Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

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

FLUTICASONE PROPIONATE 50MCG SPIN 16 GM

Facility

$232.52

Service Code	NDC 54327099
Hospital Charge Code	4400306
Hospital Revenue Code	250
Min. Negotiated Rate	$127.89
Max. Negotiated Rate	$151.14
Rate for Payer: Cash Price	$174.39
Rate for Payer: Galaxy Health Commercial	$151.14
Rate for Payer: WellCare Medicare	$127.89

FLUTICASONE PROPIONATE 50MCG SPIN 16 GM

Facility

$232.52

Service Code	NDC 54327099
Hospital Charge Code	4400306
Hospital Revenue Code	250
Min. Negotiated Rate	$34.88
Max. Negotiated Rate	$186.02
Rate for Payer: Aetna of NY Commercial	$162.76
Rate for Payer: Aetna of NY Medicare	$106.96
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$93.01
Rate for Payer: Cash Price	$174.39
Rate for Payer: CDPHP Medicare	$86.03
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$186.02
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$186.02
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$186.02
Rate for Payer: EmblemHealth Medicaid	$186.02
Rate for Payer: EmblemHealth Medicare	$79.06
Rate for Payer: EmblemHealth Select Care	$167.41
Rate for Payer: Fidelis Medicare	$93.01
Rate for Payer: Galaxy Health Commercial	$151.14
Rate for Payer: Hamaspik Choice Medicare	$93.01
Rate for Payer: Humana Medicare	$93.01
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$162.76
Rate for Payer: Local 1199SEIU Medicare	$106.96
Rate for Payer: MVP Health Care of NY Commercial	$174.39
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$130.91
Rate for Payer: MVP Health Care of NY Medicare	$97.66
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$34.88
Rate for Payer: United Healthcare Medicare	$93.01
Rate for Payer: WellCare Medicare	$127.89

FluZONE HIGH-DOSE QUAD 2022-23 1 ea, 0.7 mL

Facility

$193.00

Service Code	HCPCS 90662
Hospital Charge Code	4401456
Hospital Revenue Code	636
Min. Negotiated Rate	$98.16
Max. Negotiated Rate	$125.45
Rate for Payer: Aetna of NY Commercial	$106.15
Rate for Payer: Cash Price	$144.75
Rate for Payer: Cash Price	$144.75
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$98.16
Rate for Payer: EmblemHealth Select Care	$98.16
Rate for Payer: Galaxy Health Commercial	$125.45
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$106.15
Rate for Payer: WellCare Medicare	$106.15

FluZONE HIGH-DOSE QUAD 2022-23 1 ea, 0.7 mL

Facility

$193.00

Service Code	HCPCS 90662
Hospital Charge Code	4401456
Hospital Revenue Code	636
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$154.40
Rate for Payer: Aetna of NY Commercial	$106.15
Rate for Payer: Aetna of NY Medicare	$88.78
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$77.20
Rate for Payer: Cash Price	$144.75
Rate for Payer: Cash Price	$144.75
Rate for Payer: CDPHP Medicare	$71.41
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$98.16
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$154.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$154.40
Rate for Payer: EmblemHealth Medicaid	$154.40
Rate for Payer: EmblemHealth Medicare	$65.62
Rate for Payer: EmblemHealth Select Care	$98.16
Rate for Payer: Fidelis Medicare	$77.20
Rate for Payer: Galaxy Health Commercial	$125.45
Rate for Payer: Hamaspik Choice Medicare	$77.20
Rate for Payer: Humana Medicare	$77.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$106.15
Rate for Payer: Local 1199SEIU Medicare	$88.78
Rate for Payer: MVP Health Care of NY Commercial	$144.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$108.66
Rate for Payer: MVP Health Care of NY Medicare	$81.06
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$115.40
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$28.95
Rate for Payer: United Healthcare Commercial	$115.40
Rate for Payer: United Healthcare Medicare	$98.16
Rate for Payer: WellCare Medicare	$106.15

