Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

CYCLOPHOSPHAMIDE 2 GM/10ML IV SOLN

Facility

OP

$175.80

Service Code	HCPCS J9070
Hospital Charge Code	5074252110
Hospital Revenue Code	258
Min. Negotiated Rate	$29.15
Max. Negotiated Rate	$140.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$96.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$29.15
Rate for Payer: Aetna Government	$29.15
Rate for Payer: Brighton Health Commercial	$131.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$140.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$119.54
Rate for Payer: EmblemHealth Commercial	$87.90
Rate for Payer: Group Health Inc Commercial	$87.90
Rate for Payer: Group Health Inc Medicare	$61.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.90
Rate for Payer: Hamaspik Choice Inc Medicare	$87.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$114.27

CYCLOPHOSPHAMIDE 500 MG/2.5ML IV SOLN

Facility

IP

$175.80

Service Code	HCPCS J9075
Hospital Charge Code	5074251902
Hospital Revenue Code	258
Min. Negotiated Rate	$87.90
Max. Negotiated Rate	$87.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$87.90

CYCLOPHOSPHAMIDE 500 MG/2.5ML IV SOLN

Facility

OP

$175.80

Service Code	HCPCS J9075
Hospital Charge Code	5074251902
Hospital Revenue Code	258
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$140.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$96.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Affinity Essential Plan 1&2	$0.34
Rate for Payer: Affinity Essential Plan 3&4	$0.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$0.34
Rate for Payer: Brighton Health Commercial	$131.85
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$0.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$140.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$119.54
Rate for Payer: Elderplan Medicare Advantage	$0.48
Rate for Payer: EmblemHealth Commercial	$0.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.43
Rate for Payer: Fidelis Essential Plan Aliesa	$0.41
Rate for Payer: Fidelis Essential Plan QHP	$0.43
Rate for Payer: Fidelis Medicare Advantage	$0.48
Rate for Payer: Fidelis Qualified Health Plan	$0.43
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.48
Rate for Payer: Healthfirst Medicare Advantage	$0.41
Rate for Payer: Healthfirst QHP	$0.48
Rate for Payer: Humana Medicare	$0.49
Rate for Payer: Senior Whole Health Medicare Advantage	$0.48
Rate for Payer: United Healthcare Medicare Advantage	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$114.27
Rate for Payer: Wellcare CHP/FHP/Medicaid	$0.46
Rate for Payer: Wellcare Medicare	$0.46

CYCLOPHOSPHAMIDE 500 MG IJ SOLR

Facility

IP

$439.50

Service Code	HCPCS J9075
Hospital Charge Code	1001995550
Hospital Revenue Code	250
Min. Negotiated Rate	$219.75
Max. Negotiated Rate	$219.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$219.75

CYCLOPHOSPHAMIDE 500 MG IJ SOLR

Facility

IP

$439.50

Service Code	HCPCS J9075
Hospital Charge Code	1001995501
Hospital Revenue Code	250
Min. Negotiated Rate	$219.75
Max. Negotiated Rate	$219.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$219.75

CYCLOPHOSPHAMIDE 500 MG IJ SOLR

Facility

OP

$439.50

Service Code	HCPCS J9075
Hospital Charge Code	1001995501
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$351.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$241.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Affinity Essential Plan 1&2	$0.34
Rate for Payer: Affinity Essential Plan 3&4	$0.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$0.34
Rate for Payer: Brighton Health Commercial	$329.62
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$0.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$351.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$298.86
Rate for Payer: Elderplan Medicare Advantage	$0.48
Rate for Payer: EmblemHealth Commercial	$0.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.43
Rate for Payer: Fidelis Essential Plan Aliesa	$0.41
Rate for Payer: Fidelis Essential Plan QHP	$0.43
Rate for Payer: Fidelis Medicare Advantage	$0.48
Rate for Payer: Fidelis Qualified Health Plan	$0.43
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.48
Rate for Payer: Healthfirst Medicare Advantage	$0.41
Rate for Payer: Healthfirst QHP	$0.48
Rate for Payer: Humana Medicare	$0.49
Rate for Payer: Senior Whole Health Medicare Advantage	$0.48
Rate for Payer: United Healthcare Medicare Advantage	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$285.68
Rate for Payer: Wellcare CHP/FHP/Medicaid	$0.46
Rate for Payer: Wellcare Medicare	$0.46

CYCLOPHOSPHAMIDE 500 MG IJ SOLR

Facility

IP

$412.03

Service Code	HCPCS J9075
Hospital Charge Code	0781323394
Hospital Revenue Code	250
Min. Negotiated Rate	$206.01
Max. Negotiated Rate	$206.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$206.01

