Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

CYCLOSPORINE MODIFIED 25 MG PO CAPS

Facility

IP

$1.38

Service Code	HCPCS J7515
Hospital Charge Code	2315583711
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

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

CYPROHEPTADINE HCL 2 MG/5ML PO SYRP

Facility

OP

$0.14

Service Code	NDC 6498050448
Hospital Charge Code	6498050448
Hospital Revenue Code	250
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$0.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.07
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.07
Rate for Payer: Aetna Government	$0.07
Rate for Payer: Brighton Health Commercial	$0.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.11
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.09
Rate for Payer: EmblemHealth Commercial	$0.07
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

CYPROHEPTADINE HCL 2 MG/5ML PO SYRP

Facility

IP

$0.14

Service Code	NDC 6498050448
Hospital Charge Code	6498050448
Hospital Revenue Code	250
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$0.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.07

CYPROHEPTADINE HCL 4 MG PO TABS

Facility

IP

$1.07

Service Code	NDC 7071011101
Hospital Charge Code	7071011101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.53

CYPROHEPTADINE HCL 4 MG PO TABS

Facility

OP

$1.07

Service Code	NDC 5026818915
Hospital Charge Code	5026818915
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.54
Rate for Payer: Aetna Government	$0.54
Rate for Payer: Brighton Health Commercial	$0.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.73
Rate for Payer: EmblemHealth Commercial	$0.54
Rate for Payer: Group Health Inc Commercial	$0.54
Rate for Payer: Group Health Inc Medicare	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54
Rate for Payer: Hamaspik Choice Inc Medicare	$0.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.70

CYPROHEPTADINE HCL 4 MG PO TABS

Facility

IP

$1.07

Service Code	NDC 5074219001
Hospital Charge Code	5074219001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.53

CYPROHEPTADINE HCL 4 MG PO TABS

Facility

IP

$1.07

Service Code	NDC 5026818911
Hospital Charge Code	5026818911
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54

CYPROHEPTADINE HCL 4 MG PO TABS

Facility

IP

$1.07

Service Code	NDC 5026818915
Hospital Charge Code	5026818915
Hospital Revenue Code	250
Min. Negotiated Rate	$0.54
Max. Negotiated Rate	$0.54
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54

CYPROHEPTADINE HCL 4 MG PO TABS

Facility

OP

$1.07

Service Code	NDC 7071011101
Hospital Charge Code	7071011101
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$0.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.73
Rate for Payer: EmblemHealth Commercial	$0.53
Rate for Payer: Group Health Inc Commercial	$0.53
Rate for Payer: Group Health Inc Medicare	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.53
Rate for Payer: Hamaspik Choice Inc Medicare	$0.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.69

CYPROHEPTADINE HCL 4 MG PO TABS

Facility

OP

$1.07

Service Code	NDC 5074219001
Hospital Charge Code	5074219001
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.53
Rate for Payer: Aetna Government	$0.53
Rate for Payer: Brighton Health Commercial	$0.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.85
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.73
Rate for Payer: EmblemHealth Commercial	$0.53
Rate for Payer: Group Health Inc Commercial	$0.53
Rate for Payer: Group Health Inc Medicare	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.53
Rate for Payer: Hamaspik Choice Inc Medicare	$0.53
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.69

CYPROHEPTADINE HCL 4 MG PO TABS

Facility

OP

$1.07

Service Code	NDC 5026818911
Hospital Charge Code	5026818911
Hospital Revenue Code	250
Min. Negotiated Rate	$0.37
Max. Negotiated Rate	$0.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.59
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.54
Rate for Payer: Aetna Government	$0.54
Rate for Payer: Brighton Health Commercial	$0.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.86
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.73
Rate for Payer: EmblemHealth Commercial	$0.54
Rate for Payer: Group Health Inc Commercial	$0.54
Rate for Payer: Group Health Inc Medicare	$0.37
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.54
Rate for Payer: Hamaspik Choice Inc Medicare	$0.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.70

