|
heparin 25,000 UNIT/500 ML-D5W 25000 unit, 500 mL
|
Facility
|
OP
|
$42.50
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
4401505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Aetna of NY Medicare |
$19.55
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$17.00
|
| Rate for Payer: Cash Price |
$31.88
|
| Rate for Payer: Cash Price |
$31.88
|
| Rate for Payer: CDPHP Medicare |
$15.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$34.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$34.00
|
| Rate for Payer: EmblemHealth Medicaid |
$34.00
|
| Rate for Payer: EmblemHealth Medicare |
$14.45
|
| Rate for Payer: EmblemHealth Select Care |
$0.22
|
| Rate for Payer: Fidelis Medicare |
$17.00
|
| Rate for Payer: Galaxy Health Commercial |
$27.62
|
| Rate for Payer: Hamaspik Choice Medicare |
$17.00
|
| Rate for Payer: Humana Medicare |
$17.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$19.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$31.88
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$23.93
|
| Rate for Payer: MVP Health Care of NY Medicare |
$17.85
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.43
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.38
|
| Rate for Payer: United Healthcare Commercial |
$0.43
|
| Rate for Payer: United Healthcare Medicare |
$17.00
|
| Rate for Payer: WellCare Medicare |
$23.38
|
|
|
heparin 25,000 UNIT/500 ML-D5W 25000 unit, 500 mL
|
Facility
|
IP
|
$42.50
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
4401505
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$27.62 |
| Rate for Payer: Aetna of NY Commercial |
$23.38
|
| Rate for Payer: Cash Price |
$31.88
|
| Rate for Payer: Cash Price |
$31.88
|
| 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 |
$27.62
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$23.38
|
| Rate for Payer: WellCare Medicare |
$23.38
|
|
|
HEPARIN FLUSH 100 UNITS/ML 500UNITS 5ML
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 64253033333
|
| Hospital Charge Code |
4409196
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.65 |
| Max. Negotiated Rate |
$8.80 |
| Rate for Payer: Aetna of NY Commercial |
$7.70
|
| Rate for Payer: Aetna of NY Medicare |
$5.06
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.40
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: CDPHP Medicare |
$4.07
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$8.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$8.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$8.80
|
| Rate for Payer: EmblemHealth Medicaid |
$8.80
|
| Rate for Payer: EmblemHealth Medicare |
$3.74
|
| Rate for Payer: EmblemHealth Select Care |
$7.92
|
| Rate for Payer: Fidelis Medicare |
$4.40
|
| Rate for Payer: Galaxy Health Commercial |
$7.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.40
|
| Rate for Payer: Humana Medicare |
$4.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$7.70
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.06
|
| Rate for Payer: MVP Health Care of NY Commercial |
$8.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$6.19
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.62
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.65
|
| Rate for Payer: United Healthcare Medicare |
$4.40
|
| Rate for Payer: WellCare Medicare |
$6.05
|
|
|
HEPARIN FLUSH 100 UNITS/ML 500UNITS 5ML
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 64253033333
|
| Hospital Charge Code |
4409196
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$7.15 |
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Galaxy Health Commercial |
$7.15
|
| Rate for Payer: WellCare Medicare |
$6.05
|
|
|
HEPARIN SODIUM INJ PER 1000 UNITS
|
Facility
|
OP
|
$30.90
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
4408964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$24.72 |
| Rate for Payer: Aetna of NY Medicare |
$14.21
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.36
|
| Rate for Payer: Cash Price |
$23.17
|
| Rate for Payer: Cash Price |
$23.17
|
| Rate for Payer: CDPHP Medicare |
$11.43
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.72
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.72
|
| Rate for Payer: EmblemHealth Medicaid |
$24.72
|
| Rate for Payer: EmblemHealth Medicare |
$10.51
|
| Rate for Payer: EmblemHealth Select Care |
$0.22
|
| Rate for Payer: Fidelis Medicare |
$12.36
|
| Rate for Payer: Galaxy Health Commercial |
$20.09
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.36
|
| Rate for Payer: Humana Medicare |
$12.36
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.21
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.18
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.40
|
| Rate for Payer: MVP Health Care of NY Medicare |
$12.98
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.43
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.63
|
| Rate for Payer: United Healthcare Commercial |
$0.43
|
| Rate for Payer: United Healthcare Medicare |
$12.36
|
| Rate for Payer: WellCare Medicare |
$17.00
|
|
|
HEPARIN SODIUM INJ PER 1000 UNITS
|
Facility
|
IP
|
$30.90
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
4408964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna of NY Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$23.17
|
| Rate for Payer: Cash Price |
$23.17
|
| 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 |
$20.09
