|
HYDROCOLLOID 6X6IN
|
Facility
|
IP
|
$22.66
|
|
| Hospital Charge Code |
4471503
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.73 |
| Max. Negotiated Rate |
$14.73 |
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: Galaxy Health Commercial |
$14.73
|
|
|
HYDROCOLLOID 6X6IN
|
Facility
|
OP
|
$22.66
|
|
| Hospital Charge Code |
4471503
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$18.13 |
| Rate for Payer: Aetna of NY Commercial |
$15.86
|
| Rate for Payer: Aetna of NY Medicare |
$10.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$9.06
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: CDPHP Medicare |
$8.38
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.13
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.13
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$18.13
|
| Rate for Payer: EmblemHealth Medicaid |
$18.13
|
| Rate for Payer: EmblemHealth Medicare |
$7.70
|
| Rate for Payer: EmblemHealth Select Care |
$16.32
|
| Rate for Payer: Fidelis Medicare |
$9.06
|
| Rate for Payer: Galaxy Health Commercial |
$14.73
|
| Rate for Payer: Hamaspik Choice Medicare |
$9.06
|
| Rate for Payer: Humana Medicare |
$9.06
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$15.86
|
| Rate for Payer: Local 1199SEIU Medicare |
$10.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$17.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$12.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.52
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$3.40
|
| Rate for Payer: United Healthcare Medicare |
$9.06
|
| Rate for Payer: WellCare Medicare |
$12.46
|
|
|
HYDROCORTISONE 10MG TABS 100 EA
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
NDC 115169701
|
| Hospital Charge Code |
4400364
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: Galaxy Health Commercial |
$4.55
|
| Rate for Payer: WellCare Medicare |
$3.85
|
|
|
HYDROCORTISONE 10MG TABS 100 EA
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
NDC 115169701
|
| Hospital Charge Code |
4400364
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$5.60 |
| Rate for Payer: Aetna of NY Commercial |
$4.90
|
| Rate for Payer: Aetna of NY Medicare |
$3.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.80
|
| Rate for Payer: Cash Price |
$5.25
|
| Rate for Payer: CDPHP Medicare |
$2.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.60
|
| Rate for Payer: EmblemHealth Medicaid |
$5.60
|
| Rate for Payer: EmblemHealth Medicare |
$2.38
|
| Rate for Payer: EmblemHealth Select Care |
$5.04
|
| Rate for Payer: Fidelis Medicare |
$2.80
|
| Rate for Payer: Galaxy Health Commercial |
$4.55
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.80
|
| Rate for Payer: Humana Medicare |
$2.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.94
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.94
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.05
|
| Rate for Payer: United Healthcare Medicare |
$2.80
|
| Rate for Payer: WellCare Medicare |
$3.85
|
|
|
HYDROCORTISONE 2.5% CRM 30 GM
|
Facility
|
IP
|
$31.67
|
|
|
Service Code
|
NDC 51672300302
|
| Hospital Charge Code |
4400363
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.42 |
| Max. Negotiated Rate |
$20.59 |
| Rate for Payer: Cash Price |
$23.75
|
| Rate for Payer: Galaxy Health Commercial |
$20.59
|
| Rate for Payer: WellCare Medicare |
$17.42
|
|
|
HYDROCORTISONE 2.5% CRM 30 GM
|
Facility
|
OP
|
$31.67
|
|
|
Service Code
|
NDC 51672300302
|
| Hospital Charge Code |
4400363
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$25.34 |
| Rate for Payer: Aetna of NY Commercial |
$22.17
|
| Rate for Payer: Aetna of NY Medicare |
$14.57
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.67
|
| Rate for Payer: Cash Price |
$23.75
|
| Rate for Payer: CDPHP Medicare |
$11.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$25.34
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$25.34
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$25.34
|
| Rate for Payer: EmblemHealth Medicaid |
$25.34
|
| Rate for Payer: EmblemHealth Medicare |
$10.77
|
| Rate for Payer: EmblemHealth Select Care |
$22.80
|
| Rate for Payer: Fidelis Medicare |
$12.67
|
| Rate for Payer: Galaxy Health Commercial |
$20.59
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.67
|
| Rate for Payer: Humana Medicare |
$12.67
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.17
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.57
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.75
|
| Rate for Payer: United Healthcare Medicare |
$12.67
|
| Rate for Payer: WellCare Medicare |
$17.42
|
|
|
HYDROCORTISONE ACETATE 25MG SUPP 12 EA
|
Facility
|
OP
|
$70.04
|
|
|
Service Code
|
NDC 713050312
|
| Hospital Charge Code |
4400063
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$56.03 |
| Rate for Payer: Aetna of NY Commercial |
$49.03
|
| Rate for Payer: Aetna of NY Medicare |
$32.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.02
|
| Rate for Payer: Cash Price |
$52.53
|
| Rate for Payer: CDPHP Medicare |
$25.91
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$56.03
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$56.03
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$56.03
|
| Rate for Payer: EmblemHealth Medicaid |
$56.03
|
| Rate for Payer: EmblemHealth Medicare |
$23.81
|
| Rate for Payer: EmblemHealth Select Care |
$50.43
|
| Rate for Payer: Fidelis Medicare |
$28.02
|
| Rate for Payer: Galaxy Health Commercial |
$45.53
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.02
|
| Rate for Payer: Humana Medicare |
$28.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$49.03
|
| Rate for Payer: Local 1199SEIU Medicare |
$32.22
|
| Rate for Payer: MVP Health Care of NY Commercial |