CYCLOPHOSPHAMIDE 500 MG IJ SOLR

Facility

OP

$439.50

Service Code	HCPCS J9075
Hospital Charge Code	1001995550
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$351.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$241.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Affinity Essential Plan 1&2	$0.34
Rate for Payer: Affinity Essential Plan 3&4	$0.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$0.34
Rate for Payer: Brighton Health Commercial	$329.62
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$0.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$351.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$298.86
Rate for Payer: Elderplan Medicare Advantage	$0.48
Rate for Payer: EmblemHealth Commercial	$0.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.43
Rate for Payer: Fidelis Essential Plan Aliesa	$0.41
Rate for Payer: Fidelis Essential Plan QHP	$0.43
Rate for Payer: Fidelis Medicare Advantage	$0.48
Rate for Payer: Fidelis Qualified Health Plan	$0.43
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.48
Rate for Payer: Healthfirst Medicare Advantage	$0.41
Rate for Payer: Healthfirst QHP	$0.48
Rate for Payer: Humana Medicare	$0.49
Rate for Payer: Senior Whole Health Medicare Advantage	$0.48
Rate for Payer: United Healthcare Medicare Advantage	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$285.68
Rate for Payer: Wellcare CHP/FHP/Medicaid	$0.46
Rate for Payer: Wellcare Medicare	$0.46

CYCLOPHOSPHAMIDE 500 MG IJ SOLR

Facility

OP

$412.03

Service Code	HCPCS J9075
Hospital Charge Code	0781323394
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$329.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$226.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.48
Rate for Payer: Aetna Government	$0.48
Rate for Payer: Affinity Essential Plan 1&2	$0.34
Rate for Payer: Affinity Essential Plan 3&4	$0.34
Rate for Payer: Affinity Medicaid/CHP/HARP	$0.34
Rate for Payer: Brighton Health Commercial	$309.02
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus	$0.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$329.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$280.18
Rate for Payer: Elderplan Medicare Advantage	$0.48
Rate for Payer: EmblemHealth Commercial	$0.48
Rate for Payer: Fidelis CHP/HARP/Medicaid	$0.43
Rate for Payer: Fidelis Essential Plan Aliesa	$0.41
Rate for Payer: Fidelis Essential Plan QHP	$0.43
Rate for Payer: Fidelis Medicare Advantage	$0.48
Rate for Payer: Fidelis Qualified Health Plan	$0.43
Rate for Payer: Group Health Inc Commercial	$0.48
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.48
Rate for Payer: Hamaspik Choice Inc Medicare	$0.48
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.48
Rate for Payer: Healthfirst Medicare Advantage	$0.41
Rate for Payer: Healthfirst QHP	$0.48
Rate for Payer: Humana Medicare	$0.49
Rate for Payer: Senior Whole Health Medicare Advantage	$0.48
Rate for Payer: United Healthcare Medicare Advantage	$0.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$267.82
Rate for Payer: Wellcare CHP/FHP/Medicaid	$0.46
Rate for Payer: Wellcare Medicare	$0.46

CYCLOPHOSPHAMIDE 50 MG PO CAPS

Facility

OP

$17.75

Service Code	HCPCS J8530
Hospital Charge Code	6909751707
Hospital Revenue Code	250
Min. Negotiated Rate	$0.81
Max. Negotiated Rate	$14.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$9.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.81
Rate for Payer: Aetna Government	$0.81
Rate for Payer: Brighton Health Commercial	$13.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$14.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$12.07
Rate for Payer: EmblemHealth Commercial	$8.87
Rate for Payer: Group Health Inc Commercial	$8.87
Rate for Payer: Group Health Inc Medicare	$6.21
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.87
Rate for Payer: Hamaspik Choice Inc Medicare	$8.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$1.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$11.54

CYCLOPHOSPHAMIDE 50 MG PO CAPS

Facility

IP

$17.75

Service Code	HCPCS J8530
Hospital Charge Code	6909751707
Hospital Revenue Code	250
Min. Negotiated Rate	$8.87
Max. Negotiated Rate	$8.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.87

CYCLOSERINE 250 MG PO CAPS

Facility

OP

$83.60

Service Code	NDC 1384512022
Hospital Charge Code	1384512022
Hospital Revenue Code	250
Min. Negotiated Rate	$29.26
Max. Negotiated Rate	$66.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$45.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$41.80
Rate for Payer: Aetna Government	$41.80
Rate for Payer: Brighton Health Commercial	$62.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$66.88
Rate for Payer: Cigna LocalPlus Benefit Plan	$56.85
Rate for Payer: EmblemHealth Commercial	$41.80
Rate for Payer: Group Health Inc Commercial	$41.80
Rate for Payer: Group Health Inc Medicare	$29.26
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.80
Rate for Payer: Hamaspik Choice Inc Medicare	$41.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$54.34

CYCLOSERINE 250 MG PO CAPS

Facility

IP

$83.60

Service Code	NDC 1384512022
Hospital Charge Code	1384512022
Hospital Revenue Code	250
Min. Negotiated Rate	$41.80
Max. Negotiated Rate	$41.80
Rate for Payer: Hamaspik Choice Inc Medicaid	$41.80

