Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

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

4MM BOW PLATE

Facility

$7,476.77

Hospital Charge Code	4473000
Hospital Revenue Code	278
Min. Negotiated Rate	$1,121.52
Max. Negotiated Rate	$5,981.42
Rate for Payer: Aetna of NY Commercial	$5,233.74
Rate for Payer: Aetna of NY Medicare	$3,439.31
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2,990.71
Rate for Payer: Cash Price	$5,607.58
Rate for Payer: CDPHP Medicare	$2,766.40
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$3,738.39
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$5,981.42
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$5,981.42
Rate for Payer: EmblemHealth Medicaid	$5,981.42
Rate for Payer: EmblemHealth Medicare	$2,542.10
Rate for Payer: EmblemHealth Select Care	$3,738.39
Rate for Payer: Fidelis Medicare	$2,990.71
Rate for Payer: Galaxy Health Commercial	$4,859.90
Rate for Payer: Hamaspik Choice Medicare	$2,990.71
Rate for Payer: Humana Medicare	$2,990.71
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$5,233.74
Rate for Payer: Local 1199SEIU Medicare	$3,439.31
Rate for Payer: MVP Health Care of NY Commercial	$4,859.90
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$4,859.90
Rate for Payer: MVP Health Care of NY Medicare	$3,140.24
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,121.52
Rate for Payer: United Healthcare Medicare	$2,990.71
Rate for Payer: WellCare Medicare	$4,112.22

4MM BOW PLATE

Facility

$7,476.77

Hospital Charge Code	4473000
Hospital Revenue Code	278
Min. Negotiated Rate	$3,364.55
Max. Negotiated Rate	$5,233.74
Rate for Payer: Aetna of NY Commercial	$5,233.74
Rate for Payer: Cash Price	$5,607.58
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$3,738.39
Rate for Payer: EmblemHealth Select Care	$3,738.39
Rate for Payer: Galaxy Health Commercial	$4,859.90
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$5,233.74
Rate for Payer: Multiplan Commercial	$3,364.55
Rate for Payer: MVP Health Care of NY Commercial	$4,859.90
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$4,859.90
Rate for Payer: WellCare Medicare	$4,112.22

4MM ROW II LOCK PLATE

Facility

$6,120.26

Hospital Charge Code	4471838
Hospital Revenue Code	270
Min. Negotiated Rate	$918.04
Max. Negotiated Rate	$4,896.21
Rate for Payer: Aetna of NY Commercial	$4,284.18
Rate for Payer: Aetna of NY Medicare	$2,815.32
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2,448.10
Rate for Payer: Cash Price	$4,590.20
Rate for Payer: CDPHP Medicare	$2,264.50
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$4,896.21
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$4,896.21
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$4,896.21
Rate for Payer: EmblemHealth Medicaid	$4,896.21
Rate for Payer: EmblemHealth Medicare	$2,080.89
Rate for Payer: EmblemHealth Select Care	$4,406.59
Rate for Payer: Fidelis Medicare	$2,448.10
Rate for Payer: Galaxy Health Commercial	$3,978.17
Rate for Payer: Hamaspik Choice Medicare	$2,448.10
Rate for Payer: Humana Medicare	$2,448.10
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$4,284.18
Rate for Payer: Local 1199SEIU Medicare	$2,815.32
Rate for Payer: MVP Health Care of NY Commercial	$4,590.19
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$3,445.71
Rate for Payer: MVP Health Care of NY Medicare	$2,570.51
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$918.04
Rate for Payer: United Healthcare Medicare	$2,448.10
Rate for Payer: WellCare Medicare	$3,366.14

4MM ROW II LOCK PLATE

Facility

$6,120.26

Hospital Charge Code	4471838
Hospital Revenue Code	270
Min. Negotiated Rate	$3,978.17
Max. Negotiated Rate	$3,978.17
Rate for Payer: Cash Price	$4,590.20
Rate for Payer: Galaxy Health Commercial	$3,978.17

4" SCOTCHCAST PLUS CAST TAPE

Facility

$22.66

Hospital Charge Code	4471831
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" SCOTCHCAST PLUS CAST TAPE

Facility

$22.66

Hospital Charge Code	4471831
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" SCOTCH PLUS CST TP

Facility

$15.45

Hospital Charge Code	4472153
Hospital Revenue Code	270
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$12.36
Rate for Payer: Aetna of NY Commercial	$10.81
Rate for Payer: Aetna of NY Medicare	$7.11
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$6.18
Rate for Payer: Cash Price	$11.59
Rate for Payer: CDPHP Medicare	$5.72
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$12.36
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$12.36
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$12.36
Rate for Payer: EmblemHealth Medicaid	$12.36
Rate for Payer: EmblemHealth Medicare	$5.25
Rate for Payer: EmblemHealth Select Care	$11.12
Rate for Payer: Fidelis Medicare	$6.18
Rate for Payer: Galaxy Health Commercial	$10.04
Rate for Payer: Hamaspik Choice Medicare	$6.18
Rate for Payer: Humana Medicare	$6.18
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$10.81
Rate for Payer: Local 1199SEIU Medicare	$7.11
Rate for Payer: MVP Health Care of NY Commercial	$11.59
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$8.70
Rate for Payer: MVP Health Care of NY Medicare	$6.49
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.32
Rate for Payer: United Healthcare Medicare	$6.18
Rate for Payer: WellCare Medicare	$8.50