FML OO

Facility

$450.37

Service Code	NDC 23031604
Hospital Charge Code	4409008
Hospital Revenue Code	250
Min. Negotiated Rate	$67.56
Max. Negotiated Rate	$360.30
Rate for Payer: Aetna of NY Commercial	$315.26
Rate for Payer: Aetna of NY Medicare	$207.17
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$180.15
Rate for Payer: Cash Price	$337.78
Rate for Payer: CDPHP Medicare	$166.64
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$360.30
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$360.30
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$360.30
Rate for Payer: EmblemHealth Medicaid	$360.30
Rate for Payer: EmblemHealth Medicare	$153.13
Rate for Payer: EmblemHealth Select Care	$324.27
Rate for Payer: Fidelis Medicare	$180.15
Rate for Payer: Galaxy Health Commercial	$292.74
Rate for Payer: Hamaspik Choice Medicare	$180.15
Rate for Payer: Humana Medicare	$180.15
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$315.26
Rate for Payer: Local 1199SEIU Medicare	$207.17
Rate for Payer: MVP Health Care of NY Commercial	$337.78
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$253.56
Rate for Payer: MVP Health Care of NY Medicare	$189.16
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$67.56
Rate for Payer: United Healthcare Medicare	$180.15
Rate for Payer: WellCare Medicare	$247.70

FML OO

Facility

$450.37

Service Code	NDC 23031604
Hospital Charge Code	4409008
Hospital Revenue Code	250
Min. Negotiated Rate	$247.70
Max. Negotiated Rate	$292.74
Rate for Payer: Cash Price	$337.78
Rate for Payer: Galaxy Health Commercial	$292.74
Rate for Payer: WellCare Medicare	$247.70

FNA BX, W/ CT GUIDE; 1ST LES

Facility

$2,170.00

Service Code	HCPCS 10009
Hospital Charge Code	4853021
Hospital Revenue Code	761
Min. Negotiated Rate	$325.50
Max. Negotiated Rate	$1,736.00
Rate for Payer: Aetna of NY Commercial	$1,519.00
Rate for Payer: Aetna of NY Medicare	$998.20
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$868.00
Rate for Payer: Cash Price	$1,627.50
Rate for Payer: CDPHP Medicare	$802.90
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,736.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,736.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,736.00
Rate for Payer: EmblemHealth Medicaid	$1,736.00
Rate for Payer: EmblemHealth Medicare	$737.80
Rate for Payer: EmblemHealth Select Care	$1,562.40
Rate for Payer: Fidelis Medicare	$868.00
Rate for Payer: Galaxy Health Commercial	$1,410.50
Rate for Payer: Hamaspik Choice Medicare	$868.00
Rate for Payer: Humana Medicare	$868.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,519.00
Rate for Payer: Local 1199SEIU Medicare	$998.20
Rate for Payer: MVP Health Care of NY Commercial	$1,627.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,221.71
Rate for Payer: MVP Health Care of NY Medicare	$911.40
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$325.50
Rate for Payer: United Healthcare Medicare	$868.00
Rate for Payer: WellCare Medicare	$1,193.50

FNA BX, W/ CT GUIDE; 1ST LES

Facility

$2,170.00

Service Code	HCPCS 10009
Hospital Charge Code	4853021
Hospital Revenue Code	761
Min. Negotiated Rate	$1,410.50
Max. Negotiated Rate	$1,410.50
Rate for Payer: Cash Price	$1,627.50
Rate for Payer: Galaxy Health Commercial	$1,410.50

FNA BX, W/ CT GUIDE; EA ADDL LES

Facility

$771.00

Service Code	HCPCS 10010
Hospital Charge Code	4853022
Hospital Revenue Code	761
Min. Negotiated Rate	$501.15
Max. Negotiated Rate	$501.15
Rate for Payer: Cash Price	$578.25
Rate for Payer: Galaxy Health Commercial	$501.15

