Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

DICLOXACILLIN SODIUM 250 MG PO CAPS

Facility

OP

$1.50

Service Code	NDC 0093312301
Hospital Charge Code	0093312301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.53
Max. Negotiated Rate	$1.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.75
Rate for Payer: Aetna Government	$0.75
Rate for Payer: Brighton Health Commercial	$1.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.02
Rate for Payer: EmblemHealth Commercial	$0.75
Rate for Payer: Group Health Inc Commercial	$0.75
Rate for Payer: Group Health Inc Medicare	$0.53
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75
Rate for Payer: Hamaspik Choice Inc Medicare	$0.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.98

DICLOXACILLIN SODIUM 250 MG PO CAPS

Facility

IP

$1.50

Service Code	NDC 0093312301
Hospital Charge Code	0093312301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.75
Max. Negotiated Rate	$0.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.75

DICYCLOMINE HCL 10 MG/ML IM SOLN

Facility

OP

$23.40

Service Code	HCPCS J0500
Hospital Charge Code	6332384202
Hospital Revenue Code	250
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$32.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.99
Rate for Payer: Aetna Government	$32.99
Rate for Payer: Brighton Health Commercial	$17.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.91
Rate for Payer: EmblemHealth Commercial	$11.70
Rate for Payer: Group Health Inc Commercial	$11.70
Rate for Payer: Group Health Inc Medicare	$8.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.70
Rate for Payer: Hamaspik Choice Inc Medicare	$11.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.21

DICYCLOMINE HCL 10 MG/ML IM SOLN

Facility

OP

$50.44

Service Code	HCPCS J0500
Hospital Charge Code	5891408052
Hospital Revenue Code	250
Min. Negotiated Rate	$11.36
Max. Negotiated Rate	$40.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$27.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.99
Rate for Payer: Aetna Government	$32.99
Rate for Payer: Brighton Health Commercial	$37.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$40.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$34.30
Rate for Payer: EmblemHealth Commercial	$25.22
Rate for Payer: Group Health Inc Commercial	$25.22
Rate for Payer: Group Health Inc Medicare	$17.65
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.22
Rate for Payer: Hamaspik Choice Inc Medicare	$25.22
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$32.78

DICYCLOMINE HCL 10 MG/ML IM SOLN

Facility

OP

$14.55

Service Code	HCPCS J0500
Hospital Charge Code	0641617301
Hospital Revenue Code	250
Min. Negotiated Rate	$5.09
Max. Negotiated Rate	$32.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$8.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.99
Rate for Payer: Aetna Government	$32.99
Rate for Payer: Brighton Health Commercial	$10.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.64
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.89
Rate for Payer: EmblemHealth Commercial	$7.27
Rate for Payer: Group Health Inc Commercial	$7.27
Rate for Payer: Group Health Inc Medicare	$5.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.27
Rate for Payer: Hamaspik Choice Inc Medicare	$7.27
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.45

DICYCLOMINE HCL 10 MG/ML IM SOLN

Facility

IP

$23.40

Service Code	HCPCS J0500
Hospital Charge Code	6332384202
Hospital Revenue Code	250
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.70

DICYCLOMINE HCL 10 MG/ML IM SOLN

Facility

IP

$14.55

Service Code	HCPCS J0500
Hospital Charge Code	0641617301
Hospital Revenue Code	250
Min. Negotiated Rate	$7.27
Max. Negotiated Rate	$7.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.27

DICYCLOMINE HCL 10 MG/ML IM SOLN

Facility

IP

$50.44

Service Code	HCPCS J0500
Hospital Charge Code	5891408052
Hospital Revenue Code	250
Min. Negotiated Rate	$25.22
Max. Negotiated Rate	$25.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$25.22

DICYCLOMINE HCL 10 MG/ML IM SOLN

Facility

IP

$23.40

Service Code	HCPCS J0500
Hospital Charge Code	6332384221
Hospital Revenue Code	250
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$11.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.70

DICYCLOMINE HCL 10 MG/ML IM SOLN

Facility

OP

$23.40

Service Code	HCPCS J0500
Hospital Charge Code	6332384221
Hospital Revenue Code	250
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$32.99
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$32.99
Rate for Payer: Aetna Government	$32.99
Rate for Payer: Brighton Health Commercial	$17.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.72
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.91
Rate for Payer: EmblemHealth Commercial	$11.70
Rate for Payer: Group Health Inc Commercial	$11.70
Rate for Payer: Group Health Inc Medicare	$8.19
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.70
Rate for Payer: Hamaspik Choice Inc Medicare	$11.70
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$11.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$15.21

DICYCLOMINE HCL 10 MG PO CAPS

Facility

IP

$0.68

Service Code	NDC 0904698761
Hospital Charge Code	0904698761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.34
Max. Negotiated Rate	$0.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.34

DICYCLOMINE HCL 10 MG PO CAPS

Facility

IP

$0.45

Service Code	NDC 0527058601
Hospital Charge Code	0527058601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$0.22
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.22

DICYCLOMINE HCL 10 MG PO CAPS

Facility

IP

$0.66

Service Code	NDC 6068736911
Hospital Charge Code	6068736911
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33

DICYCLOMINE HCL 10 MG PO CAPS

Facility

OP

$0.66

Service Code	NDC 6068736901
Hospital Charge Code	6068736901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.45
Rate for Payer: EmblemHealth Commercial	$0.33
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.43

