Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

ESCITALOPRAM OXALATE 10MG TABS 10X10EA

Facility

$13.65

Service Code	NDC 904642661
Hospital Charge Code	4400435
Hospital Revenue Code	250
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$8.87
Rate for Payer: Cash Price	$10.24
Rate for Payer: Galaxy Health Commercial	$8.87
Rate for Payer: WellCare Medicare	$7.51

ESCITALOPRAM OXALATE 10MG TABS 10X10EA

Facility

$13.65

Service Code	NDC 904642661
Hospital Charge Code	4400435
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$10.92
Rate for Payer: Aetna of NY Commercial	$9.55
Rate for Payer: Aetna of NY Medicare	$6.28
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$5.46
Rate for Payer: Cash Price	$10.24
Rate for Payer: CDPHP Medicare	$5.05
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$10.92
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$10.92
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$10.92
Rate for Payer: EmblemHealth Medicaid	$10.92
Rate for Payer: EmblemHealth Medicare	$4.64
Rate for Payer: EmblemHealth Select Care	$9.83
Rate for Payer: Fidelis Medicare	$5.46
Rate for Payer: Galaxy Health Commercial	$8.87
Rate for Payer: Hamaspik Choice Medicare	$5.46
Rate for Payer: Humana Medicare	$5.46
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$9.55
Rate for Payer: Local 1199SEIU Medicare	$6.28
Rate for Payer: MVP Health Care of NY Commercial	$10.24
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$7.68
Rate for Payer: MVP Health Care of NY Medicare	$5.73
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.05
Rate for Payer: United Healthcare Medicare	$5.46
Rate for Payer: WellCare Medicare	$7.51

ESMOLOL HCL 10MG/ML SDV 25X10ML

Facility

$27.04

Service Code	NDC 67457018200
Hospital Charge Code	4400112
Hospital Revenue Code	250
Min. Negotiated Rate	$4.06
Max. Negotiated Rate	$21.63
Rate for Payer: Aetna of NY Commercial	$18.93
Rate for Payer: Aetna of NY Medicare	$12.44
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$10.82
Rate for Payer: Cash Price	$20.28
Rate for Payer: CDPHP Medicare	$10.00
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$21.63
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$21.63
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$21.63
Rate for Payer: EmblemHealth Medicaid	$21.63
Rate for Payer: EmblemHealth Medicare	$9.19
Rate for Payer: EmblemHealth Select Care	$19.47
Rate for Payer: Fidelis Medicare	$10.82
Rate for Payer: Galaxy Health Commercial	$17.58
Rate for Payer: Hamaspik Choice Medicare	$10.82
Rate for Payer: Humana Medicare	$10.82
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$18.93
Rate for Payer: Local 1199SEIU Medicare	$12.44
Rate for Payer: MVP Health Care of NY Commercial	$20.28
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$15.22
Rate for Payer: MVP Health Care of NY Medicare	$11.36
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4.06
Rate for Payer: United Healthcare Medicare	$10.82
Rate for Payer: WellCare Medicare	$14.87

ESMOLOL HCL 10MG/ML SDV 25X10ML

Facility

$27.04

Service Code	NDC 67457018200
Hospital Charge Code	4400112
Hospital Revenue Code	250
Min. Negotiated Rate	$14.87
Max. Negotiated Rate	$17.58
Rate for Payer: Cash Price	$20.28
Rate for Payer: Galaxy Health Commercial	$17.58
Rate for Payer: WellCare Medicare	$14.87

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)

Facility

$1,900.00

Service Code	CPT 43235
Hospital Revenue Code	490
Min. Negotiated Rate	$863.69
Max. Negotiated Rate	$1,900.00
Rate for Payer: Aetna of NY Commercial	$1,900.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,900.00
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,828.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$863.69
Rate for Payer: United Healthcare Commercial	$1,828.00

ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE

Facility

$1,900.00

Service Code	CPT 43239
Hospital Revenue Code	490
Min. Negotiated Rate	$863.69
Max. Negotiated Rate	$1,900.00
Rate for Payer: Aetna of NY Commercial	$1,900.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,900.00
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,828.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$863.69
Rate for Payer: United Healthcare Commercial	$1,828.00

