Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

FLUMAZENIL 0.1MG/ML MDV 10X10ML

Facility

$6.18

Service Code	HCPCS J3490
Hospital Charge Code	4400303
Hospital Revenue Code	636
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$4.94
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 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

FLUORESCEIN STRIP ER

Facility

$13.39

Hospital Charge Code	4609644
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

FLUORESCEIN STRIP ER

Facility

$13.39

Hospital Charge Code	4609644
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

FLUOR-GUIDE STEERABLE CATH KIT

Facility

$469.68

Hospital Charge Code	4472106
Hospital Revenue Code	270
Min. Negotiated Rate	$305.29
Max. Negotiated Rate	$305.29
Rate for Payer: Cash Price	$352.26
Rate for Payer: Galaxy Health Commercial	$305.29

FLUOR-GUIDE STEERABLE CATH KIT

Facility

$469.68

Hospital Charge Code	4472106
Hospital Revenue Code	270
Min. Negotiated Rate	$70.45
Max. Negotiated Rate	$375.74
Rate for Payer: Aetna of NY Commercial	$328.78
Rate for Payer: Aetna of NY Medicare	$216.05
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$187.87
Rate for Payer: Cash Price	$352.26
Rate for Payer: CDPHP Medicare	$173.78
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$375.74
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$375.74
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$375.74
Rate for Payer: EmblemHealth Medicaid	$375.74
Rate for Payer: EmblemHealth Medicare	$159.69
Rate for Payer: EmblemHealth Select Care	$338.17
Rate for Payer: Fidelis Medicare	$187.87
Rate for Payer: Galaxy Health Commercial	$305.29
Rate for Payer: Hamaspik Choice Medicare	$187.87
Rate for Payer: Humana Medicare	$187.87
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$328.78
Rate for Payer: Local 1199SEIU Medicare	$216.05
Rate for Payer: MVP Health Care of NY Commercial	$352.26
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$264.43
Rate for Payer: MVP Health Care of NY Medicare	$197.27
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$70.45
Rate for Payer: United Healthcare Medicare	$187.87
Rate for Payer: WellCare Medicare	$258.32

FLUORO-GUIDED STEERABLE CATH

Facility

$126.69

Hospital Charge Code	4471025
Hospital Revenue Code	270
Min. Negotiated Rate	$19.00
Max. Negotiated Rate	$101.35
Rate for Payer: Aetna of NY Commercial	$88.68
Rate for Payer: Aetna of NY Medicare	$58.28
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$50.68
Rate for Payer: Cash Price	$95.02
Rate for Payer: CDPHP Medicare	$46.88
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$101.35
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$101.35
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$101.35
Rate for Payer: EmblemHealth Medicaid	$101.35
Rate for Payer: EmblemHealth Medicare	$43.07
Rate for Payer: EmblemHealth Select Care	$91.22
Rate for Payer: Fidelis Medicare	$50.68
Rate for Payer: Galaxy Health Commercial	$82.35
Rate for Payer: Hamaspik Choice Medicare	$50.68
Rate for Payer: Humana Medicare	$50.68
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$88.68
Rate for Payer: Local 1199SEIU Medicare	$58.28
Rate for Payer: MVP Health Care of NY Commercial	$95.02
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$71.33
Rate for Payer: MVP Health Care of NY Medicare	$53.21
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$19.00
Rate for Payer: United Healthcare Medicare	$50.68
Rate for Payer: WellCare Medicare	$69.68

FLUORO-GUIDED STEERABLE CATH

Facility

$126.69

Hospital Charge Code	4471025
Hospital Revenue Code	270
Min. Negotiated Rate	$82.35
Max. Negotiated Rate	$82.35
Rate for Payer: Cash Price	$95.02
Rate for Payer: Galaxy Health Commercial	$82.35

