|
CIPROFLOXACIN 250 MG/5ML (5%) PO SUSR
|
Facility
|
OP
|
$1.57
|
|
|
Service Code
|
NDC 5041977701
|
| Hospital Charge Code |
5041977701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.78
|
| Rate for Payer: Aetna Government |
$0.78
|
| Rate for Payer: Brighton Health Commercial |
$1.17
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.25
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.06
|
| Rate for Payer: EmblemHealth Commercial |
$0.78
|
| Rate for Payer: Group Health Inc Commercial |
$0.78
|
| Rate for Payer: Group Health Inc Medicare |
$0.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.78
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.78
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.02
|
|
|
CIPROFLOXACIN 250 MG/5ML (5%) PO SUSR
|
Facility
|
IP
|
$1.57
|
|
|
Service Code
|
NDC 5041977701
|
| Hospital Charge Code |
5041977701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.78 |
| Max. Negotiated Rate |
$0.78 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.78
|
|
|
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP
|
Facility
|
IP
|
$37.36
|
|
|
Service Code
|
NDC 6275642790
|
| Hospital Charge Code |
6275642790
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$18.68 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.68
|
|
|
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP
|
Facility
|
OP
|
$37.36
|
|
|
Service Code
|
NDC 6275642790
|
| Hospital Charge Code |
6275642790
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$29.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$20.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$18.68
|
| Rate for Payer: Aetna Government |
$18.68
|
| Rate for Payer: Brighton Health Commercial |
$28.02
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$29.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$25.41
|
| Rate for Payer: EmblemHealth Commercial |
$18.68
|
| Rate for Payer: Group Health Inc Commercial |
$18.68
|
| Rate for Payer: Group Health Inc Medicare |
$13.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$18.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$18.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$24.29
|
|
|
CIPROFLOXACIN HCL 250 MG PO TABS
|
Facility
|
OP
|
$4.59
|
|
|
Service Code
|
NDC 0143992701
|
| Hospital Charge Code |
0143992701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.53
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.30
|
| Rate for Payer: Aetna Government |
$2.30
|
| Rate for Payer: Brighton Health Commercial |
$3.45
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.68
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.12
|
| Rate for Payer: EmblemHealth Commercial |
$2.30
|
| Rate for Payer: Group Health Inc Commercial |
$2.30
|
| Rate for Payer: Group Health Inc Medicare |
$1.61
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.30
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.30
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.99
|
|
|
CIPROFLOXACIN HCL 250 MG PO TABS
|
Facility
|
IP
|
$4.59
|
|
|
Service Code
|
NDC 0143992701
|
| Hospital Charge Code |
0143992701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.30 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.30
|
|
|
CIPROFLOXACIN HCL 250 MG PO TABS
|
Facility
|
IP
|
$4.44
|
|
|
Service Code
|
NDC 5511112601
|
| Hospital Charge Code |
5511112601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$2.22 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.22
|
|
|
CIPROFLOXACIN HCL 250 MG PO TABS
|
Facility
|
OP
|
$4.44
|
|
|
Service Code
|
NDC 5511112601
|
| Hospital Charge Code |
5511112601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.22
|
| Rate for Payer: Aetna Government |
$2.22
|
| Rate for Payer: Brighton Health Commercial |
$3.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.02
|
| Rate for Payer: EmblemHealth Commercial |
$2.22
|
| Rate for Payer: Group Health Inc Commercial |
$2.22
|
| Rate for Payer: Group Health Inc Medicare |
$1.55
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.88
|
|
|
CIPROFLOXACIN HCL 500 MG PO TABS
|
Facility
|
IP
|
$4.93
|
|
|
Service Code
|
NDC 6586207705
|
| Hospital Charge Code |
6586207705
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$2.47 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.47
|
|
|
CIPROFLOXACIN HCL 500 MG PO TABS
|
Facility
|
IP
|
$5.19
|
|
|
Service Code
|
NDC 6213530920
|
| Hospital Charge Code |
6213530920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.60
|
|
|
CIPROFLOXACIN HCL 500 MG PO TABS
|
Facility
|
OP
|
$5.19
|
|
|
Service Code
|
NDC 6213530920
|
| Hospital Charge Code |
6213530920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$4.15 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.86
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.60
|
| Rate for Payer: Aetna Government |
$2.60
|
| Rate for Payer: Brighton Health Commercial |
$3.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.15
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.53
|
| Rate for Payer: EmblemHealth Commercial |
$2.60
|
| Rate for Payer: Group Health Inc Commercial |
$2.60
|
| Rate for Payer: Group Health Inc Medicare |
$1.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.60
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.60
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.37
|
|
|
CIPROFLOXACIN HCL 500 MG PO TABS
|
Facility
|
IP
|
$5.37
|
|
|
Service Code
|
NDC 0143992801
|
| Hospital Charge Code |
0143992801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.68 |
| Max. Negotiated Rate |
$2.68 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.68
|
|
|
CIPROFLOXACIN HCL 500 MG PO TABS
|
Facility
|
IP
|
$0.44
|
|
|
Service Code
|
NDC 6068786011
|
| Hospital Charge Code |
6068786011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$0.22 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.22
|
|
|
CIPROFLOXACIN HCL 500 MG PO TABS
|
Facility
|
OP
|
$5.37
|
|
|
Service Code
|
NDC 0143992801
|
