Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

4-0 ETHILON 18" PS-4 CUTTING

Facility

$37.08

Hospital Charge Code	4471171
Hospital Revenue Code	270
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$24.10
Rate for Payer: Cash Price	$27.81
Rate for Payer: Galaxy Health Commercial	$24.10

40MEQ KCL IN5% DEXTROS+.45%SODCHL 1000ML

Facility

$8.76

Service Code	NDC 409790409
Hospital Charge Code	4450030
Hospital Revenue Code	258
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$7.01
Rate for Payer: Aetna of NY Commercial	$6.13
Rate for Payer: Aetna of NY Medicare	$4.03
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$3.50
Rate for Payer: Cash Price	$6.57
Rate for Payer: CDPHP Medicare	$3.24
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$7.01
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$7.01
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$7.01
Rate for Payer: EmblemHealth Medicaid	$7.01
Rate for Payer: EmblemHealth Medicare	$2.98
Rate for Payer: EmblemHealth Select Care	$6.31
Rate for Payer: Fidelis Medicare	$3.50
Rate for Payer: Galaxy Health Commercial	$5.69
Rate for Payer: Hamaspik Choice Medicare	$3.50
Rate for Payer: Humana Medicare	$3.50
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$6.13
Rate for Payer: Local 1199SEIU Medicare	$4.03
Rate for Payer: MVP Health Care of NY Commercial	$6.57
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$4.93
Rate for Payer: MVP Health Care of NY Medicare	$3.68
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.31
Rate for Payer: United Healthcare Medicare	$3.50
Rate for Payer: WellCare Medicare	$4.82

40MEQ KCL IN5% DEXTROS+.45%SODCHL 1000ML

Facility

$8.76

Service Code	NDC 409790409
Hospital Charge Code	4450030
Hospital Revenue Code	258
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$5.69
Rate for Payer: Cash Price	$6.57
Rate for Payer: Galaxy Health Commercial	$5.69

40MEQ KCL IN5% DEXTROSE+.9%SODCHL 1000ML

Facility

$11.85

Service Code	NDC 409710909
Hospital Charge Code	4450031
Hospital Revenue Code	258
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$9.48
Rate for Payer: Aetna of NY Commercial	$8.29
Rate for Payer: Aetna of NY Medicare	$5.45
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$4.74
Rate for Payer: Cash Price	$8.89
Rate for Payer: CDPHP Medicare	$4.38
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$9.48
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$9.48
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$9.48
Rate for Payer: EmblemHealth Medicaid	$9.48
Rate for Payer: EmblemHealth Medicare	$4.03
Rate for Payer: EmblemHealth Select Care	$8.53
Rate for Payer: Fidelis Medicare	$4.74
Rate for Payer: Galaxy Health Commercial	$7.70
Rate for Payer: Hamaspik Choice Medicare	$4.74
Rate for Payer: Humana Medicare	$4.74
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$8.29
Rate for Payer: Local 1199SEIU Medicare	$5.45
Rate for Payer: MVP Health Care of NY Commercial	$8.89
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$6.67
Rate for Payer: MVP Health Care of NY Medicare	$4.98
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.78
Rate for Payer: United Healthcare Medicare	$4.74
Rate for Payer: WellCare Medicare	$6.52

40MEQ KCL IN5% DEXTROSE+.9%SODCHL 1000ML

Facility

$11.85

Service Code	NDC 409710909
Hospital Charge Code	4450031
Hospital Revenue Code	258
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$7.70
Rate for Payer: Cash Price	$8.89
Rate for Payer: Galaxy Health Commercial	$7.70

4.0MM 12 FLUTEBARREL BUR-HOLLO

Facility

$179.22

Hospital Charge Code	4471315
Hospital Revenue Code	270
Min. Negotiated Rate	$116.49
Max. Negotiated Rate	$116.49
Rate for Payer: Cash Price	$134.42
Rate for Payer: Galaxy Health Commercial	$116.49