FLUOROMETHALONE OS

Facility

$323.85

Service Code	NDC 65009605
Hospital Charge Code	4409009
Hospital Revenue Code	250
Min. Negotiated Rate	$48.58
Max. Negotiated Rate	$259.08
Rate for Payer: Aetna of NY Commercial	$226.69
Rate for Payer: Aetna of NY Medicare	$148.97
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$129.54
Rate for Payer: Cash Price	$242.89
Rate for Payer: CDPHP Medicare	$119.82
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$259.08
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$259.08
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$259.08
Rate for Payer: EmblemHealth Medicaid	$259.08
Rate for Payer: EmblemHealth Medicare	$110.11
Rate for Payer: EmblemHealth Select Care	$233.17
Rate for Payer: Fidelis Medicare	$129.54
Rate for Payer: Galaxy Health Commercial	$210.50
Rate for Payer: Hamaspik Choice Medicare	$129.54
Rate for Payer: Humana Medicare	$129.54
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$226.69
Rate for Payer: Local 1199SEIU Medicare	$148.97
Rate for Payer: MVP Health Care of NY Commercial	$242.89
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$182.33
Rate for Payer: MVP Health Care of NY Medicare	$136.02
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$48.58
Rate for Payer: United Healthcare Medicare	$129.54
Rate for Payer: WellCare Medicare	$178.12

FLUOROMETHALONE OS

Facility

$323.85

Service Code	NDC 65009605
Hospital Charge Code	4409009
Hospital Revenue Code	250
Min. Negotiated Rate	$178.12
Max. Negotiated Rate	$210.50
Rate for Payer: Cash Price	$242.89
Rate for Payer: Galaxy Health Commercial	$210.50
Rate for Payer: WellCare Medicare	$178.12

FLUOROSCOPE EXAMINATION =< 1 HR

Facility

$48.00

Service Code	HCPCS 76000 26
Hospital Charge Code	5150064
Hospital Revenue Code	960
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$38.40
Rate for Payer: Aetna of NY Commercial	$33.60
Rate for Payer: Aetna of NY Medicare	$22.08
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$19.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: CDPHP Medicare	$17.76
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$38.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$38.40
Rate for Payer: EmblemHealth Medicaid	$38.40
Rate for Payer: EmblemHealth Medicare	$16.32
Rate for Payer: Fidelis Medicare	$19.20
Rate for Payer: Galaxy Health Commercial	$31.20
Rate for Payer: Hamaspik Choice Medicare	$19.20
Rate for Payer: Humana Medicare	$19.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$33.60
Rate for Payer: Local 1199SEIU Medicare	$22.08
Rate for Payer: MVP Health Care of NY Commercial	$36.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$27.02
Rate for Payer: MVP Health Care of NY Medicare	$20.16
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$7.20
Rate for Payer: United Healthcare Medicare	$19.20
Rate for Payer: WellCare Medicare	$26.40

FLUOROSCOPE EXAMINATION =< 1 HR

Facility

$48.00

Service Code	HCPCS 76000 26
Hospital Charge Code	5150064
Hospital Revenue Code	960
Min. Negotiated Rate	$31.20
Max. Negotiated Rate	$31.20
Rate for Payer: Cash Price	$36.00
Rate for Payer: Galaxy Health Commercial	$31.20

FLUOROSCOPE EXAMINATION =< 1 HR

Facility

$731.00

Service Code	HCPCS 76000
Hospital Charge Code	4150064
Hospital Revenue Code	320
Min. Negotiated Rate	$109.65
Max. Negotiated Rate	$584.80
Rate for Payer: Aetna of NY Commercial	$438.60
Rate for Payer: Aetna of NY Medicare	$336.26
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$292.40
Rate for Payer: Cash Price	$548.25
Rate for Payer: Cash Price	$548.25
Rate for Payer: CDPHP Medicare	$270.47
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$511.70
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$584.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$584.80
Rate for Payer: EmblemHealth Medicaid	$584.80
Rate for Payer: EmblemHealth Medicare	$248.54
Rate for Payer: EmblemHealth Select Care	$475.15
Rate for Payer: Fidelis Medicare	$292.40
Rate for Payer: Galaxy Health Commercial	$475.15
Rate for Payer: Hamaspik Choice Medicare	$292.40
Rate for Payer: Humana Medicare	$292.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$438.60
Rate for Payer: Local 1199SEIU Medicare	$336.26
Rate for Payer: MVP Health Care of NY Commercial	$548.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$411.55
Rate for Payer: MVP Health Care of NY Medicare	$307.02
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$402.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$109.65
Rate for Payer: United Healthcare Commercial	$402.00
Rate for Payer: United Healthcare Medicare	$292.40
Rate for Payer: WellCare Medicare	$402.05

