St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HYDROMORPHONE 1 MG/ML INJ CARTRIDGE

Facility

$10.94

Service Code	HCPCS J1170
Hospital Charge Code	41654161
Hospital Revenue Code	636
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$7.11
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
Rate for Payer: Brighton Health Commercial	$6.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.47
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.29
Rate for Payer: Group Health Inc Commercial	$5.47
Rate for Payer: Group Health Inc Medicare	$3.83
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.47
Rate for Payer: Hamaspik Choice Inc Medicare	$5.47
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	$7.11

HYDROMORPHONE 1MG/ML UP TO 4 MG

Facility

$3.00

Service Code	HCPCS J1170
Hospital Charge Code	41647145
Hospital Revenue Code	636
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$1.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.50
Rate for Payer: Hamaspik Choice Inc Medicare	$1.50

HYDROMORPHONE 1MG/ML UP TO 4 MG

Facility

$3.00

Service Code	HCPCS J1170
Hospital Charge Code	41647145
Hospital Revenue Code	636
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$5.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
Rate for Payer: Brighton Health Commercial	$1.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.50
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.72
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: 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	$1.95

HYDROMORPHONE 2MG/ML INJ ISEC

Facility

$4.00

Service Code	HCPCS J1170
Hospital Charge Code	41655979
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$5.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
Rate for Payer: Brighton Health Commercial	$2.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.30
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: 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	$2.60

HYDROMORPHONE 2MG/ML INJ ISEC

Facility

$4.00

Service Code	HCPCS J1170
Hospital Charge Code	41645979
Hospital Revenue Code	636
Min. Negotiated Rate	$1.40
Max. Negotiated Rate	$5.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
Rate for Payer: Brighton Health Commercial	$2.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.30
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: 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	$2.60

HYDROMORPHONE 2MG/ML INJ ISEC

Facility

$4.00

Service Code	HCPCS J1170
Hospital Charge Code	41645979
Hospital Revenue Code	636
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00

HYDROMORPHONE 2MG/ML INJ ISEC

Facility

$4.00

Service Code	HCPCS J1170
Hospital Charge Code	41655979
Hospital Revenue Code	636
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.00
Rate for Payer: Hamaspik Choice Inc Medicare	$2.00

HYDROMORPHONE 2MG TAB

Facility

$1.00

Hospital Charge Code	41650339
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

HYDROMORPHONE 2MG TAB

Facility

$1.00

Hospital Charge Code	41640339
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

HYDROMORPHONE 4 MG TAB

Facility

$0.40

Hospital Charge Code	41655213
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.26

HYDROMORPHONE 4 MG TAB

Facility

$0.40

Hospital Charge Code	41645213
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$0.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.20
Rate for Payer: Aetna Government	$0.20
Rate for Payer: Brighton Health Commercial	$0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$0.32
Rate for Payer: Cigna LocalPlus Benefit Plan	$0.27
Rate for Payer: Group Health Inc Commercial	$0.20
Rate for Payer: Group Health Inc Medicare	$0.14
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.20
Rate for Payer: Hamaspik Choice Inc Medicare	$0.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$0.26

HYDROMORPHONE 50MG/D5W 50ML PCA

Facility

$14.00

Service Code	HCPCS J1170
Hospital Charge Code	41657175
Hospital Revenue Code	636
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00

HYDROMORPHONE 50MG/D5W 50ML PCA

Facility

$14.00

Service Code	HCPCS J1170
Hospital Charge Code	41647175
Hospital Revenue Code	636
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$9.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
Rate for Payer: Brighton Health Commercial	$8.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.05
Rate for Payer: Group Health Inc Commercial	$7.00
Rate for Payer: Group Health Inc Medicare	$4.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00
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	$9.10

HYDROMORPHONE 50MG/D5W 50ML PCA

Facility

$14.00

Service Code	HCPCS J1170
Hospital Charge Code	41647175
Hospital Revenue Code	636
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00

HYDROMORPHONE 50MG/D5W 50ML PCA

Facility

$14.00

Service Code	HCPCS J1170
Hospital Charge Code	41657175
Hospital Revenue Code	636
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$9.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
Rate for Payer: Brighton Health Commercial	$8.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.05
Rate for Payer: Group Health Inc Commercial	$7.00
Rate for Payer: Group Health Inc Medicare	$4.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00
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	$9.10

HYDROMORPHONE 50MG NS 50ML PCA

Facility

$14.00

Service Code	HCPCS J1170
Hospital Charge Code	41657176
Hospital Revenue Code	636
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$9.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
Rate for Payer: Brighton Health Commercial	$8.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.05
Rate for Payer: Group Health Inc Commercial	$7.00
Rate for Payer: Group Health Inc Medicare	$4.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00
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	$9.10

HYDROMORPHONE 50MG NS 50ML PCA

Facility

$14.00

Service Code	HCPCS J1170
Hospital Charge Code	41657176
Hospital Revenue Code	636
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00

HYDROMORPHONE 50MGNS 50ML PCA

Facility

$14.00

Service Code	HCPCS J1170
Hospital Charge Code	41647176
Hospital Revenue Code	636
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$7.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00

HYDROMORPHONE 50MGNS 50ML PCA

Facility

$14.00

Service Code	HCPCS J1170
Hospital Charge Code	41647176
Hospital Revenue Code	636
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$9.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$7.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
Rate for Payer: Brighton Health Commercial	$8.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.00
Rate for Payer: Cigna LocalPlus Benefit Plan	$8.05
Rate for Payer: Group Health Inc Commercial	$7.00
Rate for Payer: Group Health Inc Medicare	$4.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$7.00
Rate for Payer: Hamaspik Choice Inc Medicare	$7.00
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	$9.10

HYDROMORPHONE HCL 1 MG/ML IJ SOLN [3757]

Facility

$9.96

Service Code	HCPCS J1170
Hospital Charge Code	76045000996
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$7.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
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: 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$4.76
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$5.04
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5.04
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.47

HYDROMORPHONE HCL 1 MG/ML IJ SOLN [3757]

Facility

$3.12

Service Code	HCPCS J1170
Hospital Charge Code	00409128303
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$5.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
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: 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$4.76
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$5.04
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5.04
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.03

HYDROMORPHONE HCL 1 MG/ML IJ SOLN [3757]

Facility

$3.12

Service Code	HCPCS J1170
Hospital Charge Code	00409128331
Hospital Revenue Code	250
Min. Negotiated Rate	$1.09
Max. Negotiated Rate	$5.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
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: 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$4.76
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$5.04
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5.04
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.03

HYDROMORPHONE HCL 1 MG/ML IJ SOLN [3757]

Facility

$3.25

Service Code	HCPCS J1170
Hospital Charge Code	00409255201
Hospital Revenue Code	250
Min. Negotiated Rate	$1.14
Max. Negotiated Rate	$5.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
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: 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$4.76
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$5.04
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5.04
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.11

HYDROMORPHONE HCL 1 MG/ML IJ SOLN [3757]

Facility

$5.88

Service Code	HCPCS J1170
Hospital Charge Code	00409128337
Hospital Revenue Code	250
Min. Negotiated Rate	$2.06
Max. Negotiated Rate	$5.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
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: 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$4.76
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$5.04
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5.04
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.82

HYDROMORPHONE HCL 1 MG/ML IJ SOLN [3757]

Facility

$9.96

Service Code	HCPCS J1170
Hospital Charge Code	76045000906
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$7.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.30
Rate for Payer: Aetna Government	$3.30
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: 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: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$4.76
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$5.04
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$5.04
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$5.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.47

Know your out-of-pocket cost for care.

All Charges