|
CLEOCIN PHOSPHATE 150 MG/ML
|
Facility
|
IP
|
$9.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4401238
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$5.86 |
| Rate for Payer: Aetna of NY Commercial |
$4.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.05
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: Galaxy Health Commercial |
$5.86
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.96
|
| Rate for Payer: WellCare Medicare |
$4.96
|
|
|
CLEOCIN PHOSPHATE 150 MG/ML
|
Facility
|
OP
|
$9.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4401238
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$7.25 |
| Rate for Payer: Aetna of NY Commercial |
$4.96
|
| Rate for Payer: Aetna of NY Medicare |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.05
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.33
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$4.50
|
| Rate for Payer: Cash Price |
$6.76
|
| Rate for Payer: CDPHP Commercial |
$7.25
|
| Rate for Payer: CDPHP Medicare |
$3.33
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.21
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.21
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.21
|
| Rate for Payer: EmblemHealth Medicaid |
$7.21
|
| Rate for Payer: EmblemHealth Medicare |
$3.06
|
| Rate for Payer: EmblemHealth Select Care |
$6.49
|
| Rate for Payer: Fidelis Medicare |
$3.43
|
| Rate for Payer: Galaxy Health Commercial |
$5.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.33
|
| Rate for Payer: Humana Medicare |
$3.33
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.96
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.14
|
| Rate for Payer: MVP Health Care of NY Commercial |
$6.76
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.50
|
| Rate for Payer: United Healthcare Medicare |
$3.33
|
| Rate for Payer: WellCare Medicare |
$4.96
|
|
|
CLIK X MRI ANCHOR
|
Facility
|
IP
|
$1,287.00
|
|
| Hospital Charge Code |
4479095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.15 |
| Max. Negotiated Rate |
$900.90 |
| Rate for Payer: Aetna of NY Commercial |
$900.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$579.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$579.15
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$643.50
|
| Rate for Payer: EmblemHealth Select Care |
$643.50
|
| Rate for Payer: Galaxy Health Commercial |
$836.55
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$900.90
|
| Rate for Payer: Multiplan Commercial |
$579.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$836.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$836.55
|
| Rate for Payer: WellCare Medicare |
$707.85
|
|
|
CLIK X MRI ANCHOR
|
Facility
|
OP
|
$1,287.00
|
|
| Hospital Charge Code |
4479095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.58 |
| Max. Negotiated Rate |
$1,036.04 |
| Rate for Payer: Aetna of NY Commercial |
$900.90
|
| Rate for Payer: Aetna of NY Medicare |
$592.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$579.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$579.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$476.19
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$643.50
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: CDPHP Commercial |
$1,036.04
|
| Rate for Payer: CDPHP Medicare |
$476.19
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$643.50
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,029.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,029.60
|
| Rate for Payer: EmblemHealth Medicaid |
$1,029.60
|
| Rate for Payer: EmblemHealth Medicare |
$437.58
|
| Rate for Payer: EmblemHealth Select Care |
$643.50
|
| Rate for Payer: Fidelis Medicare |
$490.48
|
| Rate for Payer: Galaxy Health Commercial |
$836.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$476.19
|
| Rate for Payer: Humana Medicare |
$476.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$900.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$592.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$836.55
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$836.55
|
| Rate for Payer: MVP Health Care of NY Medicare |
$500.00
|
| Rate for Payer: United Healthcare Medicare |
$476.19
|
| Rate for Payer: WellCare Medicare |
$707.85
|
|
|
CLINDAMYCIN 300 MG/50 ML-D5W 300 mg, 50 mL
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4401506
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.22 |
| Max. Negotiated Rate |
$26.56 |
| Rate for Payer: Aetna of NY Commercial |
$18.15
|
| Rate for Payer: Aetna of NY Medicare |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.21
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$16.50
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: CDPHP Commercial |
$26.56
|
| Rate for Payer: CDPHP Medicare |