Cystic fibrosis - pulmonary disease

Facility

IP

$56,287.37

Service Code	APR-DRG 1311
Min. Negotiated Rate	$12,993.00
Max. Negotiated Rate	$56,287.37
Rate for Payer: Affinity Essential Plan 1&2	$56,287.37
Rate for Payer: Affinity Essential Plan 3&4	$56,287.37
Rate for Payer: Affinity Medicaid/CHP/HARP	$25,016.61
Rate for Payer: Amida Care Medicaid	$25,016.61
Rate for Payer: EmblemHealth Essential Plan 1&2	$56,287.37
Rate for Payer: EmblemHealth Essential Plan 3&4	$25,016.61
Rate for Payer: Fidelis CHP/HARP/Medicaid	$25,016.61
Rate for Payer: Fidelis Qualified Health Plan	$30,019.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$25,016.61
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$25,016.61
Rate for Payer: Healthfirst Commercial	$23,449.00
Rate for Payer: Healthfirst Essential Plan	$56,287.37
Rate for Payer: Healthfirst QHP	$12,993.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$25,016.61
Rate for Payer: SOMOS Essential	$56,287.37
Rate for Payer: United Healthcare Essential Plan 1&2	$56,287.37
Rate for Payer: United Healthcare Essential Plan 3&4	$56,287.37
Rate for Payer: United Healthcare Medicaid	$25,016.61
Rate for Payer: Wellcare CHP/FHP/Medicaid	$25,016.61

Cystic fibrosis - pulmonary disease

Facility

IP

$76,924.49

Service Code	APR-DRG 1313
Min. Negotiated Rate	$19,256.00
Max. Negotiated Rate	$76,924.49
Rate for Payer: Affinity Essential Plan 1&2	$76,924.49
Rate for Payer: Affinity Essential Plan 3&4	$76,924.49
Rate for Payer: Affinity Medicaid/CHP/HARP	$34,188.66
Rate for Payer: Amida Care Medicaid	$34,188.66
Rate for Payer: EmblemHealth Essential Plan 1&2	$76,924.49
Rate for Payer: EmblemHealth Essential Plan 3&4	$34,188.66
Rate for Payer: Fidelis CHP/HARP/Medicaid	$34,188.66
Rate for Payer: Fidelis Qualified Health Plan	$41,026.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$34,188.66
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$34,188.66
Rate for Payer: Healthfirst Commercial	$33,240.00
Rate for Payer: Healthfirst Essential Plan	$76,924.49
Rate for Payer: Healthfirst QHP	$19,256.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$34,188.66
Rate for Payer: SOMOS Essential	$76,924.49
Rate for Payer: United Healthcare Essential Plan 1&2	$76,924.49
Rate for Payer: United Healthcare Essential Plan 3&4	$76,924.49
Rate for Payer: United Healthcare Medicaid	$34,188.66
Rate for Payer: Wellcare CHP/FHP/Medicaid	$34,188.66

Cystic fibrosis - pulmonary disease

Facility

IP

$80,091.99

Service Code	APR-DRG 1314
Min. Negotiated Rate	$27,551.00
Max. Negotiated Rate	$80,091.99
Rate for Payer: Affinity Essential Plan 1&2	$80,091.99
Rate for Payer: Affinity Essential Plan 3&4	$80,091.99
Rate for Payer: Affinity Medicaid/CHP/HARP	$35,596.44
Rate for Payer: Amida Care Medicaid	$35,596.44
Rate for Payer: EmblemHealth Essential Plan 1&2	$80,091.99
Rate for Payer: EmblemHealth Essential Plan 3&4	$35,596.44
Rate for Payer: Fidelis CHP/HARP/Medicaid	$35,596.44
Rate for Payer: Fidelis Qualified Health Plan	$42,715.73
Rate for Payer: Hamaspik Choice Inc Medicaid	$35,596.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$35,596.44
Rate for Payer: Healthfirst Commercial	$49,178.00
Rate for Payer: Healthfirst Essential Plan	$80,091.99
Rate for Payer: Healthfirst QHP	$27,551.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$35,596.44
Rate for Payer: SOMOS Essential	$80,091.99
Rate for Payer: United Healthcare Essential Plan 1&2	$80,091.99
Rate for Payer: United Healthcare Essential Plan 3&4	$80,091.99
Rate for Payer: United Healthcare Medicaid	$35,596.44
Rate for Payer: Wellcare CHP/FHP/Medicaid	$35,596.44

Cystic fibrosis - pulmonary disease

Facility

IP

$62,439.46

Service Code	APR-DRG 1312
Min. Negotiated Rate	$15,707.00
Max. Negotiated Rate	$62,439.46
Rate for Payer: Affinity Essential Plan 1&2	$62,439.46
Rate for Payer: Affinity Essential Plan 3&4	$62,439.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$27,750.87
Rate for Payer: Amida Care Medicaid	$27,750.87
Rate for Payer: EmblemHealth Essential Plan 1&2	$62,439.46
Rate for Payer: EmblemHealth Essential Plan 3&4	$27,750.87
Rate for Payer: Fidelis CHP/HARP/Medicaid	$27,750.87
Rate for Payer: Fidelis Qualified Health Plan	$33,301.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$27,750.87
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$27,750.87
Rate for Payer: Healthfirst Commercial	$27,376.00
Rate for Payer: Healthfirst Essential Plan	$62,439.46
Rate for Payer: Healthfirst QHP	$15,707.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$27,750.87
Rate for Payer: SOMOS Essential	$62,439.46
Rate for Payer: United Healthcare Essential Plan 1&2	$62,439.46
Rate for Payer: United Healthcare Essential Plan 3&4	$62,439.46
Rate for Payer: United Healthcare Medicaid	$27,750.87
Rate for Payer: Wellcare CHP/FHP/Medicaid	$27,750.87

