Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

GROUP TREATMENT THERA PROCED

Facility

$63.00

Service Code	HCPCS 97150 GP
Hospital Charge Code	4650012
Hospital Revenue Code	420
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$187.00
Rate for Payer: Aetna of NY Commercial	$115.00
Rate for Payer: Aetna of NY Medicare	$28.98
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$25.20
Rate for Payer: Cash Price	$47.25
Rate for Payer: Cash Price	$47.25
Rate for Payer: Cash Price	$47.25
Rate for Payer: CDPHP Medicare	$23.31
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$50.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$50.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$50.40
Rate for Payer: EmblemHealth Medicaid	$50.40
Rate for Payer: EmblemHealth Medicare	$21.42
Rate for Payer: EmblemHealth Select Care	$45.36
Rate for Payer: Fidelis Medicare	$25.20
Rate for Payer: Galaxy Health Commercial	$40.95
Rate for Payer: Hamaspik Choice Medicare	$25.20
Rate for Payer: Humana Medicare	$25.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$115.00
Rate for Payer: Local 1199SEIU Medicare	$28.98
Rate for Payer: MVP Health Care of NY Commercial	$187.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$141.00
Rate for Payer: MVP Health Care of NY Medicare	$26.46
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$161.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$9.45
Rate for Payer: United Healthcare Commercial	$161.00
Rate for Payer: United Healthcare Medicare	$25.20
Rate for Payer: WellCare Medicare	$34.65

GROUP TREATMENT THERA PROCED

Facility

$63.00

Service Code	HCPCS 97150 GP
Hospital Charge Code	4650012
Hospital Revenue Code	420
Min. Negotiated Rate	$40.95
Max. Negotiated Rate	$40.95
Rate for Payer: Cash Price	$47.25
Rate for Payer: Galaxy Health Commercial	$40.95

GROUP TREATMENT THERA PROCED (MOD 59)

Facility

$63.00

Service Code	HCPCS 97150 GP,59
Hospital Charge Code	4650364
Hospital Revenue Code	420
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$187.00
Rate for Payer: Aetna of NY Commercial	$115.00
Rate for Payer: Aetna of NY Medicare	$28.98
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$25.20
Rate for Payer: Cash Price	$47.25
Rate for Payer: Cash Price	$47.25
Rate for Payer: Cash Price	$47.25
Rate for Payer: CDPHP Medicare	$23.31
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$50.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$50.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$50.40
Rate for Payer: EmblemHealth Medicaid	$50.40
Rate for Payer: EmblemHealth Medicare	$21.42
Rate for Payer: EmblemHealth Select Care	$45.36
Rate for Payer: Fidelis Medicare	$25.20
Rate for Payer: Galaxy Health Commercial	$40.95
Rate for Payer: Hamaspik Choice Medicare	$25.20
Rate for Payer: Humana Medicare	$25.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$115.00
Rate for Payer: Local 1199SEIU Medicare	$28.98
Rate for Payer: MVP Health Care of NY Commercial	$187.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$141.00
Rate for Payer: MVP Health Care of NY Medicare	$26.46
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$161.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$9.45
Rate for Payer: United Healthcare Commercial	$161.00
Rate for Payer: United Healthcare Medicare	$25.20
Rate for Payer: WellCare Medicare	$34.65

GROUP TREATMENT THERA PROCED (MOD 59)

Facility

$63.00

Service Code	HCPCS 97150 GP,59
Hospital Charge Code	4650364
Hospital Revenue Code	420
Min. Negotiated Rate	$40.95
Max. Negotiated Rate	$40.95
Rate for Payer: Cash Price	$47.25
Rate for Payer: Galaxy Health Commercial	$40.95

GROUP TREATMENT THERA PROCED (MOD 59 W KX)

