Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

6"X.045 TROCAR 2 END K-WIRE

Facility

$31.93

Hospital Charge Code	4479308
Hospital Revenue Code	278
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$25.54
Rate for Payer: Aetna of NY Commercial	$22.35
Rate for Payer: Aetna of NY Medicare	$14.69
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$12.77
Rate for Payer: Cash Price	$23.95
Rate for Payer: CDPHP Medicare	$11.81
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$15.96
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$25.54
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$25.54
Rate for Payer: EmblemHealth Medicaid	$25.54
Rate for Payer: EmblemHealth Medicare	$10.86
Rate for Payer: EmblemHealth Select Care	$15.96
Rate for Payer: Fidelis Medicare	$12.77
Rate for Payer: Galaxy Health Commercial	$20.75
Rate for Payer: Hamaspik Choice Medicare	$12.77
Rate for Payer: Humana Medicare	$12.77
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$22.35
Rate for Payer: Local 1199SEIU Medicare	$14.69
Rate for Payer: MVP Health Care of NY Commercial	$20.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$20.75
Rate for Payer: MVP Health Care of NY Medicare	$13.41
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4.79
Rate for Payer: United Healthcare Medicare	$12.77
Rate for Payer: WellCare Medicare	$17.56

6"X.062 TROCAR 1 END K-WIRE

Facility

$31.93

Hospital Charge Code	4479311
Hospital Revenue Code	278
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$25.54
Rate for Payer: Aetna of NY Commercial	$22.35
Rate for Payer: Aetna of NY Medicare	$14.69
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$12.77
Rate for Payer: Cash Price	$23.95
Rate for Payer: CDPHP Medicare	$11.81
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$15.96
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$25.54
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$25.54
Rate for Payer: EmblemHealth Medicaid	$25.54
Rate for Payer: EmblemHealth Medicare	$10.86
Rate for Payer: EmblemHealth Select Care	$15.96
Rate for Payer: Fidelis Medicare	$12.77
Rate for Payer: Galaxy Health Commercial	$20.75
Rate for Payer: Hamaspik Choice Medicare	$12.77
Rate for Payer: Humana Medicare	$12.77
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$22.35
Rate for Payer: Local 1199SEIU Medicare	$14.69
Rate for Payer: MVP Health Care of NY Commercial	$20.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$20.75
Rate for Payer: MVP Health Care of NY Medicare	$13.41
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4.79
Rate for Payer: United Healthcare Medicare	$12.77
Rate for Payer: WellCare Medicare	$17.56

6"X.062 TROCAR 1 END K-WIRE

Facility

$31.93

Hospital Charge Code	4479311
Hospital Revenue Code	278
Min. Negotiated Rate	$14.37
Max. Negotiated Rate	$22.35
Rate for Payer: Aetna of NY Commercial	$22.35
Rate for Payer: Cash Price	$23.95
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$15.96
Rate for Payer: EmblemHealth Select Care	$15.96
Rate for Payer: Galaxy Health Commercial	$20.75
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$22.35
Rate for Payer: Multiplan Commercial	$14.37
Rate for Payer: MVP Health Care of NY Commercial	$20.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$20.75
Rate for Payer: WellCare Medicare	$17.56

6"X.062 TROCAR 2 END K-WIRE

Facility

$31.93

Hospital Charge Code	4479310
Hospital Revenue Code	278
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$25.54
Rate for Payer: Aetna of NY Commercial	$22.35
Rate for Payer: Aetna of NY Medicare	$14.69
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$12.77
Rate for Payer: Cash Price	$23.95
Rate for Payer: CDPHP Medicare	$11.81
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$15.96
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$25.54
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$25.54
Rate for Payer: EmblemHealth Medicaid	$25.54
Rate for Payer: EmblemHealth Medicare	$10.86
Rate for Payer: EmblemHealth Select Care	$15.96
Rate for Payer: Fidelis Medicare	$12.77
Rate for Payer: Galaxy Health Commercial	$20.75
Rate for Payer: Hamaspik Choice Medicare	$12.77
Rate for Payer: Humana Medicare	$12.77
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$22.35
Rate for Payer: Local 1199SEIU Medicare	$14.69
Rate for Payer: MVP Health Care of NY Commercial	$20.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$20.75
Rate for Payer: MVP Health Care of NY Medicare	$13.41
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4.79
Rate for Payer: United Healthcare Medicare	$12.77
Rate for Payer: WellCare Medicare	$17.56

