Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

HYDROXYZINE PAMOATE 25MG CAPS 100 EA

Facility

$6.18

Service Code	NDC 68084084711
Hospital Charge Code	4400373
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$4.94
Rate for Payer: Aetna of NY Commercial	$4.33
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 Aetna Signature Administrators	$4.33
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

HYOSCYAMINE SULFATE 0.125MG TABS 100 EA

Facility

$6.18

Service Code	NDC 43199001301
Hospital Charge Code	4400375
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$4.02
Rate for Payer: Cash Price	$4.64
Rate for Payer: Galaxy Health Commercial	$4.02
Rate for Payer: WellCare Medicare	$3.40

HYOSCYAMINE SULFATE 0.125MG TABS 100 EA

Facility

$6.18

Service Code	NDC 43199001301
Hospital Charge Code	4400375
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$4.94
Rate for Payer: Aetna of NY Commercial	$4.33
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 Aetna Signature Administrators	$4.33
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

I131 IODIDE CAP RX PER 1 MCI THERA

Facility

$72.00

Service Code	HCPCS A9517
Hospital Charge Code	4210077
Hospital Revenue Code	344
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of NY Medicare	$33.12
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$28.80
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: CDPHP Medicare	$26.64
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$57.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$57.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$57.60
Rate for Payer: EmblemHealth Medicaid	$57.60
Rate for Payer: EmblemHealth Medicare	$24.48
Rate for Payer: EmblemHealth Select Care	$51.84
Rate for Payer: Fidelis Medicare	$28.80
Rate for Payer: Galaxy Health Commercial	$46.80
Rate for Payer: Hamaspik Choice Medicare	$28.80
Rate for Payer: Humana Medicare	$28.80
Rate for Payer: Local 1199SEIU Medicare	$33.12
Rate for Payer: MVP Health Care of NY Commercial	$54.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$40.54
Rate for Payer: MVP Health Care of NY Medicare	$30.24
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$39.15
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$10.80
Rate for Payer: United Healthcare Commercial	$39.15
Rate for Payer: United Healthcare Medicare	$28.80
Rate for Payer: WellCare Medicare	$39.60

I131 IODIDE CAP RX PER 1 MCI THERA

Facility

$72.00

Service Code	HCPCS A9517
Hospital Charge Code	4210077
Hospital Revenue Code	344
Min. Negotiated Rate	$46.80
Max. Negotiated Rate	$46.80
Rate for Payer: Cash Price	$54.00
Rate for Payer: Galaxy Health Commercial	$46.80

IAAD IA SEVERE AQTRESPIRSYND CORONAVIRUS

Facility

$162.00

Service Code	HCPCS 87426
Hospital Charge Code	4302022
Hospital Revenue Code	300
Min. Negotiated Rate	$24.30
Max. Negotiated Rate	$129.60
Rate for Payer: Aetna of NY Commercial	$105.30
Rate for Payer: Aetna of NY Medicare	$74.52
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$64.80
Rate for Payer: Cash Price	$121.50
Rate for Payer: CDPHP Medicare	$59.94
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$97.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$129.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$129.60
Rate for Payer: EmblemHealth Medicaid	$129.60
Rate for Payer: EmblemHealth Medicare	$55.08
Rate for Payer: EmblemHealth Select Care	$97.20
Rate for Payer: Fidelis Medicare	$64.80
Rate for Payer: Galaxy Health Commercial	$105.30
Rate for Payer: Hamaspik Choice Medicare	$64.80
Rate for Payer: Humana Medicare	$64.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$105.30
Rate for Payer: Local 1199SEIU Medicare	$74.52
Rate for Payer: MVP Health Care of NY Commercial	$121.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$91.21
Rate for Payer: MVP Health Care of NY Medicare	$68.04
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$121.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$24.30
Rate for Payer: United Healthcare Commercial	$121.50
Rate for Payer: United Healthcare Medicare	$64.80
Rate for Payer: WellCare Medicare	$89.10

IAAD IA SEVERE AQTRESPIRSYND CORONAVIRUS

Facility

$162.00

Service Code	HCPCS 87426
Hospital Charge Code	4302022
Hospital Revenue Code	300
Min. Negotiated Rate	$105.30
Max. Negotiated Rate	$105.30
Rate for Payer: Cash Price	$121.50
Rate for Payer: Galaxy Health Commercial	$105.30

IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM

Facility

$316.00

Service Code	HCPCS 87798
Hospital Charge Code	4300398
Hospital Revenue Code	300
Min. Negotiated Rate	$205.40
Max. Negotiated Rate	$205.40
Rate for Payer: Cash Price	$237.00
Rate for Payer: Galaxy Health Commercial	$205.40