FNA BX, W/ CT GUIDE; EA ADDL LES

Facility

$771.00

Service Code	HCPCS 10010
Hospital Charge Code	4853022
Hospital Revenue Code	761
Min. Negotiated Rate	$115.65
Max. Negotiated Rate	$616.80
Rate for Payer: Aetna of NY Commercial	$539.70
Rate for Payer: Aetna of NY Medicare	$354.66
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$308.40
Rate for Payer: Cash Price	$578.25
Rate for Payer: CDPHP Medicare	$285.27
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$616.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$616.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$616.80
Rate for Payer: EmblemHealth Medicaid	$616.80
Rate for Payer: EmblemHealth Medicare	$262.14
Rate for Payer: EmblemHealth Select Care	$555.12
Rate for Payer: Fidelis Medicare	$308.40
Rate for Payer: Galaxy Health Commercial	$501.15
Rate for Payer: Hamaspik Choice Medicare	$308.40
Rate for Payer: Humana Medicare	$308.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$539.70
Rate for Payer: Local 1199SEIU Medicare	$354.66
Rate for Payer: MVP Health Care of NY Commercial	$578.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$434.07
Rate for Payer: MVP Health Care of NY Medicare	$323.82
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$115.65
Rate for Payer: United Healthcare Medicare	$308.40
Rate for Payer: WellCare Medicare	$424.05

FNA BX W/FLUOR GDN 1ST LES

Facility

$2,170.00

Service Code	HCPCS 10007
Hospital Charge Code	4853019
Hospital Revenue Code	761
Min. Negotiated Rate	$1,410.50
Max. Negotiated Rate	$1,410.50
Rate for Payer: Cash Price	$1,627.50
Rate for Payer: Galaxy Health Commercial	$1,410.50

FNA BX W/FLUOR GDN 1ST LES

Facility

$2,170.00

Service Code	HCPCS 10007
Hospital Charge Code	4853019
Hospital Revenue Code	761
Min. Negotiated Rate	$325.50
Max. Negotiated Rate	$1,736.00
Rate for Payer: Aetna of NY Commercial	$1,519.00
Rate for Payer: Aetna of NY Medicare	$998.20
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$868.00
Rate for Payer: Cash Price	$1,627.50
Rate for Payer: CDPHP Medicare	$802.90
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,736.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,736.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,736.00
Rate for Payer: EmblemHealth Medicaid	$1,736.00
Rate for Payer: EmblemHealth Medicare	$737.80
Rate for Payer: EmblemHealth Select Care	$1,562.40
Rate for Payer: Fidelis Medicare	$868.00
Rate for Payer: Galaxy Health Commercial	$1,410.50
Rate for Payer: Hamaspik Choice Medicare	$868.00
Rate for Payer: Humana Medicare	$868.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,519.00
Rate for Payer: Local 1199SEIU Medicare	$998.20
Rate for Payer: MVP Health Care of NY Commercial	$1,627.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,221.71
Rate for Payer: MVP Health Care of NY Medicare	$911.40
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$325.50
Rate for Payer: United Healthcare Medicare	$868.00
Rate for Payer: WellCare Medicare	$1,193.50

FNA BX W/FLUOR GDN EA ADDL

Facility

$462.00

Service Code	HCPCS 10008
Hospital Charge Code	4853020
Hospital Revenue Code	761
Min. Negotiated Rate	$69.30
Max. Negotiated Rate	$369.60
Rate for Payer: Aetna of NY Commercial	$323.40
Rate for Payer: Aetna of NY Medicare	$212.52
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$184.80
Rate for Payer: Cash Price	$346.50
Rate for Payer: CDPHP Medicare	$170.94
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$369.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$369.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$369.60
Rate for Payer: EmblemHealth Medicaid	$369.60
Rate for Payer: EmblemHealth Medicare	$157.08
Rate for Payer: EmblemHealth Select Care	$332.64
Rate for Payer: Fidelis Medicare	$184.80
Rate for Payer: Galaxy Health Commercial	$300.30
Rate for Payer: Hamaspik Choice Medicare	$184.80
Rate for Payer: Humana Medicare	$184.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$323.40
Rate for Payer: Local 1199SEIU Medicare	$212.52
Rate for Payer: MVP Health Care of NY Commercial	$346.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$260.11
Rate for Payer: MVP Health Care of NY Medicare	$194.04
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$69.30
Rate for Payer: United Healthcare Medicare	$184.80
Rate for Payer: WellCare Medicare	$254.10

FNA BX W/FLUOR GDN EA ADDL

Facility

$462.00

Service Code	HCPCS 10008
Hospital Charge Code	4853020
Hospital Revenue Code	761
Min. Negotiated Rate	$300.30
Max. Negotiated Rate	$300.30
Rate for Payer: Cash Price	$346.50
Rate for Payer: Galaxy Health Commercial	$300.30

