|
HUMALOG INSULIN KWIKPEN 100 UNITS/ML,
|
Facility
|
IP
|
$339.39
|
|
|
Service Code
|
NDC 2879901
|
| 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
|
|
|
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 |
$129.92 |
| Max. Negotiated Rate |
$892.63 |
| Rate for Payer: Aetna of NY Medicare |
$398.42
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$346.45
|
| Rate for Payer: Cash Price |
$649.59
|
| Rate for Payer: Cash Price |
$649.59
|
| Rate for Payer: CDPHP Medicare |
$320.46
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$558.12
|
| 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 |
$558.12
|
| Rate for Payer: Fidelis Medicare |
$346.45
|
| Rate for Payer: Galaxy Health Commercial |
$562.98
|
| Rate for Payer: Hamaspik Choice Medicare |
$346.45
|
| Rate for Payer: Humana Medicare |
$346.45
|
| 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 |
$363.77
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$892.63
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$129.92
|
| Rate for Payer: United Healthcare Commercial |
$892.63
|
| Rate for Payer: United Healthcare Medicare |
$346.45
|
| 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 |
$562.98 |
| Rate for Payer: Aetna of NY Commercial |
$476.37
|
| Rate for Payer: Cash Price |
$649.59
|
| Rate for Payer: Cash Price |
$649.59
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$558.12
|
| Rate for Payer: EmblemHealth Select Care |
$558.12
|
| 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
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
4300455
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
|
|
HVS 1/2 PCR
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 87529
|
| Hospital Charge Code |
4300455
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna of NY Commercial |
$68.25
|
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$42.00
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$63.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$84.00
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$84.00
|
| Rate for Payer: EmblemHealth Medicaid |
$84.00
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$63.00
|
| Rate for Payer: Fidelis Medicare |
$42.00
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Hamaspik Choice Medicare |
$42.00
|
| Rate for Payer: Humana Medicare |
$42.00
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$68.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$59.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$44.10
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$78.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.75
|
| Rate for Payer: United Healthcare Commercial |
$78.75
|
| Rate for Payer: United Healthcare Medicare |
$42.00
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
HYALURONAN,SYNVISC 1MG
|
Facility
|
IP
|
$102.72
|
|
|
Service Code
|
HCPCS J7325
|
| Hospital Charge Code |
4400743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.96 |
| Max. Negotiated Rate |
$66.77 |
| Rate for Payer: Aetna of NY Commercial |
$56.50
|
| Rate for Payer: Cash Price |
$77.04
|
| Rate for Payer: Cash Price |
$77.04
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.96
|
| Rate for Payer: EmblemHealth Select Care |
$6.96
|
| 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 |
$6.96 |
| Max. Negotiated Rate |
$82.18 |
| Rate for Payer: Aetna of NY Medicare |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$41.09
|
| Rate for Payer: Cash Price |
$77.04
|
| Rate for Payer: Cash Price |
$77.04
|
| Rate for Payer: CDPHP Medicare |
$38.01
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$6.96
|
| 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 |
$6.96
|
| Rate for Payer: Fidelis Medicare |
$41.09
|
| Rate for Payer: Galaxy Health Commercial |
$66.77
|
| Rate for Payer: Hamaspik Choice Medicare |
$41.09
|
| Rate for Payer: Humana Medicare |
$41.09
|
| 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 |
$43.14
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$15.87
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.41
|
| Rate for Payer: United Healthcare Commercial |
$15.87
|
| Rate for Payer: United Healthcare Medicare |
$41.09
|
| Rate for Payer: WellCare Medicare |
$56.50
|
|
|
HYDRALAZINE 10 MG TABLET
|
Facility
|
IP
|
$6.18
|
|
|
Service Code
|
NDC 904644061
|
| 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 10 MG TABLET
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 904644061
|
| Hospital Charge Code |
4408937
|
|
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
|
|
|
HYDRALAZINE 50 MG TAB
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 63739012710
|
| Hospital Charge Code |
4409018
|
|
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
|
|
|
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
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 63739012610
|
| Hospital Charge Code |
4400356
|
|
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
|
|
|
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 TO 20 MG
|
Facility
|
OP
|
$164.03
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
4400355
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$131.22 |
| Rate for Payer: Aetna of NY Medicare |
$75.45
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$65.61
|
| Rate for Payer: Cash Price |
$123.02
|
| Rate for Payer: Cash Price |
$123.02
|
| Rate for Payer: CDPHP Medicare |
$60.69
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.29
|
| 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 |
$4.29
|
| Rate for Payer: Fidelis Medicare |
$65.61
|
| Rate for Payer: Galaxy Health Commercial |
$106.62
|
| Rate for Payer: Hamaspik Choice Medicare |
$65.61
|
| Rate for Payer: Humana Medicare |
$65.61
|
| 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 |
$68.89
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$9.42
