Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

HAPTOGLOBIN

Facility

$38.00

Service Code	HCPCS 83010
Hospital Charge Code	4300396
Hospital Revenue Code	301
Min. Negotiated Rate	$5.70
Max. Negotiated Rate	$30.40
Rate for Payer: Aetna of NY Commercial	$24.70
Rate for Payer: Aetna of NY Medicare	$17.48
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$15.20
Rate for Payer: Cash Price	$28.50
Rate for Payer: CDPHP Medicare	$14.06
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$22.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$30.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$30.40
Rate for Payer: EmblemHealth Medicaid	$30.40
Rate for Payer: EmblemHealth Medicare	$12.92
Rate for Payer: EmblemHealth Select Care	$22.80
Rate for Payer: Fidelis Medicare	$15.20
Rate for Payer: Galaxy Health Commercial	$24.70
Rate for Payer: Hamaspik Choice Medicare	$15.20
Rate for Payer: Humana Medicare	$15.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$24.70
Rate for Payer: Local 1199SEIU Medicare	$17.48
Rate for Payer: MVP Health Care of NY Commercial	$28.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$21.39
Rate for Payer: MVP Health Care of NY Medicare	$15.96
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$28.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.70
Rate for Payer: United Healthcare Commercial	$28.50
Rate for Payer: United Healthcare Medicare	$15.20
Rate for Payer: WellCare Medicare	$20.90

HCG; QUAN

Facility

$45.00

Service Code	HCPCS 84702
Hospital Charge Code	4300126
Hospital Revenue Code	301
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$29.25
Rate for Payer: Cash Price	$33.75
Rate for Payer: Galaxy Health Commercial	$29.25

HCG; QUAN

Facility

$45.00

Service Code	HCPCS 84702
Hospital Charge Code	4300126
Hospital Revenue Code	301
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of NY Commercial	$29.25
Rate for Payer: Aetna of NY Medicare	$20.70
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$18.00
Rate for Payer: Cash Price	$33.75
Rate for Payer: CDPHP Medicare	$16.65
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$27.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$36.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$36.00
Rate for Payer: EmblemHealth Medicaid	$36.00
Rate for Payer: EmblemHealth Medicare	$15.30
Rate for Payer: EmblemHealth Select Care	$27.00
Rate for Payer: Fidelis Medicare	$18.00
Rate for Payer: Galaxy Health Commercial	$29.25
Rate for Payer: Hamaspik Choice Medicare	$18.00
Rate for Payer: Humana Medicare	$18.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$29.25
Rate for Payer: Local 1199SEIU Medicare	$20.70
Rate for Payer: MVP Health Care of NY Commercial	$33.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$25.34
Rate for Payer: MVP Health Care of NY Medicare	$18.90
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$33.75
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$6.75
Rate for Payer: United Healthcare Commercial	$33.75
Rate for Payer: United Healthcare Medicare	$18.00
Rate for Payer: WellCare Medicare	$24.75

HEAD DRILL4.3MM COMPRS SCREW

Facility

$288.40

Hospital Charge Code	4471371
Hospital Revenue Code	270
Min. Negotiated Rate	$187.46
Max. Negotiated Rate	$187.46
Rate for Payer: Cash Price	$216.30
Rate for Payer: Galaxy Health Commercial	$187.46

HEAD DRILL4.3MM COMPRS SCREW

Facility

$288.40

Hospital Charge Code	4471371
Hospital Revenue Code	270
Min. Negotiated Rate	$43.26
Max. Negotiated Rate	$230.72
Rate for Payer: Aetna of NY Commercial	$201.88
Rate for Payer: Aetna of NY Medicare	$132.66
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$115.36
Rate for Payer: Cash Price	$216.30
Rate for Payer: CDPHP Medicare	$106.71
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$230.72
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$230.72
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$230.72
Rate for Payer: EmblemHealth Medicaid	$230.72
Rate for Payer: EmblemHealth Medicare	$98.06
Rate for Payer: EmblemHealth Select Care	$207.65
Rate for Payer: Fidelis Medicare	$115.36
Rate for Payer: Galaxy Health Commercial	$187.46
Rate for Payer: Hamaspik Choice Medicare	$115.36
Rate for Payer: Humana Medicare	$115.36
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$201.88
Rate for Payer: Local 1199SEIU Medicare	$132.66
Rate for Payer: MVP Health Care of NY Commercial	$216.30
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$162.37
Rate for Payer: MVP Health Care of NY Medicare	$121.13
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$43.26
Rate for Payer: United Healthcare Medicare	$115.36
Rate for Payer: WellCare Medicare	$158.62