ESR-SEDIMENTATION RATE

Facility

$20.00

Service Code	HCPCS 85651
Hospital Charge Code	4300310
Hospital Revenue Code	305
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$16.00
Rate for Payer: Aetna of NY Commercial	$13.00
Rate for Payer: Aetna of NY Medicare	$9.20
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$8.00
Rate for Payer: Cash Price	$15.00
Rate for Payer: CDPHP Medicare	$7.40
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$12.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$16.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$16.00
Rate for Payer: EmblemHealth Medicaid	$16.00
Rate for Payer: EmblemHealth Medicare	$6.80
Rate for Payer: EmblemHealth Select Care	$12.00
Rate for Payer: Fidelis Medicare	$8.00
Rate for Payer: Galaxy Health Commercial	$13.00
Rate for Payer: Hamaspik Choice Medicare	$8.00
Rate for Payer: Humana Medicare	$8.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$13.00
Rate for Payer: Local 1199SEIU Medicare	$9.20
Rate for Payer: MVP Health Care of NY Commercial	$15.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$11.26
Rate for Payer: MVP Health Care of NY Medicare	$8.40
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$15.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3.00
Rate for Payer: United Healthcare Commercial	$15.00
Rate for Payer: United Healthcare Medicare	$8.00
Rate for Payer: WellCare Medicare	$11.00

ESR-SEDIMENTATION RATE

Facility

$20.00

Service Code	HCPCS 85651
Hospital Charge Code	4300310
Hospital Revenue Code	305
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$13.00
Rate for Payer: Cash Price	$15.00
Rate for Payer: Galaxy Health Commercial	$13.00

ETHANOL QUANT BLOOD

Facility

$360.00

Service Code	HCPCS G0480
Hospital Charge Code	4300314
Hospital Revenue Code	301
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$288.00
Rate for Payer: Aetna of NY Commercial	$234.00
Rate for Payer: Aetna of NY Medicare	$165.60
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$144.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: CDPHP Medicare	$133.20
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$216.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$288.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$288.00
Rate for Payer: EmblemHealth Medicaid	$288.00
Rate for Payer: EmblemHealth Medicare	$122.40
Rate for Payer: EmblemHealth Select Care	$216.00
Rate for Payer: Fidelis Medicare	$144.00
Rate for Payer: Galaxy Health Commercial	$234.00
Rate for Payer: Hamaspik Choice Medicare	$144.00
Rate for Payer: Humana Medicare	$144.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$234.00
Rate for Payer: Local 1199SEIU Medicare	$165.60
Rate for Payer: MVP Health Care of NY Commercial	$270.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$202.68
Rate for Payer: MVP Health Care of NY Medicare	$151.20
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$270.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$54.00
Rate for Payer: United Healthcare Commercial	$270.00
Rate for Payer: United Healthcare Medicare	$144.00
Rate for Payer: WellCare Medicare	$198.00

ETHANOL QUANT BLOOD

Facility

$360.00

Service Code	HCPCS G0480
Hospital Charge Code	4300314
Hospital Revenue Code	301
Min. Negotiated Rate	$234.00
Max. Negotiated Rate	$234.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Galaxy Health Commercial	$234.00

ETHIBOND GREEN 30" CT-1 TAPER

Facility

$13.39

Hospital Charge Code	4472213
Hospital Revenue Code	270
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$8.70
Rate for Payer: Cash Price	$10.04
Rate for Payer: Galaxy Health Commercial	$8.70

ETHIBOND GREEN 30" CT-1 TAPER

Facility

$13.39

Hospital Charge Code	4472213
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

ETHILON CT-1 GRN BRAIDED

Facility

$17.51

Hospital Charge Code	4478159
Hospital Revenue Code	270
Min. Negotiated Rate	$11.38
Max. Negotiated Rate	$11.38
Rate for Payer: Cash Price	$13.13
Rate for Payer: Galaxy Health Commercial	$11.38

ETHILON CT-1 GRN BRAIDED

Facility

$17.51

Hospital Charge Code	4478159
Hospital Revenue Code	270
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$14.01
Rate for Payer: Aetna of NY Commercial	$12.26
Rate for Payer: Aetna of NY Medicare	$8.05
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$7.00
Rate for Payer: Cash Price	$13.13
Rate for Payer: CDPHP Medicare	$6.48
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$14.01
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$14.01
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$14.01
Rate for Payer: EmblemHealth Medicaid	$14.01
Rate for Payer: EmblemHealth Medicare	$5.95
Rate for Payer: EmblemHealth Select Care	$12.61
Rate for Payer: Fidelis Medicare	$7.00
Rate for Payer: Galaxy Health Commercial	$11.38
Rate for Payer: Hamaspik Choice Medicare	$7.00
Rate for Payer: Humana Medicare	$7.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$12.26
Rate for Payer: Local 1199SEIU Medicare	$8.05
Rate for Payer: MVP Health Care of NY Commercial	$13.13
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$9.86
Rate for Payer: MVP Health Care of NY Medicare	$7.35
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.63
Rate for Payer: United Healthcare Medicare	$7.00
Rate for Payer: WellCare Medicare	$9.63