6"X.062 TROCAR 2 END K-WIRE

Facility

$31.93

Hospital Charge Code	4479310
Hospital Revenue Code	278
Min. Negotiated Rate	$14.37
Max. Negotiated Rate	$22.35
Rate for Payer: Aetna of NY Commercial	$22.35
Rate for Payer: Cash Price	$23.95
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$15.96
Rate for Payer: EmblemHealth Select Care	$15.96
Rate for Payer: Galaxy Health Commercial	$20.75
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$22.35
Rate for Payer: Multiplan Commercial	$14.37
Rate for Payer: MVP Health Care of NY Commercial	$20.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$20.75
Rate for Payer: WellCare Medicare	$17.56

6X5YD SPECIALIST EXTRA-FAST PL

Facility

$95.79

Hospital Charge Code	4471917
Hospital Revenue Code	270
Min. Negotiated Rate	$14.37
Max. Negotiated Rate	$76.63
Rate for Payer: Aetna of NY Commercial	$67.05
Rate for Payer: Aetna of NY Medicare	$44.06
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$38.32
Rate for Payer: Cash Price	$71.84
Rate for Payer: CDPHP Medicare	$35.44
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$76.63
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$76.63
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$76.63
Rate for Payer: EmblemHealth Medicaid	$76.63
Rate for Payer: EmblemHealth Medicare	$32.57
Rate for Payer: EmblemHealth Select Care	$68.97
Rate for Payer: Fidelis Medicare	$38.32
Rate for Payer: Galaxy Health Commercial	$62.26
Rate for Payer: Hamaspik Choice Medicare	$38.32
Rate for Payer: Humana Medicare	$38.32
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$67.05
Rate for Payer: Local 1199SEIU Medicare	$44.06
Rate for Payer: MVP Health Care of NY Commercial	$71.84
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$53.93
Rate for Payer: MVP Health Care of NY Medicare	$40.23
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$14.37
Rate for Payer: United Healthcare Medicare	$38.32
Rate for Payer: WellCare Medicare	$52.68

6X5YD SPECIALIST EXTRA-FAST PL

Facility

$95.79

Hospital Charge Code	4471917
Hospital Revenue Code	270
Min. Negotiated Rate	$62.26
Max. Negotiated Rate	$62.26
Rate for Payer: Cash Price	$71.84
Rate for Payer: Galaxy Health Commercial	$62.26

6X6 AQUACEL EXTRATM DRESSING

Facility

$60.77

Hospital Charge Code	4470500
Hospital Revenue Code	272
Min. Negotiated Rate	$39.50
Max. Negotiated Rate	$39.50
Rate for Payer: Cash Price	$45.58
Rate for Payer: Galaxy Health Commercial	$39.50

6X6 AQUACEL EXTRATM DRESSING

Facility

$60.77

Hospital Charge Code	4470500
Hospital Revenue Code	272
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

7.0 ET TUBE

Facility

$10.30

Hospital Charge Code	4471473
Hospital Revenue Code	270
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$6.70
Rate for Payer: Cash Price	$7.72
Rate for Payer: Galaxy Health Commercial	$6.70