$52.53
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$39.43
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$10.51
|
| Rate for Payer: United Healthcare Medicare |
$28.02
|
| Rate for Payer: WellCare Medicare |
$38.52
|
|
|
HYDROCORTISONE ACETATE 25MG SUPP 12 EA
|
Facility
|
IP
|
$70.04
|
|
|
Service Code
|
NDC 713050312
|
| Hospital Charge Code |
4400063
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.52 |
| Max. Negotiated Rate |
$45.53 |
| Rate for Payer: Cash Price |
$52.53
|
| Rate for Payer: Galaxy Health Commercial |
$45.53
|
| Rate for Payer: WellCare Medicare |
$38.52
|
|
|
HYDROCORTISONE SODIUM SUCCINATE, UP TO 100 MG
|
Facility
|
OP
|
$34.76
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
4400712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna of NY Medicare |
$15.99
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.90
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: CDPHP Medicare |
$12.86
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.14
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.81
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.81
|
| Rate for Payer: EmblemHealth Medicaid |
$27.81
|
| Rate for Payer: EmblemHealth Medicare |
$11.82
|
| Rate for Payer: EmblemHealth Select Care |
$22.14
|
| Rate for Payer: Fidelis Medicare |
$13.90
|
| Rate for Payer: Galaxy Health Commercial |
$22.59
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.90
|
| Rate for Payer: Humana Medicare |
$13.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.99
|
| Rate for Payer: MVP Health Care of NY Commercial |
$26.07
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.60
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$28.89
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.21
|
| Rate for Payer: United Healthcare Commercial |
$28.89
|
| Rate for Payer: United Healthcare Medicare |
$13.90
|
| Rate for Payer: WellCare Medicare |
$19.12
|
|
|
HYDROCORTISONE SODIUM SUCCINATE, UP TO 100 MG
|
Facility
|
IP
|
$34.76
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
4400712
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.12 |
| Max. Negotiated Rate |
$22.59 |
| Rate for Payer: Aetna of NY Commercial |
$19.12
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: Cash Price |
$26.07
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.14
|
| Rate for Payer: EmblemHealth Select Care |
$22.14
|
| Rate for Payer: Galaxy Health Commercial |
$22.59
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.12
|
| Rate for Payer: WellCare Medicare |
$19.12
|
|
|
HYDROmorphone 0.5 MG/0.5 ML 0.5 mg, 0.5 mL
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
4401577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.70 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna of NY Commercial |
$62.70
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Galaxy Health Commercial |
$74.10
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$62.70
|
| Rate for Payer: WellCare Medicare |
$62.70
|
|
|
HYDROmorphone 0.5 MG/0.5 ML 0.5 mg, 0.5 mL
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
4401577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.18 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna of NY Medicare |
$52.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$45.60
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: CDPHP Medicare |
$42.18
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$91.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$91.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$91.20
|
| Rate for Payer: EmblemHealth Medicaid |
$91.20
|
| Rate for Payer: EmblemHealth Medicare |
$38.76
|
| Rate for Payer: EmblemHealth Select Care |
$82.08
|
| Rate for Payer: Fidelis Medicare |
$45.60
|
| Rate for Payer: Galaxy Health Commercial |
$74.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$45.60
|
| Rate for Payer: Humana Medicare |
$45.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$52.44
|
| Rate for Payer: MVP Health Care of NY Commercial |
$85.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$64.18
|
| Rate for Payer: MVP Health Care of NY Medicare |
$47.88
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$7.18
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$17.10
|
| Rate for Payer: United Healthcare Commercial |
$7.18
|
| Rate for Payer: United Healthcare Medicare |
$45.60
|
| Rate for Payer: WellCare Medicare |
$62.70
|
|
|
HYDROmorphone 1 MG/ML CARPUJCT 1 mg, 1 mL
|
Facility
|
IP
|
$9.50
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
4401934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$6.17 |
| Rate for Payer: Aetna of NY Commercial |
$5.22
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Galaxy Health Commercial |
$6.17
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.22
|
| Rate for Payer: WellCare Medicare |
$5.22
|
|
|
HYDROmorphone 1 MG/ML CARPUJCT 1 mg, 1 mL
|
Facility
|
OP
|
$9.50
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
4401934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Aetna of NY Medicare |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.80
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: CDPHP Medicare |
$3.52
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$7.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.60
|
| Rate for Payer: EmblemHealth Medicaid |
$7.60
|
| Rate for Payer: EmblemHealth Medicare |
$3.23
|
| Rate for Payer: EmblemHealth Select Care |
$6.84
|
| Rate for Payer: Fidelis Medicare |
$3.80
|
| Rate for Payer: Galaxy Health Commercial |
$6.17
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.80
|
| Rate for Payer: Humana Medicare |
$3.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.37