4.0MM 12 FLUTEBARREL BUR-HOLLO

Facility

$179.22

Hospital Charge Code	4471315
Hospital Revenue Code	270
Min. Negotiated Rate	$26.88
Max. Negotiated Rate	$143.38
Rate for Payer: Aetna of NY Commercial	$125.45
Rate for Payer: Aetna of NY Medicare	$82.44
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$71.69
Rate for Payer: Cash Price	$134.42
Rate for Payer: CDPHP Medicare	$66.31
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$143.38
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$143.38
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$143.38
Rate for Payer: EmblemHealth Medicaid	$143.38
Rate for Payer: EmblemHealth Medicare	$60.93
Rate for Payer: EmblemHealth Select Care	$129.04
Rate for Payer: Fidelis Medicare	$71.69
Rate for Payer: Galaxy Health Commercial	$116.49
Rate for Payer: Hamaspik Choice Medicare	$71.69
Rate for Payer: Humana Medicare	$71.69
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$125.45
Rate for Payer: Local 1199SEIU Medicare	$82.44
Rate for Payer: MVP Health Care of NY Commercial	$134.41
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$100.90
Rate for Payer: MVP Health Care of NY Medicare	$75.27
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$26.88
Rate for Payer: United Healthcare Medicare	$71.69
Rate for Payer: WellCare Medicare	$98.57

4.0MM 12 FLUTE ROUND BUR-HOLLO

Facility

$179.22

Hospital Charge Code	4471314
Hospital Revenue Code	270
Min. Negotiated Rate	$26.88
Max. Negotiated Rate	$143.38
Rate for Payer: Aetna of NY Commercial	$125.45
Rate for Payer: Aetna of NY Medicare	$82.44
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$71.69
Rate for Payer: Cash Price	$134.42
Rate for Payer: CDPHP Medicare	$66.31
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$143.38
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$143.38
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$143.38
Rate for Payer: EmblemHealth Medicaid	$143.38
Rate for Payer: EmblemHealth Medicare	$60.93
Rate for Payer: EmblemHealth Select Care	$129.04
Rate for Payer: Fidelis Medicare	$71.69
Rate for Payer: Galaxy Health Commercial	$116.49
Rate for Payer: Hamaspik Choice Medicare	$71.69
Rate for Payer: Humana Medicare	$71.69
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$125.45
Rate for Payer: Local 1199SEIU Medicare	$82.44
Rate for Payer: MVP Health Care of NY Commercial	$134.41
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$100.90
Rate for Payer: MVP Health Care of NY Medicare	$75.27
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$26.88
Rate for Payer: United Healthcare Medicare	$71.69
Rate for Payer: WellCare Medicare	$98.57

4.0MM 12 FLUTE ROUND BUR-HOLLO

Facility

$179.22

Hospital Charge Code	4471314
Hospital Revenue Code	270
Min. Negotiated Rate	$116.49
Max. Negotiated Rate	$116.49
Rate for Payer: Cash Price	$134.42
Rate for Payer: Galaxy Health Commercial	$116.49

4.0MM 1/3 THREAD CANULATED SCREW 00-1147

Facility

$269.86

Hospital Charge Code	4479266
Hospital Revenue Code	270
Min. Negotiated Rate	$175.41
Max. Negotiated Rate	$175.41
Rate for Payer: Cash Price	$202.40
Rate for Payer: Galaxy Health Commercial	$175.41

4.0MM 1/3 THREAD CANULATED SCREW 00-1147

Facility

$269.86

Hospital Charge Code	4479266
Hospital Revenue Code	270
Min. Negotiated Rate	$40.48
Max. Negotiated Rate	$215.89
Rate for Payer: Aetna of NY Commercial	$188.90
Rate for Payer: Aetna of NY Medicare	$124.14
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$107.94
Rate for Payer: Cash Price	$202.40
Rate for Payer: CDPHP Medicare	$99.85
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$215.89
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$215.89
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$215.89
Rate for Payer: EmblemHealth Medicaid	$215.89
Rate for Payer: EmblemHealth Medicare	$91.75
Rate for Payer: EmblemHealth Select Care	$194.30
Rate for Payer: Fidelis Medicare	$107.94
Rate for Payer: Galaxy Health Commercial	$175.41
Rate for Payer: Hamaspik Choice Medicare	$107.94
Rate for Payer: Humana Medicare	$107.94
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$188.90
Rate for Payer: Local 1199SEIU Medicare	$124.14
Rate for Payer: MVP Health Care of NY Commercial	$202.40
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$151.93
Rate for Payer: MVP Health Care of NY Medicare	$113.34
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$40.48
Rate for Payer: United Healthcare Medicare	$107.94
Rate for Payer: WellCare Medicare	$148.42

