Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

4.0MM TOMCAT CUTTER

Facility

$179.22

Hospital Charge Code	4471312
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 TOMCAT CUTTER

Facility

$179.22

Hospital Charge Code	4471312
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

4-0 MONOSOF P-12

Facility

$31.93

Hospital Charge Code	4478150
Hospital Revenue Code	270
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$25.54
Rate for Payer: Aetna of NY Commercial	$22.35
Rate for Payer: Aetna of NY Medicare	$14.69
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$12.77
Rate for Payer: Cash Price	$23.95
Rate for Payer: CDPHP Medicare	$11.81
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$25.54
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$25.54
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$25.54
Rate for Payer: EmblemHealth Medicaid	$25.54
Rate for Payer: EmblemHealth Medicare	$10.86
Rate for Payer: EmblemHealth Select Care	$22.99
Rate for Payer: Fidelis Medicare	$12.77
Rate for Payer: Galaxy Health Commercial	$20.75
Rate for Payer: Hamaspik Choice Medicare	$12.77
Rate for Payer: Humana Medicare	$12.77
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$22.35
Rate for Payer: Local 1199SEIU Medicare	$14.69
Rate for Payer: MVP Health Care of NY Commercial	$23.95
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$17.98
Rate for Payer: MVP Health Care of NY Medicare	$13.41
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4.79
Rate for Payer: United Healthcare Medicare	$12.77
Rate for Payer: WellCare Medicare	$17.56

4-0 MONOSOF P-12

Facility

$31.93

Hospital Charge Code	4478150
Hospital Revenue Code	270
Min. Negotiated Rate	$20.75
Max. Negotiated Rate	$20.75
Rate for Payer: Cash Price	$23.95
Rate for Payer: Galaxy Health Commercial	$20.75

4-0 MONOSOF P-13

Facility

$32.96

Hospital Charge Code	4478152
Hospital Revenue Code	270
Min. Negotiated Rate	$21.42
Max. Negotiated Rate	$21.42
Rate for Payer: Cash Price	$24.72
Rate for Payer: Galaxy Health Commercial	$21.42

4-0 MONOSOF P-13

Facility

$32.96

Hospital Charge Code	4478152
Hospital Revenue Code	270
Min. Negotiated Rate	$4.94
Max. Negotiated Rate	$26.37
Rate for Payer: Aetna of NY Commercial	$23.07
Rate for Payer: Aetna of NY Medicare	$15.16
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$13.18
Rate for Payer: Cash Price	$24.72
Rate for Payer: CDPHP Medicare	$12.20
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$26.37
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$26.37
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$26.37
Rate for Payer: EmblemHealth Medicaid	$26.37
Rate for Payer: EmblemHealth Medicare	$11.21
Rate for Payer: EmblemHealth Select Care	$23.73
Rate for Payer: Fidelis Medicare	$13.18
Rate for Payer: Galaxy Health Commercial	$21.42
Rate for Payer: Hamaspik Choice Medicare	$13.18
Rate for Payer: Humana Medicare	$13.18
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$23.07
Rate for Payer: Local 1199SEIU Medicare	$15.16
Rate for Payer: MVP Health Care of NY Commercial	$24.72
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$18.56
Rate for Payer: MVP Health Care of NY Medicare	$13.84
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4.94
Rate for Payer: United Healthcare Medicare	$13.18
Rate for Payer: WellCare Medicare	$18.13

4-0 VICRYL 18" FS-2 CUTTING

Facility

$22.66

Hospital Charge Code	4471910
Hospital Revenue Code	270
Min. Negotiated Rate	$14.73
Max. Negotiated Rate	$14.73
Rate for Payer: Cash Price	$17.00
Rate for Payer: Galaxy Health Commercial	$14.73

4-0 VICRYL 18" FS-2 CUTTING

Facility

$22.66

Hospital Charge Code	4471910
Hospital Revenue Code	270
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$18.13
Rate for Payer: Aetna of NY Commercial	$15.86
Rate for Payer: Aetna of NY Medicare	$10.42
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$9.06
Rate for Payer: Cash Price	$17.00
Rate for Payer: CDPHP Medicare	$8.38
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$18.13
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$18.13
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$18.13
Rate for Payer: EmblemHealth Medicaid	$18.13
Rate for Payer: EmblemHealth Medicare	$7.70
Rate for Payer: EmblemHealth Select Care	$16.32
Rate for Payer: Fidelis Medicare	$9.06
Rate for Payer: Galaxy Health Commercial	$14.73
Rate for Payer: Hamaspik Choice Medicare	$9.06
Rate for Payer: Humana Medicare	$9.06
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$15.86
Rate for Payer: Local 1199SEIU Medicare	$10.42
Rate for Payer: MVP Health Care of NY Commercial	$17.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$12.76
Rate for Payer: MVP Health Care of NY Medicare	$9.52
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3.40
Rate for Payer: United Healthcare Medicare	$9.06
Rate for Payer: WellCare Medicare	$12.46