CYCLOSPORINE 100 MG PO CAPS

Facility

IP

$15.35

Service Code	HCPCS J7502
Hospital Charge Code	6050501340
Hospital Revenue Code	250
Min. Negotiated Rate	$7.68
Max. Negotiated Rate	$7.68
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.68

CYCLOSPORINE 100 MG PO CAPS

Facility

OP

$15.35

Service Code	HCPCS J7502
Hospital Charge Code	6050501340
Hospital Revenue Code	250
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$12.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.42
Rate for Payer: Aetna Government	$2.42
Rate for Payer: Brighton Health Commercial	$11.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$12.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.44
Rate for Payer: EmblemHealth Commercial	$7.68
Rate for Payer: Group Health Inc Commercial	$7.68
Rate for Payer: Group Health Inc Medicare	$5.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.68
Rate for Payer: Hamaspik Choice Inc Medicare	$7.68
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.98

CYCLOSPORINE MODIFIED 100 MG PO CAPS

Facility

OP

$5.50

Service Code	HCPCS J7502
Hospital Charge Code	2315583911
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$4.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.42
Rate for Payer: Aetna Government	$2.42
Rate for Payer: Brighton Health Commercial	$4.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.74
Rate for Payer: EmblemHealth Commercial	$2.75
Rate for Payer: Group Health Inc Commercial	$2.75
Rate for Payer: Group Health Inc Medicare	$1.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.75
Rate for Payer: Hamaspik Choice Inc Medicare	$2.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.57

CYCLOSPORINE MODIFIED 100 MG PO CAPS

Facility

IP

$5.50

Service Code	HCPCS J7502
Hospital Charge Code	2315583911
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$2.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.75

CYCLOSPORINE MODIFIED 100 MG PO CAPS

Facility

OP

$5.50

Service Code	HCPCS J7502
Hospital Charge Code	0093902065
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$4.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.42
Rate for Payer: Aetna Government	$2.42
Rate for Payer: Brighton Health Commercial	$4.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.74
Rate for Payer: EmblemHealth Commercial	$2.75
Rate for Payer: Group Health Inc Commercial	$2.75
Rate for Payer: Group Health Inc Medicare	$1.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.75
Rate for Payer: Hamaspik Choice Inc Medicare	$2.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.57

CYCLOSPORINE MODIFIED 100 MG PO CAPS

Facility

OP

$5.50

Service Code	HCPCS J7502
Hospital Charge Code	0093902019
Hospital Revenue Code	250
Min. Negotiated Rate	$1.92
Max. Negotiated Rate	$4.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.42
Rate for Payer: Aetna Government	$2.42
Rate for Payer: Brighton Health Commercial	$4.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.74
Rate for Payer: EmblemHealth Commercial	$2.75
Rate for Payer: Group Health Inc Commercial	$2.75
Rate for Payer: Group Health Inc Medicare	$1.92
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.75
Rate for Payer: Hamaspik Choice Inc Medicare	$2.75
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$2.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.57

CYCLOSPORINE MODIFIED 100 MG PO CAPS

Facility

IP

$5.50

Service Code	HCPCS J7502
Hospital Charge Code	0093902019
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$2.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.75

CYCLOSPORINE MODIFIED 100 MG PO CAPS

Facility

IP

$5.50

Service Code	HCPCS J7502
Hospital Charge Code	0093902065
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$2.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.75

CYCLOSPORINE MODIFIED 25 MG PO CAPS

Facility

IP

$1.38

Service Code	HCPCS J7515
Hospital Charge Code	0093901819
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.69

CYCLOSPORINE MODIFIED 25 MG PO CAPS

Facility

OP

$1.38

Service Code	HCPCS J7515
Hospital Charge Code	2315583711
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Brighton Health Commercial	$1.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.94
Rate for Payer: EmblemHealth Commercial	$0.69
Rate for Payer: Group Health Inc Commercial	$0.69
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.69
Rate for Payer: Hamaspik Choice Inc Medicare	$0.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.89

CYCLOSPORINE MODIFIED 25 MG PO CAPS

Facility

OP

$1.38

Service Code	HCPCS J7515
Hospital Charge Code	0093901865
Hospital Revenue Code	250
Min. Negotiated Rate	$0.48
Max. Negotiated Rate	$1.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.82
Rate for Payer: Aetna Government	$0.82
Rate for Payer: Brighton Health Commercial	$1.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.10
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.94
Rate for Payer: EmblemHealth Commercial	$0.69
Rate for Payer: Group Health Inc Commercial	$0.69
Rate for Payer: Group Health Inc Medicare	$0.48
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.69
Rate for Payer: Hamaspik Choice Inc Medicare	$0.69
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.89

CYCLOSPORINE MODIFIED 25 MG PO CAPS

Facility

IP

$1.38

Service Code	HCPCS J7515
Hospital Charge Code	0093901865
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.69

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