Facility

$63.00

Service Code	HCPCS 97150 GP,59,KX
Hospital Charge Code	4650416
Hospital Revenue Code	420
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$187.00
Rate for Payer: Aetna of NY Commercial	$115.00
Rate for Payer: Aetna of NY Medicare	$28.98
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$25.20
Rate for Payer: Cash Price	$47.25
Rate for Payer: Cash Price	$47.25
Rate for Payer: Cash Price	$47.25
Rate for Payer: CDPHP Medicare	$23.31
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$50.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$50.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$50.40
Rate for Payer: EmblemHealth Medicaid	$50.40
Rate for Payer: EmblemHealth Medicare	$21.42
Rate for Payer: EmblemHealth Select Care	$45.36
Rate for Payer: Fidelis Medicare	$25.20
Rate for Payer: Galaxy Health Commercial	$40.95
Rate for Payer: Hamaspik Choice Medicare	$25.20
Rate for Payer: Humana Medicare	$25.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$115.00
Rate for Payer: Local 1199SEIU Medicare	$28.98
Rate for Payer: MVP Health Care of NY Commercial	$187.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$141.00
Rate for Payer: MVP Health Care of NY Medicare	$26.46
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$161.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$9.45
Rate for Payer: United Healthcare Commercial	$161.00
Rate for Payer: United Healthcare Medicare	$25.20
Rate for Payer: WellCare Medicare	$34.65

GROUP TREATMENT THERA PROCED (MOD 59 W KX)

Facility

$63.00

Service Code	HCPCS 97150 GP,59,KX
Hospital Charge Code	4650416
Hospital Revenue Code	420
Min. Negotiated Rate	$40.95
Max. Negotiated Rate	$40.95
Rate for Payer: Cash Price	$47.25
Rate for Payer: Galaxy Health Commercial	$40.95

GROUP TREATMENT THERA PROCED (W/ KX)

Facility

$63.00

Service Code	HCPCS 97150 GP,KX
Hospital Charge Code	4650309
Hospital Revenue Code	420
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$187.00
Rate for Payer: Aetna of NY Commercial	$115.00
Rate for Payer: Aetna of NY Medicare	$28.98
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$25.20
Rate for Payer: Cash Price	$47.25
Rate for Payer: Cash Price	$47.25
Rate for Payer: Cash Price	$47.25
Rate for Payer: CDPHP Medicare	$23.31
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$50.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$50.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$50.40
Rate for Payer: EmblemHealth Medicaid	$50.40
Rate for Payer: EmblemHealth Medicare	$21.42
Rate for Payer: EmblemHealth Select Care	$45.36
Rate for Payer: Fidelis Medicare	$25.20
Rate for Payer: Galaxy Health Commercial	$40.95
Rate for Payer: Hamaspik Choice Medicare	$25.20
Rate for Payer: Humana Medicare	$25.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$115.00
Rate for Payer: Local 1199SEIU Medicare	$28.98
Rate for Payer: MVP Health Care of NY Commercial	$187.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$141.00
Rate for Payer: MVP Health Care of NY Medicare	$26.46
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$161.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$9.45
Rate for Payer: United Healthcare Commercial	$161.00
Rate for Payer: United Healthcare Medicare	$25.20
Rate for Payer: WellCare Medicare	$34.65

GROUP TREATMENT THERA PROCED (W/ KX)

Facility

$63.00

Service Code	HCPCS 97150 GP,KX
Hospital Charge Code	4650309
Hospital Revenue Code	420
Min. Negotiated Rate	$40.95
Max. Negotiated Rate	$40.95
Rate for Payer: Cash Price	$47.25
Rate for Payer: Galaxy Health Commercial	$40.95

GUAIFEN/COD 100-10MG/5ML SYRP 100X5ML

Facility

$6.18

Service Code	NDC 121177505
Hospital Charge Code	4400338
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

GUAIFEN/COD 100-10MG/5ML SYRP 100X5ML

Facility

$6.18

Service Code	NDC 121177505
Hospital Charge Code	4400338
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$4.94
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) Medicare	$2.47
Rate for Payer: Cash Price	$4.64
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	$2.47
Rate for Payer: Galaxy Health Commercial	$4.02
Rate for Payer: Hamaspik Choice Medicare	$2.47
Rate for Payer: Humana Medicare	$2.47
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	$4.63
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$3.48
Rate for Payer: MVP Health Care of NY Medicare	$2.60
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.93
Rate for Payer: United Healthcare Medicare	$2.47
Rate for Payer: WellCare Medicare	$3.40

GUAIFEN/DM 100-10MG/5ML SYRP 100X10ML

Facility

$6.18

Service Code	NDC 121127610
Hospital Charge Code	4400337
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

