Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

GEN COOLED RF GUAGE CRP-17-75-4

Facility

$2,190.81

Hospital Charge Code	4479261
Hospital Revenue Code	270
Min. Negotiated Rate	$1,424.03
Max. Negotiated Rate	$1,424.03
Rate for Payer: Cash Price	$1,643.11
Rate for Payer: Galaxy Health Commercial	$1,424.03

GEN COOLED RF KIT 75MM CRK-17-75-4

Facility

$3,131.20

Hospital Charge Code	4479260
Hospital Revenue Code	270
Min. Negotiated Rate	$2,035.28
Max. Negotiated Rate	$2,035.28
Rate for Payer: Cash Price	$2,348.40
Rate for Payer: Galaxy Health Commercial	$2,035.28

GEN COOLED RF KIT 75MM CRK-17-75-4

Facility

$3,131.20

Hospital Charge Code	4479260
Hospital Revenue Code	270
Min. Negotiated Rate	$469.68
Max. Negotiated Rate	$2,504.96
Rate for Payer: Aetna of NY Commercial	$2,191.84
Rate for Payer: Aetna of NY Medicare	$1,440.35
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,252.48
Rate for Payer: Cash Price	$2,348.40
Rate for Payer: CDPHP Medicare	$1,158.54
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$2,504.96
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,504.96
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,504.96
Rate for Payer: EmblemHealth Medicaid	$2,504.96
Rate for Payer: EmblemHealth Medicare	$1,064.61
Rate for Payer: EmblemHealth Select Care	$2,254.46
Rate for Payer: Fidelis Medicare	$1,252.48
Rate for Payer: Galaxy Health Commercial	$2,035.28
Rate for Payer: Hamaspik Choice Medicare	$1,252.48
Rate for Payer: Humana Medicare	$1,252.48
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$2,191.84
Rate for Payer: Local 1199SEIU Medicare	$1,440.35
Rate for Payer: MVP Health Care of NY Commercial	$2,348.40
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,762.87
Rate for Payer: MVP Health Care of NY Medicare	$1,315.10
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$469.68
Rate for Payer: United Healthcare Medicare	$1,252.48
Rate for Payer: WellCare Medicare	$1,722.16

GEN COOLED RF KIT CRK-17-100-4

Facility

$3,131.20

Hospital Charge Code	4479257
Hospital Revenue Code	270
Min. Negotiated Rate	$2,035.28
Max. Negotiated Rate	$2,035.28
Rate for Payer: Cash Price	$2,348.40
Rate for Payer: Galaxy Health Commercial	$2,035.28

GEN COOLED RF KIT CRK-17-100-4

Facility

$3,131.20

Hospital Charge Code	4479257
Hospital Revenue Code	270
Min. Negotiated Rate	$469.68
Max. Negotiated Rate	$2,504.96
Rate for Payer: Aetna of NY Commercial	$2,191.84
Rate for Payer: Aetna of NY Medicare	$1,440.35
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,252.48
Rate for Payer: Cash Price	$2,348.40
Rate for Payer: CDPHP Medicare	$1,158.54
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$2,504.96
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,504.96
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,504.96
Rate for Payer: EmblemHealth Medicaid	$2,504.96
Rate for Payer: EmblemHealth Medicare	$1,064.61
Rate for Payer: EmblemHealth Select Care	$2,254.46
Rate for Payer: Fidelis Medicare	$1,252.48
Rate for Payer: Galaxy Health Commercial	$2,035.28
Rate for Payer: Hamaspik Choice Medicare	$1,252.48
Rate for Payer: Humana Medicare	$1,252.48
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$2,191.84
Rate for Payer: Local 1199SEIU Medicare	$1,440.35
Rate for Payer: MVP Health Care of NY Commercial	$2,348.40
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,762.87
Rate for Payer: MVP Health Care of NY Medicare	$1,315.10
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$469.68
Rate for Payer: United Healthcare Medicare	$1,252.48
Rate for Payer: WellCare Medicare	$1,722.16

