.70

FLUOROURACIL 5 % EX CREA [10065]

Facility

$7.10

Service Code	NDC 00378479106
Hospital Charge Code	00378479106
Hospital Revenue Code	250
Min. Negotiated Rate	$2.49
Max. Negotiated Rate	$5.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.55
Rate for Payer: Aetna Government	$3.55
Rate for Payer: Brighton Health Commercial	$5.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.68
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.83
Rate for Payer: Group Health Inc Commercial	$3.55
Rate for Payer: Group Health Inc Medicare	$2.49
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.55
Rate for Payer: Hamaspik Choice Inc Medicare	$3.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.62

FLUOROURACIL 5 GM/100ML IV SOLN [98249]

Facility

$0.69

Service Code	HCPCS J9190
Hospital Charge Code	16729027638
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 5 GM/100ML IV SOLN [98249]

Facility

$0.69

Service Code	HCPCS J9190
Hospital Charge Code	16729027638
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 5 GM/100ML IV SOLN [98249]

Facility

$0.35

Service Code	HCPCS J9190
Hospital Charge Code	63323011761
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 5 GM/100ML IV SOLN [98249]

Facility

$0.35

Service Code	HCPCS J9190
Hospital Charge Code	63323011761
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 CR 5% CREAM

Facility

$643.48

Service Code	HCPCS J9999
Hospital Charge Code	41640316
Hospital Revenue Code	636
Min. Negotiated Rate	$225.22
Max. Negotiated Rate	$418.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$353.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$321.74
Rate for Payer: Aetna Government	$321.74
Rate for Payer: Brighton Health Commercial	$386.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$321.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$370.00
Rate for Payer: Group Health Inc Commercial	$321.74
Rate for Payer: Group Health Inc Medicare	$225.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$321.74
Rate for Payer: Hamaspik Choice Inc Medicare	$321.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$418.26

FLUOROURACIL CR 5% CREAM

Facility

$643.48

Service Code	HCPCS J9999
Hospital Charge Code	41650316
Hospital Revenue Code	636
Min. Negotiated Rate	$321.74
Max. Negotiated Rate	$321.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$321.74
Rate for Payer: Hamaspik Choice Inc Medicare	$321.74

FLUOROURACIL CR 5% CREAM

Facility

$643.48

Service Code	HCPCS J9999
Hospital Charge Code	41650316
Hospital Revenue Code	636
Min. Negotiated Rate	$225.22
Max. Negotiated Rate	$418.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$353.91
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$321.74
Rate for Payer: Aetna Government	$321.74
Rate for Payer: Brighton Health Commercial	$386.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$321.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$370.00
Rate for Payer: Group Health Inc Commercial	$321.74
Rate for Payer: Group Health Inc Medicare	$225.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$321.74
Rate for Payer: Hamaspik Choice Inc Medicare	$321.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$418.26

FLUOROURACIL CR 5% CREAM

Facility

$643.48

Service Code	HCPCS J9999
Hospital Charge Code	41640316
Hospital Revenue Code	636
Min. Negotiated Rate	$321.74
Max. Negotiated Rate	$321.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$321.74
Rate for Payer: Hamaspik Choice Inc Medicare	$321.74

FLUOXETINE 10 MG CAP

Facility

$0.05

Hospital Charge Code	41653787
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
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	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

FLUOXETINE 10 MG CAP

Facility

$0.05

Hospital Charge Code	41643787
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
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	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

FLUOXETINE 20 MG/5 ML LIQUID

Facility

$0.05

Hospital Charge Code	41642454
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
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	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

FLUOXETINE 20 MG/5 ML LIQUID

Facility

$0.05

Hospital Charge Code	41652454
Hospital Revenue Code	250
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.03
Rate for Payer: Aetna Government	$0.03
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	$0.03
Rate for Payer: Group Health Inc Commercial	$0.03
Rate for Payer: Group Health Inc Medicare	$0.02
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.03
Rate for Payer: Hamaspik Choice Inc Medicare	$0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.03

