St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HYDROCORTISONE 250 MG INJ

Facility

$6.72

Service Code	HCPCS J1720
Hospital Charge Code	41650474
Hospital Revenue Code	636
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$19.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.81
Rate for Payer: Aetna Government	$14.81
Rate for Payer: Brighton Health Commercial	$4.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.86
Rate for Payer: Group Health Inc Commercial	$3.36
Rate for Payer: Group Health Inc Medicare	$2.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.36
Rate for Payer: Hamaspik Choice Inc Medicare	$3.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.57
Rate for Payer: SOMOS Essential	$19.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.37

HYDROCORTISONE 250 MG INJ

Facility

$6.72

Service Code	HCPCS J1720
Hospital Charge Code	41640474
Hospital Revenue Code	636
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$3.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.36
Rate for Payer: Hamaspik Choice Inc Medicare	$3.36

HYDROCORTISONE 250 MG INJ

Facility

$6.72

Service Code	HCPCS J1720
Hospital Charge Code	41650474
Hospital Revenue Code	636
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$3.36
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.36
Rate for Payer: Hamaspik Choice Inc Medicare	$3.36

HYDROCORTISONE 250 MG INJ

Facility

$6.72

Service Code	HCPCS J1720
Hospital Charge Code	41640474
Hospital Revenue Code	636
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$19.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$14.81
Rate for Payer: Aetna Government	$14.81
Rate for Payer: Brighton Health Commercial	$4.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.36
Rate for Payer: Cigna LocalPlus Benefit Plan	$3.86
Rate for Payer: Group Health Inc Commercial	$3.36
Rate for Payer: Group Health Inc Medicare	$2.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.36
Rate for Payer: Hamaspik Choice Inc Medicare	$3.36
Rate for Payer: SOMOS CHP/HARP/Medicaid	$19.57
Rate for Payer: SOMOS Essential	$19.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.37

HYDROCORTISONE 2.5% CREAM 30 GRAMS

Facility

$4.00

Hospital Charge Code	41650555
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

HYDROCORTISONE 2.5% CREAM 30 GRAMS

Facility

$4.00

Hospital Charge Code	41640555
Hospital Revenue Code	250
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$3.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.00
Rate for Payer: Aetna Government	$2.00
Rate for Payer: Brighton Health Commercial	$3.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$3.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.72
Rate for Payer: Group Health Inc Commercial	$2.00
Rate for Payer: Group Health Inc Medicare	$1.40
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.60

HYDROCORTISONE 2.5 % EX CREA [3727]

Facility

$0.37

Service Code	NDC 00168008031
Hospital Charge Code	00168008031
Hospital Revenue Code	250
Min. Negotiated Rate	$0.13
Max. Negotiated Rate	$0.29
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.18
Rate for Payer: Aetna Government	$0.18
Rate for Payer: Brighton Health Commercial	$0.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.29
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.25
Rate for Payer: Group Health Inc Commercial	$0.18
Rate for Payer: Group Health Inc Medicare	$0.13
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.18
Rate for Payer: Hamaspik Choice Inc Medicare	$0.18
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.24

HYDROCORTISONE 2.5 % EX CREA [3727]

Facility

$0.25

Service Code	NDC 45802000402
Hospital Charge Code	45802000402
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.16

HYDROCORTISONE 2.5 % EX OINT [3732]

Facility

$0.25

Service Code	NDC 45802001402
Hospital Charge Code	45802001402
Hospital Revenue Code	250
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$0.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.12
Rate for Payer: Aetna Government	$0.12
Rate for Payer: Brighton Health Commercial	$0.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.17
Rate for Payer: Group Health Inc Commercial	$0.12
Rate for Payer: Group Health Inc Medicare	$0.09
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.12
Rate for Payer: Hamaspik Choice Inc Medicare	$0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.16

HYDROCORTISONE 2.5 % EX OINT [3732]