GEN COOLED RF PROBE CRI 17-75

Facility

$419.21

Hospital Charge Code	4479262
Hospital Revenue Code	270
Min. Negotiated Rate	$272.49
Max. Negotiated Rate	$272.49
Rate for Payer: Cash Price	$314.41
Rate for Payer: Galaxy Health Commercial	$272.49

GEN COOLED RF PROBE CRI 17-75

Facility

$419.21

Hospital Charge Code	4479262
Hospital Revenue Code	270
Min. Negotiated Rate	$62.88
Max. Negotiated Rate	$335.37
Rate for Payer: Aetna of NY Commercial	$293.45
Rate for Payer: Aetna of NY Medicare	$192.84
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$167.68
Rate for Payer: Cash Price	$314.41
Rate for Payer: CDPHP Medicare	$155.11
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$335.37
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$335.37
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$335.37
Rate for Payer: EmblemHealth Medicaid	$335.37
Rate for Payer: EmblemHealth Medicare	$142.53
Rate for Payer: EmblemHealth Select Care	$301.83
Rate for Payer: Fidelis Medicare	$167.68
Rate for Payer: Galaxy Health Commercial	$272.49
Rate for Payer: Hamaspik Choice Medicare	$167.68
Rate for Payer: Humana Medicare	$167.68
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$293.45
Rate for Payer: Local 1199SEIU Medicare	$192.84
Rate for Payer: MVP Health Care of NY Commercial	$314.41
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$236.02
Rate for Payer: MVP Health Care of NY Medicare	$176.07
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$62.88
Rate for Payer: United Healthcare Medicare	$167.68
Rate for Payer: WellCare Medicare	$230.57

GEN COOLED RF PROBE TIP CRP 17-100-4

Facility

$2,190.81

Hospital Charge Code	4479258
Hospital Revenue Code	270
Min. Negotiated Rate	$328.62
Max. Negotiated Rate	$1,752.65
Rate for Payer: Aetna of NY Commercial	$1,533.57
Rate for Payer: Aetna of NY Medicare	$1,007.77
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$876.32
Rate for Payer: Cash Price	$1,643.11
Rate for Payer: CDPHP Medicare	$810.60
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,752.65
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,752.65
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,752.65
Rate for Payer: EmblemHealth Medicaid	$1,752.65
Rate for Payer: EmblemHealth Medicare	$744.88
Rate for Payer: EmblemHealth Select Care	$1,577.38
Rate for Payer: Fidelis Medicare	$876.32
Rate for Payer: Galaxy Health Commercial	$1,424.03
Rate for Payer: Hamaspik Choice Medicare	$876.32
Rate for Payer: Humana Medicare	$876.32
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,533.57
Rate for Payer: Local 1199SEIU Medicare	$1,007.77
Rate for Payer: MVP Health Care of NY Commercial	$1,643.11
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,233.43
Rate for Payer: MVP Health Care of NY Medicare	$920.14
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$328.62
Rate for Payer: United Healthcare Medicare	$876.32
Rate for Payer: WellCare Medicare	$1,204.95

GEN COOLED RF PROBE TIP CRP 17-100-4

Facility

$2,190.81

Hospital Charge Code	4479258
Hospital Revenue Code	270
Min. Negotiated Rate	$1,424.03
Max. Negotiated Rate	$1,424.03
Rate for Payer: Cash Price	$1,643.11
Rate for Payer: Galaxy Health Commercial	$1,424.03