4" SCOTCH PLUS CST TP

Facility

$15.45

Hospital Charge Code	4472153
Hospital Revenue Code	270
Min. Negotiated Rate	$10.04
Max. Negotiated Rate	$10.04
Rate for Payer: Cash Price	$11.59
Rate for Payer: Galaxy Health Commercial	$10.04

4" SMOOTH CAST PADDING STERILE

Facility

$50.47

Hospital Charge Code	4471793
Hospital Revenue Code	270
Min. Negotiated Rate	$7.57
Max. Negotiated Rate	$40.38
Rate for Payer: Aetna of NY Commercial	$35.33
Rate for Payer: Aetna of NY Medicare	$23.22
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$20.19
Rate for Payer: Cash Price	$37.85
Rate for Payer: CDPHP Medicare	$18.67
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$40.38
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$40.38
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$40.38
Rate for Payer: EmblemHealth Medicaid	$40.38
Rate for Payer: EmblemHealth Medicare	$17.16
Rate for Payer: EmblemHealth Select Care	$36.34
Rate for Payer: Fidelis Medicare	$20.19
Rate for Payer: Galaxy Health Commercial	$32.81
Rate for Payer: Hamaspik Choice Medicare	$20.19
Rate for Payer: Humana Medicare	$20.19
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$35.33
Rate for Payer: Local 1199SEIU Medicare	$23.22
Rate for Payer: MVP Health Care of NY Commercial	$37.85
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$28.41
Rate for Payer: MVP Health Care of NY Medicare	$21.20
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$7.57
Rate for Payer: United Healthcare Medicare	$20.19
Rate for Payer: WellCare Medicare	$27.76

4" SMOOTH CAST PADDING STERILE

Facility

$50.47

Hospital Charge Code	4471793
Hospital Revenue Code	270
Min. Negotiated Rate	$32.81
Max. Negotiated Rate	$32.81
Rate for Payer: Cash Price	$37.85
Rate for Payer: Galaxy Health Commercial	$32.81

4" STRAIGHT INSERTION NEEDLE (10CM)

Facility

$721.00

Hospital Charge Code	4479093
Hospital Revenue Code	272
Min. Negotiated Rate	$108.15
Max. Negotiated Rate	$576.80
Rate for Payer: Aetna of NY Commercial	$504.70
Rate for Payer: Aetna of NY Medicare	$331.66
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$288.40
Rate for Payer: Cash Price	$540.75
Rate for Payer: CDPHP Medicare	$266.77
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$576.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$576.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$576.80
Rate for Payer: EmblemHealth Medicaid	$576.80
Rate for Payer: EmblemHealth Medicare	$245.14
Rate for Payer: EmblemHealth Select Care	$519.12
Rate for Payer: Fidelis Medicare	$288.40
Rate for Payer: Galaxy Health Commercial	$468.65
Rate for Payer: Hamaspik Choice Medicare	$288.40
Rate for Payer: Humana Medicare	$288.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$504.70
Rate for Payer: Local 1199SEIU Medicare	$331.66
Rate for Payer: MVP Health Care of NY Commercial	$540.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$405.92
Rate for Payer: MVP Health Care of NY Medicare	$302.82
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$108.15
Rate for Payer: United Healthcare Medicare	$288.40
Rate for Payer: WellCare Medicare	$396.55

4" STRAIGHT INSERTION NEEDLE (10CM)

Facility

$721.00

Hospital Charge Code	4479093
Hospital Revenue Code	272
Min. Negotiated Rate	$468.65
Max. Negotiated Rate	$468.65
Rate for Payer: Cash Price	$540.75
Rate for Payer: Galaxy Health Commercial	$468.65

4" STRETCH BANDAGE

Facility

$5.15

Hospital Charge Code	4471769
Hospital Revenue Code	270
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$4.12
Rate for Payer: Aetna of NY Commercial	$3.60
Rate for Payer: Aetna of NY Medicare	$2.37
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2.06
Rate for Payer: Cash Price	$3.86
Rate for Payer: CDPHP Medicare	$1.91
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$4.12
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$4.12
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$4.12
Rate for Payer: EmblemHealth Medicaid	$4.12
Rate for Payer: EmblemHealth Medicare	$1.75
Rate for Payer: EmblemHealth Select Care	$3.71
Rate for Payer: Fidelis Medicare	$2.06
Rate for Payer: Galaxy Health Commercial	$3.35
Rate for Payer: Hamaspik Choice Medicare	$2.06
Rate for Payer: Humana Medicare	$2.06
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$3.60
Rate for Payer: Local 1199SEIU Medicare	$2.37
Rate for Payer: MVP Health Care of NY Commercial	$3.86
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$2.90
Rate for Payer: MVP Health Care of NY Medicare	$2.16
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.77
Rate for Payer: United Healthcare Medicare	$2.06
Rate for Payer: WellCare Medicare	$2.83

