|
HYDROCORTISONE (PERIANAL) 2.5 % EX CREA [172266]
|
Facility
|
OP
|
$3.08
|
|
|
Service Code
|
NDC 10631040701
|
| Hospital Charge Code |
10631040701
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$2.46 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.69
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.54
|
| Rate for Payer: Aetna Government |
$1.54
|
| Rate for Payer: Brighton Health Commercial |
$2.31
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.46
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.09
|
| Rate for Payer: Group Health Inc Commercial |
$1.54
|
| Rate for Payer: Group Health Inc Medicare |
$1.08
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.54
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.54
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$2.00
|
|
|
HYDROCORTISONE (PERIANAL) 2.5 % EX CREA [172266]
|
Facility
|
OP
|
$2.91
|
|
|
Service Code
|
NDC 64980032430
|
| Hospital Charge Code |
64980032430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.60
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.46
|
| Rate for Payer: Aetna Government |
$1.46
|
| Rate for Payer: Brighton Health Commercial |
$2.18
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.33
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.98
|
| Rate for Payer: Group Health Inc Commercial |
$1.46
|
| Rate for Payer: Group Health Inc Medicare |
$1.02
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.46
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.46
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.89
|
|
|
HYDROCORTISONE (PERIANAL) 2.5 % EX CREA [172266]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 69315031228
|
| Hospital Charge Code |
69315031228
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.65
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.50
|
| Rate for Payer: Aetna Government |
$1.50
|
| Rate for Payer: Brighton Health Commercial |
$2.25
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.40
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.04
|
| Rate for Payer: Group Health Inc Commercial |
$1.50
|
| Rate for Payer: Group Health Inc Medicare |
$1.05
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.50
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.50
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.95
|
|
|
HYDROCORTISONE SOD SUC (PF) 100 MG IJ SOLR [187022]
|
Facility
|
OP
|
$24.49
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
00009001104
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$19.59 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.81
|
| Rate for Payer: Aetna Government |
$14.81
|
| Rate for Payer: Brighton Health Commercial |
$18.37
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.59
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.65
|
| Rate for Payer: Group Health Inc Commercial |
$12.24
|
| Rate for Payer: Group Health Inc Medicare |
$8.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.92
|
|
|
HYDROCORTISONE SOD SUC (PF) 100 MG IJ SOLR [187022]
|
Facility
|
OP
|
$18.12
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
00009082501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.34 |
| Max. Negotiated Rate |
$19.57 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$9.97
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.81
|
| Rate for Payer: Aetna Government |
$14.81
|
| Rate for Payer: Brighton Health Commercial |
$13.59
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$14.50
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$12.32
|
| Rate for Payer: Group Health Inc Commercial |
$9.06
|
| Rate for Payer: Group Health Inc Medicare |
$6.34
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$9.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$9.06
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$11.78
|
|
|
HYDROCORTISONE SOD SUC (PF) 100 MG IJ SOLR [187022]
|
Facility
|
OP
|
$24.48
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
00009001103
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.57 |
| Max. Negotiated Rate |
$19.58 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$13.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$14.81
|
| Rate for Payer: Aetna Government |
$14.81
|
| Rate for Payer: Brighton Health Commercial |
$18.36
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$19.58
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$16.65
|
| Rate for Payer: Group Health Inc Commercial |
$12.24
|
| Rate for Payer: Group Health Inc Medicare |
$8.57
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$12.24
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$12.24
|
| Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$15.91
|
|
|
HYDROCORTISONE SOD SUC (PF) 250 MG IJ SOLR [187023]
|
Facility
|
OP
|
$45.30
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
00009001305
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.81 |
| Max. Negotiated Rate |
$36.24 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$24.92
|
| 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: 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.57
|
| 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 [187025]
|
Facility
|
OP
|
$90.64
|
|
|
Service Code
|
HCPCS J1720
|
| Hospital Charge Code |
00009001612
|
|
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: 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid |
$18.46
|
| Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage |
$19.57
|
| Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa) |
$19.57
|
| Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa) |
$19.57