4.3 X 48MM COMPRSION SCREW

Facility

$389.34

Service Code	HCPCS C1713
Hospital Charge Code	4471367
Hospital Revenue Code	278
Min. Negotiated Rate	$58.40
Max. Negotiated Rate	$311.47
Rate for Payer: Aetna of NY Commercial	$272.54
Rate for Payer: Aetna of NY Medicare	$179.10
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$155.74
Rate for Payer: Cash Price	$292.00
Rate for Payer: CDPHP Medicare	$144.06
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$194.67
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$311.47
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$311.47
Rate for Payer: EmblemHealth Medicaid	$311.47
Rate for Payer: EmblemHealth Medicare	$132.38
Rate for Payer: EmblemHealth Select Care	$194.67
Rate for Payer: Fidelis Medicare	$155.74
Rate for Payer: Galaxy Health Commercial	$253.07
Rate for Payer: Hamaspik Choice Medicare	$155.74
Rate for Payer: Humana Medicare	$155.74
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$272.54
Rate for Payer: Local 1199SEIU Medicare	$179.10
Rate for Payer: MVP Health Care of NY Commercial	$253.07
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$253.07
Rate for Payer: MVP Health Care of NY Medicare	$163.52
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$58.40
Rate for Payer: United Healthcare Medicare	$155.74
Rate for Payer: WellCare Medicare	$214.14

4.3 X 48MM COMPRSION SCREW

Facility

$389.34

Service Code	HCPCS C1713
Hospital Charge Code	4471367
Hospital Revenue Code	278
Min. Negotiated Rate	$175.20
Max. Negotiated Rate	$272.54
Rate for Payer: Aetna of NY Commercial	$272.54
Rate for Payer: Cash Price	$292.00
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$194.67
Rate for Payer: EmblemHealth Select Care	$194.67
Rate for Payer: Galaxy Health Commercial	$253.07
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$272.54
Rate for Payer: Multiplan Commercial	$175.20
Rate for Payer: MVP Health Care of NY Commercial	$253.07
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$253.07
Rate for Payer: WellCare Medicare	$214.14

4.3 X 50MM COMPRSION SCREW

Facility

$389.34

Service Code	HCPCS C1713
Hospital Charge Code	4471368
Hospital Revenue Code	278
Min. Negotiated Rate	$58.40
Max. Negotiated Rate	$311.47
Rate for Payer: Aetna of NY Commercial	$272.54
Rate for Payer: Aetna of NY Medicare	$179.10
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$155.74
Rate for Payer: Cash Price	$292.00
Rate for Payer: CDPHP Medicare	$144.06
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$194.67
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$311.47
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$311.47
Rate for Payer: EmblemHealth Medicaid	$311.47
Rate for Payer: EmblemHealth Medicare	$132.38
Rate for Payer: EmblemHealth Select Care	$194.67
Rate for Payer: Fidelis Medicare	$155.74
Rate for Payer: Galaxy Health Commercial	$253.07
Rate for Payer: Hamaspik Choice Medicare	$155.74
Rate for Payer: Humana Medicare	$155.74
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$272.54
Rate for Payer: Local 1199SEIU Medicare	$179.10
Rate for Payer: MVP Health Care of NY Commercial	$253.07
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$253.07
Rate for Payer: MVP Health Care of NY Medicare	$163.52
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$58.40
Rate for Payer: United Healthcare Medicare	$155.74
Rate for Payer: WellCare Medicare	$214.14

4.3 X 50MM COMPRSION SCREW

Facility

$389.34

Service Code	HCPCS C1713
Hospital Charge Code	4471368
Hospital Revenue Code	278
Min. Negotiated Rate	$175.20
Max. Negotiated Rate	$272.54
Rate for Payer: Aetna of NY Commercial	$272.54
Rate for Payer: Cash Price	$292.00
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$194.67
Rate for Payer: EmblemHealth Select Care	$194.67
Rate for Payer: Galaxy Health Commercial	$253.07
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$272.54
Rate for Payer: Multiplan Commercial	$175.20
Rate for Payer: MVP Health Care of NY Commercial	$253.07
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$253.07
Rate for Payer: WellCare Medicare	$214.14