FLUOXETINE 20 MG CAP

Facility

$0.14

Hospital Charge Code	41643788
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

FLUOXETINE 20 MG CAP

Facility

$0.14

Hospital Charge Code	41653788
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.10
Rate for Payer: Group Health Inc Commercial	$0.07
Rate for Payer: Group Health Inc Medicare	$0.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07
Rate for Payer: Hamaspik Choice Inc Medicare	$0.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.09

FLUOXETINE HCL 10 MG PO CAPS [10069]

Facility

$2.42

Service Code	NDC 00904578461
Hospital Charge Code	00904578461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.85
Max. Negotiated Rate	$1.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.21
Rate for Payer: Aetna Government	$1.21
Rate for Payer: Brighton Health Commercial	$1.81
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.64
Rate for Payer: Group Health Inc Commercial	$1.21
Rate for Payer: Group Health Inc Medicare	$0.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.21
Rate for Payer: Hamaspik Choice Inc Medicare	$1.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.57

FLUOXETINE HCL 10 MG PO CAPS [10069]

Facility

$2.60

Service Code	NDC 65862019201
Hospital Charge Code	65862019201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$2.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.30
Rate for Payer: Aetna Government	$1.30
Rate for Payer: Brighton Health Commercial	$1.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.77
Rate for Payer: Group Health Inc Commercial	$1.30
Rate for Payer: Group Health Inc Medicare	$0.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.30
Rate for Payer: Hamaspik Choice Inc Medicare	$1.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.69

FLUOXETINE HCL 10 MG PO CAPS [10069]

Facility

$2.60

Service Code	NDC 62332002231
Hospital Charge Code	62332002231
Hospital Revenue Code	250
Min. Negotiated Rate	$0.91
Max. Negotiated Rate	$2.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.30
Rate for Payer: Aetna Government	$1.30
Rate for Payer: Brighton Health Commercial	$1.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.77
Rate for Payer: Group Health Inc Commercial	$1.30
Rate for Payer: Group Health Inc Medicare	$0.91
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.30
Rate for Payer: Hamaspik Choice Inc Medicare	$1.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.69

FLUOXETINE HCL 20 MG/5ML PO SOLN [38488]

Facility

$1.37

Service Code	NDC 00121472105
Hospital Charge Code	00121472105
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.68
Rate for Payer: Aetna Government	$0.68
Rate for Payer: Brighton Health Commercial	$1.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.93
Rate for Payer: Group Health Inc Commercial	$0.68
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.68
Rate for Payer: Hamaspik Choice Inc Medicare	$0.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.89

FLUOXETINE HCL 20 MG/5ML PO SOLN [38488]

Facility

$0.98

Service Code	NDC 54838052340
Hospital Charge Code	54838052340
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.79
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.49
Rate for Payer: Aetna Government	$0.49
Rate for Payer: Brighton Health Commercial	$0.74
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.79
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.67
Rate for Payer: Group Health Inc Commercial	$0.49
Rate for Payer: Group Health Inc Medicare	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.49
Rate for Payer: Hamaspik Choice Inc Medicare	$0.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.64

FLUOXETINE HCL 20 MG PO CAPS [10070]

Facility

$2.62

Service Code	NDC 65862019399
Hospital Charge Code	65862019399
Hospital Revenue Code	250
Min. Negotiated Rate	$0.92
Max. Negotiated Rate	$2.09
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.31
Rate for Payer: Aetna Government	$1.31
Rate for Payer: Brighton Health Commercial	$1.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.09
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.78
Rate for Payer: Group Health Inc Commercial	$1.31
Rate for Payer: Group Health Inc Medicare	$0.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.31
Rate for Payer: Hamaspik Choice Inc Medicare	$1.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.70

Know your out-of-pocket cost for care.

All Charges