HEART/LUNG RESUSCITATION CPR

Facility

$662.00

Service Code	HCPCS 92950
Hospital Charge Code	4480090
Hospital Revenue Code	480
Min. Negotiated Rate	$99.30
Max. Negotiated Rate	$529.60
Rate for Payer: Aetna of NY Commercial	$463.40
Rate for Payer: Aetna of NY Medicare	$304.52
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$264.80
Rate for Payer: Cash Price	$496.50
Rate for Payer: CDPHP Medicare	$244.94
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$463.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$529.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$529.60
Rate for Payer: EmblemHealth Medicaid	$529.60
Rate for Payer: EmblemHealth Medicare	$225.08
Rate for Payer: EmblemHealth Select Care	$430.30
Rate for Payer: Fidelis Medicare	$264.80
Rate for Payer: Galaxy Health Commercial	$430.30
Rate for Payer: Hamaspik Choice Medicare	$264.80
Rate for Payer: Humana Medicare	$264.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$463.40
Rate for Payer: Local 1199SEIU Medicare	$304.52
Rate for Payer: MVP Health Care of NY Commercial	$496.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$372.71
Rate for Payer: MVP Health Care of NY Medicare	$278.04
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$496.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$99.30
Rate for Payer: United Healthcare Commercial	$496.50
Rate for Payer: United Healthcare Medicare	$264.80
Rate for Payer: WellCare Medicare	$364.10

HEART/LUNG RESUSCITATION CPR

Facility

$662.00

Service Code	HCPCS 92950
Hospital Charge Code	4480090
Hospital Revenue Code	480
Min. Negotiated Rate	$430.30
Max. Negotiated Rate	$430.30
Rate for Payer: Cash Price	$496.50
Rate for Payer: Galaxy Health Commercial	$430.30

HEELBO LARGE WHITE

Facility

$23.69

Hospital Charge Code	4471290
Hospital Revenue Code	270
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$15.40
Rate for Payer: Cash Price	$17.77
Rate for Payer: Galaxy Health Commercial	$15.40

HEELBO LARGE WHITE

Facility

$23.69

Hospital Charge Code	4471290
Hospital Revenue Code	270
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$18.95
Rate for Payer: Aetna of NY Commercial	$16.58
Rate for Payer: Aetna of NY Medicare	$10.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$9.48
Rate for Payer: Cash Price	$17.77
Rate for Payer: CDPHP Medicare	$8.77
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$18.95
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$18.95
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$18.95
Rate for Payer: EmblemHealth Medicaid	$18.95
Rate for Payer: EmblemHealth Medicare	$8.05
Rate for Payer: EmblemHealth Select Care	$17.06
Rate for Payer: Fidelis Medicare	$9.48
Rate for Payer: Galaxy Health Commercial	$15.40
Rate for Payer: Hamaspik Choice Medicare	$9.48
Rate for Payer: Humana Medicare	$9.48
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$16.58
Rate for Payer: Local 1199SEIU Medicare	$10.90
Rate for Payer: MVP Health Care of NY Commercial	$17.77
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$13.34
Rate for Payer: MVP Health Care of NY Medicare	$9.95
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3.55
Rate for Payer: United Healthcare Medicare	$9.48
Rate for Payer: WellCare Medicare	$13.03

