|
HUMALOG INSULIN KWIKPEN 100 UNITS/ML,
|
Facility
|
IP
|
$339.39
|
|
|
Service Code
|
NDC 00002879901
|
| Hospital Charge Code |
4409140
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$186.66 |
| Max. Negotiated Rate |
$220.60 |
| Rate for Payer: Cash Price |
$254.54
|
| Rate for Payer: Galaxy Health Commercial |
$220.60
|
| Rate for Payer: WellCare Medicare |
$186.66
|
|
|
HUMALOG INSULIN KWIKPEN 100 UNITS/ML,
|
Facility
|
OP
|
$339.39
|
|
|
Service Code
|
NDC 00002879901
|
| Hospital Charge Code |
4409140
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$115.39 |
| Max. Negotiated Rate |
$273.21 |
| Rate for Payer: Aetna of NY Commercial |
$237.57
|
| Rate for Payer: Aetna of NY Medicare |
$156.12
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$254.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$254.54
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$125.57
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$169.70
|
| Rate for Payer: Cash Price |
$254.54
|
| Rate for Payer: CDPHP Commercial |
$273.21
|
| Rate for Payer: CDPHP Medicare |
$125.57
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$271.51
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$271.51
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$271.51
|
| Rate for Payer: EmblemHealth Medicaid |
$271.51
|
| Rate for Payer: EmblemHealth Medicare |
$115.39
|
| Rate for Payer: EmblemHealth Select Care |
$244.36
|
| Rate for Payer: Fidelis Medicare |
$129.34
|
| Rate for Payer: Galaxy Health Commercial |
$220.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$125.57
|
| Rate for Payer: Humana Medicare |
$125.57
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$237.57
|
| Rate for Payer: Local 1199SEIU Medicare |
$156.12
|
| Rate for Payer: MVP Health Care of NY Commercial |
$254.54
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$191.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$131.85
|
| Rate for Payer: United Healthcare Medicare |
$125.57
|
| Rate for Payer: WellCare Medicare |
$186.66
|
|
|
HUMAN TETANUS IG INJ TO 250 UNITS
|
Facility
|
OP
|
$866.12
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
4409063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$294.48 |
| Max. Negotiated Rate |
$892.63 |
| Rate for Payer: Aetna of NY Commercial |
$476.37
|
| Rate for Payer: Aetna of NY Medicare |
$398.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$578.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$578.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$320.46
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$433.06
|
| Rate for Payer: Cash Price |
$649.59
|
| Rate for Payer: Cash Price |
$649.59
|
| Rate for Payer: CDPHP Commercial |
$697.23
|
| Rate for Payer: CDPHP Medicare |
$320.46
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$578.78
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$692.90
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$692.90
|
| Rate for Payer: EmblemHealth Medicaid |
$692.90
|
| Rate for Payer: EmblemHealth Medicare |
$294.48
|
| Rate for Payer: EmblemHealth Select Care |
$578.78
|
| Rate for Payer: Fidelis Medicare |
$330.08
|
| Rate for Payer: Galaxy Health Commercial |
$562.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$320.46
|
| Rate for Payer: Humana Medicare |
$320.46
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$476.37
|
| Rate for Payer: Local 1199SEIU Medicare |
$398.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$649.59
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$487.63
|
| Rate for Payer: MVP Health Care of NY Medicare |
$336.49
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$892.63
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$578.78
|
| Rate for Payer: United Healthcare Commercial |
$892.63
|
| Rate for Payer: United Healthcare Medicare |
$320.46
|
| Rate for Payer: WellCare Medicare |
$476.37
|
|
|
HUMAN TETANUS IG INJ TO 250 UNITS
|
Facility
|
IP
|
$866.12
|
|
|
Service Code
|
HCPCS J1670
|
| Hospital Charge Code |
4409063
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$476.37 |
| Max. Negotiated Rate |
$578.78 |
| Rate for Payer: Aetna of NY Commercial |
$476.37
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$578.78
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$578.78
|
| Rate for Payer: Cash Price |
$649.59
|
| Rate for Payer: Cash Price |
$649.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$578.78
|
| Rate for Payer: EmblemHealth Select Care |
$578.78
|
| Rate for Payer: Galaxy Health Commercial |
$562.98
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$476.37
|
| Rate for Payer: WellCare Medicare |
$476.37
|
|
|
HVS 1/2 PCR
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
4300455
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$32.47 |
| Max. Negotiated Rate |
$464.48 |
| Rate for Payer: Aetna of NY Commercial |
$375.05
|
| Rate for Payer: Aetna of NY Medicare |
$265.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$432.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$432.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$213.49
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$288.50
|
| Rate for Payer: Cash Price |