IADNA NOS AMPLIFIED PROBE TQ EACH ORGANISM

Facility

$316.00

Service Code	HCPCS 87798
Hospital Charge Code	4300398
Hospital Revenue Code	300
Min. Negotiated Rate	$47.40
Max. Negotiated Rate	$252.80
Rate for Payer: Aetna of NY Commercial	$205.40
Rate for Payer: Aetna of NY Medicare	$145.36
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$126.40
Rate for Payer: Cash Price	$237.00
Rate for Payer: CDPHP Medicare	$116.92
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$189.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$252.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$252.80
Rate for Payer: EmblemHealth Medicaid	$252.80
Rate for Payer: EmblemHealth Medicare	$107.44
Rate for Payer: EmblemHealth Select Care	$189.60
Rate for Payer: Fidelis Medicare	$126.40
Rate for Payer: Galaxy Health Commercial	$205.40
Rate for Payer: Hamaspik Choice Medicare	$126.40
Rate for Payer: Humana Medicare	$126.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$205.40
Rate for Payer: Local 1199SEIU Medicare	$145.36
Rate for Payer: MVP Health Care of NY Commercial	$237.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$177.91
Rate for Payer: MVP Health Care of NY Medicare	$132.72
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$237.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$47.40
Rate for Payer: United Healthcare Commercial	$237.00
Rate for Payer: United Healthcare Medicare	$126.40
Rate for Payer: WellCare Medicare	$173.80

IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ

Facility

$154.00

Service Code	HCPCS 87635
Hospital Charge Code	4302021
Hospital Revenue Code	300
Min. Negotiated Rate	$23.10
Max. Negotiated Rate	$123.20
Rate for Payer: Aetna of NY Commercial	$100.10
Rate for Payer: Aetna of NY Medicare	$70.84
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$61.60
Rate for Payer: Cash Price	$115.50
Rate for Payer: CDPHP Medicare	$56.98
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$92.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$123.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$123.20
Rate for Payer: EmblemHealth Medicaid	$123.20
Rate for Payer: EmblemHealth Medicare	$52.36
Rate for Payer: EmblemHealth Select Care	$92.40
Rate for Payer: Fidelis Medicare	$61.60
Rate for Payer: Galaxy Health Commercial	$100.10
Rate for Payer: Hamaspik Choice Medicare	$61.60
Rate for Payer: Humana Medicare	$61.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$100.10
Rate for Payer: Local 1199SEIU Medicare	$70.84
Rate for Payer: MVP Health Care of NY Commercial	$115.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$86.70
Rate for Payer: MVP Health Care of NY Medicare	$64.68
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$115.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$23.10
Rate for Payer: United Healthcare Commercial	$115.50
Rate for Payer: United Healthcare Medicare	$61.60
Rate for Payer: WellCare Medicare	$84.70

IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ

Facility

$154.00

Service Code	HCPCS 87635
Hospital Charge Code	4302021
Hospital Revenue Code	300
Min. Negotiated Rate	$100.10
Max. Negotiated Rate	$100.10
Rate for Payer: Cash Price	$115.50
Rate for Payer: Galaxy Health Commercial	$100.10

IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ

Facility

$442.00

Service Code	HCPCS 87637
Hospital Charge Code	4302028
Hospital Revenue Code	300
Min. Negotiated Rate	$287.30
Max. Negotiated Rate	$287.30
Rate for Payer: Cash Price	$331.50
Rate for Payer: Galaxy Health Commercial	$287.30

IADNA SARSCOV2 & INF A&B & RSV MULT AMP PROBE TQ

Facility

$442.00

Service Code	HCPCS 87637
Hospital Charge Code	4302028
Hospital Revenue Code	300
Min. Negotiated Rate	$66.30
Max. Negotiated Rate	$353.60
Rate for Payer: Aetna of NY Commercial	$287.30
Rate for Payer: Aetna of NY Medicare	$203.32
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$176.80
Rate for Payer: Cash Price	$331.50
Rate for Payer: CDPHP Medicare	$163.54
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$265.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$353.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$353.60
Rate for Payer: EmblemHealth Medicaid	$353.60
Rate for Payer: EmblemHealth Medicare	$150.28
Rate for Payer: EmblemHealth Select Care	$265.20
Rate for Payer: Fidelis Medicare	$176.80
Rate for Payer: Galaxy Health Commercial	$287.30
Rate for Payer: Hamaspik Choice Medicare	$176.80
Rate for Payer: Humana Medicare	$176.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$287.30
Rate for Payer: Local 1199SEIU Medicare	$203.32
Rate for Payer: MVP Health Care of NY Commercial	$331.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$248.85
Rate for Payer: MVP Health Care of NY Medicare	$185.64
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$331.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$66.30
Rate for Payer: United Healthcare Commercial	$331.50
Rate for Payer: United Healthcare Medicare	$176.80
Rate for Payer: WellCare Medicare	$243.10