4.0MM AGRESSIVE PLUS CUTTER

Facility

$179.22

Hospital Charge Code	4471311
Hospital Revenue Code	270
Min. Negotiated Rate	$26.88
Max. Negotiated Rate	$143.38
Rate for Payer: Aetna of NY Commercial	$125.45
Rate for Payer: Aetna of NY Medicare	$82.44
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$71.69
Rate for Payer: Cash Price	$134.42
Rate for Payer: CDPHP Medicare	$66.31
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$143.38
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$143.38
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$143.38
Rate for Payer: EmblemHealth Medicaid	$143.38
Rate for Payer: EmblemHealth Medicare	$60.93
Rate for Payer: EmblemHealth Select Care	$129.04
Rate for Payer: Fidelis Medicare	$71.69
Rate for Payer: Galaxy Health Commercial	$116.49
Rate for Payer: Hamaspik Choice Medicare	$71.69
Rate for Payer: Humana Medicare	$71.69
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$125.45
Rate for Payer: Local 1199SEIU Medicare	$82.44
Rate for Payer: MVP Health Care of NY Commercial	$134.41
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$100.90
Rate for Payer: MVP Health Care of NY Medicare	$75.27
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$26.88
Rate for Payer: United Healthcare Medicare	$71.69
Rate for Payer: WellCare Medicare	$98.57

4.0MM AGRESSIVE PLUS CUTTER

Facility

$179.22

Hospital Charge Code	4471311
Hospital Revenue Code	270
Min. Negotiated Rate	$116.49
Max. Negotiated Rate	$116.49
Rate for Payer: Cash Price	$134.42
Rate for Payer: Galaxy Health Commercial	$116.49

4.0MM CANCELLOUS SCREW, SMALL HEX RECESS

Facility

$81.37

Service Code	HCPCS C1713
Hospital Charge Code	4472222
Hospital Revenue Code	278
Min. Negotiated Rate	$12.21
Max. Negotiated Rate	$65.10
Rate for Payer: Aetna of NY Commercial	$56.96
Rate for Payer: Aetna of NY Medicare	$37.43
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$32.55
Rate for Payer: Cash Price	$61.03
Rate for Payer: CDPHP Medicare	$30.11
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$40.69
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$65.10
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$65.10
Rate for Payer: EmblemHealth Medicaid	$65.10
Rate for Payer: EmblemHealth Medicare	$27.67
Rate for Payer: EmblemHealth Select Care	$40.69
Rate for Payer: Fidelis Medicare	$32.55
Rate for Payer: Galaxy Health Commercial	$52.89
Rate for Payer: Hamaspik Choice Medicare	$32.55
Rate for Payer: Humana Medicare	$32.55
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$56.96
Rate for Payer: Local 1199SEIU Medicare	$37.43
Rate for Payer: MVP Health Care of NY Commercial	$52.89
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$52.89
Rate for Payer: MVP Health Care of NY Medicare	$34.18
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$12.21
Rate for Payer: United Healthcare Medicare	$32.55
Rate for Payer: WellCare Medicare	$44.75

4.0MM CANCELLOUS SCREW, SMALL HEX RECESS

Facility

$81.37

Service Code	HCPCS C1713
Hospital Charge Code	4472222
Hospital Revenue Code	278
Min. Negotiated Rate	$36.62
Max. Negotiated Rate	$56.96
Rate for Payer: Aetna of NY Commercial	$56.96
Rate for Payer: Cash Price	$61.03
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$40.69
Rate for Payer: EmblemHealth Select Care	$40.69
Rate for Payer: Galaxy Health Commercial	$52.89
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$56.96
Rate for Payer: Multiplan Commercial	$36.62
Rate for Payer: MVP Health Care of NY Commercial	$52.89
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$52.89
Rate for Payer: WellCare Medicare	$44.75

4.0MM CANCELLOUS SCREW SM HEX FULL RECES

Facility

$108.15

Hospital Charge Code	4479265
Hospital Revenue Code	270
Min. Negotiated Rate	$70.30
Max. Negotiated Rate	$70.30
Rate for Payer: Cash Price	$81.11
Rate for Payer: Galaxy Health Commercial	$70.30