$12.21
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$26.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$26.40
|
| Rate for Payer: EmblemHealth Medicaid |
$26.40
|
| Rate for Payer: EmblemHealth Medicare |
$11.22
|
| Rate for Payer: EmblemHealth Select Care |
$23.76
|
| Rate for Payer: Fidelis Medicare |
$12.58
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.21
|
| Rate for Payer: Humana Medicare |
$12.21
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.18
|
| Rate for Payer: MVP Health Care of NY Commercial |
$24.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$18.58
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.82
|
| Rate for Payer: United Healthcare Medicare |
$12.21
|
| Rate for Payer: WellCare Medicare |
$18.15
|
|
|
CLINDAMYCIN 300 MG/50 ML-D5W 300 mg, 50 mL
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4401506
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna of NY Commercial |
$18.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.85
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.15
|
| Rate for Payer: WellCare Medicare |
$18.15
|
|
|
CLINDAMYCIN 600 MG/50 ML-D5W 600 mg, 50 mL
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4401507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$40.25 |
| Rate for Payer: Aetna of NY Commercial |
$27.50
|
| Rate for Payer: Aetna of NY Medicare |
$23.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$18.50
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$25.00
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: CDPHP Commercial |
$40.25
|
| Rate for Payer: CDPHP Medicare |
$18.50
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$40.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$40.00
|
| Rate for Payer: EmblemHealth Medicaid |
$40.00
|
| Rate for Payer: EmblemHealth Medicare |
$17.00
|
| Rate for Payer: EmblemHealth Select Care |
$36.00
|
| Rate for Payer: Fidelis Medicare |
$19.06
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.50
|
| Rate for Payer: Humana Medicare |
$18.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$27.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$23.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$37.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$28.15
|
| Rate for Payer: MVP Health Care of NY Medicare |
$19.42
|
| Rate for Payer: United Healthcare Medicare |
$18.50
|
| Rate for Payer: WellCare Medicare |
$27.50
|
|
|
CLINDAMYCIN 600 MG/50 ML-D5W 600 mg, 50 mL
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4401507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Aetna of NY Commercial |
$27.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$22.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$27.50
|
| Rate for Payer: WellCare Medicare |
$27.50
|
|
|
CLINDAMYCIN 900 MG/50 ML-NS 900 mg, 50 mL
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
NDC 00338955350
|
| Hospital Charge Code |
4401930
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$37.84 |
| Rate for Payer: Aetna of NY Commercial |
$32.90
|
| Rate for Payer: Aetna of NY Medicare |
$21.62
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$35.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$35.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.39
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$23.50
|
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: CDPHP Commercial |
$37.84
|
| Rate for Payer: CDPHP Medicare |
$17.39
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$37.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$37.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$37.60
|
| Rate for Payer: EmblemHealth Medicaid |
$37.60
|
| Rate for Payer: EmblemHealth Medicare |
$15.98
|
| Rate for Payer: EmblemHealth Select Care |
$33.84
|
| Rate for Payer: Fidelis Medicare |
$17.91
|
| Rate for Payer: Galaxy Health Commercial |
$30.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.39
|
| Rate for Payer: Humana Medicare |
$17.39
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$32.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$21.62
|
| Rate for Payer: MVP Health Care of NY Commercial |
$35.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$26.46
|
| Rate for Payer: MVP Health Care of NY Medicare |
$18.26
|
| Rate for Payer: United Healthcare Medicare |
$17.39
|
| Rate for Payer: WellCare Medicare |
$25.85
|
|
|
CLINDAMYCIN 900 MG/50 ML-NS 900 mg, 50 mL
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
NDC 00338955350
|
| Hospital Charge Code |
4401930
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.85 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: Cash Price |
$35.25
|
| Rate for Payer: Galaxy Health Commercial |
$30.55
|
| Rate for Payer: WellCare Medicare |
$25.85
|
|
|