FLUOROSCOPE EXAMINATION =< 1 HR

Facility

$731.00

Service Code	HCPCS 76000
Hospital Charge Code	4150064
Hospital Revenue Code	320
Min. Negotiated Rate	$475.15
Max. Negotiated Rate	$475.15
Rate for Payer: Cash Price	$548.25
Rate for Payer: Galaxy Health Commercial	$475.15

FLUOROSCOPIC GUIDANCE AND LOCALIZATION OF NEEDLE OR CATHETER TIP FOR SPINE OR PARASPINOUS DIAGNOSTIC OR THERAPEUTIC INJECTION PROCEDURES (EPIDURAL OR SUBARACHNOID) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$1,900.00

Service Code	CPT 77003
Hospital Revenue Code	490
Min. Negotiated Rate	$25.25
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: United Healthcare CHIP/Family Health Plus/Medicaid	$25.25

FLUOROSCOPIC GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION, LOCALIZATION DEVICE) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Facility

$1,900.00

Service Code	CPT 77002
Hospital Revenue Code	490
Min. Negotiated Rate	$25.25
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: United Healthcare CHIP/Family Health Plus/Medicaid	$25.25

FLUOROSCOPY (SEPARATE PROCEDURE), UP TO 1 HOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL TIME

Facility

$1,900.00

Service Code	CPT 76000
Hospital Revenue Code	490
Min. Negotiated Rate	$10.10
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: United Healthcare CHIP/Family Health Plus/Medicaid	$10.10

FLUOXETINE 10 MG

Facility

$7.47

Service Code	NDC 904578461
Hospital Charge Code	4409041
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$5.98
Rate for Payer: Aetna of NY Commercial	$5.23
Rate for Payer: Aetna of NY Medicare	$3.44
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2.99
Rate for Payer: Cash Price	$5.60
Rate for Payer: CDPHP Medicare	$2.76
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$5.98
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$5.98
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$5.98
Rate for Payer: EmblemHealth Medicaid	$5.98
Rate for Payer: EmblemHealth Medicare	$2.54
Rate for Payer: EmblemHealth Select Care	$5.38
Rate for Payer: Fidelis Medicare	$2.99
Rate for Payer: Galaxy Health Commercial	$4.86
Rate for Payer: Hamaspik Choice Medicare	$2.99
Rate for Payer: Humana Medicare	$2.99
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$5.23
Rate for Payer: Local 1199SEIU Medicare	$3.44
Rate for Payer: MVP Health Care of NY Commercial	$5.60
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$4.21
Rate for Payer: MVP Health Care of NY Medicare	$3.14
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.12
Rate for Payer: United Healthcare Medicare	$2.99
Rate for Payer: WellCare Medicare	$4.11

FLUOXETINE 10 MG

Facility

$7.47

Service Code	NDC 904578461
Hospital Charge Code	4409041
Hospital Revenue Code	250
Min. Negotiated Rate	$4.11
Max. Negotiated Rate	$4.86
Rate for Payer: Cash Price	$5.60
Rate for Payer: Galaxy Health Commercial	$4.86
Rate for Payer: WellCare Medicare	$4.11

FLUoxetine HCL 20 MG CAPSULE 20 mg, 100 eaches

Facility

$6.00

Service Code	NDC 65862019301
Hospital Charge Code	4401502
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.90
Rate for Payer: Cash Price	$4.50
Rate for Payer: Galaxy Health Commercial	$3.90
Rate for Payer: WellCare Medicare	$3.30

FLUoxetine HCL 20 MG CAPSULE 20 mg, 100 eaches

Facility

$6.00

Service Code	NDC 65862019301
Hospital Charge Code	4401502
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$4.80
Rate for Payer: Aetna of NY Commercial	$4.20
Rate for Payer: Aetna of NY Medicare	$2.76
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2.40
Rate for Payer: Cash Price	$4.50
Rate for Payer: CDPHP Medicare	$2.22
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$4.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$4.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$4.80
Rate for Payer: EmblemHealth Medicaid	$4.80
Rate for Payer: EmblemHealth Medicare	$2.04
Rate for Payer: EmblemHealth Select Care	$4.32
Rate for Payer: Fidelis Medicare	$2.40
Rate for Payer: Galaxy Health Commercial	$3.90
Rate for Payer: Hamaspik Choice Medicare	$2.40
Rate for Payer: Humana Medicare	$2.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$4.20
Rate for Payer: Local 1199SEIU Medicare	$2.76
Rate for Payer: MVP Health Care of NY Commercial	$4.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$3.38
Rate for Payer: MVP Health Care of NY Medicare	$2.52
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.90
Rate for Payer: United Healthcare Medicare	$2.40
Rate for Payer: WellCare Medicare	$3.30