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$17.00
|
| Rate for Payer: WellCare Medicare |
$17.00
|
|
|
HEPARIN SODIUM INJ PER 1000 UNITS
|
Facility
|
OP
|
$9.53
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
4400347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$7.62 |
| Rate for Payer: Aetna of NY Medicare |
$4.38
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$3.81
|
| Rate for Payer: Cash Price |
$7.15
|
| Rate for Payer: Cash Price |
$7.15
|
| Rate for Payer: CDPHP Medicare |
$3.53
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$0.22
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$7.62
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$7.62
|
| Rate for Payer: EmblemHealth Medicaid |
$7.62
|
| Rate for Payer: EmblemHealth Medicare |
$3.24
|
| Rate for Payer: EmblemHealth Select Care |
$0.22
|
| Rate for Payer: Fidelis Medicare |
$3.81
|
| Rate for Payer: Galaxy Health Commercial |
$6.19
|
| Rate for Payer: Hamaspik Choice Medicare |
$3.81
|
| Rate for Payer: Humana Medicare |
$3.81
|
| Rate for Payer: Local 1199SEIU Medicare |
$4.38
|
| Rate for Payer: MVP Health Care of NY Commercial |
$7.15
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$5.37
|
| Rate for Payer: MVP Health Care of NY Medicare |
$4.00
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$0.43
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.43
|
| Rate for Payer: United Healthcare Commercial |
$0.43
|
| Rate for Payer: United Healthcare Medicare |
$3.81
|
| Rate for Payer: WellCare Medicare |
$5.24
|
|
|
HEPARIN SODIUM INJ PER 1000 UNITS
|
Facility
|
IP
|
$9.53
|
|
|
Service Code
|
HCPCS J1644
|
| Hospital Charge Code |
4400347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.22 |
| Max. Negotiated Rate |
$6.19 |
| Rate for Payer: Aetna of NY Commercial |
$5.24
|
| Rate for Payer: Cash Price |
$7.15
|
| Rate for Payer: Cash Price |
$7.15
|
| 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 |
$6.19
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$5.24
|
| Rate for Payer: WellCare Medicare |
$5.24
|
|
|
HEPATIC FUNCTION PANEL
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
4300426
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$26.00 |
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
|
|
HEPATIC FUNCTION PANEL
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS 80076
|
| Hospital Charge Code |
4300426
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna of NY Commercial |
$26.00
|
| Rate for Payer: Aetna of NY Medicare |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$16.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: CDPHP Medicare |
$14.80
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$24.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$32.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$32.00
|
| Rate for Payer: EmblemHealth Medicaid |
$32.00
|
| Rate for Payer: EmblemHealth Medicare |
$13.60
|
| Rate for Payer: EmblemHealth Select Care |
$24.00
|
| Rate for Payer: Fidelis Medicare |
$16.00
|
| Rate for Payer: Galaxy Health Commercial |
$26.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$16.00
|
| Rate for Payer: Humana Medicare |
$16.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$26.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$18.40
|
| Rate for Payer: MVP Health Care of NY Commercial |
$30.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$22.52
|
| Rate for Payer: MVP Health Care of NY Medicare |
$16.80
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$30.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$6.00
|
| Rate for Payer: United Healthcare Commercial |
$30.00
|
| Rate for Payer: United Healthcare Medicare |
$16.00
|
| Rate for Payer: WellCare Medicare |
$22.00
|
|
|
HEPATITIS ANTIBODY HAAB IGM ANTIBODY
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS 86709
|
| Hospital Charge Code |
4302033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$27.20 |
| Rate for Payer: Aetna of NY Commercial |
$22.10
|
| Rate for Payer: Aetna of NY Medicare |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$13.60
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: CDPHP Medicare |
$12.58
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$20.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$27.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$27.20
|
| Rate for Payer: EmblemHealth Medicaid |
$27.20
|
| Rate for Payer: EmblemHealth Medicare |
$11.56
|
| Rate for Payer: EmblemHealth Select Care |
$20.40
|
| Rate for Payer: Fidelis Medicare |
$13.60
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$13.60
|
| Rate for Payer: Humana Medicare |
$13.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$22.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$15.64
|
| Rate for Payer: MVP Health Care of NY Commercial |
$25.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$19.14
|
| Rate for Payer: MVP Health Care of NY Medicare |
$14.28
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$25.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.10
|
| Rate for Payer: United Healthcare Commercial |
$25.50
|
| Rate for Payer: United Healthcare Medicare |
$13.60
|
| Rate for Payer: WellCare Medicare |
$18.70
|
|
|
HEPATITIS ANTIBODY HAAB IGM ANTIBODY
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS 86709
|
| Hospital Charge Code |
4302033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Galaxy Health Commercial |