$432.75
|
| Rate for Payer: Cash Price |
$432.75
|
| Rate for Payer: CDPHP Commercial |
$464.48
|
| Rate for Payer: CDPHP Medicare |
$213.49
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$346.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$461.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$461.60
|
| Rate for Payer: EmblemHealth Medicaid |
$461.60
|
| Rate for Payer: EmblemHealth Medicare |
$196.18
|
| Rate for Payer: EmblemHealth Select Care |
$346.20
|
| Rate for Payer: Fidelis Medicare |
$219.89
|
| Rate for Payer: Galaxy Health Commercial |
$375.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$213.49
|
| Rate for Payer: Humana Medicare |
$213.49
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$375.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$265.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$432.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$324.85
|
| Rate for Payer: MVP Health Care of NY Medicare |
$224.16
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$432.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$32.47
|
| Rate for Payer: United Healthcare Commercial |
$432.75
|
| Rate for Payer: United Healthcare Medicare |
$213.49
|
| Rate for Payer: WellCare Medicare |
$317.35
|
|
|
HVS 1/2 PCR
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
4300455
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$375.05 |
| Max. Negotiated Rate |
$375.05 |
| Rate for Payer: Cash Price |
$432.75
|
| Rate for Payer: Galaxy Health Commercial |
$375.05
|
|
|
HYALURONAN,SYNVISC 1MG
|
Facility
|
IP
|
$102.72
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
4400743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$66.77 |
| Rate for Payer: Aetna of NY Commercial |
$56.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8.88
|
| Rate for Payer: Cash Price |
$77.04
|
| Rate for Payer: Cash Price |
$77.04
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.88
|
| Rate for Payer: EmblemHealth Select Care |
$8.88
|
| Rate for Payer: Galaxy Health Commercial |
$66.77
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$56.50
|
| Rate for Payer: WellCare Medicare |
$56.50
|
|
|
HYALURONAN,SYNVISC 1MG
|
Facility
|
OP
|
$102.72
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
4400743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$82.69 |
| Rate for Payer: Aetna of NY Commercial |
$56.50
|
| Rate for Payer: Aetna of NY Medicare |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$8.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$8.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.01
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$51.36
|
| Rate for Payer: Cash Price |
$77.04
|
| Rate for Payer: Cash Price |
$77.04
|
| Rate for Payer: CDPHP Commercial |
$82.69
|
| Rate for Payer: CDPHP Medicare |
$38.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.88
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$82.18
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$82.18
|
| Rate for Payer: EmblemHealth Medicaid |
$82.18
|
| Rate for Payer: EmblemHealth Medicare |
$34.92
|
| Rate for Payer: EmblemHealth Select Care |
$8.88
|
| Rate for Payer: Fidelis Medicare |
$39.15
|
| Rate for Payer: Galaxy Health Commercial |
$66.77
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.01
|
| Rate for Payer: Humana Medicare |
$38.01
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$56.50
|
| Rate for Payer: Local 1199SEIU Medicare |
$47.25
|
| Rate for Payer: MVP Health Care of NY Commercial |
$77.04
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$57.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$39.91
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$15.87
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.88
|
| Rate for Payer: United Healthcare Commercial |
$15.87
|
| Rate for Payer: United Healthcare Medicare |
$38.01
|
| Rate for Payer: WellCare Medicare |
$56.50
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 00904644061
|
| Hospital Charge Code |
4408937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 00904644061
|
| Hospital Charge Code |
4408937
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
HYDRALAZINE 50 MG TAB
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 63739012710
|
| Hospital Charge Code |
4409018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
HYDRALAZINE 50 MG TAB
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 63739012710
|
| Hospital Charge Code |
4409018
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
HYDRALAZINE HCL 25MG TABS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 63739012610
|
| Hospital Charge Code |
4400356
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
HYDRALAZINE HCL 25MG TABS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 63739012610
|
| Hospital Charge Code |
4400356
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
HYDRALAZINE HCL TO 20 MG
|
Facility
|
OP
|
$164.03
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
4400355
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$132.04 |
| Rate for Payer: Aetna of NY Commercial |
$90.22
|
| Rate for Payer: Aetna of NY Medicare |