DICYCLOMINE HCL 10 MG PO CAPS

Facility

OP

$0.68

Service Code	NDC 0904698761
Hospital Charge Code	0904698761
Hospital Revenue Code	250
Min. Negotiated Rate	$0.24
Max. Negotiated Rate	$0.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.34
Rate for Payer: Aetna Government	$0.34
Rate for Payer: Brighton Health Commercial	$0.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.46
Rate for Payer: EmblemHealth Commercial	$0.34
Rate for Payer: Group Health Inc Commercial	$0.34
Rate for Payer: Group Health Inc Medicare	$0.24
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.34
Rate for Payer: Hamaspik Choice Inc Medicare	$0.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.44

DICYCLOMINE HCL 10 MG PO CAPS

Facility

IP

$0.66

Service Code	NDC 6068736901
Hospital Charge Code	6068736901
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33

DICYCLOMINE HCL 10 MG PO CAPS

Facility

OP

$0.66

Service Code	NDC 6068736911
Hospital Charge Code	6068736911
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.49
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.45
Rate for Payer: EmblemHealth Commercial	$0.33
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.43

DICYCLOMINE HCL 10 MG PO CAPS

Facility

OP

$0.45

Service Code	NDC 0527058601
Hospital Charge Code	0527058601
Hospital Revenue Code	250
Min. Negotiated Rate	$0.16
Max. Negotiated Rate	$0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.22
Rate for Payer: Aetna Government	$0.22
Rate for Payer: Brighton Health Commercial	$0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.31
Rate for Payer: EmblemHealth Commercial	$0.22
Rate for Payer: Group Health Inc Commercial	$0.22
Rate for Payer: Group Health Inc Medicare	$0.16
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	$0.29

DICYCLOMINE HCL 20 MG PO TABS

Facility

OP

$0.58

Service Code	NDC 0527128201
Hospital Charge Code	0527128201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.29
Rate for Payer: Aetna Government	$0.29
Rate for Payer: Brighton Health Commercial	$0.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.40
Rate for Payer: EmblemHealth Commercial	$0.29
Rate for Payer: Group Health Inc Commercial	$0.29
Rate for Payer: Group Health Inc Medicare	$0.20
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.29
Rate for Payer: Hamaspik Choice Inc Medicare	$0.29
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.38

DICYCLOMINE HCL 20 MG PO TABS

Facility

IP

$0.58

Service Code	NDC 0527128201
Hospital Charge Code	0527128201
Hospital Revenue Code	250
Min. Negotiated Rate	$0.29
Max. Negotiated Rate	$0.29
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.29

DICYCLOMINE HCL 20 MG PO TABS

Facility

OP

$0.78

Service Code	NDC 0143122701
Hospital Charge Code	0143122701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$0.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.39
Rate for Payer: Aetna Government	$0.39
Rate for Payer: Brighton Health Commercial	$0.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.62
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.53
Rate for Payer: EmblemHealth Commercial	$0.39
Rate for Payer: Group Health Inc Commercial	$0.39
Rate for Payer: Group Health Inc Medicare	$0.27
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39
Rate for Payer: Hamaspik Choice Inc Medicare	$0.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.50

DICYCLOMINE HCL 20 MG PO TABS

Facility

OP

$0.67

Service Code	NDC 0904698861
Hospital Charge Code	0904698861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.23
Max. Negotiated Rate	$0.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.33
Rate for Payer: Aetna Government	$0.33
Rate for Payer: Brighton Health Commercial	$0.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.45
Rate for Payer: EmblemHealth Commercial	$0.33
Rate for Payer: Group Health Inc Commercial	$0.33
Rate for Payer: Group Health Inc Medicare	$0.23
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33
Rate for Payer: Hamaspik Choice Inc Medicare	$0.33
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.43

DICYCLOMINE HCL 20 MG PO TABS

Facility

IP

$0.78

Service Code	NDC 0143122701
Hospital Charge Code	0143122701
Hospital Revenue Code	250
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$0.39
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.39

DICYCLOMINE HCL 20 MG PO TABS

Facility

IP

$0.67

Service Code	NDC 0904698861
Hospital Charge Code	0904698861
Hospital Revenue Code	250
Min. Negotiated Rate	$0.33
Max. Negotiated Rate	$0.33
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.33

Digestive malignancy

Facility

IP

$48,712.46

Service Code	APR-DRG 2402
Min. Negotiated Rate	$10,040.00
Max. Negotiated Rate	$48,712.46
Rate for Payer: Affinity Essential Plan 1&2	$48,712.46
Rate for Payer: Affinity Essential Plan 3&4	$48,712.46
Rate for Payer: Affinity Medicaid/CHP/HARP	$21,649.98
Rate for Payer: Amida Care Medicaid	$21,649.98
Rate for Payer: EmblemHealth Essential Plan 1&2	$48,712.46
Rate for Payer: EmblemHealth Essential Plan 3&4	$21,649.98
Rate for Payer: Fidelis CHP/HARP/Medicaid	$21,649.98
Rate for Payer: Fidelis Qualified Health Plan	$25,979.98
Rate for Payer: Hamaspik Choice Inc Medicaid	$21,649.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$21,649.98
Rate for Payer: Healthfirst Commercial	$16,998.00
Rate for Payer: Healthfirst Essential Plan	$48,712.46
Rate for Payer: Healthfirst QHP	$10,040.00
Rate for Payer: SOMOS CHP/HARP/Medicaid	$21,649.98
Rate for Payer: SOMOS Essential	$48,712.46
Rate for Payer: United Healthcare Essential Plan 1&2	$48,712.46
Rate for Payer: United Healthcare Essential Plan 3&4	$48,712.46
Rate for Payer: United Healthcare Medicaid	$21,649.98
Rate for Payer: Wellcare CHP/FHP/Medicaid	$21,649.98

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