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$58.92
|
|
|
HYDROCORTISONE VALERATE 0.2% CREAM 15 GR
|
Facility
|
OP
|
$1.95
|
|
| Hospital Charge Code |
41652524
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.98
|
| Rate for Payer: Aetna Government |
$0.98
|
| Rate for Payer: Brighton Health Commercial |
$1.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.98
|
| Rate for Payer: Group Health Inc Medicare |
$0.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.27
|
|
|
HYDROCORTISONE VALERATE 0.2% CREAM 15 GR
|
Facility
|
OP
|
$1.95
|
|
| Hospital Charge Code |
41642524
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.56 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.07
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$0.98
|
| Rate for Payer: Aetna Government |
$0.98
|
| Rate for Payer: Brighton Health Commercial |
$1.46
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$1.56
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$1.33
|
| Rate for Payer: Group Health Inc Commercial |
$0.98
|
| Rate for Payer: Group Health Inc Medicare |
$0.68
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$0.98
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$0.98
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$1.27
|
|
|
HYDROCORTISONE VALERATE 0.2 % EX CREA [10218]
|
Facility
|
OP
|
$2.87
|
|
|
Service Code
|
NDC 45802045535
|
| Hospital Charge Code |
45802045535
|
|
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: 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
|
|
|
HYDRODCOLLOID DRESSING
|
Facility
|
OP
|
$13.74
|
|
|
Service Code
|
HCPCS A6246
|
| Hospital Charge Code |
41809568
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.81 |
| Max. Negotiated Rate |
$10.99 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$7.56
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.04
|
| Rate for Payer: Aetna Government |
$6.04
|
| Rate for Payer: Brighton Health Commercial |
$10.30
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$10.99
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$9.34
|
| Rate for Payer: Group Health Inc Commercial |
$6.87
|
| Rate for Payer: Group Health Inc Medicare |
$4.81
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$6.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$6.87
|
|
|
HYDROFERA BLU RDY NONBORDER 4X5
|
Facility
|
OP
|
$33.61
|
|
| Hospital Charge Code |
64905621
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$26.89 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$18.49
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$16.80
|
| Rate for Payer: Aetna Government |
$16.80
|
| Rate for Payer: Brighton Health Commercial |
$25.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$26.89
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$22.85
|
| Rate for Payer: Group Health Inc Commercial |
$16.80
|
| Rate for Payer: Group Health Inc Medicare |
$11.76
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$16.80
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$16.80
|
|
|
HYDROGEL DRESSING
|
Facility
|
OP
|
$20.84
|
|
|
Service Code
|
HCPCS A6246
|
| Hospital Charge Code |
41809569
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$16.67 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$11.46
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$6.04
|
| Rate for Payer: Aetna Government |
$6.04
|
| Rate for Payer: Brighton Health Commercial |
$15.63
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$16.67
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.17
|
| Rate for Payer: Group Health Inc Commercial |
$10.42
|
| Rate for Payer: Group Health Inc Medicare |
$7.29
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$10.42
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$10.42
|
|
|
HYDROGEL, SKINTEGRITY
|
Facility
|
OP
|
$2.95
|
|
| Hospital Charge Code |
40201969
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$1.62
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$1.48
|
| Rate for Payer: Aetna Government |
$1.48
|
| Rate for Payer: Brighton Health Commercial |
$2.21
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.36
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2.01
|
| Rate for Payer: Group Health Inc Commercial |
$1.48
|
| Rate for Payer: Group Health Inc Medicare |
$1.03
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$1.48
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$1.48
|
|
|
HYDROGEL,SKINTEGRITY
|
Facility
|
OP
|
$11.78
|
|
| Hospital Charge Code |
64903419
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$9.42 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$6.48
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$5.89
|
| Rate for Payer: Aetna Government |
$5.89
|
| Rate for Payer: Brighton Health Commercial |
$8.84
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$9.42
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$8.01
|
| Rate for Payer: Group Health Inc Commercial |
$5.89
|
| Rate for Payer: Group Health Inc Medicare |
$4.12
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$5.89
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$5.89
|
|
|
HYDROGEN BREATH TEST
|
Facility
|
OP
|
$419.03
|
|
|
Service Code
|
HCPCS 91065 TC
|
| Hospital Charge Code |
30301310
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$126.45 |
| Max. Negotiated Rate |
$2,915.00 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$230.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$180.64
|
| Rate for Payer: Aetna Government |
$180.64
|
| Rate for Payer: Affinity Essential Plan 1&2 |
$126.45
|
| Rate for Payer: Affinity Essential Plan 3&4 |