GENET VIRUS ISOLATE HSV

Facility

$102.00

Service Code	HCPCS 87255
Hospital Charge Code	4304878
Hospital Revenue Code	306
Min. Negotiated Rate	$15.30
Max. Negotiated Rate	$81.60
Rate for Payer: Aetna of NY Commercial	$66.30
Rate for Payer: Aetna of NY Medicare	$46.92
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$40.80
Rate for Payer: Cash Price	$76.50
Rate for Payer: CDPHP Medicare	$37.74
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$61.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$81.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$81.60
Rate for Payer: EmblemHealth Medicaid	$81.60
Rate for Payer: EmblemHealth Medicare	$34.68
Rate for Payer: EmblemHealth Select Care	$61.20
Rate for Payer: Fidelis Medicare	$40.80
Rate for Payer: Galaxy Health Commercial	$66.30
Rate for Payer: Hamaspik Choice Medicare	$40.80
Rate for Payer: Humana Medicare	$40.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$66.30
Rate for Payer: Local 1199SEIU Medicare	$46.92
Rate for Payer: MVP Health Care of NY Commercial	$76.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$57.43
Rate for Payer: MVP Health Care of NY Medicare	$42.84
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$76.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$15.30
Rate for Payer: United Healthcare Commercial	$76.50
Rate for Payer: United Healthcare Medicare	$40.80
Rate for Payer: WellCare Medicare	$56.10

GENET VIRUS ISOLATE HSV

Facility

$102.00

Service Code	HCPCS 87255
Hospital Charge Code	4304878
Hospital Revenue Code	306
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$66.30
Rate for Payer: Cash Price	$76.50
Rate for Payer: Galaxy Health Commercial	$66.30

GENET VIRUS ISOLATE HSV

Facility

$132.00

Service Code	HCPCS 87255
Hospital Charge Code	4304883
Hospital Revenue Code	306
Min. Negotiated Rate	$85.80
Max. Negotiated Rate	$85.80
Rate for Payer: Cash Price	$99.00
Rate for Payer: Galaxy Health Commercial	$85.80

GENET VIRUS ISOLATE HSV

Facility

$132.00

Service Code	HCPCS 87255
Hospital Charge Code	4304883
Hospital Revenue Code	306
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$105.60
Rate for Payer: Aetna of NY Commercial	$85.80
Rate for Payer: Aetna of NY Medicare	$60.72
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$52.80
Rate for Payer: Cash Price	$99.00
Rate for Payer: CDPHP Medicare	$48.84
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$79.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$105.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$105.60
Rate for Payer: EmblemHealth Medicaid	$105.60
Rate for Payer: EmblemHealth Medicare	$44.88
Rate for Payer: EmblemHealth Select Care	$79.20
Rate for Payer: Fidelis Medicare	$52.80
Rate for Payer: Galaxy Health Commercial	$85.80
Rate for Payer: Hamaspik Choice Medicare	$52.80
Rate for Payer: Humana Medicare	$52.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$85.80
Rate for Payer: Local 1199SEIU Medicare	$60.72
Rate for Payer: MVP Health Care of NY Commercial	$99.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$74.32
Rate for Payer: MVP Health Care of NY Medicare	$55.44
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$99.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$19.80
Rate for Payer: United Healthcare Commercial	$99.00
Rate for Payer: United Healthcare Medicare	$52.80
Rate for Payer: WellCare Medicare	$72.60

GENTAMICIN SULFATE 0.001 OINT 15 GM

Facility

$152.70

Service Code	NDC 45802004635
Hospital Charge Code	4400320
Hospital Revenue Code	250
Min. Negotiated Rate	$83.98
Max. Negotiated Rate	$99.25
Rate for Payer: Cash Price	$114.52
Rate for Payer: Galaxy Health Commercial	$99.25
Rate for Payer: WellCare Medicare	$83.98

GENTAMICIN SULFATE 0.001 OINT 15 GM

Facility

$152.70

Service Code	NDC 45802004635
Hospital Charge Code	4400320
Hospital Revenue Code	250
Min. Negotiated Rate	$22.91
Max. Negotiated Rate	$122.16
Rate for Payer: Aetna of NY Commercial	$106.89
Rate for Payer: Aetna of NY Medicare	$70.24
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$61.08
Rate for Payer: Cash Price	$114.52
Rate for Payer: CDPHP Medicare	$56.50
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$122.16
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$122.16
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$122.16
Rate for Payer: EmblemHealth Medicaid	$122.16
Rate for Payer: EmblemHealth Medicare	$51.92
Rate for Payer: EmblemHealth Select Care	$109.94
Rate for Payer: Fidelis Medicare	$61.08
Rate for Payer: Galaxy Health Commercial	$99.25
Rate for Payer: Hamaspik Choice Medicare	$61.08
Rate for Payer: Humana Medicare	$61.08
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$106.89
Rate for Payer: Local 1199SEIU Medicare	$70.24
Rate for Payer: MVP Health Care of NY Commercial	$114.53
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$85.97
Rate for Payer: MVP Health Care of NY Medicare	$64.13
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$22.91
Rate for Payer: United Healthcare Medicare	$61.08
Rate for Payer: WellCare Medicare	$83.98