ETHYL CHLORIDE AREX 103.5 ML

Facility

$10.56

Service Code	NDC 386000111
Hospital Charge Code	4400279
Hospital Revenue Code	250
Min. Negotiated Rate	$5.81
Max. Negotiated Rate	$6.86
Rate for Payer: Cash Price	$7.92
Rate for Payer: Galaxy Health Commercial	$6.86
Rate for Payer: WellCare Medicare	$5.81

ETHYL CHLORIDE AREX 103.5 ML

Facility

$10.56

Service Code	NDC 386000111
Hospital Charge Code	4400279
Hospital Revenue Code	250
Min. Negotiated Rate	$1.58
Max. Negotiated Rate	$8.45
Rate for Payer: Aetna of NY Commercial	$7.39
Rate for Payer: Aetna of NY Medicare	$4.86
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$4.22
Rate for Payer: Cash Price	$7.92
Rate for Payer: CDPHP Medicare	$3.91
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$8.45
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$8.45
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$8.45
Rate for Payer: EmblemHealth Medicaid	$8.45
Rate for Payer: EmblemHealth Medicare	$3.59
Rate for Payer: EmblemHealth Select Care	$7.60
Rate for Payer: Fidelis Medicare	$4.22
Rate for Payer: Galaxy Health Commercial	$6.86
Rate for Payer: Hamaspik Choice Medicare	$4.22
Rate for Payer: Humana Medicare	$4.22
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$7.39
Rate for Payer: Local 1199SEIU Medicare	$4.86
Rate for Payer: MVP Health Care of NY Commercial	$7.92
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$5.95
Rate for Payer: MVP Health Care of NY Medicare	$4.44
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.58
Rate for Payer: United Healthcare Medicare	$4.22
Rate for Payer: WellCare Medicare	$5.81

ETOMIDATE 2MG/ML SDV 10X10ML

Facility

$36.31

Service Code	NDC 409669501
Hospital Charge Code	4400035
Hospital Revenue Code	250
Min. Negotiated Rate	$19.97
Max. Negotiated Rate	$23.60
Rate for Payer: Cash Price	$27.23
Rate for Payer: Galaxy Health Commercial	$23.60
Rate for Payer: WellCare Medicare	$19.97

ETOMIDATE 2MG/ML SDV 10X10ML

Facility

$36.31

Service Code	NDC 409669501
Hospital Charge Code	4400035
Hospital Revenue Code	250
Min. Negotiated Rate	$5.45
Max. Negotiated Rate	$29.05
Rate for Payer: Aetna of NY Commercial	$25.42
Rate for Payer: Aetna of NY Medicare	$16.70
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$14.52
Rate for Payer: Cash Price	$27.23
Rate for Payer: CDPHP Medicare	$13.43
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$29.05
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$29.05
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$29.05
Rate for Payer: EmblemHealth Medicaid	$29.05
Rate for Payer: EmblemHealth Medicare	$12.35
Rate for Payer: EmblemHealth Select Care	$26.14
Rate for Payer: Fidelis Medicare	$14.52
Rate for Payer: Galaxy Health Commercial	$23.60
Rate for Payer: Hamaspik Choice Medicare	$14.52
Rate for Payer: Humana Medicare	$14.52
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$25.42
Rate for Payer: Local 1199SEIU Medicare	$16.70
Rate for Payer: MVP Health Care of NY Commercial	$27.23
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$20.44
Rate for Payer: MVP Health Care of NY Medicare	$15.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.45
Rate for Payer: United Healthcare Medicare	$14.52
Rate for Payer: WellCare Medicare	$19.97

ETOMIDATE 40 MG/20 ML VIAL 40 mg, 20 mL

Facility

$25.00

Service Code	NDC 143950710
Hospital Charge Code	4401389
Hospital Revenue Code	250
Min. Negotiated Rate	$3.75
Max. Negotiated Rate	$20.00
Rate for Payer: Aetna of NY Commercial	$17.50
Rate for Payer: Aetna of NY Medicare	$11.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$10.00
Rate for Payer: Cash Price	$18.75
Rate for Payer: CDPHP Medicare	$9.25
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$20.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$20.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$20.00
Rate for Payer: EmblemHealth Medicaid	$20.00
Rate for Payer: EmblemHealth Medicare	$8.50
Rate for Payer: EmblemHealth Select Care	$18.00
Rate for Payer: Fidelis Medicare	$10.00
Rate for Payer: Galaxy Health Commercial	$16.25
Rate for Payer: Hamaspik Choice Medicare	$10.00
Rate for Payer: Humana Medicare	$10.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$17.50
Rate for Payer: Local 1199SEIU Medicare	$11.50
Rate for Payer: MVP Health Care of NY Commercial	$18.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$14.07
Rate for Payer: MVP Health Care of NY Medicare	$10.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3.75
Rate for Payer: United Healthcare Medicare	$10.00
Rate for Payer: WellCare Medicare	$13.75