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.12
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$3.99
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$7.18
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.43
|
| Rate for Payer: United Healthcare Commercial |
$7.18
|
| Rate for Payer: United Healthcare Medicare |
$3.80
|
| Rate for Payer: WellCare Medicare |
$5.22
|
|
|
HYDROMORPHONE HCL 2MG TABS 4X25EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 42858030125
|
| Hospital Charge Code |
4400367
|
|
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
|
|
|
HYDROMORPHONE HCL 2MG TABS 4X25EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 42858030125
|
| Hospital Charge Code |
4400367
|
|
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
|
|
|
HYDROMORPHONE INJ, UP TO 4 MG
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
4400368
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$7.18 |
| 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: 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 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: Oxford Health Plans Freedom/Liberty/Metro |
$7.18
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$0.93
|
| Rate for Payer: United Healthcare Commercial |
$7.18
|
| Rate for Payer: United Healthcare Medicare |
$2.47
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
HYDROMORPHONE INJ, UP TO 4 MG
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
4400368
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Aetna of NY Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$3.40
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
HYDROXYCHLOROQUINE 200 MG TAB
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 43598072101
|
| Hospital Charge Code |
4409026
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.25 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
|
HYDROXYCHLOROQUINE 200 MG TAB
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 43598072101
|
| Hospital Charge Code |
4409026
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna of NY Commercial |
$10.50
|
| Rate for Payer: Aetna of NY Medicare |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: CDPHP Medicare |
$5.55
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$12.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$12.00
|
| Rate for Payer: EmblemHealth Medicaid |
$12.00
|
| Rate for Payer: EmblemHealth Medicare |
$5.10
|
| Rate for Payer: EmblemHealth Select Care |
$10.80
|
| Rate for Payer: Fidelis Medicare |
$6.00
|
| Rate for Payer: Galaxy Health Commercial |
$9.75
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.00
|
| Rate for Payer: Humana Medicare |
$6.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$10.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$6.90
|
| Rate for Payer: MVP Health Care of NY Commercial |
$11.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$8.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.30
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.25
|
| Rate for Payer: United Healthcare Medicare |
$6.00
|
| Rate for Payer: WellCare Medicare |
$8.25
|
|
|
HYDROXYIREA 500 MG CAPSULE
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 49884072401
|
| Hospital Charge Code |
4409208
|
|
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
|
|
|
HYDROXYIREA 500 MG CAPSULE
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 49884072401
|
| Hospital Charge Code |
4409208
|
|
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
|
|
|
HYDROXYZINE HCL INJ TO 25 MG
|
Facility
|
IP
|
$16.48
|
|
|
Service Code
|
HCPCS J3410
|
| Hospital Charge Code |
4400372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.06 |
| Max. Negotiated Rate |
$15.16 |
| Rate for Payer: Aetna of NY Commercial |
$9.06
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.16
|
| Rate for Payer: EmblemHealth Select Care |
$15.16
|
| Rate for Payer: Galaxy Health Commercial |
$10.71
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.06
|
| Rate for Payer: WellCare Medicare |
$9.06
|
|
|
HYDROXYZINE HCL INJ TO 25 MG
|
Facility
|
OP
|
$16.48
|
|
|
Service Code
|
HCPCS J3410
|
| Hospital Charge Code |
4400372
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.47 |
| Max. Negotiated Rate |
$22.47 |
| Rate for Payer: Aetna of NY Medicare |
$7.58
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$6.59
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: CDPHP Medicare |
$6.10
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.16
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$13.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$13.18
|
| Rate for Payer: EmblemHealth Medicaid |
$13.18
|
| Rate for Payer: EmblemHealth Medicare |
$5.60
|
| Rate for Payer: EmblemHealth Select Care |
$15.16
|
| Rate for Payer: Fidelis Medicare |
$6.59
|
| Rate for Payer: Galaxy Health Commercial |
$10.71
|
| Rate for Payer: Hamaspik Choice Medicare |
$6.59
|
| Rate for Payer: Humana Medicare |
$6.59
|
| Rate for Payer: Local 1199SEIU Medicare |
$7.58
|
| Rate for Payer: MVP Health Care of NY Commercial |
$12.36
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$9.28
|
| Rate for Payer: MVP Health Care of NY Medicare |
$6.92
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$22.47
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.47
|
| Rate for Payer: United Healthcare Commercial |
$22.47
|
| Rate for Payer: United Healthcare Medicare |
$6.59
|
| Rate for Payer: WellCare Medicare |
$9.06
|
|
|
HYDROXYZINE PAMOATE 25MG CAPS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 68084084711
|
| Hospital Charge Code |
4400373
|
|
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
|
|