$22.10
|
|
|
HEPATITIS B CORE ANTIBODY HBCAB TOTAL
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
4302034
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.05 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
|
|
HEPATITIS B CORE ANTIBODY HBCAB TOTAL
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS 86704
|
| Hospital Charge Code |
4302034
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$29.60 |
| Rate for Payer: Aetna of NY Commercial |
$24.05
|
| Rate for Payer: Aetna of NY Medicare |
$17.02
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$14.80
|
| Rate for Payer: Cash Price |
$27.75
|
| Rate for Payer: CDPHP Medicare |
$13.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$29.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$29.60
|
| Rate for Payer: EmblemHealth Medicaid |
$29.60
|
| Rate for Payer: EmblemHealth Medicare |
$12.58
|
| Rate for Payer: EmblemHealth Select Care |
$22.20
|
| Rate for Payer: Fidelis Medicare |
$14.80
|
| Rate for Payer: Galaxy Health Commercial |
$24.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$14.80
|
| Rate for Payer: Humana Medicare |
$14.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$24.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$17.02
|
| Rate for Payer: MVP Health Care of NY Commercial |
$27.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$20.83
|
| Rate for Payer: MVP Health Care of NY Medicare |
$15.54
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$27.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$5.55
|
| Rate for Payer: United Healthcare Commercial |
$27.75
|
| Rate for Payer: United Healthcare Medicare |
$14.80
|
| Rate for Payer: WellCare Medicare |
$20.35
|
|
|
HEPATITIS B VACCINE 20MCG/ML SDPF 10X1ML
|
Facility
|
OP
|
$200.08
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.01 |
| Max. Negotiated Rate |
$160.06 |
| Rate for Payer: Aetna of NY Medicare |
$92.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$80.03
|
| Rate for Payer: Cash Price |
$150.06
|
| Rate for Payer: CDPHP Medicare |
$74.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$160.06
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$160.06
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$160.06
|
| Rate for Payer: EmblemHealth Medicaid |
$160.06
|
| Rate for Payer: EmblemHealth Medicare |
$68.03
|
| Rate for Payer: EmblemHealth Select Care |
$144.06
|
| Rate for Payer: Fidelis Medicare |
$80.03
|
| Rate for Payer: Galaxy Health Commercial |
$130.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$80.03
|
| Rate for Payer: Humana Medicare |
$80.03
|
| Rate for Payer: Local 1199SEIU Medicare |
$92.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$150.06
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$112.65
|
| Rate for Payer: MVP Health Care of NY Medicare |
$84.03
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$30.01
|
| Rate for Payer: United Healthcare Medicare |
$80.03
|
| Rate for Payer: WellCare Medicare |
$110.04
|
|
|
HEPATITIS B VACCINE 20MCG/ML SDPF 10X1ML
|
Facility
|
IP
|
$200.08
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
4400271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.04 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: Aetna of NY Commercial |
$110.04
|
| Rate for Payer: Cash Price |
$150.06
|
| Rate for Payer: Galaxy Health Commercial |
$130.05
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$110.04
|
| Rate for Payer: WellCare Medicare |
$110.04
|
|
|
HEP B PREVACCINATION
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
4300421
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.15 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
|
|
HEP B PREVACCINATION
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS 87340
|
| Hospital Charge Code |
4300421
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$24.80 |
| Rate for Payer: Aetna of NY Commercial |
$20.15
|
| Rate for Payer: Aetna of NY Medicare |
$14.26
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$12.40
|
| Rate for Payer: Cash Price |
$23.25
|
| Rate for Payer: CDPHP Medicare |
$11.47
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$18.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$24.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$24.80
|
| Rate for Payer: EmblemHealth Medicaid |
$24.80
|
| Rate for Payer: EmblemHealth Medicare |
$10.54
|
| Rate for Payer: EmblemHealth Select Care |
$18.60
|
| Rate for Payer: Fidelis Medicare |
$12.40
|
| Rate for Payer: Galaxy Health Commercial |
$20.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$12.40
|
| Rate for Payer: Humana Medicare |
$12.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$20.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$14.26
|
| Rate for Payer: MVP Health Care of NY Commercial |
$23.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$17.45
|
| Rate for Payer: MVP Health Care of NY Medicare |
$13.02
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$23.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$4.65
|
| Rate for Payer: United Healthcare Commercial |
$23.25
|
| Rate for Payer: United Healthcare Medicare |
$12.40
|
| Rate for Payer: WellCare Medicare |
$17.05
|
|
|
HEP B SURF ANTIBODY
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
4300422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$61.60 |