ETOMIDATE 40 MG/20 ML VIAL 40 mg, 20 mL

Facility

$15.00

Service Code	NDC 143931110
Hospital Charge Code	4401528
Hospital Revenue Code	250
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna of NY Commercial	$10.50
Rate for Payer: Aetna of NY Medicare	$6.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$6.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: CDPHP Medicare	$5.55
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$12.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$12.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$12.00
Rate for Payer: EmblemHealth Medicaid	$12.00
Rate for Payer: EmblemHealth Medicare	$5.10
Rate for Payer: EmblemHealth Select Care	$10.80
Rate for Payer: Fidelis Medicare	$6.00
Rate for Payer: Galaxy Health Commercial	$9.75
Rate for Payer: Hamaspik Choice Medicare	$6.00
Rate for Payer: Humana Medicare	$6.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$10.50
Rate for Payer: Local 1199SEIU Medicare	$6.90
Rate for Payer: MVP Health Care of NY Commercial	$11.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$8.45
Rate for Payer: MVP Health Care of NY Medicare	$6.30
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.25
Rate for Payer: United Healthcare Medicare	$6.00
Rate for Payer: WellCare Medicare	$8.25

ETOMIDATE 40 MG/20 ML VIAL 40 mg, 20 mL

Facility

$25.00

Service Code	NDC 143950710
Hospital Charge Code	4401389
Hospital Revenue Code	250
Min. Negotiated Rate	$13.75
Max. Negotiated Rate	$16.25
Rate for Payer: Cash Price	$18.75
Rate for Payer: Galaxy Health Commercial	$16.25
Rate for Payer: WellCare Medicare	$13.75

ETOMIDATE 40 MG/20 ML VIAL 40 mg, 20 mL

Facility

$15.00

Service Code	NDC 143931110
Hospital Charge Code	4401528
Hospital Revenue Code	250
Min. Negotiated Rate	$8.25
Max. Negotiated Rate	$9.75
Rate for Payer: Cash Price	$11.25
Rate for Payer: Galaxy Health Commercial	$9.75
Rate for Payer: WellCare Medicare	$8.25

ETOMIDATE INJ

Facility

$28.84

Service Code	NDC 517078010
Hospital Charge Code	4408985
Hospital Revenue Code	250
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$23.07
Rate for Payer: Aetna of NY Commercial	$20.19
Rate for Payer: Aetna of NY Medicare	$13.27
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$11.54
Rate for Payer: Cash Price	$21.63
Rate for Payer: CDPHP Medicare	$10.67
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$23.07
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$23.07
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$23.07
Rate for Payer: EmblemHealth Medicaid	$23.07
Rate for Payer: EmblemHealth Medicare	$9.81
Rate for Payer: EmblemHealth Select Care	$20.76
Rate for Payer: Fidelis Medicare	$11.54
Rate for Payer: Galaxy Health Commercial	$18.75
Rate for Payer: Hamaspik Choice Medicare	$11.54
Rate for Payer: Humana Medicare	$11.54
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$20.19
Rate for Payer: Local 1199SEIU Medicare	$13.27
Rate for Payer: MVP Health Care of NY Commercial	$21.63
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$16.24
Rate for Payer: MVP Health Care of NY Medicare	$12.11
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4.33
Rate for Payer: United Healthcare Medicare	$11.54
Rate for Payer: WellCare Medicare	$15.86

ETOMIDATE INJ

Facility

$28.84

Service Code	NDC 517078010
Hospital Charge Code	4408985
Hospital Revenue Code	250
Min. Negotiated Rate	$15.86
Max. Negotiated Rate	$18.75
Rate for Payer: Cash Price	$21.63
Rate for Payer: Galaxy Health Commercial	$18.75
Rate for Payer: WellCare Medicare	$15.86

EUFLEXXA 20 MG/2 ML SYRINGE 2 mL, 2 mL

Facility

$1,224.00

Service Code	HCPCS J7323
Hospital Charge Code	4401429
Hospital Revenue Code	636
Min. Negotiated Rate	$105.58
Max. Negotiated Rate	$795.60
Rate for Payer: Aetna of NY Commercial	$673.20
Rate for Payer: Cash Price	$918.00
Rate for Payer: Cash Price	$918.00
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$105.58
Rate for Payer: EmblemHealth Select Care	$105.58
Rate for Payer: Galaxy Health Commercial	$795.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$673.20
Rate for Payer: WellCare Medicare	$673.20

Know your out-of-pocket cost for care.

All Charges