GENTAMICIN SULFATE 0.003 DROP 5 ML

Facility

$132.36

Service Code	NDC 24208058060
Hospital Charge Code	4400321
Hospital Revenue Code	250
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$86.03
Rate for Payer: Cash Price	$99.27
Rate for Payer: Galaxy Health Commercial	$86.03
Rate for Payer: WellCare Medicare	$72.80

GENTAMICIN SULFATE 0.003 DROP 5 ML

Facility

$132.36

Service Code	NDC 24208058060
Hospital Charge Code	4400321
Hospital Revenue Code	250
Min. Negotiated Rate	$19.85
Max. Negotiated Rate	$105.89
Rate for Payer: Aetna of NY Commercial	$92.65
Rate for Payer: Aetna of NY Medicare	$60.89
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$52.94
Rate for Payer: Cash Price	$99.27
Rate for Payer: CDPHP Medicare	$48.97
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$105.89
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$105.89
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$105.89
Rate for Payer: EmblemHealth Medicaid	$105.89
Rate for Payer: EmblemHealth Medicare	$45.00
Rate for Payer: EmblemHealth Select Care	$95.30
Rate for Payer: Fidelis Medicare	$52.94
Rate for Payer: Galaxy Health Commercial	$86.03
Rate for Payer: Hamaspik Choice Medicare	$52.94
Rate for Payer: Humana Medicare	$52.94
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$92.65
Rate for Payer: Local 1199SEIU Medicare	$60.89
Rate for Payer: MVP Health Care of NY Commercial	$99.27
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$74.52
Rate for Payer: MVP Health Care of NY Medicare	$55.59
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$19.85
Rate for Payer: United Healthcare Medicare	$52.94
Rate for Payer: WellCare Medicare	$72.80

GENTAMICIN SULFATE 0.003 OINT 3.5 GM

Facility

$60.77

Service Code	NDC 17478028435
Hospital Charge Code	4400319
Hospital Revenue Code	250
Min. Negotiated Rate	$33.42
Max. Negotiated Rate	$39.50
Rate for Payer: Cash Price	$45.58
Rate for Payer: Galaxy Health Commercial	$39.50
Rate for Payer: WellCare Medicare	$33.42

GENTAMICIN SULFATE 0.003 OINT 3.5 GM

Facility

$60.77

Service Code	NDC 17478028435
Hospital Charge Code	4400319
Hospital Revenue Code	250
Min. Negotiated Rate	$9.12
Max. Negotiated Rate	$48.62
Rate for Payer: Aetna of NY Commercial	$42.54
Rate for Payer: Aetna of NY Medicare	$27.95
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$24.31
Rate for Payer: Cash Price	$45.58
Rate for Payer: CDPHP Medicare	$22.48
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$48.62
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$48.62
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$48.62
Rate for Payer: EmblemHealth Medicaid	$48.62
Rate for Payer: EmblemHealth Medicare	$20.66
Rate for Payer: EmblemHealth Select Care	$43.75
Rate for Payer: Fidelis Medicare	$24.31
Rate for Payer: Galaxy Health Commercial	$39.50
Rate for Payer: Hamaspik Choice Medicare	$24.31
Rate for Payer: Humana Medicare	$24.31
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$42.54
Rate for Payer: Local 1199SEIU Medicare	$27.95
Rate for Payer: MVP Health Care of NY Commercial	$45.58
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$34.21
Rate for Payer: MVP Health Care of NY Medicare	$25.52
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$9.12
Rate for Payer: United Healthcare Medicare	$24.31
Rate for Payer: WellCare Medicare	$33.42