HEELBO MEDIUM BLUE

Facility

$23.69

Hospital Charge Code	4471289
Hospital Revenue Code	270
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$18.95
Rate for Payer: Aetna of NY Commercial	$16.58
Rate for Payer: Aetna of NY Medicare	$10.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$9.48
Rate for Payer: Cash Price	$17.77
Rate for Payer: CDPHP Medicare	$8.77
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$18.95
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$18.95
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$18.95
Rate for Payer: EmblemHealth Medicaid	$18.95
Rate for Payer: EmblemHealth Medicare	$8.05
Rate for Payer: EmblemHealth Select Care	$17.06
Rate for Payer: Fidelis Medicare	$9.48
Rate for Payer: Galaxy Health Commercial	$15.40
Rate for Payer: Hamaspik Choice Medicare	$9.48
Rate for Payer: Humana Medicare	$9.48
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$16.58
Rate for Payer: Local 1199SEIU Medicare	$10.90
Rate for Payer: MVP Health Care of NY Commercial	$17.77
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$13.34
Rate for Payer: MVP Health Care of NY Medicare	$9.95
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3.55
Rate for Payer: United Healthcare Medicare	$9.48
Rate for Payer: WellCare Medicare	$13.03

HEELBO MEDIUM BLUE

Facility

$23.69

Hospital Charge Code	4471289
Hospital Revenue Code	270
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$15.40
Rate for Payer: Cash Price	$17.77
Rate for Payer: Galaxy Health Commercial	$15.40

HEELBO SMALL YELLOW

Facility

$38.11

Hospital Charge Code	4471196
Hospital Revenue Code	270
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$30.49
Rate for Payer: Aetna of NY Commercial	$26.68
Rate for Payer: Aetna of NY Medicare	$17.53
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$15.24
Rate for Payer: Cash Price	$28.58
Rate for Payer: CDPHP Medicare	$14.10
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$30.49
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$30.49
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$30.49
Rate for Payer: EmblemHealth Medicaid	$30.49
Rate for Payer: EmblemHealth Medicare	$12.96
Rate for Payer: EmblemHealth Select Care	$27.44
Rate for Payer: Fidelis Medicare	$15.24
Rate for Payer: Galaxy Health Commercial	$24.77
Rate for Payer: Hamaspik Choice Medicare	$15.24
Rate for Payer: Humana Medicare	$15.24
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$26.68
Rate for Payer: Local 1199SEIU Medicare	$17.53
Rate for Payer: MVP Health Care of NY Commercial	$28.58
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$21.46
Rate for Payer: MVP Health Care of NY Medicare	$16.01
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.72
Rate for Payer: United Healthcare Medicare	$15.24
Rate for Payer: WellCare Medicare	$20.96

HEELBO SMALL YELLOW

Facility

$38.11

Hospital Charge Code	4471196
Hospital Revenue Code	270
Min. Negotiated Rate	$24.77
Max. Negotiated Rate	$24.77
Rate for Payer: Cash Price	$28.58
Rate for Payer: Galaxy Health Commercial	$24.77

HEEL FLOAT LARGE

Facility

$141.11

Hospital Charge Code	4471262
Hospital Revenue Code	270
Min. Negotiated Rate	$21.17
Max. Negotiated Rate	$112.89
Rate for Payer: Aetna of NY Commercial	$98.78
Rate for Payer: Aetna of NY Medicare	$64.91
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$56.44
Rate for Payer: Cash Price	$105.83
Rate for Payer: CDPHP Medicare	$52.21
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$112.89
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$112.89
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$112.89
Rate for Payer: EmblemHealth Medicaid	$112.89
Rate for Payer: EmblemHealth Medicare	$47.98
Rate for Payer: EmblemHealth Select Care	$101.60
Rate for Payer: Fidelis Medicare	$56.44
Rate for Payer: Galaxy Health Commercial	$91.72
Rate for Payer: Hamaspik Choice Medicare	$56.44
Rate for Payer: Humana Medicare	$56.44
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$98.78
Rate for Payer: Local 1199SEIU Medicare	$64.91
Rate for Payer: MVP Health Care of NY Commercial	$105.83
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$79.44
Rate for Payer: MVP Health Care of NY Medicare	$59.27
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$21.17
Rate for Payer: United Healthcare Medicare	$56.44
Rate for Payer: WellCare Medicare	$77.61

HEEL FLOAT LARGE

Facility

$141.11

Hospital Charge Code	4471262
Hospital Revenue Code	270
Min. Negotiated Rate	$91.72
Max. Negotiated Rate	$91.72
Rate for Payer: Cash Price	$105.83
Rate for Payer: Galaxy Health Commercial	$91.72