Facility

$0.39

Service Code	NDC 00168014630
Hospital Charge Code	00168014630
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.19
Rate for Payer: Aetna Government	$0.19
Rate for Payer: Brighton Health Commercial	$0.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.31
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.26
Rate for Payer: Group Health Inc Commercial	$0.19
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.19
Rate for Payer: Hamaspik Choice Inc Medicare	$0.19
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.25

HYDROCORTISONE 25 MG SUPP

Facility

$1.98

Hospital Charge Code	41653364
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.99
Rate for Payer: Aetna Government	$0.99
Rate for Payer: Brighton Health Commercial	$1.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.35
Rate for Payer: Group Health Inc Commercial	$0.99
Rate for Payer: Group Health Inc Medicare	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.99
Rate for Payer: Hamaspik Choice Inc Medicare	$0.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.29

HYDROCORTISONE 25 MG SUPP

Facility

$1.98

Hospital Charge Code	41643364
Hospital Revenue Code	250
Min. Negotiated Rate	$0.69
Max. Negotiated Rate	$1.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.99
Rate for Payer: Aetna Government	$0.99
Rate for Payer: Brighton Health Commercial	$1.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.35
Rate for Payer: Group Health Inc Commercial	$0.99
Rate for Payer: Group Health Inc Medicare	$0.69
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.99
Rate for Payer: Hamaspik Choice Inc Medicare	$0.99
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.29

HYDROCORTISONE 2.5% OINT 30 GRAMS

Facility

$6.00

Hospital Charge Code	41650884
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

HYDROCORTISONE 2.5% OINT 30 GRAMS

Facility

$6.00

Hospital Charge Code	41640884
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.00
Rate for Payer: Aetna Government	$3.00
Rate for Payer: Brighton Health Commercial	$4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.80
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.08
Rate for Payer: Group Health Inc Commercial	$3.00
Rate for Payer: Group Health Inc Medicare	$2.10
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.00
Rate for Payer: Hamaspik Choice Inc Medicare	$3.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.90

HYDROCORTISONE 2.5% (RECTAL) CREAM 30 GR

Facility

$6.72

Hospital Charge Code	41654298
Hospital Revenue Code	250
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$5.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.36
Rate for Payer: Aetna Government	$3.36
Rate for Payer: Brighton Health Commercial	$5.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.57
Rate for Payer: Group Health Inc Commercial	$3.36
Rate for Payer: Group Health Inc Medicare	$2.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.36
Rate for Payer: Hamaspik Choice Inc Medicare	$3.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.37

HYDROCORTISONE 2.5% (RECTAL) CREAM 30 GR

Facility

$6.72

Hospital Charge Code	41644298
Hospital Revenue Code	250
Min. Negotiated Rate	$2.35
Max. Negotiated Rate	$5.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.36
Rate for Payer: Aetna Government	$3.36
Rate for Payer: Brighton Health Commercial	$5.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.57
Rate for Payer: Group Health Inc Commercial	$3.36
Rate for Payer: Group Health Inc Medicare	$2.35
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.36
Rate for Payer: Hamaspik Choice Inc Medicare	$3.36
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.37

HYDROCORTISONE 5 MG PO TABS [10209]

Facility

$0.34

Service Code	NDC 59762007301
Hospital Charge Code	59762007301
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.23
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.22

HYDROCORTISONE 5 MG PO TABS [10209]

Facility

$0.34

Service Code	NDC 00115169606
Hospital Charge Code	00115169606
Hospital Revenue Code	250
Min. Negotiated Rate	$0.12
Max. Negotiated Rate	$0.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.17
Rate for Payer: Aetna Government	$0.17
Rate for Payer: Brighton Health Commercial	$0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.23
Rate for Payer: Group Health Inc Commercial	$0.17
Rate for Payer: Group Health Inc Medicare	$0.12
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.17
Rate for Payer: Hamaspik Choice Inc Medicare	$0.17
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.22