GENTAMICIN TROUGH

Facility

$49.00

Service Code	HCPCS 80170
Hospital Charge Code	4300369
Hospital Revenue Code	300
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$39.20
Rate for Payer: Aetna of NY Commercial	$31.85
Rate for Payer: Aetna of NY Medicare	$22.54
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$19.60
Rate for Payer: Cash Price	$36.75
Rate for Payer: CDPHP Medicare	$18.13
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$29.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$39.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$39.20
Rate for Payer: EmblemHealth Medicaid	$39.20
Rate for Payer: EmblemHealth Medicare	$16.66
Rate for Payer: EmblemHealth Select Care	$29.40
Rate for Payer: Fidelis Medicare	$19.60
Rate for Payer: Galaxy Health Commercial	$31.85
Rate for Payer: Hamaspik Choice Medicare	$19.60
Rate for Payer: Humana Medicare	$19.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$31.85
Rate for Payer: Local 1199SEIU Medicare	$22.54
Rate for Payer: MVP Health Care of NY Commercial	$36.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$27.59
Rate for Payer: MVP Health Care of NY Medicare	$20.58
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$36.75
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$7.35
Rate for Payer: United Healthcare Commercial	$36.75
Rate for Payer: United Healthcare Medicare	$19.60
Rate for Payer: WellCare Medicare	$26.95

GENTAMICIN TROUGH

Facility

$49.00

Service Code	HCPCS 80170
Hospital Charge Code	4300369
Hospital Revenue Code	300
Min. Negotiated Rate	$31.85
Max. Negotiated Rate	$31.85
Rate for Payer: Cash Price	$36.75
Rate for Payer: Galaxy Health Commercial	$31.85

GIARDIA LAMBLIA ABS EIA

Facility

$44.00

Service Code	HCPCS 86674
Hospital Charge Code	4300372
Hospital Revenue Code	302
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna of NY Commercial	$28.60
Rate for Payer: Aetna of NY Medicare	$20.24
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$17.60
Rate for Payer: Cash Price	$33.00
Rate for Payer: CDPHP Medicare	$16.28
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$26.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$35.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$35.20
Rate for Payer: EmblemHealth Medicaid	$35.20
Rate for Payer: EmblemHealth Medicare	$14.96
Rate for Payer: EmblemHealth Select Care	$26.40
Rate for Payer: Fidelis Medicare	$17.60
Rate for Payer: Galaxy Health Commercial	$28.60
Rate for Payer: Hamaspik Choice Medicare	$17.60
Rate for Payer: Humana Medicare	$17.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$28.60
Rate for Payer: Local 1199SEIU Medicare	$20.24
Rate for Payer: MVP Health Care of NY Commercial	$33.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$24.77
Rate for Payer: MVP Health Care of NY Medicare	$18.48
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$33.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$6.60
Rate for Payer: United Healthcare Commercial	$33.00
Rate for Payer: United Healthcare Medicare	$17.60
Rate for Payer: WellCare Medicare	$24.20

GIARDIA LAMBLIA ABS EIA

Facility

$44.00

Service Code	HCPCS 86674
Hospital Charge Code	4300372
Hospital Revenue Code	302
Min. Negotiated Rate	$28.60
Max. Negotiated Rate	$28.60
Rate for Payer: Cash Price	$33.00
Rate for Payer: Galaxy Health Commercial	$28.60

GI BLEEDING

Facility

$1,225.00

Service Code	HCPCS 78278
Hospital Charge Code	4210001
Hospital Revenue Code	341
Min. Negotiated Rate	$796.25
Max. Negotiated Rate	$796.25
Rate for Payer: Cash Price	$918.75
Rate for Payer: Galaxy Health Commercial	$796.25

GI BLEEDING

Facility

$142.00

Service Code	HCPCS 78278 26
Hospital Charge Code	5210001
Hospital Revenue Code	960
Min. Negotiated Rate	$92.30
Max. Negotiated Rate	$92.30
Rate for Payer: Cash Price	$106.50
Rate for Payer: Galaxy Health Commercial	$92.30

Know your out-of-pocket cost for care.

All Charges