|
CLARITHROMYCIN 500 MG TABLET
|
Facility
|
IP
|
$19.06
|
|
|
Service Code
|
NDC 68084065195
|
| Hospital Charge Code |
4409103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$12.39 |
| Rate for Payer: Cash Price |
$14.29
|
| Rate for Payer: Galaxy Health Commercial |
$12.39
|
| Rate for Payer: WellCare Medicare |
$10.48
|
|
|
CLAVICLE STRAP ANY SIZE
|
Facility
|
OP
|
$25.75
|
|
| Hospital Charge Code |
4472169
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$20.60 |
| Rate for Payer: Aetna of NY Commercial |
$18.02
|
| Rate for Payer: Aetna of NY Medicare |
$11.85
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.30
|
| Rate for Payer: Cash Price |
$19.31
|
| Rate for Payer: CDPHP Medicare |
$9.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$20.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$20.60
|
| Rate for Payer: EmblemHealth Medicaid |
$20.60
|
| Rate for Payer: EmblemHealth Medicare |
$8.76
|
| Rate for Payer: EmblemHealth Select Care |
$18.54
|
| Rate for Payer: Fidelis Medicare |
$10.30
|
| Rate for Payer: Galaxy Health Commercial |
$16.74
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.30
|
| Rate for Payer: Humana Medicare |
$10.30
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$18.02
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.85
|
| Rate for Payer: MVP Health Care of NY Commercial |
$19.31
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$14.50
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.81
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.86
|
| Rate for Payer: United Healthcare Medicare |
$10.30
|
| Rate for Payer: WellCare Medicare |
$14.16
|
|
|
CLAVICLE STRAP ANY SIZE
|
Facility
|
IP
|
$25.75
|
|
| Hospital Charge Code |
4472169
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.74 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Cash Price |
$19.31
|
| Rate for Payer: Galaxy Health Commercial |
$16.74
|
|
|
CLEOCIN PHOSPHATE 150 MG/ML
|
Facility
|
OP
|
$9.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4401238
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.35 |
| Max. Negotiated Rate |
$7.21 |
| Rate for Payer: Aetna of NY Medicare |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.60
|
| Rate for Payer: Cash Price |
$6.76
|
| 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 |
$3.60
|
| Rate for Payer: Galaxy Health Commercial |
$5.86
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.60
|
| Rate for Payer: Humana Medicare |
$3.60
|
| 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 |
$3.78
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.35
|
| Rate for Payer: United Healthcare Medicare |
$3.60
|
| Rate for Payer: WellCare Medicare |
$4.96
|
|
|
CLEOCIN PHOSPHATE 150 MG/ML
|
Facility
|
IP
|
$9.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4401238
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$5.86 |
| Rate for Payer: Aetna of NY Commercial |
$4.96
|
| 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
|
|
|
CLIK X MRI ANCHOR
|
Facility
|
IP
|
$1,325.61
|
|
| Hospital Charge Code |
4479095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$596.52 |
| Max. Negotiated Rate |
$927.93 |
| Rate for Payer: Aetna of NY Commercial |
$927.93
|
| Rate for Payer: Cash Price |
$994.21
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$662.80
|
| Rate for Payer: EmblemHealth Select Care |
$662.80
|
| Rate for Payer: Galaxy Health Commercial |
$861.65
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$927.93
|
| Rate for Payer: Multiplan Commercial |
$596.52
|
| Rate for Payer: MVP Health Care of NY Commercial |
$861.65
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$861.65
|
| Rate for Payer: WellCare Medicare |
$729.09
|
|
|
CLIK X MRI ANCHOR
|
Facility
|
OP
|
$1,325.61
|
|
| Hospital Charge Code |
4479095
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.84 |
| Max. Negotiated Rate |
$1,060.49 |
| Rate for Payer: Aetna of NY Commercial |
$927.93
|
| Rate for Payer: Aetna of NY Medicare |
$609.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$530.24
|
| Rate for Payer: Cash Price |
$994.21
|
| Rate for Payer: CDPHP Medicare |
$490.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$662.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$1,060.49
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$1,060.49
|
| Rate for Payer: EmblemHealth Medicaid |
$1,060.49
|
| Rate for Payer: EmblemHealth Medicare |
$450.71
|
| Rate for Payer: EmblemHealth Select Care |
$662.80
|
| Rate for Payer: Fidelis Medicare |
$530.24
|
| Rate for Payer: Galaxy Health Commercial |
$861.65
|
| Rate for Payer: Hamaspik Choice Medicare |
$530.24
|
| Rate for Payer: Humana Medicare |
$530.24
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$927.93
|
| Rate for Payer: Local 1199SEIU Medicare |
$609.78
|
| Rate for Payer: MVP Health Care of NY Commercial |
$861.65
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$861.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$556.76
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$198.84
|
| Rate for Payer: United Healthcare Medicare |
$530.24
|
| Rate for Payer: WellCare Medicare |
$729.09
|
|
|
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 |
$4.95 |
| Max. Negotiated Rate |
$26.40 |
| Rate for Payer: Aetna of NY Medicare |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.20
|
| Rate for Payer: Cash Price |
$24.75
|
| 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 |
$13.20
|
| Rate for Payer: Galaxy Health Commercial |
$21.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.20
|
| Rate for Payer: Humana Medicare |
$13.20
|
| 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 |
$13.86
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.95
|
| Rate for Payer: United Healthcare Medicare |
$13.20
|
| 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 |
$18.15 |
| Max. Negotiated Rate |
$21.45 |
| Rate for Payer: Aetna of NY Commercial |
$18.15
|
| 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
|
IP
|
$50.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4401507
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$32.50 |
| Rate for Payer: Aetna of NY Commercial |
$27.50
|
| 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 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 |