CLINDAMYCIN HCL 150MG CAPS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904595961
|
| Hospital Charge Code |
4400170
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
CLINDAMYCIN HCL 150MG CAPS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904595961
|
| Hospital Charge Code |
4400170
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
clindamycin HCL 300 MG CAPSULE 300 mg, 50 eaches
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 50268018515
|
| Hospital Charge Code |
4401569
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Aetna of NY Commercial |
$4.20
|
| Rate for Payer: Aetna of NY Medicare |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.22
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: CDPHP Commercial |
$4.83
|
| Rate for Payer: CDPHP Medicare |
$2.22
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.80
|
| Rate for Payer: EmblemHealth Medicaid |
$4.80
|
| Rate for Payer: EmblemHealth Medicare |
$2.04
|
| Rate for Payer: EmblemHealth Select Care |
$4.32
|
| Rate for Payer: Fidelis Medicare |
$2.29
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.22
|
| Rate for Payer: Humana Medicare |
$2.22
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.38
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.33
|
| Rate for Payer: United Healthcare Medicare |
$2.22
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
clindamycin HCL 300 MG CAPSULE 300 mg, 50 eaches
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 50268018515
|
| Hospital Charge Code |
4401569
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: WellCare Medicare |
$3.30
|
|
|
CLINDAMYCIN PHOSPHATE 150MG/ML SDV 25X4M
|
Facility
|
OP
|
$10.82
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.68 |
| Max. Negotiated Rate |
$8.71 |
| Rate for Payer: Aetna of NY Commercial |
$5.95
|
| Rate for Payer: Aetna of NY Medicare |
$4.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.87
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.87
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.00
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$5.41
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: CDPHP Commercial |
$8.71
|
| Rate for Payer: CDPHP Medicare |
$4.00
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.66
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.66
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.66
|
| Rate for Payer: EmblemHealth Medicaid |
$8.66
|
| Rate for Payer: EmblemHealth Medicare |
$3.68
|
| Rate for Payer: EmblemHealth Select Care |
$7.79
|
| Rate for Payer: Fidelis Medicare |
$4.12
|
| Rate for Payer: Galaxy Health Commercial |
$7.03
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.00
|
| Rate for Payer: Humana Medicare |
$4.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.95
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.12
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.09
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.20
|
| Rate for Payer: United Healthcare Medicare |
$4.00
|
| Rate for Payer: WellCare Medicare |
$5.95
|
|
|
CLINDAMYCIN PHOSPHATE 150MG/ML SDV 25X4M
|
Facility
|
IP
|
$10.82
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna of NY Commercial |
$5.95
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.87
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.87
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: Galaxy Health Commercial |
$7.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.95
|
| Rate for Payer: WellCare Medicare |
$5.95
|
|
|
CLIP APPLIER 10MM
|
Facility
|
IP
|
$622.00
|
|
| Hospital Charge Code |
4479182
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$404.30 |
| Max. Negotiated Rate |
$404.30 |
| Rate for Payer: Cash Price |
$466.50
|
| Rate for Payer: Galaxy Health Commercial |
$404.30
|
|
|
CLIP APPLIER 10MM
|
Facility
|
OP
|
$622.00
|
|
| Hospital Charge Code |
4479182
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$211.48 |
| Max. Negotiated Rate |
$500.71 |
| Rate for Payer: Aetna of NY Commercial |
$435.40
|
| Rate for Payer: Aetna of NY Medicare |
$286.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$466.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$466.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$230.14
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$311.00
|
| Rate for Payer: Cash Price |
$466.50
|
| Rate for Payer: CDPHP Commercial |
$500.71
|
| Rate for Payer: CDPHP Medicare |
$230.14
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$497.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$497.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$497.60
|
| Rate for Payer: EmblemHealth Medicaid |
$497.60
|
| Rate for Payer: EmblemHealth Medicare |
$211.48
|
| Rate for Payer: EmblemHealth Select Care |
$447.84
|