4.5CM SMALL ANATOMY/PEDIATRICS

Facility

$120.51

Hospital Charge Code	4471072
Hospital Revenue Code	270
Min. Negotiated Rate	$18.08
Max. Negotiated Rate	$96.41
Rate for Payer: Aetna of NY Commercial	$84.36
Rate for Payer: Aetna of NY Medicare	$55.43
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$48.20
Rate for Payer: Cash Price	$90.38
Rate for Payer: CDPHP Medicare	$44.59
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$96.41
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$96.41
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$96.41
Rate for Payer: EmblemHealth Medicaid	$96.41
Rate for Payer: EmblemHealth Medicare	$40.97
Rate for Payer: EmblemHealth Select Care	$86.77
Rate for Payer: Fidelis Medicare	$48.20
Rate for Payer: Galaxy Health Commercial	$78.33
Rate for Payer: Hamaspik Choice Medicare	$48.20
Rate for Payer: Humana Medicare	$48.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$84.36
Rate for Payer: Local 1199SEIU Medicare	$55.43
Rate for Payer: MVP Health Care of NY Commercial	$90.38
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$67.85
Rate for Payer: MVP Health Care of NY Medicare	$50.61
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$18.08
Rate for Payer: United Healthcare Medicare	$48.20
Rate for Payer: WellCare Medicare	$66.28

4.5CM SMALL ANATOMY/PEDIATRICS

Facility

$120.51

Hospital Charge Code	4471072
Hospital Revenue Code	270
Min. Negotiated Rate	$78.33
Max. Negotiated Rate	$78.33
Rate for Payer: Cash Price	$90.38
Rate for Payer: Galaxy Health Commercial	$78.33

4.5MM ANGLED AGGRESSIVE PLUS

Facility

$211.15

Hospital Charge Code	4479237
Hospital Revenue Code	270
Min. Negotiated Rate	$31.67
Max. Negotiated Rate	$168.92
Rate for Payer: Aetna of NY Commercial	$147.81
Rate for Payer: Aetna of NY Medicare	$97.13
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$84.46
Rate for Payer: Cash Price	$158.36
Rate for Payer: CDPHP Medicare	$78.13
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$168.92
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$168.92
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$168.92
Rate for Payer: EmblemHealth Medicaid	$168.92
Rate for Payer: EmblemHealth Medicare	$71.79
Rate for Payer: EmblemHealth Select Care	$152.03
Rate for Payer: Fidelis Medicare	$84.46
Rate for Payer: Galaxy Health Commercial	$137.25
Rate for Payer: Hamaspik Choice Medicare	$84.46
Rate for Payer: Humana Medicare	$84.46
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$147.81
Rate for Payer: Local 1199SEIU Medicare	$97.13
Rate for Payer: MVP Health Care of NY Commercial	$158.36
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$118.88
Rate for Payer: MVP Health Care of NY Medicare	$88.68
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$31.67
Rate for Payer: United Healthcare Medicare	$84.46
Rate for Payer: WellCare Medicare	$116.13

4.5MM ANGLED AGGRESSIVE PLUS

Facility

$211.15

Hospital Charge Code	4479237
Hospital Revenue Code	270
Min. Negotiated Rate	$137.25
Max. Negotiated Rate	$137.25
Rate for Payer: Cash Price	$158.36
Rate for Payer: Galaxy Health Commercial	$137.25

4.5" X 24" CERVICAL COLLAR

Facility

$10.30

Hospital Charge Code	4471888
Hospital Revenue Code	270
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$6.70
Rate for Payer: Cash Price	$7.72
Rate for Payer: Galaxy Health Commercial	$6.70

4.5" X 24" CERVICAL COLLAR

Facility

$10.30

Hospital Charge Code	4471888
Hospital Revenue Code	270
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$8.24
Rate for Payer: Aetna of NY Commercial	$7.21
Rate for Payer: Aetna of NY Medicare	$4.74
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$4.12
Rate for Payer: Cash Price	$7.72
Rate for Payer: CDPHP Medicare	$3.81
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$8.24
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$8.24
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$8.24
Rate for Payer: EmblemHealth Medicaid	$8.24
Rate for Payer: EmblemHealth Medicare	$3.50
Rate for Payer: EmblemHealth Select Care	$7.42
Rate for Payer: Fidelis Medicare	$4.12
Rate for Payer: Galaxy Health Commercial	$6.70
Rate for Payer: Hamaspik Choice Medicare	$4.12
Rate for Payer: Humana Medicare	$4.12
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$7.21
Rate for Payer: Local 1199SEIU Medicare	$4.74
Rate for Payer: MVP Health Care of NY Commercial	$7.72
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$5.80
Rate for Payer: MVP Health Care of NY Medicare	$4.33
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.54
Rate for Payer: United Healthcare Medicare	$4.12
Rate for Payer: WellCare Medicare	$5.67