HEEL FLOAT MEDIUM

Facility

$123.60

Hospital Charge Code	4471397
Hospital Revenue Code	270
Min. Negotiated Rate	$18.54
Max. Negotiated Rate	$98.88
Rate for Payer: Aetna of NY Commercial	$86.52
Rate for Payer: Aetna of NY Medicare	$56.86
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$49.44
Rate for Payer: Cash Price	$92.70
Rate for Payer: CDPHP Medicare	$45.73
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$98.88
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$98.88
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$98.88
Rate for Payer: EmblemHealth Medicaid	$98.88
Rate for Payer: EmblemHealth Medicare	$42.02
Rate for Payer: EmblemHealth Select Care	$88.99
Rate for Payer: Fidelis Medicare	$49.44
Rate for Payer: Galaxy Health Commercial	$80.34
Rate for Payer: Hamaspik Choice Medicare	$49.44
Rate for Payer: Humana Medicare	$49.44
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$86.52
Rate for Payer: Local 1199SEIU Medicare	$56.86
Rate for Payer: MVP Health Care of NY Commercial	$92.70
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$69.59
Rate for Payer: MVP Health Care of NY Medicare	$51.91
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$18.54
Rate for Payer: United Healthcare Medicare	$49.44
Rate for Payer: WellCare Medicare	$67.98

HEEL FLOAT MEDIUM

Facility

$123.60

Hospital Charge Code	4471397
Hospital Revenue Code	270
Min. Negotiated Rate	$80.34
Max. Negotiated Rate	$80.34
Rate for Payer: Cash Price	$92.70
Rate for Payer: Galaxy Health Commercial	$80.34

HEEL FLOAT SMALL

Facility

$23.69

Hospital Charge Code	4471250
Hospital Revenue Code	270
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$18.95
Rate for Payer: Aetna of NY Commercial	$16.58
Rate for Payer: Aetna of NY Medicare	$10.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$9.48
Rate for Payer: Cash Price	$17.77
Rate for Payer: CDPHP Medicare	$8.77
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$18.95
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$18.95
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$18.95
Rate for Payer: EmblemHealth Medicaid	$18.95
Rate for Payer: EmblemHealth Medicare	$8.05
Rate for Payer: EmblemHealth Select Care	$17.06
Rate for Payer: Fidelis Medicare	$9.48
Rate for Payer: Galaxy Health Commercial	$15.40
Rate for Payer: Hamaspik Choice Medicare	$9.48
Rate for Payer: Humana Medicare	$9.48
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$16.58
Rate for Payer: Local 1199SEIU Medicare	$10.90
Rate for Payer: MVP Health Care of NY Commercial	$17.77
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$13.34
Rate for Payer: MVP Health Care of NY Medicare	$9.95
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3.55
Rate for Payer: United Healthcare Medicare	$9.48
Rate for Payer: WellCare Medicare	$13.03

HEEL FLOAT SMALL

Facility

$23.69

Hospital Charge Code	4471250
Hospital Revenue Code	270
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$15.40
Rate for Payer: Cash Price	$17.77
Rate for Payer: Galaxy Health Commercial	$15.40

HEMATOCRIT

Facility

$7.00

Service Code	HCPCS 85014
Hospital Charge Code	4300402
Hospital Revenue Code	300
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$4.55
Rate for Payer: Cash Price	$5.25
Rate for Payer: Galaxy Health Commercial	$4.55

HEMATOCRIT

Facility

$7.00

Service Code	HCPCS 85014
Hospital Charge Code	4300402
Hospital Revenue Code	300
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$5.60
Rate for Payer: Aetna of NY Commercial	$4.55
Rate for Payer: Aetna of NY Medicare	$3.22
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2.80
Rate for Payer: Cash Price	$5.25
Rate for Payer: CDPHP Medicare	$2.59
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$4.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$5.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$5.60
Rate for Payer: EmblemHealth Medicaid	$5.60
Rate for Payer: EmblemHealth Medicare	$2.38
Rate for Payer: EmblemHealth Select Care	$4.20
Rate for Payer: Fidelis Medicare	$2.80
Rate for Payer: Galaxy Health Commercial	$4.55
Rate for Payer: Hamaspik Choice Medicare	$2.80
Rate for Payer: Humana Medicare	$2.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$4.55
Rate for Payer: Local 1199SEIU Medicare	$3.22
Rate for Payer: MVP Health Care of NY Commercial	$5.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$3.94
Rate for Payer: MVP Health Care of NY Medicare	$2.94
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$5.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.05
Rate for Payer: United Healthcare Commercial	$5.25
Rate for Payer: United Healthcare Medicare	$2.80
Rate for Payer: WellCare Medicare	$3.85

