|
HYDROCORTISONE SOD SUC (PF) 250 MG IJ SOLR
|
Facility
|
OP
|
$45.30
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
0009001305
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.81 |
| Max. Negotiated Rate |
$36.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.81
|
| Rate for Payer: Aetna Government |
$14.81
|
| Rate for Payer: Brighton Health Commercial |
$33.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.80
|
| Rate for Payer: EmblemHealth Commercial |
$22.65
|
| Rate for Payer: Group Health Inc Commercial |
$22.65
|
| Rate for Payer: Group Health Inc Medicare |
$15.86
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.45
|
|
|
HYDROCORTISONE SOD SUC (PF) 250 MG IJ SOLR
|
Facility
|
IP
|
$45.30
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
0009001306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.65 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.65
|
|
|
HYDROCORTISONE SOD SUC (PF) 250 MG IJ SOLR
|
Facility
|
IP
|
$45.30
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
0009001305
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.65 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.65
|
|
|
HYDROCORTISONE SOD SUC (PF) 250 MG IJ SOLR
|
Facility
|
OP
|
$45.30
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
0009001306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.81 |
| Max. Negotiated Rate |
$36.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.91
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.81
|
| Rate for Payer: Aetna Government |
$14.81
|
| Rate for Payer: Brighton Health Commercial |
$33.97
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$36.24
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$30.80
|
| Rate for Payer: EmblemHealth Commercial |
$22.65
|
| Rate for Payer: Group Health Inc Commercial |
$22.65
|
| Rate for Payer: Group Health Inc Medicare |
$15.85
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$22.65
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$22.65
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$29.44
|
|
|
HYDROCORTISONE SOD SUC (PF) 500 MG IJ SOLR
|
Facility
|
IP
|
$90.64
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
0009001612
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.32 |
| Max. Negotiated Rate |
$45.32 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.32
|
|
|
HYDROCORTISONE SOD SUC (PF) 500 MG IJ SOLR
|
Facility
|
OP
|
$90.64
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
0009001612
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.81 |
| Max. Negotiated Rate |
$72.51 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$49.85
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.81
|
| Rate for Payer: Aetna Government |
$14.81
|
| Rate for Payer: Brighton Health Commercial |
$67.98
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$72.51
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$61.64
|
| Rate for Payer: EmblemHealth Commercial |
$45.32
|
| Rate for Payer: Group Health Inc Commercial |
$45.32
|
| Rate for Payer: Group Health Inc Medicare |
$31.72
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$45.32
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$45.32
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$21.31
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.92
|
|
|
HYDROCORTISONE VALERATE 0.2 % EX CREA
|
Facility
|
OP
|
$2.87
|
|
|
Service Code
|
NDC 4580245535
|
| Hospital Charge Code |
4580245535
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$2.29 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.58
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.43
|
| Rate for Payer: Aetna Government |
$1.43
|
| Rate for Payer: Brighton Health Commercial |
$2.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.29
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.95
|
| Rate for Payer: EmblemHealth Commercial |
$1.43
|
| Rate for Payer: Group Health Inc Commercial |
$1.43
|
| Rate for Payer: Group Health Inc Medicare |
$1.00
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.43
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.43
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.86
|
|
|
HYDROCORTISONE VALERATE 0.2 % EX CREA
|
Facility
|
IP
|
$2.87
|
|
|
Service Code
|
NDC 4580245535
|
| Hospital Charge Code |
4580245535
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.43
|
|
|
HYDROMORPHONE HCL 1 MG/ML IJ SOLN
|
Facility
|
OP
|
$7.63
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0409426401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$6.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.82
|
| Rate for Payer: Aetna Government |
$3.82
|
| Rate for Payer: Brighton Health Commercial |
$5.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.19
|
| Rate for Payer: EmblemHealth Commercial |
$3.82
|
| Rate for Payer: Group Health Inc Commercial |
$3.82
|
| Rate for Payer: Group Health Inc Medicare |
$2.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.96
|
|
|
HYDROMORPHONE HCL 1 MG/ML IJ SOLN
|
Facility
|
OP
|
$9.96
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
7604500996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$7.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.98
|
| Rate for Payer: Aetna Government |
$4.98
|
| Rate for Payer: Brighton Health Commercial |
$7.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.77
|
| Rate for Payer: EmblemHealth Commercial |
$4.98
|
| Rate for Payer: Group Health Inc Commercial |
$4.98
|
| Rate for Payer: Group Health Inc Medicare |
$3.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.47
|
|
|
HYDROMORPHONE HCL 1 MG/ML IJ SOLN
|
Facility
|
OP
|
$5.88
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0409128337
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$4.71 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.94
|
| Rate for Payer: Aetna Government |
$2.94
|
| Rate for Payer: Brighton Health Commercial |
$4.41
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.71
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.00
|
| Rate for Payer: EmblemHealth Commercial |
$2.94
|
| Rate for Payer: Group Health Inc Commercial |
$2.94
|
| Rate for Payer: Group Health Inc Medicare |