CYSTIC FIBROSIS - PULMONARY DISEASE

Facility

OP

$307.76

Service Code	EAPG 00570
Min. Negotiated Rate	$224.49
Max. Negotiated Rate	$307.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$224.49
Rate for Payer: Healthfirst Commercial	$307.76

DABIGATRAN ETEXILATE MESYLATE 150 MG PO CAPS

Facility

OP

$3.97

Service Code	NDC 0597036082
Hospital Charge Code	0597036082
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$3.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.98
Rate for Payer: Aetna Government	$1.98
Rate for Payer: Brighton Health Commercial	$2.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.70
Rate for Payer: EmblemHealth Commercial	$1.98
Rate for Payer: Group Health Inc Commercial	$1.98
Rate for Payer: Group Health Inc Medicare	$1.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.98
Rate for Payer: Hamaspik Choice Inc Medicare	$1.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.58

DABIGATRAN ETEXILATE MESYLATE 150 MG PO CAPS

Facility

IP

$3.97

Service Code	NDC 0597036082
Hospital Charge Code	0597036082
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$1.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.98

DABIGATRAN ETEXILATE MESYLATE 75 MG PO CAPS

Facility

IP

$3.97

Service Code	NDC 0597035556
Hospital Charge Code	0597035556
Hospital Revenue Code	250
Min. Negotiated Rate	$1.98
Max. Negotiated Rate	$1.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.98

DABIGATRAN ETEXILATE MESYLATE 75 MG PO CAPS

Facility

OP

$3.97

Service Code	NDC 0597035556
Hospital Charge Code	0597035556
Hospital Revenue Code	250
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$3.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.98
Rate for Payer: Aetna Government	$1.98
Rate for Payer: Brighton Health Commercial	$2.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.70
Rate for Payer: EmblemHealth Commercial	$1.98
Rate for Payer: Group Health Inc Commercial	$1.98
Rate for Payer: Group Health Inc Medicare	$1.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.98
Rate for Payer: Hamaspik Choice Inc Medicare	$1.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.58

DACARBAZINE 100 MG IV SOLR

Facility

OP

$14.87

Service Code	HCPCS J9130
Hospital Charge Code	6332312710
Hospital Revenue Code	258
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$11.89
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.71
Rate for Payer: Aetna Government	$3.71
Rate for Payer: Brighton Health Commercial	$11.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.89
Rate for Payer: Cigna LocalPlus Benefit Plan	$10.11
Rate for Payer: EmblemHealth Commercial	$7.43
Rate for Payer: Group Health Inc Commercial	$7.43
Rate for Payer: Group Health Inc Medicare	$5.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.43
Rate for Payer: Hamaspik Choice Inc Medicare	$7.43
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.66

DACARBAZINE 100 MG IV SOLR

Facility

IP

$14.87

Service Code	HCPCS J9130
Hospital Charge Code	6332312710
Hospital Revenue Code	258
Min. Negotiated Rate	$7.43
Max. Negotiated Rate	$7.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.43

DACARBAZINE 200 MG IV SOLR

Facility

OP

$14.40

Service Code	HCPCS J9130
Hospital Charge Code	6332312820
Hospital Revenue Code	258
Min. Negotiated Rate	$3.45
Max. Negotiated Rate	$11.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.92
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.71
Rate for Payer: Aetna Government	$3.71
Rate for Payer: Brighton Health Commercial	$10.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.52
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.79
Rate for Payer: EmblemHealth Commercial	$7.20
Rate for Payer: Group Health Inc Commercial	$7.20
Rate for Payer: Group Health Inc Medicare	$5.04
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.20
Rate for Payer: Hamaspik Choice Inc Medicare	$7.20
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$3.45
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.36

DACARBAZINE 200 MG IV SOLR

Facility

IP

$19.69

Service Code	HCPCS J9130
Hospital Charge Code	0703507501
Hospital Revenue Code	258
Min. Negotiated Rate	$9.85
Max. Negotiated Rate	$9.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$9.85

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