FNA BX, W/ MR GUIDE; 1ST LES

Facility

$2,170.00

Service Code	HCPCS 10011
Hospital Charge Code	4853023
Hospital Revenue Code	761
Min. Negotiated Rate	$1,410.50
Max. Negotiated Rate	$1,410.50
Rate for Payer: Cash Price	$1,627.50
Rate for Payer: Galaxy Health Commercial	$1,410.50

FNA BX, W/ MR GUIDE; 1ST LES

Facility

$2,170.00

Service Code	HCPCS 10011
Hospital Charge Code	4853023
Hospital Revenue Code	761
Min. Negotiated Rate	$325.50
Max. Negotiated Rate	$1,736.00
Rate for Payer: Aetna of NY Commercial	$1,519.00
Rate for Payer: Aetna of NY Medicare	$998.20
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$868.00
Rate for Payer: Cash Price	$1,627.50
Rate for Payer: CDPHP Medicare	$802.90
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,736.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,736.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,736.00
Rate for Payer: EmblemHealth Medicaid	$1,736.00
Rate for Payer: EmblemHealth Medicare	$737.80
Rate for Payer: EmblemHealth Select Care	$1,562.40
Rate for Payer: Fidelis Medicare	$868.00
Rate for Payer: Galaxy Health Commercial	$1,410.50
Rate for Payer: Hamaspik Choice Medicare	$868.00
Rate for Payer: Humana Medicare	$868.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,519.00
Rate for Payer: Local 1199SEIU Medicare	$998.20
Rate for Payer: MVP Health Care of NY Commercial	$1,627.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,221.71
Rate for Payer: MVP Health Care of NY Medicare	$911.40
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$325.50
Rate for Payer: United Healthcare Medicare	$868.00
Rate for Payer: WellCare Medicare	$1,193.50

FNA BX, W/ MR GUIDE; EA ADDL LES

Facility

$329.60

Service Code	HCPCS 10012
Hospital Charge Code	4853024
Hospital Revenue Code	761
Min. Negotiated Rate	$49.44
Max. Negotiated Rate	$263.68
Rate for Payer: Aetna of NY Commercial	$230.72
Rate for Payer: Aetna of NY Medicare	$151.62
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$131.84
Rate for Payer: Cash Price	$247.20
Rate for Payer: CDPHP Medicare	$121.95
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$263.68
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$263.68
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$263.68
Rate for Payer: EmblemHealth Medicaid	$263.68
Rate for Payer: EmblemHealth Medicare	$112.06
Rate for Payer: EmblemHealth Select Care	$237.31
Rate for Payer: Fidelis Medicare	$131.84
Rate for Payer: Galaxy Health Commercial	$214.24
Rate for Payer: Hamaspik Choice Medicare	$131.84
Rate for Payer: Humana Medicare	$131.84
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$230.72
Rate for Payer: Local 1199SEIU Medicare	$151.62
Rate for Payer: MVP Health Care of NY Commercial	$247.20
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$185.56
Rate for Payer: MVP Health Care of NY Medicare	$138.43
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$49.44
Rate for Payer: United Healthcare Medicare	$131.84
Rate for Payer: WellCare Medicare	$181.28

FNA BX, W/ MR GUIDE; EA ADDL LES

Facility

$329.60

Service Code	HCPCS 10012
Hospital Charge Code	4853024
Hospital Revenue Code	761
Min. Negotiated Rate	$214.24
Max. Negotiated Rate	$214.24
Rate for Payer: Cash Price	$247.20
Rate for Payer: Galaxy Health Commercial	$214.24

FNA BX, W/ US GUIDE; 1ST LES

Facility

$2,170.00

Service Code	HCPCS 10005
Hospital Charge Code	4853017
Hospital Revenue Code	761
Min. Negotiated Rate	$325.50
Max. Negotiated Rate	$1,736.00
Rate for Payer: Aetna of NY Commercial	$1,519.00
Rate for Payer: Aetna of NY Medicare	$998.20
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$868.00
Rate for Payer: Cash Price	$1,627.50
Rate for Payer: CDPHP Medicare	$802.90
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,736.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,736.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,736.00
Rate for Payer: EmblemHealth Medicaid	$1,736.00
Rate for Payer: EmblemHealth Medicare	$737.80
Rate for Payer: EmblemHealth Select Care	$1,562.40
Rate for Payer: Fidelis Medicare	$868.00
Rate for Payer: Galaxy Health Commercial	$1,410.50
Rate for Payer: Hamaspik Choice Medicare	$868.00
Rate for Payer: Humana Medicare	$868.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,519.00
Rate for Payer: Local 1199SEIU Medicare	$998.20
Rate for Payer: MVP Health Care of NY Commercial	$1,627.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,221.71
Rate for Payer: MVP Health Care of NY Medicare	$911.40
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$325.50
Rate for Payer: United Healthcare Medicare	$868.00
Rate for Payer: WellCare Medicare	$1,193.50