$2.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.94
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.94
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.82
|
|
|
HYDROMORPHONE HCL 1 MG/ML IJ SOLN
|
Facility
|
OP
|
$3.25
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0409255201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.79
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.62
|
| Rate for Payer: Aetna Government |
$1.62
|
| Rate for Payer: Brighton Health Commercial |
$2.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.60
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.21
|
| Rate for Payer: EmblemHealth Commercial |
$1.62
|
| Rate for Payer: Group Health Inc Commercial |
$1.62
|
| Rate for Payer: Group Health Inc Medicare |
$1.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.62
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.62
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.11
|
|
|
HYDROMORPHONE HCL 1 MG/ML IJ SOLN
|
Facility
|
IP
|
$4.98
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
7604500901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.49 |
| Max. Negotiated Rate |
$2.49 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.49
|
|
|
HYDROMORPHONE HCL 1 MG/ML IJ SOLN
|
Facility
|
IP
|
$9.96
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
7604500996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$4.98 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.98
|
|
|
HYDROMORPHONE HCL 1 MG/ML IJ SOLN
|
Facility
|
IP
|
$7.63
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0409426401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.82
|
|
|
HYDROMORPHONE HCL 1 MG/ML IJ SOLN
|
Facility
|
OP
|
$7.63
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0409426411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$6.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.20
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.82
|
| Rate for Payer: Aetna Government |
$3.82
|
| Rate for Payer: Brighton Health Commercial |
$5.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$6.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$5.19
|
| Rate for Payer: EmblemHealth Commercial |
$3.82
|
| Rate for Payer: Group Health Inc Commercial |
$3.82
|
| Rate for Payer: Group Health Inc Medicare |
$2.67
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.82
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.82
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.96
|
|
|
HYDROMORPHONE HCL 1 MG/ML IJ SOLN
|
Facility
|
OP
|
$4.98
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
7604500901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$3.98 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.74
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.49
|
| Rate for Payer: Aetna Government |
$2.49
|
| Rate for Payer: Brighton Health Commercial |
$3.73
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.98
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.39
|
| Rate for Payer: EmblemHealth Commercial |
$2.49
|
| Rate for Payer: Group Health Inc Commercial |
$2.49
|
| Rate for Payer: Group Health Inc Medicare |
$1.74
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.49
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.49
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.24
|
|
|
HYDROMORPHONE HCL 1 MG/ML IJ SOLN
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0409128303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$2.50 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.72
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.56
|
| Rate for Payer: Aetna Government |
$1.56
|
| Rate for Payer: Brighton Health Commercial |
$2.34
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.12
|
| Rate for Payer: EmblemHealth Commercial |
$1.56
|
| Rate for Payer: Group Health Inc Commercial |
$1.56
|
| Rate for Payer: Group Health Inc Medicare |
$1.09
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.56
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.56
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.03
|
|
|
HYDROMORPHONE HCL 1 MG/ML IJ SOLN
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0409128331
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.56
|
|
|
HYDROMORPHONE HCL 1 MG/ML IJ SOLN
|
Facility
|
IP
|
$9.96
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
7604500906
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.98 |
| Max. Negotiated Rate |
$4.98 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.98
|
|
|
HYDROMORPHONE HCL 1 MG/ML IJ SOLN
|
Facility
|
IP
|
$3.25
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0409255201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.62
|
|
|
HYDROMORPHONE HCL 1 MG/ML IJ SOLN
|
Facility
|
IP
|
$7.63
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0409426411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$3.82 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.82
|
|
|
HYDROMORPHONE HCL 1 MG/ML IJ SOLN
|
Facility
|
IP
|
$5.88
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0409128337
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$2.94 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.94
|
|
|
HYDROMORPHONE HCL 1 MG/ML IJ SOLN
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0409128303
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.56
|
|
|
HYDROMORPHONE HCL 1 MG/ML IJ SOLN
|
Facility
|
OP
|
$9.96
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
7604500906
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$7.97 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$5.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$4.98
|
| Rate for Payer: Aetna Government |
$4.98
|
| Rate for Payer: Brighton Health Commercial |
$7.47
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$7.97
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$6.77
|
| Rate for Payer: EmblemHealth Commercial |
$4.98
|
| Rate for Payer: Group Health Inc Commercial |
$4.98
|
| Rate for Payer: Group Health Inc Medicare |
$3.49
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.98
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$6.47
|
|