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$24.60
|
| Rate for Payer: United Healthcare Commercial |
$9.42
|
| Rate for Payer: United Healthcare Medicare |
$65.61
|
| 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 |
$4.29 |
| Max. Negotiated Rate |
$106.62 |
| Rate for Payer: Aetna of NY Commercial |
$90.22
|
| Rate for Payer: Cash Price |
$123.02
|
| Rate for Payer: Cash Price |
$123.02
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$4.29
|
| Rate for Payer: EmblemHealth Select Care |
$4.29
|
| 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
|
IP
|
$144.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
4450104
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Galaxy Health Commercial |
$93.60
|
|
|
HYDRATION EACH ADDITIONAL HOUR
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
HCPCS 96361
|
| Hospital Charge Code |
4450104
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$510.99 |
| Rate for Payer: Aetna of NY Commercial |
$100.80
|
| Rate for Payer: Aetna of NY Medicare |
$66.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$57.60
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: CDPHP Medicare |
$53.28
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$115.20
|
| 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 |
$48.96
|
| Rate for Payer: EmblemHealth Select Care |
$103.68
|
| Rate for Payer: Fidelis Medicare |
$57.60
|
| Rate for Payer: Galaxy Health Commercial |
$93.60
|
| Rate for Payer: Galaxy Health Workers Comp |
$232.92
|
| Rate for Payer: Hamaspik Choice Medicaid |
$237.67
|
| Rate for Payer: Hamaspik Choice Medicare |
$57.60
|
| Rate for Payer: Humana Medicare |
$57.60
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$100.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$66.24
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$249.55
|
| Rate for Payer: MVP Health Care of NY Commercial |
$108.00
|
| 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 |
$81.07
|
| Rate for Payer: MVP Health Care of NY Medicare |
$60.48
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$108.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$21.60
|
| Rate for Payer: United Healthcare Commercial |
$108.00
|
| Rate for Payer: United Healthcare Medicare |
$57.60
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$249.55
|
| Rate for Payer: WellCare Medicare |
$79.20
|
|
|
HYDRATION IV INFUSION INIT 31-60 MINS
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
4450103
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$97.80 |
| Max. Negotiated Rate |
$521.60 |
| Rate for Payer: Aetna of NY Commercial |
$456.40
|
| Rate for Payer: Aetna of NY Medicare |
$299.92
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$260.80
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: CDPHP Medicare |
$241.24
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$521.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$521.60
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$521.60
|
| Rate for Payer: EmblemHealth Medicaid |
$521.60
|
| Rate for Payer: EmblemHealth Medicare |
$221.68
|
| Rate for Payer: EmblemHealth Select Care |
$469.44
|
| Rate for Payer: Fidelis Medicare |
$260.80
|
| Rate for Payer: Galaxy Health Commercial |
$423.80
|
| Rate for Payer: Hamaspik Choice Medicare |
$260.80
|
| Rate for Payer: Humana Medicare |
$260.80
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$456.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$299.92
|
| Rate for Payer: MVP Health Care of NY Commercial |
$489.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$367.08
|
| Rate for Payer: MVP Health Care of NY Medicare |
$273.84
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$489.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$97.80
|
| Rate for Payer: United Healthcare Commercial |
$489.00
|
| Rate for Payer: United Healthcare Medicare |
$260.80
|
| Rate for Payer: WellCare Medicare |
$358.60
|
|
|
HYDRATION IV INFUSION INIT 31-60 MINS
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
HCPCS 96360
|
| Hospital Charge Code |
4450103
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$423.80 |
| Max. Negotiated Rate |
$423.80 |
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Galaxy Health Commercial |
$423.80
|
|
|
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 |
$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
|
|
|
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
|
|
|
HYDROCHLOROTHIAZIDE 25MG TABS 100 EA
|
Facility
|
OP
|
$6.18
|
|
|
Service Code
|
NDC 63739012810
|
| Hospital Charge Code |
4400359
|
|
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
|
|
|
HYDROCODONE/APAP 5/325 TABLET
|
Facility
|
OP
|
$6.85
|
|
|
Service Code
|
NDC 904682461
|
| Hospital Charge Code |
4409117
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$5.48 |
| Rate for Payer: Aetna of NY Commercial |
$4.79
|
| Rate for Payer: Aetna of NY Medicare |
$3.15
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$2.74
|
| Rate for Payer: Cash Price |
$5.14
|
| 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 |
$2.74
|
| Rate for Payer: Galaxy Health Commercial |
$4.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$2.74
|
| Rate for Payer: Humana Medicare |
$2.74
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$4.79
|
| 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 |
$2.88
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$1.03
|
| Rate for Payer: United Healthcare Medicare |
$2.74
|
| Rate for Payer: WellCare Medicare |
$3.77
|
|
|
HYDROCODONE/APAP 5/325 TABLET
|
Facility
|
IP
|
$6.85
|
|
|
Service Code
|
NDC 904682461
|
| Hospital Charge Code |
4409117
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.77 |
| Max. Negotiated Rate |
$4.45 |
| Rate for Payer: Cash Price |
$5.14
|
| Rate for Payer: Galaxy Health Commercial |
$4.45
|
| Rate for Payer: WellCare Medicare |
$3.77
|
|