FNA BX, W/ US GUIDE; 1ST LES

Facility

$2,170.00

Service Code	HCPCS 10005
Hospital Charge Code	4853017
Hospital Revenue Code	761
Min. Negotiated Rate	$1,410.50
Max. Negotiated Rate	$1,410.50
Rate for Payer: Cash Price	$1,627.50
Rate for Payer: Galaxy Health Commercial	$1,410.50

FNA BX, W/ US GUIDE; EA ADDL LES

Facility

$195.00

Service Code	HCPCS 10006
Hospital Charge Code	4853018
Hospital Revenue Code	761
Min. Negotiated Rate	$126.75
Max. Negotiated Rate	$126.75
Rate for Payer: Cash Price	$146.25
Rate for Payer: Galaxy Health Commercial	$126.75

FNA BX, W/ US GUIDE; EA ADDL LES

Facility

$195.00

Service Code	HCPCS 10006
Hospital Charge Code	4853018
Hospital Revenue Code	761
Min. Negotiated Rate	$29.25
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna of NY Commercial	$136.50
Rate for Payer: Aetna of NY Medicare	$89.70
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$78.00
Rate for Payer: Cash Price	$146.25
Rate for Payer: CDPHP Medicare	$72.15
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$156.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$156.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$156.00
Rate for Payer: EmblemHealth Medicaid	$156.00
Rate for Payer: EmblemHealth Medicare	$66.30
Rate for Payer: EmblemHealth Select Care	$140.40
Rate for Payer: Fidelis Medicare	$78.00
Rate for Payer: Galaxy Health Commercial	$126.75
Rate for Payer: Hamaspik Choice Medicare	$78.00
Rate for Payer: Humana Medicare	$78.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$136.50
Rate for Payer: Local 1199SEIU Medicare	$89.70
Rate for Payer: MVP Health Care of NY Commercial	$146.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$109.78
Rate for Payer: MVP Health Care of NY Medicare	$81.90
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$29.25
Rate for Payer: United Healthcare Medicare	$78.00
Rate for Payer: WellCare Medicare	$107.25

FOLEY INSERTION TRAY 10CC

Facility

$16.48

Hospital Charge Code	4471221
Hospital Revenue Code	272
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$13.18
Rate for Payer: Aetna of NY Commercial	$11.54
Rate for Payer: Aetna of NY Medicare	$7.58
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$6.59
Rate for Payer: Cash Price	$12.36
Rate for Payer: CDPHP Medicare	$6.10
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$13.18
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$13.18
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$13.18
Rate for Payer: EmblemHealth Medicaid	$13.18
Rate for Payer: EmblemHealth Medicare	$5.60
Rate for Payer: EmblemHealth Select Care	$11.87
Rate for Payer: Fidelis Medicare	$6.59
Rate for Payer: Galaxy Health Commercial	$10.71
Rate for Payer: Hamaspik Choice Medicare	$6.59
Rate for Payer: Humana Medicare	$6.59
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$11.54
Rate for Payer: Local 1199SEIU Medicare	$7.58
Rate for Payer: MVP Health Care of NY Commercial	$12.36
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$9.28
Rate for Payer: MVP Health Care of NY Medicare	$6.92
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.47
Rate for Payer: United Healthcare Medicare	$6.59
Rate for Payer: WellCare Medicare	$9.06

FOLEY INSERTION TRAY 10CC

Facility

$16.48

Hospital Charge Code	4471221
Hospital Revenue Code	272
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$10.71
Rate for Payer: Cash Price	$12.36
Rate for Payer: Galaxy Health Commercial	$10.71

Know your out-of-pocket cost for care.

All Charges