$7.50 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna of NY Medicare |
$23.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$20.00
|
| Rate for Payer: Cash Price |
$37.50
|
| 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 |
$20.00
|
| Rate for Payer: Galaxy Health Commercial |
$32.50
|
| Rate for Payer: Hamaspik Choice Medicare |
$20.00
|
| Rate for Payer: Humana Medicare |
$20.00
|
| 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 |
$21.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.50
|
| Rate for Payer: United Healthcare Medicare |
$20.00
|
| Rate for Payer: WellCare Medicare |
$27.50
|
|
|
CLINDAMYCIN 900 MG/50 ML-NS 900 mg, 50 mL
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
NDC 338955350
|
| 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 900 MG/50 ML-NS 900 mg, 50 mL
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
NDC 338955350
|
| Hospital Charge Code |
4401930
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$37.60 |
| 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) Medicare |
$18.80
|
| Rate for Payer: Cash Price |
$35.25
|
| 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 |
$18.80
|
| Rate for Payer: Galaxy Health Commercial |
$30.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$18.80
|
| Rate for Payer: Humana Medicare |
$18.80
|
| 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 |
$19.74
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$7.05
|
| Rate for Payer: United Healthcare Medicare |
$18.80
|
| Rate for Payer: WellCare Medicare |
$25.85
|
|
|
CLINDAMYCIN HCL 150MG CAPS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904595961
|
| 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 904595961
|
| Hospital Charge Code |
4400170
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
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 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 |
$0.90 |
| Max. Negotiated Rate |
$4.80 |
| 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) Medicare |
$2.40
|
| Rate for Payer: Cash Price |
$4.50
|
| 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 |
$2.40
|
| Rate for Payer: Galaxy Health Commercial |
$3.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.40
|
| Rate for Payer: Humana Medicare |
$2.40
|
| 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 |
$2.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.90
|
| Rate for Payer: United Healthcare Medicare |
$2.40
|
| 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 |
$1.62 |
| Max. Negotiated Rate |
$8.66 |
| Rate for Payer: Aetna of NY Medicare |
$4.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.33
|
| Rate for Payer: Cash Price |
$8.12
|
| 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 |
$4.33
|
| Rate for Payer: Galaxy Health Commercial |
$7.03
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.33
|
| Rate for Payer: Humana Medicare |
$4.33
|
| 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 |
$4.54
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.62
|
| Rate for Payer: United Healthcare Medicare |
$4.33
|
| 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 |
$5.95 |
| Max. Negotiated Rate |
$7.03 |
| Rate for Payer: Aetna of NY Commercial |
$5.95
|
| 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
|
$640.66
|
|
| Hospital Charge Code |
4479182
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$416.43 |
| Max. Negotiated Rate |
$416.43 |
| Rate for Payer: Cash Price |
$480.50
|
| Rate for Payer: Galaxy Health Commercial |
$416.43
|
|
|
CLIP APPLIER 10MM
|
Facility
|
OP
|
$640.66
|
|
| Hospital Charge Code |
4479182
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.10 |
| Max. Negotiated Rate |
$512.53 |
| Rate for Payer: Aetna of NY Commercial |
$448.46
|
| Rate for Payer: Aetna of NY Medicare |
$294.70
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$256.26
|
| Rate for Payer: Cash Price |
$480.50
|
| Rate for Payer: CDPHP Medicare |
$237.04
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$512.53
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$512.53
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$512.53
|
| Rate for Payer: EmblemHealth Medicaid |
$512.53
|
| Rate for Payer: EmblemHealth Medicare |
$217.82
|
| Rate for Payer: EmblemHealth Select Care |
$461.28
|
| Rate for Payer: Fidelis Medicare |
$256.26
|
| Rate for Payer: Galaxy Health Commercial |
$416.43
|
| Rate for Payer: Hamaspik Choice Medicare |
$256.26
|
| Rate for Payer: Humana Medicare |
$256.26
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$448.46
|
| Rate for Payer: Local 1199SEIU Medicare |
$294.70
|
| Rate for Payer: MVP Health Care of NY Commercial |
$480.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$360.69
|
| Rate for Payer: MVP Health Care of NY Medicare |
$269.08
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$96.10
|
| Rate for Payer: United Healthcare Medicare |
$256.26
|
| Rate for Payer: WellCare Medicare |
$352.36
|
|
|
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
|
|
|
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 |
$59.44 |
| Max. Negotiated Rate |
$317.03 |
| 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) Medicare |
$158.52
|
| Rate for Payer: Cash Price |
$297.22
|
| 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 |
$158.52
|
| Rate for Payer: Galaxy Health Commercial |
$257.59
|
| Rate for Payer: Hamaspik Choice Medicare |
$158.52
|
| Rate for Payer: Humana Medicare |
$158.52
|
| 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 |
$166.44
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$59.44
|
| Rate for Payer: United Healthcare Medicare |
$158.52
|
| 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 |
$0.93 |
| Max. Negotiated Rate |
$4.94 |
| 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) Medicare |
$2.47
|
| Rate for Payer: Cash Price |
$4.64
|
| 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 |
$2.47
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.47
|
| Rate for Payer: Humana Medicare |
$2.47
|
| 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 |
$4.63
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.60
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
