|
HYDRALAZINE 10 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41650911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
HYDRALAZINE 10 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41640911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
HYDRALAZINE 20 MG/ML INJ
|
Facility
|
IP
|
$7.58
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
41651728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.79
|
|
|
HYDRALAZINE 20 MG/ML INJ
|
Facility
|
IP
|
$7.58
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
41641728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.79
|
|
|
HYDRALAZINE 20 MG/ML INJ
|
Facility
|
OP
|
$7.58
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
41641728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$5.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.20
|
| Rate for Payer: Aetna Government |
$5.20
|
| Rate for Payer: Brighton Health Commercial |
$4.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.36
|
| Rate for Payer: Group Health Inc Commercial |
$3.79
|
| Rate for Payer: Group Health Inc Medicare |
$2.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.89
|
| Rate for Payer: SOMOS Essential |
$5.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.93
|
|
|
HYDRALAZINE 20 MG/ML INJ
|
Facility
|
OP
|
$7.58
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
41651728
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$5.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.17
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.20
|
| Rate for Payer: Aetna Government |
$5.20
|
| Rate for Payer: Brighton Health Commercial |
$4.55
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$3.79
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.36
|
| Rate for Payer: Group Health Inc Commercial |
$3.79
|
| Rate for Payer: Group Health Inc Medicare |
$2.65
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$3.79
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$3.79
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.89
|
| Rate for Payer: SOMOS Essential |
$5.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$4.93
|
|
|
HYDRALAZINE 25 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41640913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
HYDRALAZINE 25 MG TAB
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
41650913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.80 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.55
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.50
|
| Rate for Payer: Aetna Government |
$0.50
|
| Rate for Payer: Brighton Health Commercial |
$0.75
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.80
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.68
|
| Rate for Payer: Group Health Inc Commercial |
$0.50
|
| Rate for Payer: Group Health Inc Medicare |
$0.35
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.65
|
|
|
HYDRALAZINE 50 MG TAB
|
Facility
|
OP
|
$0.41
|
|
| Hospital Charge Code |
41643452
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Brighton Health Commercial |
$0.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.27
|
|
|
HYDRALAZINE 50 MG TAB
|
Facility
|
OP
|
$0.41
|
|
| Hospital Charge Code |
41653452
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Brighton Health Commercial |
$0.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.27
|
|
|
HYDRALAZINE HCL 10 MG PO TABS [3698]
|
Facility
|
OP
|
$0.13
|
|
|
Service Code
|
NDC 00904644061
|
| Hospital Charge Code |
00904644061
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.10 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.06
|
| Rate for Payer: Aetna Government |
$0.06
|
| Rate for Payer: Brighton Health Commercial |
$0.09
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.10
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.09
|
| Rate for Payer: Group Health Inc Commercial |
$0.06
|
| Rate for Payer: Group Health Inc Medicare |
$0.04
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.06
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.08
|
|
|
HYDRALAZINE HCL 10 MG PO TABS [3698]
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
NDC 31722051901
|
| Hospital Charge Code |
31722051901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Brighton Health Commercial |
$0.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.27
|
|
|
HYDRALAZINE HCL 10 MG PO TABS [3698]
|
Facility
|
OP
|
$0.41
|
|
|
Service Code
|
NDC 23155000101
|
| Hospital Charge Code |
23155000101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.23
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.21
|
| Rate for Payer: Aetna Government |
$0.21
|
| Rate for Payer: Brighton Health Commercial |
$0.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.28
|
| Rate for Payer: Group Health Inc Commercial |
$0.21
|
| Rate for Payer: Group Health Inc Medicare |
$0.14
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.21
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.21
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.27
|
|
|
HYDRALAZINE HCL 10 MG PO TABS [3698]
|
Facility
|
OP
|
$0.53
|
|
|
Service Code
|
NDC 68084044701
|
| Hospital Charge Code |
68084044701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$0.43 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.29
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.27
|
| Rate for Payer: Aetna Government |
$0.27
|
| Rate for Payer: Brighton Health Commercial |
$0.40
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.43
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.36
|
| Rate for Payer: Group Health Inc Commercial |
$0.27
|
| Rate for Payer: Group Health Inc Medicare |
$0.19
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.27
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.27
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.35
|
|
|
HYDRALAZINE HCL 20 MG/ML IJ SOLN [3697]
|
Facility
|
OP
|
$17.18
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
63323061400
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$13.74 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.20
|
| Rate for Payer: Aetna Government |
$5.20
|
| Rate for Payer: Brighton Health Commercial |
$12.88
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.74
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.68
|
| Rate for Payer: Group Health Inc Commercial |
$8.59
|
| Rate for Payer: Group Health Inc Medicare |
$6.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$5.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.17
|
|
|
HYDRALAZINE HCL 20 MG/ML IJ SOLN [3697]
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
00641623125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$14.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.20
|
| Rate for Payer: Aetna Government |
$5.20
|
| Rate for Payer: Brighton Health Commercial |
$13.50
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.24
|
| Rate for Payer: Group Health Inc Commercial |
$9.00
|
| Rate for Payer: Group Health Inc Medicare |
$6.30
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.00
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$5.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.70
|
|
|
HYDRALAZINE HCL 20 MG/ML IJ SOLN [3697]
|
Facility
|
OP
|
$17.18
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