| Rate for Payer: Aetna of NY Commercial |
$50.05
|
| Rate for Payer: Aetna of NY Medicare |
$35.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$30.80
|
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: CDPHP Medicare |
$28.49
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$46.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$61.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$61.60
|
| Rate for Payer: EmblemHealth Medicaid |
$61.60
|
| Rate for Payer: EmblemHealth Medicare |
$26.18
|
| Rate for Payer: EmblemHealth Select Care |
$46.20
|
| Rate for Payer: Fidelis Medicare |
$30.80
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
| Rate for Payer: Hamaspik Choice Medicare |
$30.80
|
| Rate for Payer: Humana Medicare |
$30.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$50.05
|
| Rate for Payer: Local 1199SEIU Medicare |
$35.42
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$43.35
|
| Rate for Payer: MVP Health Care of NY Medicare |
$32.34
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$57.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$11.55
|
| Rate for Payer: United Healthcare Commercial |
$57.75
|
| Rate for Payer: United Healthcare Medicare |
$30.80
|
| Rate for Payer: WellCare Medicare |
$42.35
|
|
|
HEP B SURF ANTIBODY
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS 86706
|
| Hospital Charge Code |
4300422
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$50.05 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Cash Price |
$57.75
|
| Rate for Payer: Galaxy Health Commercial |
$50.05
|
|
|
HEP C RNA (PCR)
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
4300434
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$161.20 |
| Max. Negotiated Rate |
$161.20 |
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Galaxy Health Commercial |
$161.20
|
|
|
HEP C RNA (PCR)
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
HCPCS 87522
|
| Hospital Charge Code |
4300434
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$198.40 |
| Rate for Payer: Aetna of NY Commercial |
$161.20
|
| Rate for Payer: Aetna of NY Medicare |
$114.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$99.20
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: CDPHP Medicare |
$91.76
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$148.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$198.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$198.40
|
| Rate for Payer: EmblemHealth Medicaid |
$198.40
|
| Rate for Payer: EmblemHealth Medicare |
$84.32
|
| Rate for Payer: EmblemHealth Select Care |
$148.80
|
| Rate for Payer: Fidelis Medicare |
$99.20
|
| Rate for Payer: Galaxy Health Commercial |
$161.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$99.20
|
| Rate for Payer: Humana Medicare |
$99.20
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$161.20
|
| Rate for Payer: Local 1199SEIU Medicare |
$114.08
|
| Rate for Payer: MVP Health Care of NY Commercial |
$186.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$139.62
|
| Rate for Payer: MVP Health Care of NY Medicare |
$104.16
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$186.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$37.20
|
| Rate for Payer: United Healthcare Commercial |
$186.00
|
| Rate for Payer: United Healthcare Medicare |
$99.20
|
| Rate for Payer: WellCare Medicare |
$136.40
|
|
|
HEP C VIRUS AB
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
4300424
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$36.40 |
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Galaxy Health Commercial |
$36.40
|
|
|
HEP C VIRUS AB
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
HCPCS 86803
|
| Hospital Charge Code |
4300424
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$44.80 |
| Rate for Payer: Aetna of NY Commercial |
$36.40
|
| Rate for Payer: Aetna of NY Medicare |
$25.76
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$22.40
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: CDPHP Medicare |
$20.72
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$33.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$44.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$44.80
|
| Rate for Payer: EmblemHealth Medicaid |
$44.80
|
| Rate for Payer: EmblemHealth Medicare |
$19.04
|
| Rate for Payer: EmblemHealth Select Care |
$33.60
|
| Rate for Payer: Fidelis Medicare |
$22.40
|
| Rate for Payer: Galaxy Health Commercial |
$36.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$22.40
|
| Rate for Payer: Humana Medicare |
$22.40
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$36.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$25.76
|
| Rate for Payer: MVP Health Care of NY Commercial |
$42.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$31.53
|
| Rate for Payer: MVP Health Care of NY Medicare |
$23.52
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$42.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$8.40
|
| Rate for Payer: United Healthcare Commercial |
$42.00
|
| Rate for Payer: United Healthcare Medicare |
$22.40
|
| Rate for Payer: WellCare Medicare |
$30.80
|
|
|
HERCULES 3 STAGE #431928
|
Facility
|
IP
|
$355.35
|
|
| Hospital Charge Code |
4479314
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$230.98 |
| Max. Negotiated Rate |
$230.98 |
| Rate for Payer: Cash Price |
$266.51
|
| Rate for Payer: Galaxy Health Commercial |
$230.98
|
|
