|
HYDROMORPHONE HCL 1 MG/ML IJ SOLN
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0409128331
|
|
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 2 MG/ML IJ SOLN
|
Facility
|
IP
|
$2.30
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0409336510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$1.15 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.15
|
|
|
HYDROMORPHONE HCL 2 MG/ML IJ SOLN
|
Facility
|
OP
|
$2.30
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0409336510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.26
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.15
|
| Rate for Payer: Aetna Government |
$1.15
|
| Rate for Payer: Brighton Health Commercial |
$1.72
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.84
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.56
|
| Rate for Payer: EmblemHealth Commercial |
$1.15
|
| Rate for Payer: Group Health Inc Commercial |
$1.15
|
| Rate for Payer: Group Health Inc Medicare |
$0.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.15
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.15
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.49
|
|
|
HYDROMORPHONE HCL 2 MG PO TABS
|
Facility
|
IP
|
$0.20
|
|
|
Service Code
|
NDC 4285830125
|
| Hospital Charge Code |
4285830125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
|
|
HYDROMORPHONE HCL 2 MG PO TABS
|
Facility
|
OP
|
$0.20
|
|
|
Service Code
|
NDC 4285830125
|
| Hospital Charge Code |
4285830125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.16 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.11
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.10
|
| Rate for Payer: Aetna Government |
$0.10
|
| Rate for Payer: Brighton Health Commercial |
$0.15
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.16
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.14
|
| Rate for Payer: EmblemHealth Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Commercial |
$0.10
|
| Rate for Payer: Group Health Inc Medicare |
$0.07
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.10
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.13
|
|
|
HYDROMORPHONE HCL 2 MG PO TABS
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 6068757911
|
| Hospital Charge Code |
6068757911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.36
|
| Rate for Payer: Aetna Government |
$0.36
|
| Rate for Payer: Brighton Health Commercial |
$0.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.48
|
| Rate for Payer: EmblemHealth Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.46
|
|
|
HYDROMORPHONE HCL 2 MG PO TABS
|
Facility
|
OP
|
$0.71
|
|
|
Service Code
|
NDC 6068757901
|
| Hospital Charge Code |
6068757901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.36
|
| Rate for Payer: Aetna Government |
$0.36
|
| Rate for Payer: Brighton Health Commercial |
$0.53
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.48
|
| Rate for Payer: EmblemHealth Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.46
|
|
|
HYDROMORPHONE HCL 2 MG PO TABS
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 6068757901
|
| Hospital Charge Code |
6068757901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
|
|
HYDROMORPHONE HCL 2 MG PO TABS
|
Facility
|
IP
|
$0.71
|
|
|
Service Code
|
NDC 6068757911
|
| Hospital Charge Code |
6068757911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
|
|
HYDROMORPHONE HCL 4 MG PO TABS
|
Facility
|
IP
|
$0.72
|
|
|
Service Code
|
NDC 6068759011
|
| Hospital Charge Code |
6068759011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$0.36 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
|
|
HYDROMORPHONE HCL 4 MG PO TABS
|
Facility
|
OP
|
$0.69
|
|
|
Service Code
|
NDC 0406324401
|
| Hospital Charge Code |
0406324401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.24 |
| Max. Negotiated Rate |
$0.55 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.38
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.35
|
| Rate for Payer: Aetna Government |
$0.35
|
| Rate for Payer: Brighton Health Commercial |
$0.52
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.55
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.47
|
| Rate for Payer: EmblemHealth Commercial |
$0.35
|
| Rate for Payer: Group Health Inc Commercial |
$0.35
|
| Rate for Payer: Group Health Inc Medicare |
$0.24
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.35
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.45
|
|
|
HYDROMORPHONE HCL 4 MG PO TABS
|
Facility
|
IP
|
$0.69
|
|
|
Service Code
|
NDC 0406324401
|
| Hospital Charge Code |
0406324401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.35 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.35
|
|
|
HYDROMORPHONE HCL 4 MG PO TABS
|
Facility
|
OP
|
$0.72
|
|
|
Service Code
|
NDC 6068759011
|
| Hospital Charge Code |
6068759011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.39
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.36
|
| Rate for Payer: Aetna Government |
$0.36
|
| Rate for Payer: Brighton Health Commercial |
$0.54
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.57
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.49
|
| Rate for Payer: EmblemHealth Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Commercial |
$0.36
|
| Rate for Payer: Group Health Inc Medicare |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.36