| Rate for Payer: Fidelis Medicare |
$237.04
|
| Rate for Payer: Galaxy Health Commercial |
$404.30
|
| Rate for Payer: Hamaspik Choice Medicare |
$230.14
|
| Rate for Payer: Humana Medicare |
$230.14
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$435.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$286.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$466.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$350.19
|
| Rate for Payer: MVP Health Care of NY Medicare |
$241.65
|
| Rate for Payer: United Healthcare Medicare |
$230.14
|
| Rate for Payer: WellCare Medicare |
$342.10
|
|
|
CLOBETASOL CREAM 0.05% 15 GRAMS
|
Facility
|
OP
|
$396.29
|
|
|
Service Code
|
NDC 51672125801
|
| Hospital Charge Code |
4409166
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$134.74 |
| Max. Negotiated Rate |
$319.01 |
| Rate for Payer: Aetna of NY Commercial |
$277.40
|
| Rate for Payer: Aetna of NY Medicare |
$182.29
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$297.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$297.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$146.63
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$198.14
|
| Rate for Payer: Cash Price |
$297.22
|
| Rate for Payer: CDPHP Commercial |
$319.01
|
| Rate for Payer: CDPHP Medicare |
$146.63
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$317.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$317.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$317.03
|
| Rate for Payer: EmblemHealth Medicaid |
$317.03
|
| Rate for Payer: EmblemHealth Medicare |
$134.74
|
| Rate for Payer: EmblemHealth Select Care |
$285.33
|
| Rate for Payer: Fidelis Medicare |
$151.03
|
| Rate for Payer: Galaxy Health Commercial |
$257.59
|
| Rate for Payer: Hamaspik Choice Medicare |
$146.63
|
| Rate for Payer: Humana Medicare |
$146.63
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$277.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$182.29
|
| Rate for Payer: MVP Health Care of NY Commercial |
$297.22
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$223.11
|
| Rate for Payer: MVP Health Care of NY Medicare |
$153.96
|
| Rate for Payer: United Healthcare Medicare |
$146.63
|
| Rate for Payer: WellCare Medicare |
$217.96
|
|
|
CLOBETASOL CREAM 0.05% 15 GRAMS
|
Facility
|
IP
|
$396.29
|
|
|
Service Code
|
NDC 51672125801
|
| Hospital Charge Code |
4409166
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$217.96 |
| Max. Negotiated Rate |
$257.59 |
| Rate for Payer: Cash Price |
$297.22
|
| Rate for Payer: Galaxy Health Commercial |
$257.59
|
| Rate for Payer: WellCare Medicare |
$217.96
|
|
|
CLONAZEPAM 0.5MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 63739026310
|
| Hospital Charge Code |
4400173
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
CLONAZEPAM 0.5MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 63739026310
|
| Hospital Charge Code |
4400173
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
CLONIDINE HCL 0.1MG/24HR PTCH 4 EA
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
NDC 00597003134
|
| Hospital Charge Code |
4400138
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
CLONIDINE HCL 0.1MG/24HR PTCH 4 EA
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
NDC 00597003134
|
| Hospital Charge Code |
4400138
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$36.22 |
| Rate for Payer: Aetna of NY Commercial |
$31.50
|
| Rate for Payer: Aetna of NY Medicare |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$33.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.65
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$22.50
|
| Rate for Payer: Cash Price |
$33.75
|
| Rate for Payer: CDPHP Commercial |
$36.22
|
| Rate for Payer: CDPHP Medicare |
$16.65
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$36.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$36.00
|
| Rate for Payer: EmblemHealth Medicaid |
$36.00
|
| Rate for Payer: EmblemHealth Medicare |
$15.30
|
| Rate for Payer: EmblemHealth Select Care |
$32.40
|
| Rate for Payer: Fidelis Medicare |
$17.15
|
| Rate for Payer: Galaxy Health Commercial |
$29.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.65
|
| Rate for Payer: Humana Medicare |
$16.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$31.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$20.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$33.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$25.34
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.48
|
| Rate for Payer: United Healthcare Medicare |
$16.65
|
| Rate for Payer: WellCare Medicare |
$24.75
|
|
|
CLONIDINE HCL 0.1MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904565661
|
| Hospital Charge Code |
4400174
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