4.0MM CANCELLOUS SCREW SM HEX FULL RECES

Facility

$108.15

Hospital Charge Code	4479265
Hospital Revenue Code	270
Min. Negotiated Rate	$16.22
Max. Negotiated Rate	$86.52
Rate for Payer: Aetna of NY Commercial	$75.70
Rate for Payer: Aetna of NY Medicare	$49.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$43.26
Rate for Payer: Cash Price	$81.11
Rate for Payer: CDPHP Medicare	$40.02
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$86.52
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$86.52
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$86.52
Rate for Payer: EmblemHealth Medicaid	$86.52
Rate for Payer: EmblemHealth Medicare	$36.77
Rate for Payer: EmblemHealth Select Care	$77.87
Rate for Payer: Fidelis Medicare	$43.26
Rate for Payer: Galaxy Health Commercial	$70.30
Rate for Payer: Hamaspik Choice Medicare	$43.26
Rate for Payer: Humana Medicare	$43.26
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$75.70
Rate for Payer: Local 1199SEIU Medicare	$49.75
Rate for Payer: MVP Health Care of NY Commercial	$81.11
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$60.89
Rate for Payer: MVP Health Care of NY Medicare	$45.42
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$16.22
Rate for Payer: United Healthcare Medicare	$43.26
Rate for Payer: WellCare Medicare	$59.48

4.0MM CANNULATED SCREW

Facility

$710.70

Service Code	HCPCS C1713
Hospital Charge Code	4472238
Hospital Revenue Code	278
Min. Negotiated Rate	$106.61
Max. Negotiated Rate	$568.56
Rate for Payer: Aetna of NY Commercial	$497.49
Rate for Payer: Aetna of NY Medicare	$326.92
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$284.28
Rate for Payer: Cash Price	$533.03
Rate for Payer: CDPHP Medicare	$262.96
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$355.35
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$568.56
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$568.56
Rate for Payer: EmblemHealth Medicaid	$568.56
Rate for Payer: EmblemHealth Medicare	$241.64
Rate for Payer: EmblemHealth Select Care	$355.35
Rate for Payer: Fidelis Medicare	$284.28
Rate for Payer: Galaxy Health Commercial	$461.95
Rate for Payer: Hamaspik Choice Medicare	$284.28
Rate for Payer: Humana Medicare	$284.28
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$497.49
Rate for Payer: Local 1199SEIU Medicare	$326.92
Rate for Payer: MVP Health Care of NY Commercial	$461.95
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$461.95
Rate for Payer: MVP Health Care of NY Medicare	$298.49
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$106.61
Rate for Payer: United Healthcare Medicare	$284.28
Rate for Payer: WellCare Medicare	$390.88

4.0MM CANNULATED SCREW

Facility

$710.70

Service Code	HCPCS C1713
Hospital Charge Code	4472238
Hospital Revenue Code	278
Min. Negotiated Rate	$319.81
Max. Negotiated Rate	$497.49
Rate for Payer: Aetna of NY Commercial	$497.49
Rate for Payer: Cash Price	$533.03
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$355.35
Rate for Payer: EmblemHealth Select Care	$355.35
Rate for Payer: Galaxy Health Commercial	$461.95
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$497.49
Rate for Payer: Multiplan Commercial	$319.81
Rate for Payer: MVP Health Care of NY Commercial	$461.95
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$461.95
Rate for Payer: WellCare Medicare	$390.88

4.0MM END CUTTER

Facility

$179.22

Hospital Charge Code	4471313
Hospital Revenue Code	270
Min. Negotiated Rate	$26.88
Max. Negotiated Rate	$143.38
Rate for Payer: Aetna of NY Commercial	$125.45
Rate for Payer: Aetna of NY Medicare	$82.44
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$71.69
Rate for Payer: Cash Price	$134.42
Rate for Payer: CDPHP Medicare	$66.31
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$143.38
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$143.38
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$143.38
Rate for Payer: EmblemHealth Medicaid	$143.38
Rate for Payer: EmblemHealth Medicare	$60.93
Rate for Payer: EmblemHealth Select Care	$129.04
Rate for Payer: Fidelis Medicare	$71.69
Rate for Payer: Galaxy Health Commercial	$116.49
Rate for Payer: Hamaspik Choice Medicare	$71.69
Rate for Payer: Humana Medicare	$71.69
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$125.45
Rate for Payer: Local 1199SEIU Medicare	$82.44
Rate for Payer: MVP Health Care of NY Commercial	$134.41
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$100.90
Rate for Payer: MVP Health Care of NY Medicare	$75.27
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$26.88
Rate for Payer: United Healthcare Medicare	$71.69
Rate for Payer: WellCare Medicare	$98.57