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.36
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.46
|
|
|
HYDROMORPHONE HCL PF 10 MG/ML IJ SOLN
|
Facility
|
IP
|
$4.19
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0703011001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.09
|
|
|
HYDROMORPHONE HCL PF 10 MG/ML IJ SOLN
|
Facility
|
OP
|
$4.19
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0703011001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.09
|
| Rate for Payer: Aetna Government |
$2.09
|
| Rate for Payer: Brighton Health Commercial |
$3.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.85
|
| Rate for Payer: EmblemHealth Commercial |
$2.09
|
| Rate for Payer: Group Health Inc Commercial |
$2.09
|
| Rate for Payer: Group Health Inc Medicare |
$1.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.72
|
|
|
HYDROMORPHONE HCL PF 10 MG/ML IJ SOLN
|
Facility
|
OP
|
$5.14
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0409263401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.83
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.57
|
| Rate for Payer: Aetna Government |
$2.57
|
| Rate for Payer: Brighton Health Commercial |
$3.86
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.11
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.50
|
| Rate for Payer: EmblemHealth Commercial |
$2.57
|
| Rate for Payer: Group Health Inc Commercial |
$2.57
|
| Rate for Payer: Group Health Inc Medicare |
$1.80
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.57
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.57
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.34
|
|
|
HYDROMORPHONE HCL PF 10 MG/ML IJ SOLN
|
Facility
|
IP
|
$5.14
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0409263401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.57
|
|
|
HYDROMORPHONE HCL PF 500 MG/50ML IJ SOLN
|
Facility
|
OP
|
$4.08
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
6332385150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$3.26 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.24
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.04
|
| Rate for Payer: Aetna Government |
$2.04
|
| Rate for Payer: Brighton Health Commercial |
$3.06
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.26
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.78
|
| Rate for Payer: EmblemHealth Commercial |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$2.04
|
| Rate for Payer: Group Health Inc Medicare |
$1.43
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.04
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.04
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.65
|
|
|
HYDROMORPHONE HCL PF 500 MG/50ML IJ SOLN
|
Facility
|
OP
|
$4.19
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0703011001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$2.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$2.09
|
| Rate for Payer: Aetna Government |
$2.09
|
| Rate for Payer: Brighton Health Commercial |
$3.14
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.35
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.85
|
| Rate for Payer: EmblemHealth Commercial |
$2.09
|
| Rate for Payer: Group Health Inc Commercial |
$2.09
|
| Rate for Payer: Group Health Inc Medicare |
$1.47
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.09
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.09
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.72
|
|
|
HYDROMORPHONE HCL PF 500 MG/50ML IJ SOLN
|
Facility
|
OP
|
$2.61
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0409263425
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.44
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.31
|
| Rate for Payer: Aetna Government |
$1.31
|
| Rate for Payer: Brighton Health Commercial |
$1.96
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.09
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.78
|
| Rate for Payer: EmblemHealth Commercial |
$1.31
|
| Rate for Payer: Group Health Inc Commercial |
$1.31
|
| Rate for Payer: Group Health Inc Medicare |
$0.91
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.31
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.31
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$0.10
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.70
|
|
|
HYDROMORPHONE HCL PF 500 MG/50ML IJ SOLN
|
Facility
|
IP
|
$4.08
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
6332385150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.04
|
|
|
HYDROMORPHONE HCL PF 500 MG/50ML IJ SOLN
|
Facility
|
IP
|
$2.61
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0409263405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.31
|
|
|
HYDROMORPHONE HCL PF 500 MG/50ML IJ SOLN
|
Facility
|
IP
|
$4.19
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0703011001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.09
|
|
|
HYDROMORPHONE HCL PF 500 MG/50ML IJ SOLN
|
Facility
|
IP
|
$2.61
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0409263425
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.31
|
|
|
HYDROMORPHONE HCL PF 500 MG/50ML IJ SOLN
|
Facility
|
IP
|
$2.94
|
|
|
Service Code
|
HCPCS J1171
|
| Hospital Charge Code |
0409263450
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.47
|
|