4" ACE BANDAGE

Facility

$3.09

Hospital Charge Code	4471153
Hospital Revenue Code	270
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$2.47
Rate for Payer: Aetna of NY Commercial	$2.16
Rate for Payer: Aetna of NY Medicare	$1.42
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1.24
Rate for Payer: Cash Price	$2.32
Rate for Payer: CDPHP Medicare	$1.14
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$2.47
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2.47
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2.47
Rate for Payer: EmblemHealth Medicaid	$2.47
Rate for Payer: EmblemHealth Medicare	$1.05
Rate for Payer: EmblemHealth Select Care	$2.22
Rate for Payer: Fidelis Medicare	$1.24
Rate for Payer: Galaxy Health Commercial	$2.01
Rate for Payer: Hamaspik Choice Medicare	$1.24
Rate for Payer: Humana Medicare	$1.24
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$2.16
Rate for Payer: Local 1199SEIU Medicare	$1.42
Rate for Payer: MVP Health Care of NY Commercial	$2.32
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1.74
Rate for Payer: MVP Health Care of NY Medicare	$1.30
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.46
Rate for Payer: United Healthcare Medicare	$1.24
Rate for Payer: WellCare Medicare	$1.70

4" ACE BANDAGE

Facility

$3.09

Hospital Charge Code	4471153
Hospital Revenue Code	270
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.01
Rate for Payer: Cash Price	$2.32
Rate for Payer: Galaxy Health Commercial	$2.01

4" CANNULA FOR GPS III

Facility

$175.10

Hospital Charge Code	4471611
Hospital Revenue Code	272
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" CANNULA FOR GPS III

Facility

$175.10

Hospital Charge Code	4471611
Hospital Revenue Code	272
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

4" COBAN STERILE LF

Facility

$11.33

Hospital Charge Code	4471424
Hospital Revenue Code	270
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$7.36
Rate for Payer: Cash Price	$8.50
Rate for Payer: Galaxy Health Commercial	$7.36

4" COBAN STERILE LF

Facility

$11.33

Hospital Charge Code	4471424
Hospital Revenue Code	270
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$9.06
Rate for Payer: Aetna of NY Commercial	$7.93
Rate for Payer: Aetna of NY Medicare	$5.21
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$4.53
Rate for Payer: Cash Price	$8.50
Rate for Payer: CDPHP Medicare	$4.19
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$9.06
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$9.06
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$9.06
Rate for Payer: EmblemHealth Medicaid	$9.06
Rate for Payer: EmblemHealth Medicare	$3.85
Rate for Payer: EmblemHealth Select Care	$8.16
Rate for Payer: Fidelis Medicare	$4.53
Rate for Payer: Galaxy Health Commercial	$7.36
Rate for Payer: Hamaspik Choice Medicare	$4.53
Rate for Payer: Humana Medicare	$4.53
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$7.93
Rate for Payer: Local 1199SEIU Medicare	$5.21
Rate for Payer: MVP Health Care of NY Commercial	$8.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$6.38
Rate for Payer: MVP Health Care of NY Medicare	$4.76
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.70
Rate for Payer: United Healthcare Medicare	$4.53
Rate for Payer: WellCare Medicare	$6.23

4" ECONOMY COTTON STOCKINETTE

Facility

$13.39

Hospital Charge Code	4471873
Hospital Revenue Code	270
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$10.71
Rate for Payer: Aetna of NY Commercial	$9.37
Rate for Payer: Aetna of NY Medicare	$6.16
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$5.36
Rate for Payer: Cash Price	$10.04
Rate for Payer: CDPHP Medicare	$4.95
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$10.71
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$10.71
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$10.71
Rate for Payer: EmblemHealth Medicaid	$10.71
Rate for Payer: EmblemHealth Medicare	$4.55
Rate for Payer: EmblemHealth Select Care	$9.64
Rate for Payer: Fidelis Medicare	$5.36
Rate for Payer: Galaxy Health Commercial	$8.70
Rate for Payer: Hamaspik Choice Medicare	$5.36
Rate for Payer: Humana Medicare	$5.36
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$9.37
Rate for Payer: Local 1199SEIU Medicare	$6.16
Rate for Payer: MVP Health Care of NY Commercial	$10.04
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$7.54
Rate for Payer: MVP Health Care of NY Medicare	$5.62
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.01
Rate for Payer: United Healthcare Medicare	$5.36
Rate for Payer: WellCare Medicare	$7.36

Know your out-of-pocket cost for care.

All Charges