63323061401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$13.75 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.45
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.20
|
| Rate for Payer: Aetna Government |
$5.20
|
| Rate for Payer: Brighton Health Commercial |
$12.89
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.75
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$11.69
|
| Rate for Payer: Group Health Inc Commercial |
$8.59
|
| Rate for Payer: Group Health Inc Medicare |
$6.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$8.59
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$8.59
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$5.56
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$5.89
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$5.89
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$5.89
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.17
|
|
|
HYDRALAZINE HCL 25 MG PO TABS [3700]
|
Facility
|
OP
|
$0.51
|
|
|
Service Code
|
NDC 31722052010
|
| Hospital Charge Code |
31722052010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.25
|
| Rate for Payer: Aetna Government |
$0.25
|
| Rate for Payer: Brighton Health Commercial |
$0.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.34
|
| Rate for Payer: Group Health Inc Commercial |
$0.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.33
|
|
|
HYDRALAZINE HCL 25 MG PO TABS [3700]
|
Facility
|
OP
|
$0.15
|
|
|
Service Code
|
NDC 00904644161
|
| Hospital Charge Code |
00904644161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.12 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.08
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.07
|
| Rate for Payer: Aetna Government |
$0.07
|
| Rate for Payer: Brighton Health Commercial |
$0.11
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.12
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.10
|
| 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 |
$0.10
|
|
|
HYDRALAZINE HCL 25 MG PO TABS [3700]
|
Facility
|
OP
|
$0.51
|
|
|
Service Code
|
NDC 23155000201
|
| Hospital Charge Code |
23155000201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.41 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.28
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.25
|
| Rate for Payer: Aetna Government |
$0.25
|
| Rate for Payer: Brighton Health Commercial |
$0.38
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.41
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.35
|
| Rate for Payer: Group Health Inc Commercial |
$0.25
|
| Rate for Payer: Group Health Inc Medicare |
$0.18
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.25
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.25
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.33
|
|
|
HYDRALAZINE HCL 50 MG PO TABS [3701]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 63739032810
|
| Hospital Charge Code |
63739032810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Brighton Health Commercial |
$0.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$0.08
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.11
|
|
|
HYDRALAZINE HCL 50 MG PO TABS [3701]
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 00904644261
|
| Hospital Charge Code |
00904644261
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$0.13 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$0.09
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.08
|
| Rate for Payer: Aetna Government |
$0.08
|
| Rate for Payer: Brighton Health Commercial |
$0.12
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$0.13
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$0.11
|
| Rate for Payer: Group Health Inc Commercial |
$0.08
|
| Rate for Payer: Group Health Inc Medicare |
$0.06
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.08
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.08
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$0.11
|
|
|
HYDRATION EA. ADD HOUR UPTO 8 HRS
|
Facility
|
IP
|
$115.43
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
40509892
|
|
Hospital Revenue Code
|
260
|
| Rate for Payer: Cash Price |
$54.93
|
|
|
HYDRATION EA. ADD HOUR UPTO 8 HRS
|
Facility
|
OP
|
$115.43
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
40509892
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$43.94 |
| Max. Negotiated Rate |
$30,767.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$63.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$54.93
|
| Rate for Payer: Aetna Government |
$54.93
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$692.26
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$692.26
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$307.67
|
| Rate for Payer: Amida Care Medicaid |
$307.67
|
| Rate for Payer: Brighton Health Commercial |
$86.57
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Cash Price |
$54.93
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$54.93
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$92.34
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$78.49
|
| Rate for Payer: Elderplan Medicare Advantage |
$54.93
|
| Rate for Payer: EmblemHealth Commercial |
$54.93
|
| Rate for Payer: Fidelis CHP/HARP/Medicaid |
$30,767.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$307.67
|
| Rate for Payer: Fidelis Essential Plan QHP |
$307.67
|
| Rate for Payer: Fidelis Medicare Advantage |
$54.93
|
| Rate for Payer: Fidelis Qualified Health Plan |
$323.05
|
| Rate for Payer: Group Health Inc Commercial |
$54.93
|
| Rate for Payer: Group Health Inc Medicare |
$54.93
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$307.67
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$54.93
|
| Rate for Payer: Healthfirst CHP/FHP/Medicaid |
$307.67
|
| Rate for Payer: Healthfirst Essential Plan |
$692.26
|
| Rate for Payer: Healthfirst Medicare Advantage |
$46.69
|
| Rate for Payer: Healthfirst QHP |
$307.67
|
| Rate for Payer: Humana Medicare |
$56.03
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$54.93
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$307.67
|
| Rate for Payer: SOMOS Essential |
$692.26
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Essential Plan 1&2 |
$692.26
|
| Rate for Payer: United Healthcare Essential Plan 3&4 |
$338.44
|
| Rate for Payer: United Healthcare Medicaid |
$307.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.93
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$54.93
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$43.94
|
| Rate for Payer: Wellcare Medicare |
$52.18
|
|
|
HYDRATOME SPHINCTEROSTOME RX44
|
Facility
|
OP
|
$1,359.48
|
|
| Hospital Charge Code |
64904393
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$475.82 |
| Max. Negotiated Rate |
$1,087.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$747.71
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$679.74
|
| Rate for Payer: Aetna Government |
$679.74
|
| Rate for Payer: Brighton Health Commercial |
$1,019.61
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1,087.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$924.45
|
| Rate for Payer: Group Health Inc Commercial |
$679.74
|
| Rate for Payer: Group Health Inc Medicare |
$475.82
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$679.74
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$679.74
|
|