4" STRETCH BANDAGE

Facility

$5.15

Hospital Charge Code	4471769
Hospital Revenue Code	270
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$3.35
Rate for Payer: Cash Price	$3.86
Rate for Payer: Galaxy Health Commercial	$3.35

4"X0.045" K-WIRES

Facility

$22.66

Hospital Charge Code	4471406
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"X0.045" K-WIRES

Facility

$22.66

Hospital Charge Code	4471406
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" X 23" CERVICAL COLLAR

Facility

$10.30

Hospital Charge Code	4471887
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" X 23" CERVICAL COLLAR

Facility

$10.30

Hospital Charge Code	4471887
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"X36" NYLATEX WRAPS

Facility

$37.08

Hospital Charge Code	4471770
Hospital Revenue Code	270
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$29.66
Rate for Payer: Aetna of NY Commercial	$25.96
Rate for Payer: Aetna of NY Medicare	$17.06
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$14.83
Rate for Payer: Cash Price	$27.81
Rate for Payer: CDPHP Medicare	$13.72
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$29.66
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$29.66
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$29.66
Rate for Payer: EmblemHealth Medicaid	$29.66
Rate for Payer: EmblemHealth Medicare	$12.61
Rate for Payer: EmblemHealth Select Care	$26.70
Rate for Payer: Fidelis Medicare	$14.83
Rate for Payer: Galaxy Health Commercial	$24.10
Rate for Payer: Hamaspik Choice Medicare	$14.83
Rate for Payer: Humana Medicare	$14.83
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$25.96
Rate for Payer: Local 1199SEIU Medicare	$17.06
Rate for Payer: MVP Health Care of NY Commercial	$27.81
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$20.88
Rate for Payer: MVP Health Care of NY Medicare	$15.57
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.56
Rate for Payer: United Healthcare Medicare	$14.83
Rate for Payer: WellCare Medicare	$20.39

4"X36" NYLATEX WRAPS

Facility

$37.08

Hospital Charge Code	4471770
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

4"X48" NYLATEX WRAPS

Facility

$46.35

Hospital Charge Code	4471771
Hospital Revenue Code	270
Min. Negotiated Rate	$30.13
Max. Negotiated Rate	$30.13
Rate for Payer: Cash Price	$34.76
Rate for Payer: Galaxy Health Commercial	$30.13

4"X48" NYLATEX WRAPS

Facility

$46.35

Hospital Charge Code	4471771
Hospital Revenue Code	270
Min. Negotiated Rate	$6.95
Max. Negotiated Rate	$37.08
Rate for Payer: Aetna of NY Commercial	$32.45
Rate for Payer: Aetna of NY Medicare	$21.32
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$18.54
Rate for Payer: Cash Price	$34.76
Rate for Payer: CDPHP Medicare	$17.15
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$37.08
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$37.08
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$37.08
Rate for Payer: EmblemHealth Medicaid	$37.08
Rate for Payer: EmblemHealth Medicare	$15.76
Rate for Payer: EmblemHealth Select Care	$33.37
Rate for Payer: Fidelis Medicare	$18.54
Rate for Payer: Galaxy Health Commercial	$30.13
Rate for Payer: Hamaspik Choice Medicare	$18.54
Rate for Payer: Humana Medicare	$18.54
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$32.45
Rate for Payer: Local 1199SEIU Medicare	$21.32
Rate for Payer: MVP Health Care of NY Commercial	$34.76
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$26.10
Rate for Payer: MVP Health Care of NY Medicare	$19.47
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$6.95
Rate for Payer: United Healthcare Medicare	$18.54
Rate for Payer: WellCare Medicare	$25.49

4X4 AQUACEL DRESSING

Facility

$33.99

Hospital Charge Code	4479236
Hospital Revenue Code	270
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$27.19
Rate for Payer: Aetna of NY Commercial	$23.79
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	$25.49
Rate for Payer: CDPHP Medicare	$12.58
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$27.19
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$27.19
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$27.19
Rate for Payer: EmblemHealth Medicaid	$27.19
Rate for Payer: EmblemHealth Medicare	$11.56
Rate for Payer: EmblemHealth Select Care	$24.47
Rate for Payer: Fidelis Medicare	$13.60
Rate for Payer: Galaxy Health Commercial	$22.09
Rate for Payer: Hamaspik Choice Medicare	$13.60
Rate for Payer: Humana Medicare	$13.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$23.79
Rate for Payer: Local 1199SEIU Medicare	$15.64
Rate for Payer: MVP Health Care of NY Commercial	$25.49
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: United Healthcare CHIP/Family Health Plus/Medicaid	$5.10
Rate for Payer: United Healthcare Medicare	$13.60
Rate for Payer: WellCare Medicare	$18.69

4X4 AQUACEL DRESSING

Facility

$33.99

Hospital Charge Code	4479236
Hospital Revenue Code	270
Min. Negotiated Rate	$22.09
Max. Negotiated Rate	$22.09
Rate for Payer: Cash Price	$25.49
Rate for Payer: Galaxy Health Commercial	$22.09

Know your out-of-pocket cost for care.

All Charges