7.0 ET TUBE

Facility

$10.30

Hospital Charge Code	4471473
Hospital Revenue Code	270
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$8.24
Rate for Payer: Aetna of NY Commercial	$7.21
Rate for Payer: Aetna of NY Medicare	$4.74
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$4.12
Rate for Payer: Cash Price	$7.72
Rate for Payer: CDPHP Medicare	$3.81
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$8.24
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$8.24
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$8.24
Rate for Payer: EmblemHealth Medicaid	$8.24
Rate for Payer: EmblemHealth Medicare	$3.50
Rate for Payer: EmblemHealth Select Care	$7.42
Rate for Payer: Fidelis Medicare	$4.12
Rate for Payer: Galaxy Health Commercial	$6.70
Rate for Payer: Hamaspik Choice Medicare	$4.12
Rate for Payer: Humana Medicare	$4.12
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$7.21
Rate for Payer: Local 1199SEIU Medicare	$4.74
Rate for Payer: MVP Health Care of NY Commercial	$7.72
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$5.80
Rate for Payer: MVP Health Care of NY Medicare	$4.33
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.54
Rate for Payer: United Healthcare Medicare	$4.12
Rate for Payer: WellCare Medicare	$5.67

7.0 ET TUBE CUFFED

Facility

$15.45

Hospital Charge Code	4479149
Hospital Revenue Code	270
Min. Negotiated Rate	$10.04
Max. Negotiated Rate	$10.04
Rate for Payer: Cash Price	$11.59
Rate for Payer: Galaxy Health Commercial	$10.04

7.0 ET TUBE CUFFED

Facility

$15.45

Hospital Charge Code	4479149
Hospital Revenue Code	270
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$12.36
Rate for Payer: Aetna of NY Commercial	$10.81
Rate for Payer: Aetna of NY Medicare	$7.11
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$6.18
Rate for Payer: Cash Price	$11.59
Rate for Payer: CDPHP Medicare	$5.72
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$12.36
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$12.36
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$12.36
Rate for Payer: EmblemHealth Medicaid	$12.36
Rate for Payer: EmblemHealth Medicare	$5.25
Rate for Payer: EmblemHealth Select Care	$11.12
Rate for Payer: Fidelis Medicare	$6.18
Rate for Payer: Galaxy Health Commercial	$10.04
Rate for Payer: Hamaspik Choice Medicare	$6.18
Rate for Payer: Humana Medicare	$6.18
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$10.81
Rate for Payer: Local 1199SEIU Medicare	$7.11
Rate for Payer: MVP Health Care of NY Commercial	$11.59
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$8.70
Rate for Payer: MVP Health Care of NY Medicare	$6.49
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.32
Rate for Payer: United Healthcare Medicare	$6.18
Rate for Payer: WellCare Medicare	$8.50

70 MG TABLET (ALENDRONATE

Facility

$63.35

Service Code	NDC 16252060144
Hospital Charge Code	4409114
Hospital Revenue Code	250
Min. Negotiated Rate	$34.84
Max. Negotiated Rate	$41.18
Rate for Payer: Cash Price	$47.51
Rate for Payer: Galaxy Health Commercial	$41.18
Rate for Payer: WellCare Medicare	$34.84

70 MG TABLET (ALENDRONATE

Facility

$63.35

Service Code	NDC 16252060144
Hospital Charge Code	4409114
Hospital Revenue Code	250
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$50.68
Rate for Payer: Aetna of NY Commercial	$44.34
Rate for Payer: Aetna of NY Medicare	$29.14
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$25.34
Rate for Payer: Cash Price	$47.51
Rate for Payer: CDPHP Medicare	$23.44
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$50.68
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$50.68
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$50.68
Rate for Payer: EmblemHealth Medicaid	$50.68
Rate for Payer: EmblemHealth Medicare	$21.54
Rate for Payer: EmblemHealth Select Care	$45.61
Rate for Payer: Fidelis Medicare	$25.34
Rate for Payer: Galaxy Health Commercial	$41.18
Rate for Payer: Hamaspik Choice Medicare	$25.34
Rate for Payer: Humana Medicare	$25.34
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$44.34
Rate for Payer: Local 1199SEIU Medicare	$29.14
Rate for Payer: MVP Health Care of NY Commercial	$47.51
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$35.67
Rate for Payer: MVP Health Care of NY Medicare	$26.61
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$9.50
Rate for Payer: United Healthcare Medicare	$25.34
Rate for Payer: WellCare Medicare	$34.84