$75.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$60.69
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$82.02
|
| Rate for Payer: Cash Price |
$123.02
|
| Rate for Payer: Cash Price |
$123.02
|
| Rate for Payer: CDPHP Commercial |
$132.04
|
| Rate for Payer: CDPHP Medicare |
$60.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.56
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$131.22
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$131.22
|
| Rate for Payer: EmblemHealth Medicaid |
$131.22
|
| Rate for Payer: EmblemHealth Medicare |
$55.77
|
| Rate for Payer: EmblemHealth Select Care |
$5.56
|
| Rate for Payer: Fidelis Medicare |
$62.51
|
| Rate for Payer: Galaxy Health Commercial |
$106.62
|
| Rate for Payer: Hamaspik Choice Medicare |
$60.69
|
| Rate for Payer: Humana Medicare |
$60.69
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$90.22
|
| Rate for Payer: Local 1199SEIU Medicare |
$75.45
|
| Rate for Payer: MVP Health Care of NY Commercial |
$123.02
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$92.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$63.73
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$9.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.56
|
| Rate for Payer: United Healthcare Commercial |
$9.42
|
| Rate for Payer: United Healthcare Medicare |
$60.69
|
| Rate for Payer: WellCare Medicare |
$90.22
|
|
|
HYDRALAZINE HCL TO 20 MG
|
Facility
|
IP
|
$164.03
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
4400355
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$106.62 |
| Rate for Payer: Aetna of NY Commercial |
$90.22
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.56
|
| Rate for Payer: Cash Price |
$123.02
|
| Rate for Payer: Cash Price |
$123.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.56
|
| Rate for Payer: EmblemHealth Select Care |
$5.56
|
| Rate for Payer: Galaxy Health Commercial |
$106.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$90.22
|
| Rate for Payer: WellCare Medicare |
$90.22
|
|
|
HYDRATION EACH ADDITIONAL HOUR
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
4450104
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$23,767.00 |
| Rate for Payer: Aetna of NY Commercial |
$95.20
|
| Rate for Payer: Aetna of NY Medicare |
$62.56
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$320.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$400.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$534.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$237.67
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$50.32
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$68.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$237.67
|
| Rate for Payer: CDPHP Commercial |
$109.48
|
| Rate for Payer: CDPHP Essential Plan |
$534.76
|
| Rate for Payer: CDPHP Medicare |
$50.32
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$108.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$285.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$237.67
|
| Rate for Payer: EmblemHealth Medicaid |
$237.67
|
| Rate for Payer: EmblemHealth Medicare |
$46.24
|
| Rate for Payer: EmblemHealth Select Care |
$97.92
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$534.76
|
| Rate for Payer: Fidelis Medicare |
$51.83
|
| Rate for Payer: Galaxy Health Commercial |
$88.40
|
| Rate for Payer: Galaxy Health Workers Comp |
$349.37
|
| Rate for Payer: Hamaspik Choice Medicaid |
$23,767.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$50.32
|
| Rate for Payer: Humana Medicare |
$50.32
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$95.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$62.56
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$23,767.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$102.00
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$510.99
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$510.99
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$76.57
|
| Rate for Payer: MVP Health Care of NY Medicare |
$52.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$102.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$237.67
|
| Rate for Payer: United Healthcare Commercial |
$102.00
|
| Rate for Payer: United Healthcare Medicare |
$50.32
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$249.55
|
| Rate for Payer: WellCare Medicare |
$74.80
|
|
|
HYDRATION EACH ADDITIONAL HOUR
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
4450104
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$88.40 |
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Galaxy Health Commercial |
$88.40
|
|
|
HYDRATION IV INFUSION INIT 31-60 MINS
|
Facility
|
OP
|
$613.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
4450103
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$493.46 |
| Rate for Payer: Aetna of NY Commercial |
$429.10
|
| Rate for Payer: Aetna of NY Medicare |
$281.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$320.44
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$400.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$226.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$306.50
|
| Rate for Payer: Cash Price |
$459.75
|
| Rate for Payer: Cash Price |
$459.75