$126.45
|
| Rate for Payer: Affinity Medicaid/CHP/HARP |
$126.45
|
| Rate for Payer: Brighton Health Commercial |
$314.27
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Cash Price |
$180.64
|
| Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus |
$180.64
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2,915.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$2,477.75
|
| Rate for Payer: Elderplan Medicare Advantage |
$180.64
|
| Rate for Payer: EmblemHealth Commercial |
$1,505.00
|
| Rate for Payer: Fidelis Essential Plan Aliesa |
$153.54
|
| Rate for Payer: Fidelis Essential Plan QHP |
$160.77
|
| Rate for Payer: Fidelis Medicare Advantage |
$180.64
|
| Rate for Payer: Fidelis Qualified Health Plan |
$160.77
|
| Rate for Payer: Group Health Inc Commercial |
$180.64
|
| Rate for Payer: Group Health Inc Medicare |
$180.64
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$209.52
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$180.64
|
| Rate for Payer: Healthfirst Medicare Advantage |
$153.54
|
| Rate for Payer: Healthfirst QHP |
$180.64
|
| Rate for Payer: Humana Medicare |
$184.25
|
| Rate for Payer: Senior Whole Health Medicare Advantage |
$180.64
|
| Rate for Payer: United Healthcare Commercial |
$1,113.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$180.64
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$180.64
|
| Rate for Payer: Wellcare CHP/FHP/Medicaid |
$144.51
|
| Rate for Payer: Wellcare Medicare |
$171.61
|
|
|
HYDROGEN BREATH TEST
|
Facility
|
IP
|
$419.03
|
|
|
Service Code
|
HCPCS 91065 TC
|
| Hospital Charge Code |
30301310
|
|
Hospital Revenue Code
|
750
|
| Rate for Payer: Cash Price |
$180.64
|
|
|
HYDROMOPHONE 1MG/ML
|
Facility
|
IP
|
$8.12
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
41657047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$4.06 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.06
|
|
|
HYDROMOPHONE 1MG/ML
|
Facility
|
OP
|
$8.12
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
41657047
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$5.28 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$4.47
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.30
|
| Rate for Payer: Aetna Government |
$3.30
|
| Rate for Payer: Brighton Health Commercial |
$4.87
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$4.06
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$4.67
|
| Rate for Payer: Group Health Inc Commercial |
$4.06
|
| Rate for Payer: Group Health Inc Medicare |
$2.84
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$4.06
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$4.06
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.04
|
| Rate for Payer: SOMOS Essential |
$5.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$5.28
|
|
|
HYDROMORPHONE 0.5MG/0.5ML INJ
|
Facility
|
IP
|
$5.74
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
41647812
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.87
|
|
|
HYDROMORPHONE 0.5MG/0.5ML INJ
|
Facility
|
IP
|
$5.74
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
41657812
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.87
|
|
|
HYDROMORPHONE 0.5MG/0.5ML INJ
|
Facility
|
OP
|
$5.74
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
41657812
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$5.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.30
|
| Rate for Payer: Aetna Government |
$3.30
|
| Rate for Payer: Brighton Health Commercial |
$3.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.30
|
| Rate for Payer: Group Health Inc Commercial |
$2.87
|
| Rate for Payer: Group Health Inc Medicare |
$2.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.04
|
| Rate for Payer: SOMOS Essential |
$5.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.73
|
|
|
HYDROMORPHONE 0.5MG/0.5ML INJ
|
Facility
|
OP
|
$5.74
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
41647812
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.01 |
| Max. Negotiated Rate |
$5.04 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$3.16
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.30
|
| Rate for Payer: Aetna Government |
$3.30
|
| Rate for Payer: Brighton Health Commercial |
$3.44
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$2.87
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$3.30
|
| Rate for Payer: Group Health Inc Commercial |
$2.87
|
| Rate for Payer: Group Health Inc Medicare |
$2.01
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$2.87
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$2.87
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.04
|
| Rate for Payer: SOMOS Essential |
$5.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$3.73
|
|
|
HYDROMORPHONE 100MG/D5W 100ML PCA
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
41657172
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: 1199SEIU National Benefit Fund Commercial |
$14.30
|
| Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper |
$3.30
|
| Rate for Payer: Aetna Government |
$3.30
|
| Rate for Payer: Brighton Health Commercial |
$15.60
|
| Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access |
$13.00
|
| Rate for Payer: Cigna LocalPlus Benefit Plan |
$14.95
|
| Rate for Payer: Group Health Inc Commercial |
$13.00
|
| Rate for Payer: Group Health Inc Medicare |
$9.10
|
| Rate for Payer: Hamaspik Choice Inc Medicaid |
$13.00
|
| Rate for Payer: Hamaspik Choice Inc Medicare |
$13.00
|
| Rate for Payer: SOMOS CHP/HARP/Medicaid |
$5.04
|
| Rate for Payer: SOMOS Essential |
$5.04
|
| Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual |
$16.90
|
|