7.0 NEOPRENE SURG GLOVE

Facility

$3.09

Hospital Charge Code	4471259
Hospital Revenue Code	270
Min. Negotiated Rate	$0.46
Max. Negotiated Rate	$2.47
Rate for Payer: Aetna of NY Commercial	$2.16
Rate for Payer: Aetna of NY Medicare	$1.42
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1.24
Rate for Payer: Cash Price	$2.32
Rate for Payer: CDPHP Medicare	$1.14
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$2.47
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2.47
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2.47
Rate for Payer: EmblemHealth Medicaid	$2.47
Rate for Payer: EmblemHealth Medicare	$1.05
Rate for Payer: EmblemHealth Select Care	$2.22
Rate for Payer: Fidelis Medicare	$1.24
Rate for Payer: Galaxy Health Commercial	$2.01
Rate for Payer: Hamaspik Choice Medicare	$1.24
Rate for Payer: Humana Medicare	$1.24
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$2.16
Rate for Payer: Local 1199SEIU Medicare	$1.42
Rate for Payer: MVP Health Care of NY Commercial	$2.32
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1.74
Rate for Payer: MVP Health Care of NY Medicare	$1.30
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.46
Rate for Payer: United Healthcare Medicare	$1.24
Rate for Payer: WellCare Medicare	$1.70

7.0 NEOPRENE SURG GLOVE

Facility

$3.09

Hospital Charge Code	4471259
Hospital Revenue Code	270
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$2.01
Rate for Payer: Cash Price	$2.32
Rate for Payer: Galaxy Health Commercial	$2.01

7.5 ET TUBE

Facility

$8.24

Hospital Charge Code	4471474
Hospital Revenue Code	270
Min. Negotiated Rate	$5.36
Max. Negotiated Rate	$5.36
Rate for Payer: Cash Price	$6.18
Rate for Payer: Galaxy Health Commercial	$5.36

7.5 ET TUBE

Facility

$8.24

Hospital Charge Code	4471474
Hospital Revenue Code	270
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$6.59
Rate for Payer: Aetna of NY Commercial	$5.77
Rate for Payer: Aetna of NY Medicare	$3.79
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$3.30
Rate for Payer: Cash Price	$6.18
Rate for Payer: CDPHP Medicare	$3.05
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$6.59
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$6.59
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$6.59
Rate for Payer: EmblemHealth Medicaid	$6.59
Rate for Payer: EmblemHealth Medicare	$2.80
Rate for Payer: EmblemHealth Select Care	$5.93
Rate for Payer: Fidelis Medicare	$3.30
Rate for Payer: Galaxy Health Commercial	$5.36
Rate for Payer: Hamaspik Choice Medicare	$3.30
Rate for Payer: Humana Medicare	$3.30
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$5.77
Rate for Payer: Local 1199SEIU Medicare	$3.79
Rate for Payer: MVP Health Care of NY Commercial	$6.18
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$4.64
Rate for Payer: MVP Health Care of NY Medicare	$3.46
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.24
Rate for Payer: United Healthcare Medicare	$3.30
Rate for Payer: WellCare Medicare	$4.53

7.5 ET TUBE CUFFED

Facility

$15.45

Hospital Charge Code	4479150
Hospital Revenue Code	270
Min. Negotiated Rate	$10.04
Max. Negotiated Rate	$10.04
Rate for Payer: Cash Price	$11.59
Rate for Payer: Galaxy Health Commercial	$10.04