HEMOGLOBIN

Facility

$7.00

Service Code	HCPCS 85018
Hospital Charge Code	4300390
Hospital Revenue Code	305
Min. Negotiated Rate	$4.55
Max. Negotiated Rate	$4.55
Rate for Payer: Cash Price	$5.25
Rate for Payer: Galaxy Health Commercial	$4.55

HEMOGLOBIN

Facility

$7.00

Service Code	HCPCS 85018
Hospital Charge Code	4300390
Hospital Revenue Code	305
Min. Negotiated Rate	$1.05
Max. Negotiated Rate	$5.60
Rate for Payer: Aetna of NY Commercial	$4.55
Rate for Payer: Aetna of NY Medicare	$3.22
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2.80
Rate for Payer: Cash Price	$5.25
Rate for Payer: CDPHP Medicare	$2.59
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$4.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$5.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$5.60
Rate for Payer: EmblemHealth Medicaid	$5.60
Rate for Payer: EmblemHealth Medicare	$2.38
Rate for Payer: EmblemHealth Select Care	$4.20
Rate for Payer: Fidelis Medicare	$2.80
Rate for Payer: Galaxy Health Commercial	$4.55
Rate for Payer: Hamaspik Choice Medicare	$2.80
Rate for Payer: Humana Medicare	$2.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$4.55
Rate for Payer: Local 1199SEIU Medicare	$3.22
Rate for Payer: MVP Health Care of NY Commercial	$5.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$3.94
Rate for Payer: MVP Health Care of NY Medicare	$2.94
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$5.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.05
Rate for Payer: United Healthcare Commercial	$5.25
Rate for Payer: United Healthcare Medicare	$2.80
Rate for Payer: WellCare Medicare	$3.85

heparin 25,000 UNIT/250-1/2 NS 25000 unit, 250 mL

Facility

$26.00

Service Code	HCPCS J1644
Hospital Charge Code	4401514
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna of NY Medicare	$11.96
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$10.40
Rate for Payer: Cash Price	$19.50
Rate for Payer: Cash Price	$19.50
Rate for Payer: CDPHP Medicare	$9.62
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.22
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$20.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$20.80
Rate for Payer: EmblemHealth Medicaid	$20.80
Rate for Payer: EmblemHealth Medicare	$8.84
Rate for Payer: EmblemHealth Select Care	$0.22
Rate for Payer: Fidelis Medicare	$10.40
Rate for Payer: Galaxy Health Commercial	$16.90
Rate for Payer: Hamaspik Choice Medicare	$10.40
Rate for Payer: Humana Medicare	$10.40
Rate for Payer: Local 1199SEIU Medicare	$11.96
Rate for Payer: MVP Health Care of NY Commercial	$19.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$14.64
Rate for Payer: MVP Health Care of NY Medicare	$10.92
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$0.43
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3.90
Rate for Payer: United Healthcare Commercial	$0.43
Rate for Payer: United Healthcare Medicare	$10.40
Rate for Payer: WellCare Medicare	$14.30

heparin 25,000 UNIT/250-1/2 NS 25000 unit, 250 mL

Facility

$26.00

Service Code	HCPCS J1644
Hospital Charge Code	4401514
Hospital Revenue Code	636
Min. Negotiated Rate	$0.22
Max. Negotiated Rate	$16.90
Rate for Payer: Aetna of NY Commercial	$14.30
Rate for Payer: Cash Price	$19.50
Rate for Payer: Cash Price	$19.50
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.22
Rate for Payer: EmblemHealth Select Care	$0.22
Rate for Payer: Galaxy Health Commercial	$16.90
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$14.30
Rate for Payer: WellCare Medicare	$14.30

Know your out-of-pocket cost for care.

All Charges