|
| Rate for Payer: Cash Price |
$459.75
|
| Rate for Payer: CDPHP Commercial |
$493.46
|
| Rate for Payer: CDPHP Medicare |
$226.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$490.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$490.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$490.40
|
| Rate for Payer: EmblemHealth Medicaid |
$490.40
|
| Rate for Payer: EmblemHealth Medicare |
$208.42
|
| Rate for Payer: EmblemHealth Select Care |
$441.36
|
| Rate for Payer: Fidelis Medicare |
$233.61
|
| Rate for Payer: Galaxy Health Commercial |
$398.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$226.81
|
| Rate for Payer: Humana Medicare |
$226.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$429.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$281.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$459.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$345.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$238.15
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$459.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$35.35
|
| Rate for Payer: United Healthcare Commercial |
$459.75
|
| Rate for Payer: United Healthcare Medicare |
$226.81
|
| Rate for Payer: WellCare Medicare |
$337.15
|
|
|
HYDRATION IV INFUSION INIT 31-60 MINS
|
Facility
|
IP
|
$613.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
4450103
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$398.45 |
| Max. Negotiated Rate |
$398.45 |
| Rate for Payer: Cash Price |
$459.75
|
| Rate for Payer: Galaxy Health Commercial |
$398.45
|
|
|
HYDROCHLOROTHIAZIDE 12.5MG CAPS 10X10EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 51079077620
|
| Hospital Charge Code |
4400358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
HYDROCHLOROTHIAZIDE 12.5MG CAPS 10X10EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 51079077620
|
| Hospital Charge Code |
4400358
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
HYDROCHLOROTHIAZIDE 25MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 63739012810
|
| Hospital Charge Code |
4400359
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.10 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Aetna of NY Commercial |
$4.33
|
| Rate for Payer: Aetna of NY Medicare |
$2.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$4.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.29
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.09
|
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: CDPHP Commercial |
$4.97
|
| Rate for Payer: CDPHP Medicare |
$2.29
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$4.94
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$4.94
|
| Rate for Payer: EmblemHealth Medicaid |
$4.94
|
| Rate for Payer: EmblemHealth Medicare |
$2.10
|
| Rate for Payer: EmblemHealth Select Care |
$4.45
|
| Rate for Payer: Fidelis Medicare |
$2.36
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.29
|
| Rate for Payer: Humana Medicare |
$2.29
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.33
|
| Rate for Payer: Local 1199SEIU Medicare |
$2.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$4.64
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.48
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.40
|
| Rate for Payer: United Healthcare Medicare |
$2.29
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
HYDROCHLOROTHIAZIDE 25MG TABS 100 EA
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 63739012810
|
| Hospital Charge Code |
4400359
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$4.02 |
| Rate for Payer: Cash Price |
$4.64
|
| Rate for Payer: Galaxy Health Commercial |
$4.02
|
| Rate for Payer: WellCare Medicare |
$3.40
|
|
|
HYDROCODONE/APAP 5/325 TABLET
|
Facility
|
OP
|
$6.85
|
|
|
Service Code
|
NDC 00904682461
|
| Hospital Charge Code |
4409117
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$5.51 |
| Rate for Payer: Aetna of NY Commercial |
$4.80
|
| Rate for Payer: Aetna of NY Medicare |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$5.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$5.14
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.53
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$3.42
|
| Rate for Payer: Cash Price |
$5.14
|
| Rate for Payer: CDPHP Commercial |
$5.51
|
| Rate for Payer: CDPHP Medicare |
$2.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$5.48
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$5.48
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$5.48
|
| Rate for Payer: EmblemHealth Medicaid |
$5.48
|
| Rate for Payer: EmblemHealth Medicare |
$2.33
|
| Rate for Payer: EmblemHealth Select Care |
$4.93
|
| Rate for Payer: Fidelis Medicare |
$2.61
|
| Rate for Payer: Galaxy Health Commercial |
$4.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.53
|
| Rate for Payer: Humana Medicare |
$2.53
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$3.15
|
| Rate for Payer: MVP Health Care of NY Commercial |
$5.14
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$3.86
|
| Rate for Payer: MVP Health Care of NY Medicare |
$2.66
|
| Rate for Payer: United Healthcare Medicare |
$2.53
|
| Rate for Payer: WellCare Medicare |
$3.77
|
|