IBUPROFEN 200MG TABS 10X10EA

Facility

$6.18

Service Code	NDC 904791461
Hospital Charge Code	4400378
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$4.94
Rate for Payer: Aetna of NY Commercial	$4.33
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 Aetna Signature Administrators	$4.33
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

IBUPROFEN 200MG TABS 10X10EA

Facility

$6.18

Service Code	NDC 904791461
Hospital Charge Code	4400378
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$4.02
Rate for Payer: Cash Price	$4.64
Rate for Payer: Galaxy Health Commercial	$4.02
Rate for Payer: WellCare Medicare	$3.40

IBUPROFEN 400MG TABS 100 EA

Facility

$6.18

Service Code	NDC 904585361
Hospital Charge Code	4400379
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$4.94
Rate for Payer: Aetna of NY Commercial	$4.33
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 Aetna Signature Administrators	$4.33
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

IBUPROFEN 400MG TABS 100 EA

Facility

$6.18

Service Code	NDC 904585361
Hospital Charge Code	4400379
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$4.02
Rate for Payer: Cash Price	$4.64
Rate for Payer: Galaxy Health Commercial	$4.02
Rate for Payer: WellCare Medicare	$3.40

IBUPROFEN 600MG TABS 10X10EA

Facility

$6.18

Service Code	NDC 904585461
Hospital Charge Code	4400380
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$4.94
Rate for Payer: Aetna of NY Commercial	$4.33
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 Aetna Signature Administrators	$4.33
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

IBUPROFEN 600MG TABS 10X10EA

Facility

$6.18

Service Code	NDC 904585461
Hospital Charge Code	4400380
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$4.02
Rate for Payer: Cash Price	$4.64
Rate for Payer: Galaxy Health Commercial	$4.02
Rate for Payer: WellCare Medicare	$3.40

IBUPROFEN 800MG TABS 10X10EA

Facility

$6.18

Service Code	NDC 68084077211
Hospital Charge Code	4400383
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$4.02
Rate for Payer: Cash Price	$4.64
Rate for Payer: Galaxy Health Commercial	$4.02
Rate for Payer: WellCare Medicare	$3.40

IBUPROFEN 800MG TABS 10X10EA

Facility

$6.18

Service Code	NDC 68084077211
Hospital Charge Code	4400383
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$4.94
Rate for Payer: Aetna of NY Commercial	$4.33
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 Aetna Signature Administrators	$4.33
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

IBUPROFEN SUSP 100MG 5MG

Facility

$6.18

Service Code	NDC 68094049459
Hospital Charge Code	4409189
Hospital Revenue Code	250
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$4.94
Rate for Payer: Aetna of NY Commercial	$4.33
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 Aetna Signature Administrators	$4.33
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

IBUPROFEN SUSP 100MG 5MG

Facility

$6.18

Service Code	NDC 68094049459
Hospital Charge Code	4409189
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$4.02
Rate for Payer: Cash Price	$4.64
Rate for Payer: Galaxy Health Commercial	$4.02
Rate for Payer: WellCare Medicare	$3.40

I&D ABSC; COMPL OR MULTI

Facility

$1,246.00

Service Code	HCPCS 10061
Hospital Charge Code	4856706
Hospital Revenue Code	761
Min. Negotiated Rate	$809.90
Max. Negotiated Rate	$809.90
Rate for Payer: Cash Price	$934.50
Rate for Payer: Galaxy Health Commercial	$809.90

I&D ABSC; COMPL OR MULTI

Facility

$1,246.00

Service Code	HCPCS 10061
Hospital Charge Code	4856706
Hospital Revenue Code	761
Min. Negotiated Rate	$186.90
Max. Negotiated Rate	$996.80
Rate for Payer: Aetna of NY Commercial	$872.20
Rate for Payer: Aetna of NY Medicare	$573.16
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$498.40
Rate for Payer: Cash Price	$934.50
Rate for Payer: CDPHP Medicare	$461.02
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$996.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$996.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$996.80
Rate for Payer: EmblemHealth Medicaid	$996.80
Rate for Payer: EmblemHealth Medicare	$423.64
Rate for Payer: EmblemHealth Select Care	$897.12
Rate for Payer: Fidelis Medicare	$498.40
Rate for Payer: Galaxy Health Commercial	$809.90
Rate for Payer: Hamaspik Choice Medicare	$498.40
Rate for Payer: Humana Medicare	$498.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$872.20
Rate for Payer: Local 1199SEIU Medicare	$573.16
Rate for Payer: MVP Health Care of NY Commercial	$934.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$701.50
Rate for Payer: MVP Health Care of NY Medicare	$523.32
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$186.90
Rate for Payer: United Healthcare Medicare	$498.40
Rate for Payer: WellCare Medicare	$685.30

Know your out-of-pocket cost for care.

All Charges