FLUPHENAZINE HCL 2.5MG TABS 100 EA

Facility

$17.50

Service Code	NDC 527178901
Hospital Charge Code	4400304
Hospital Revenue Code	250
Min. Negotiated Rate	$2.62
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna of NY Commercial	$12.25
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	$13.12
Rate for Payer: CDPHP Medicare	$6.47
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$14.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$14.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$14.00
Rate for Payer: EmblemHealth Medicaid	$14.00
Rate for Payer: EmblemHealth Medicare	$5.95
Rate for Payer: EmblemHealth Select Care	$12.60
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	$12.25
Rate for Payer: Local 1199SEIU Medicare	$8.05
Rate for Payer: MVP Health Care of NY Commercial	$13.12
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$9.85
Rate for Payer: MVP Health Care of NY Medicare	$7.35
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.62
Rate for Payer: United Healthcare Medicare	$7.00
Rate for Payer: WellCare Medicare	$9.62

FLUPHENAZINE HCL 2.5MG TABS 100 EA

Facility

$17.50

Service Code	NDC 527178901
Hospital Charge Code	4400304
Hospital Revenue Code	250
Min. Negotiated Rate	$9.62
Max. Negotiated Rate	$11.38
Rate for Payer: Cash Price	$13.12
Rate for Payer: Galaxy Health Commercial	$11.38
Rate for Payer: WellCare Medicare	$9.62

FLURBIPROFEN SODIUM 0.0003 DROP 2.5 ML

Facility

$129.60

Service Code	NDC 69292072225
Hospital Charge Code	4400305
Hospital Revenue Code	250
Min. Negotiated Rate	$19.44
Max. Negotiated Rate	$103.68
Rate for Payer: Aetna of NY Commercial	$90.72
Rate for Payer: Aetna of NY Medicare	$59.62
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$51.84
Rate for Payer: Cash Price	$97.20
Rate for Payer: CDPHP Medicare	$47.95
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$103.68
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$103.68
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$103.68
Rate for Payer: EmblemHealth Medicaid	$103.68
Rate for Payer: EmblemHealth Medicare	$44.06
Rate for Payer: EmblemHealth Select Care	$93.31
Rate for Payer: Fidelis Medicare	$51.84
Rate for Payer: Galaxy Health Commercial	$84.24
Rate for Payer: Hamaspik Choice Medicare	$51.84
Rate for Payer: Humana Medicare	$51.84
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$90.72
Rate for Payer: Local 1199SEIU Medicare	$59.62
Rate for Payer: MVP Health Care of NY Commercial	$97.20
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$72.96
Rate for Payer: MVP Health Care of NY Medicare	$54.43
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$19.44
Rate for Payer: United Healthcare Medicare	$51.84
Rate for Payer: WellCare Medicare	$71.28

FLURBIPROFEN SODIUM 0.0003 DROP 2.5 ML

Facility

$129.60

Service Code	NDC 69292072225
Hospital Charge Code	4400305
Hospital Revenue Code	250
Min. Negotiated Rate	$71.28
Max. Negotiated Rate	$84.24
Rate for Payer: Cash Price	$97.20
Rate for Payer: Galaxy Health Commercial	$84.24
Rate for Payer: WellCare Medicare	$71.28

FLUTICASONE PROPIONATE 110MCG ARIN 12 GM

Facility

$787.95

Service Code	NDC 173071920
Hospital Charge Code	4400300
Hospital Revenue Code	250
Min. Negotiated Rate	$433.37
Max. Negotiated Rate	$512.17
Rate for Payer: Cash Price	$590.96
Rate for Payer: Galaxy Health Commercial	$512.17
Rate for Payer: WellCare Medicare	$433.37

Know your out-of-pocket cost for care.

All Charges