HYDROCORTISONE 5 MG TAB

Facility

$0.57

Hospital Charge Code	41653920
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.29
Rate for Payer: Aetna Government	$0.29
Rate for Payer: Brighton Health Commercial	$0.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.39
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	$0.37

HYDROCORTISONE 5 MG TAB

Facility

$0.57

Hospital Charge Code	41643920
Hospital Revenue Code	250
Min. Negotiated Rate	$0.20
Max. Negotiated Rate	$0.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.29
Rate for Payer: Aetna Government	$0.29
Rate for Payer: Brighton Health Commercial	$0.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.46
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.39
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	$0.37

HYDROCORTISONE ACETATE 25 MG RE SUPP [3738]

Facility

$14.43

Service Code	NDC 69367024312
Hospital Charge Code	69367024312
Hospital Revenue Code	250
Min. Negotiated Rate	$5.05
Max. Negotiated Rate	$11.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$7.21
Rate for Payer: Aetna Government	$7.21
Rate for Payer: Brighton Health Commercial	$10.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$11.54
Rate for Payer: Cigna LocalPlus Benefit Plan	$9.81
Rate for Payer: Group Health Inc Commercial	$7.21
Rate for Payer: Group Health Inc Medicare	$5.05
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.21
Rate for Payer: Hamaspik Choice Inc Medicare	$7.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$9.38

HYDROCORTISONE ACETATE 25 MG RE SUPP [3738]

Facility

$22.65

Service Code	NDC 00713050312
Hospital Charge Code	00713050312
Hospital Revenue Code	250
Min. Negotiated Rate	$7.93
Max. Negotiated Rate	$18.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$12.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$11.32
Rate for Payer: Aetna Government	$11.32
Rate for Payer: Brighton Health Commercial	$16.99
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$18.12
Rate for Payer: Cigna LocalPlus Benefit Plan	$15.40
Rate for Payer: Group Health Inc Commercial	$11.32
Rate for Payer: Group Health Inc Medicare	$7.93
Rate for Payer: Hamaspik Choice Inc Medicaid	$11.32
Rate for Payer: Hamaspik Choice Inc Medicare	$11.32
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$14.72

HYDROCORTISONE ACETATE 25 MG RE SUPP [3738]

Facility

$73.25

Service Code	NDC 65649041124
Hospital Charge Code	65649041124
Hospital Revenue Code	250
Min. Negotiated Rate	$25.64
Max. Negotiated Rate	$58.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$40.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$36.63
Rate for Payer: Aetna Government	$36.63
Rate for Payer: Brighton Health Commercial	$54.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$58.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$49.81
Rate for Payer: Group Health Inc Commercial	$36.63
Rate for Payer: Group Health Inc Medicare	$25.64
Rate for Payer: Hamaspik Choice Inc Medicaid	$36.63
Rate for Payer: Hamaspik Choice Inc Medicare	$36.63
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$47.62

HYDROCORTISONE ENEMA 100 MG/60 ML

Facility

$11.46

Hospital Charge Code	41643398
Hospital Revenue Code	250
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$9.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.73
Rate for Payer: Aetna Government	$5.73
Rate for Payer: Brighton Health Commercial	$8.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.79
Rate for Payer: Group Health Inc Commercial	$5.73
Rate for Payer: Group Health Inc Medicare	$4.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.73
Rate for Payer: Hamaspik Choice Inc Medicare	$5.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.45

HYDROCORTISONE ENEMA 100 MG/60 ML

Facility

$11.46

Hospital Charge Code	41653398
Hospital Revenue Code	250
Min. Negotiated Rate	$4.01
Max. Negotiated Rate	$9.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.73
Rate for Payer: Aetna Government	$5.73
Rate for Payer: Brighton Health Commercial	$8.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$9.17
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.79
Rate for Payer: Group Health Inc Commercial	$5.73
Rate for Payer: Group Health Inc Medicare	$4.01
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.73
Rate for Payer: Hamaspik Choice Inc Medicare	$5.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.45

Know your out-of-pocket cost for care.

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