7.5 ET TUBE CUFFED

Facility

$15.45

Hospital Charge Code	4479150
Hospital Revenue Code	270
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$12.36
Rate for Payer: Aetna of NY Commercial	$10.81
Rate for Payer: Aetna of NY Medicare	$7.11
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$6.18
Rate for Payer: Cash Price	$11.59
Rate for Payer: CDPHP Medicare	$5.72
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$12.36
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$12.36
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$12.36
Rate for Payer: EmblemHealth Medicaid	$12.36
Rate for Payer: EmblemHealth Medicare	$5.25
Rate for Payer: EmblemHealth Select Care	$11.12
Rate for Payer: Fidelis Medicare	$6.18
Rate for Payer: Galaxy Health Commercial	$10.04
Rate for Payer: Hamaspik Choice Medicare	$6.18
Rate for Payer: Humana Medicare	$6.18
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$10.81
Rate for Payer: Local 1199SEIU Medicare	$7.11
Rate for Payer: MVP Health Care of NY Commercial	$11.59
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$8.70
Rate for Payer: MVP Health Care of NY Medicare	$6.49
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.32
Rate for Payer: United Healthcare Medicare	$6.18
Rate for Payer: WellCare Medicare	$8.50

7.5 NEOPRENE SURG GLOVE

Facility

$5.15

Hospital Charge Code	4471257
Hospital Revenue Code	270
Min. Negotiated Rate	$0.77
Max. Negotiated Rate	$4.12
Rate for Payer: Aetna of NY Commercial	$3.60
Rate for Payer: Aetna of NY Medicare	$2.37
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2.06
Rate for Payer: Cash Price	$3.86
Rate for Payer: CDPHP Medicare	$1.91
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$4.12
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$4.12
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$4.12
Rate for Payer: EmblemHealth Medicaid	$4.12
Rate for Payer: EmblemHealth Medicare	$1.75
Rate for Payer: EmblemHealth Select Care	$3.71
Rate for Payer: Fidelis Medicare	$2.06
Rate for Payer: Galaxy Health Commercial	$3.35
Rate for Payer: Hamaspik Choice Medicare	$2.06
Rate for Payer: Humana Medicare	$2.06
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$3.60
Rate for Payer: Local 1199SEIU Medicare	$2.37
Rate for Payer: MVP Health Care of NY Commercial	$3.86
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$2.90
Rate for Payer: MVP Health Care of NY Medicare	$2.16
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.77
Rate for Payer: United Healthcare Medicare	$2.06
Rate for Payer: WellCare Medicare	$2.83

7.5 NEOPRENE SURG GLOVE

Facility

$5.15

Hospital Charge Code	4471257
Hospital Revenue Code	270
Min. Negotiated Rate	$3.35
Max. Negotiated Rate	$3.35
Rate for Payer: Cash Price	$3.86
Rate for Payer: Galaxy Health Commercial	$3.35

7.6CM HEX WRENCH

Facility

$254.41

Hospital Charge Code	4479097
Hospital Revenue Code	272
Min. Negotiated Rate	$38.16
Max. Negotiated Rate	$203.53
Rate for Payer: Aetna of NY Commercial	$178.09
Rate for Payer: Aetna of NY Medicare	$117.03
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$101.76
Rate for Payer: Cash Price	$190.81
Rate for Payer: CDPHP Medicare	$94.13
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$203.53
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$203.53
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$203.53
Rate for Payer: EmblemHealth Medicaid	$203.53
Rate for Payer: EmblemHealth Medicare	$86.50
Rate for Payer: EmblemHealth Select Care	$183.18
Rate for Payer: Fidelis Medicare	$101.76
Rate for Payer: Galaxy Health Commercial	$165.37
Rate for Payer: Hamaspik Choice Medicare	$101.76
Rate for Payer: Humana Medicare	$101.76
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$178.09
Rate for Payer: Local 1199SEIU Medicare	$117.03
Rate for Payer: MVP Health Care of NY Commercial	$190.81
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$143.23
Rate for Payer: MVP Health Care of NY Medicare	$106.85
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$38.16
Rate for Payer: United Healthcare Medicare	$101.76
Rate for Payer: WellCare Medicare	$139.93

7.6CM HEX WRENCH

Facility

$254.41

Hospital Charge Code	4479097
Hospital Revenue Code	272
Min. Negotiated Rate	$165.37
Max. Negotiated Rate	$165.37
Rate for Payer: Cash Price	$190.81
Rate for Payer: Galaxy Health Commercial	$165.37

Know your out-of-pocket cost for care.

All Charges