GUAIFEN/DM 100-10MG/5ML SYRP 100X10ML

Facility

$6.18

Service Code	NDC 121127610
Hospital Charge Code	4400337
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$4.94
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) Medicare	$2.47
Rate for Payer: Cash Price	$4.64
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	$2.47
Rate for Payer: Galaxy Health Commercial	$4.02
Rate for Payer: Hamaspik Choice Medicare	$2.47
Rate for Payer: Humana Medicare	$2.47
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	$4.63
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$3.48
Rate for Payer: MVP Health Care of NY Medicare	$2.60
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.93
Rate for Payer: United Healthcare Medicare	$2.47
Rate for Payer: WellCare Medicare	$3.40

GUAIFENESIN 100MG/5ML SYRP 100X10ML

Facility

$6.18

Service Code	NDC 121174410
Hospital Charge Code	4400336
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$4.94
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) Medicare	$2.47
Rate for Payer: Cash Price	$4.64
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	$2.47
Rate for Payer: Galaxy Health Commercial	$4.02
Rate for Payer: Hamaspik Choice Medicare	$2.47
Rate for Payer: Humana Medicare	$2.47
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	$4.63
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$3.48
Rate for Payer: MVP Health Care of NY Medicare	$2.60
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.93
Rate for Payer: United Healthcare Medicare	$2.47
Rate for Payer: WellCare Medicare	$3.40

GUAIFENESIN 100MG/5ML SYRP 100X10ML

Facility

$6.18

Service Code	NDC 121174410
Hospital Charge Code	4400336
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

GUAIFENESIN 600MG TABS 100 EA

Facility

$6.18

Service Code	NDC 63824000815
Hospital Charge Code	4400529
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$4.94
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) Medicare	$2.47
Rate for Payer: Cash Price	$4.64
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	$2.47
Rate for Payer: Galaxy Health Commercial	$4.02
Rate for Payer: Hamaspik Choice Medicare	$2.47
Rate for Payer: Humana Medicare	$2.47
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	$4.63
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$3.48
Rate for Payer: MVP Health Care of NY Medicare	$2.60
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.93
Rate for Payer: United Healthcare Medicare	$2.47
Rate for Payer: WellCare Medicare	$3.40

GUAIFENESIN 600MG TABS 100 EA

Facility

$6.18

Service Code	NDC 63824000815
Hospital Charge Code	4400529
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

GUHL ANKLE DISTRAKTER

Facility

$990.86

Hospital Charge Code	4479158
Hospital Revenue Code	270
Min. Negotiated Rate	$148.63
Max. Negotiated Rate	$792.69
Rate for Payer: Aetna of NY Commercial	$693.60
Rate for Payer: Aetna of NY Medicare	$455.80
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$396.34
Rate for Payer: Cash Price	$743.14
Rate for Payer: CDPHP Medicare	$366.62
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$792.69
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$792.69
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$792.69
Rate for Payer: EmblemHealth Medicaid	$792.69
Rate for Payer: EmblemHealth Medicare	$336.89
Rate for Payer: EmblemHealth Select Care	$713.42
Rate for Payer: Fidelis Medicare	$396.34
Rate for Payer: Galaxy Health Commercial	$644.06
Rate for Payer: Hamaspik Choice Medicare	$396.34
Rate for Payer: Humana Medicare	$396.34
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$693.60
Rate for Payer: Local 1199SEIU Medicare	$455.80
Rate for Payer: MVP Health Care of NY Commercial	$743.14
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$557.85
Rate for Payer: MVP Health Care of NY Medicare	$416.16
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$148.63
Rate for Payer: United Healthcare Medicare	$396.34
Rate for Payer: WellCare Medicare	$544.97

GUHL ANKLE DISTRAKTER

Facility

$990.86

Hospital Charge Code	4479158
Hospital Revenue Code	270
Min. Negotiated Rate	$644.06
Max. Negotiated Rate	$644.06
Rate for Payer: Cash Price	$743.14
Rate for Payer: Galaxy Health Commercial	$644.06

HALOPERIDOL 1MG TABS 100 EA

Facility

$6.18

Service Code	NDC 51079073401
Hospital Charge Code	4400340
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$4.94
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) Medicare	$2.47
Rate for Payer: Cash Price	$4.64
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	$2.47
Rate for Payer: Galaxy Health Commercial	$4.02
Rate for Payer: Hamaspik Choice Medicare	$2.47
Rate for Payer: Humana Medicare	$2.47
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	$4.63
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$3.48
Rate for Payer: MVP Health Care of NY Medicare	$2.60
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.93
Rate for Payer: United Healthcare Medicare	$2.47
Rate for Payer: WellCare Medicare	$3.40