| Hospital Charge Code |
0143992801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$4.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.95
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.68
|
| Rate for Payer: Aetna Government |
$2.68
|
| Rate for Payer: Brighton Health Commercial |
$4.03
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.65
|
| Rate for Payer: EmblemHealth Commercial |
$2.68
|
| Rate for Payer: Group Health Inc Commercial |
$2.68
|
| Rate for Payer: Group Health Inc Medicare |
$1.88
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.68
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.68
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.49
|
|
|
CIPROFLOXACIN HCL 500 MG PO TABS
|
Facility
|
OP
|
$4.93
|
|
|
Service Code
|
NDC 6586207705
|
| Hospital Charge Code |
6586207705
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$3.95 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.47
|
| Rate for Payer: Aetna Government |
$2.47
|
| Rate for Payer: Brighton Health Commercial |
$3.70
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.95
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.35
|
| Rate for Payer: EmblemHealth Commercial |
$2.47
|
| Rate for Payer: Group Health Inc Commercial |
$2.47
|
| Rate for Payer: Group Health Inc Medicare |
$1.73
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.47
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.47
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.21
|
|
|
CIPROFLOXACIN HCL 500 MG PO TABS
|
Facility
|
OP
|
$0.44
|
|
|
Service Code
|
NDC 6068786011
|
| Hospital Charge Code |
6068786011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.22
|
| Rate for Payer: Aetna Government |
$0.22
|
| Rate for Payer: Brighton Health Commercial |
$0.33
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.30
|
| Rate for Payer: EmblemHealth Commercial |
$0.22
|
| Rate for Payer: Group Health Inc Commercial |
$0.22
|
| Rate for Payer: Group Health Inc Medicare |
$0.15
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.22
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.22
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.28
|
|
|
CIPROFLOXACIN HCL 750 MG PO TABS
|
Facility
|
OP
|
$5.65
|
|
|
Service Code
|
NDC 0143992950
|
| Hospital Charge Code |
0143992950
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.10
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.82
|
| Rate for Payer: Aetna Government |
$2.82
|
| Rate for Payer: Brighton Health Commercial |
$4.23
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.52
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.84
|
| Rate for Payer: EmblemHealth Commercial |
$2.82
|
| Rate for Payer: Group Health Inc Commercial |
$2.82
|
| Rate for Payer: Group Health Inc Medicare |
$1.98
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.82
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.67
|
|
|
CIPROFLOXACIN HCL 750 MG PO TABS
|
Facility
|
OP
|
$0.54
|
|
|
Service Code
|
NDC 5965187350
|
| Hospital Charge Code |
5965187350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.27
|
| Rate for Payer: Aetna Government |
$0.27
|
| Rate for Payer: Brighton Health Commercial |
$0.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.37
|
| Rate for Payer: EmblemHealth Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.35
|
|
|
CIPROFLOXACIN HCL 750 MG PO TABS
|
Facility
|
IP
|
$0.54
|
|
|
Service Code
|
NDC 5965187350
|
| Hospital Charge Code |
5965187350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.27 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
|
|
CIPROFLOXACIN HCL 750 MG PO TABS
|
Facility
|
IP
|
$5.63
|
|
|
Service Code
|
NDC 6586207850
|
| Hospital Charge Code |
6586207850
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.81 |
| Max. Negotiated Rate |
$2.81 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.81
|
|
|
CIPROFLOXACIN HCL 750 MG PO TABS
|
Facility
|
OP
|
$5.63
|
|
|
Service Code
|
NDC 6586207850
|
| Hospital Charge Code |
6586207850
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$4.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.81
|
| Rate for Payer: Aetna Government |
$2.81
|
| Rate for Payer: Brighton Health Commercial |
$4.22
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.83
|
| Rate for Payer: EmblemHealth Commercial |
$2.81
|
| Rate for Payer: Group Health Inc Commercial |
$2.81
|
| Rate for Payer: Group Health Inc Medicare |
$1.97
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.81
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.81
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.66
|
|
|
CIPROFLOXACIN HCL 750 MG PO TABS
|
Facility
|
IP
|
$5.65
|
|
|
Service Code
|
NDC 0143992950
|
| Hospital Charge Code |
0143992950
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$2.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.82
|
|
|
CIPROFLOXACIN HCL 750 MG PO TABS
|
Facility
|
OP
|
$5.45
|
|
|
Service Code
|
NDC 5511112850
|
| Hospital Charge Code |
5511112850
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.99
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.72
|
| Rate for Payer: Aetna Government |
$2.72
|
| Rate for Payer: Brighton Health Commercial |
$4.08
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.70
|
| Rate for Payer: EmblemHealth Commercial |
$2.72
|
| Rate for Payer: Group Health Inc Commercial |
$2.72
|
| Rate for Payer: Group Health Inc Medicare |
$1.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.72
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.72
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.54
|
|
|
CIPROFLOXACIN HCL 750 MG PO TABS
|
Facility
|
IP
|
$5.45
|
|
|
Service Code
|
NDC 5511112850
|
| Hospital Charge Code |
5511112850
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.72
|
|
|
CIPROFLOXACIN IN D5W 200 MG/100ML IV SOLN
|
Facility
|
IP
|
$0.04
|
|
|
Service Code
|
HCPCS J0744
|
| Hospital Charge Code |
3600000824
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.02
|
|