4.0MM END CUTTER

Facility

$179.22

Hospital Charge Code	4471313
Hospital Revenue Code	270
Min. Negotiated Rate	$116.49
Max. Negotiated Rate	$116.49
Rate for Payer: Cash Price	$134.42
Rate for Payer: Galaxy Health Commercial	$116.49

4.0MM RESECTOR CUTTER

Facility

$179.22

Hospital Charge Code	4471310
Hospital Revenue Code	270
Min. Negotiated Rate	$26.88
Max. Negotiated Rate	$143.38
Rate for Payer: Aetna of NY Commercial	$125.45
Rate for Payer: Aetna of NY Medicare	$82.44
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$71.69
Rate for Payer: Cash Price	$134.42
Rate for Payer: CDPHP Medicare	$66.31
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$143.38
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$143.38
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$143.38
Rate for Payer: EmblemHealth Medicaid	$143.38
Rate for Payer: EmblemHealth Medicare	$60.93
Rate for Payer: EmblemHealth Select Care	$129.04
Rate for Payer: Fidelis Medicare	$71.69
Rate for Payer: Galaxy Health Commercial	$116.49
Rate for Payer: Hamaspik Choice Medicare	$71.69
Rate for Payer: Humana Medicare	$71.69
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$125.45
Rate for Payer: Local 1199SEIU Medicare	$82.44
Rate for Payer: MVP Health Care of NY Commercial	$134.41
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$100.90
Rate for Payer: MVP Health Care of NY Medicare	$75.27
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$26.88
Rate for Payer: United Healthcare Medicare	$71.69
Rate for Payer: WellCare Medicare	$98.57

4.0MM RESECTOR CUTTER

Facility

$179.22

Hospital Charge Code	4471310
Hospital Revenue Code	270
Min. Negotiated Rate	$116.49
Max. Negotiated Rate	$116.49
Rate for Payer: Cash Price	$134.42
Rate for Payer: Galaxy Health Commercial	$116.49

4.0 MM TOMCAT ARTHROSCOPY BLAD

Facility

$175.10

Hospital Charge Code	4471241
Hospital Revenue Code	270
Min. Negotiated Rate	$26.27
Max. Negotiated Rate	$140.08
Rate for Payer: Aetna of NY Commercial	$122.57
Rate for Payer: Aetna of NY Medicare	$80.55
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$70.04
Rate for Payer: Cash Price	$131.32
Rate for Payer: CDPHP Medicare	$64.79
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$140.08
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$140.08
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$140.08
Rate for Payer: EmblemHealth Medicaid	$140.08
Rate for Payer: EmblemHealth Medicare	$59.53
Rate for Payer: EmblemHealth Select Care	$126.07
Rate for Payer: Fidelis Medicare	$70.04
Rate for Payer: Galaxy Health Commercial	$113.81
Rate for Payer: Hamaspik Choice Medicare	$70.04
Rate for Payer: Humana Medicare	$70.04
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$122.57
Rate for Payer: Local 1199SEIU Medicare	$80.55
Rate for Payer: MVP Health Care of NY Commercial	$131.32
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$98.58
Rate for Payer: MVP Health Care of NY Medicare	$73.54
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$26.27
Rate for Payer: United Healthcare Medicare	$70.04
Rate for Payer: WellCare Medicare	$96.31

4.0 MM TOMCAT ARTHROSCOPY BLAD

Facility

$175.10

Hospital Charge Code	4471241
Hospital Revenue Code	270
Min. Negotiated Rate	$113.81
Max. Negotiated Rate	$113.81
Rate for Payer: Cash Price	$131.32
Rate for Payer: Galaxy Health Commercial	$113.81

Know your out-of-pocket cost for care.

All Charges