HALOPERIDOL 1MG TABS 100 EA

Facility

$6.18

Service Code	NDC 51079073401
Hospital Charge Code	4400340
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

HALOPERIDOL INJ, UP TO 5 MG

Facility

$110.98

Service Code	HCPCS J1630
Hospital Charge Code	4400341
Hospital Revenue Code	636
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$88.78
Rate for Payer: Aetna of NY Medicare	$51.05
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$44.39
Rate for Payer: Cash Price	$83.24
Rate for Payer: Cash Price	$83.24
Rate for Payer: CDPHP Medicare	$41.06
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.79
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$88.78
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$88.78
Rate for Payer: EmblemHealth Medicaid	$88.78
Rate for Payer: EmblemHealth Medicare	$37.73
Rate for Payer: EmblemHealth Select Care	$0.79
Rate for Payer: Fidelis Medicare	$44.39
Rate for Payer: Galaxy Health Commercial	$72.14
Rate for Payer: Hamaspik Choice Medicare	$44.39
Rate for Payer: Humana Medicare	$44.39
Rate for Payer: Local 1199SEIU Medicare	$51.05
Rate for Payer: MVP Health Care of NY Commercial	$83.23
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$62.48
Rate for Payer: MVP Health Care of NY Medicare	$46.61
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$2.28
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$16.65
Rate for Payer: United Healthcare Commercial	$2.28
Rate for Payer: United Healthcare Medicare	$44.39
Rate for Payer: WellCare Medicare	$61.04

HALOPERIDOL INJ, UP TO 5 MG

Facility

$110.98

Service Code	HCPCS J1630
Hospital Charge Code	4400341
Hospital Revenue Code	636
Min. Negotiated Rate	$0.79
Max. Negotiated Rate	$72.14
Rate for Payer: Aetna of NY Commercial	$61.04
Rate for Payer: Cash Price	$83.24
Rate for Payer: Cash Price	$83.24
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.79
Rate for Payer: EmblemHealth Select Care	$0.79
Rate for Payer: Galaxy Health Commercial	$72.14
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$61.04
Rate for Payer: WellCare Medicare	$61.04

HAMMERTOE OP ONE TOE

Facility

$10,029.00

Service Code	HCPCS 28285
Hospital Charge Code	4856716
Hospital Revenue Code	761
Min. Negotiated Rate	$1,504.35
Max. Negotiated Rate	$8,023.20
Rate for Payer: Aetna of NY Commercial	$7,020.30
Rate for Payer: Aetna of NY Medicare	$4,613.34
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$4,011.60
Rate for Payer: Cash Price	$7,521.75
Rate for Payer: CDPHP Medicare	$3,710.73
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$8,023.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$8,023.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$8,023.20
Rate for Payer: EmblemHealth Medicaid	$8,023.20
Rate for Payer: EmblemHealth Medicare	$3,409.86
Rate for Payer: EmblemHealth Select Care	$7,220.88
Rate for Payer: Fidelis Medicare	$4,011.60
Rate for Payer: Galaxy Health Commercial	$6,518.85
Rate for Payer: Hamaspik Choice Medicare	$4,011.60
Rate for Payer: Humana Medicare	$4,011.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$7,020.30
Rate for Payer: Local 1199SEIU Medicare	$4,613.34
Rate for Payer: MVP Health Care of NY Commercial	$7,521.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$5,646.33
Rate for Payer: MVP Health Care of NY Medicare	$4,212.18
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,504.35
Rate for Payer: United Healthcare Medicare	$4,011.60
Rate for Payer: WellCare Medicare	$5,515.95

HAMMERTOE OP ONE TOE

Facility

$10,029.00

Service Code	HCPCS 28285
Hospital Charge Code	4856716
Hospital Revenue Code	761
Min. Negotiated Rate	$6,518.85
Max. Negotiated Rate	$6,518.85
Rate for Payer: Cash Price	$7,521.75
Rate for Payer: Galaxy Health Commercial	$6,518.85

HAPTOGLOBIN

Facility

$38.00

Service Code	HCPCS 83010
Hospital Charge Code	4300396
Hospital Revenue Code	301
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$24.70
Rate for Payer: Cash Price	$28.50
Rate for Payer: Galaxy Health Commercial	$24.70

Know your out-of-pocket cost for care.

All Charges