Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

INJECT TRIGGER POINTS 3/>

Facility

$941.00

Service Code	HCPCS 20553
Hospital Charge Code	4601196
Hospital Revenue Code	450
Min. Negotiated Rate	$141.15
Max. Negotiated Rate	$1,234.00
Rate for Payer: Aetna of NY Commercial	$1,000.00
Rate for Payer: Aetna of NY Medicare	$432.86
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$376.40
Rate for Payer: Cash Price	$705.75
Rate for Payer: Cash Price	$705.75
Rate for Payer: Cash Price	$705.75
Rate for Payer: CDPHP Medicare	$348.17
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,206.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$752.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$752.80
Rate for Payer: EmblemHealth Medicaid	$752.80
Rate for Payer: EmblemHealth Medicare	$319.94
Rate for Payer: EmblemHealth Select Care	$1,085.00
Rate for Payer: Fidelis Medicare	$376.40
Rate for Payer: Galaxy Health Commercial	$611.65
Rate for Payer: Hamaspik Choice Medicare	$376.40
Rate for Payer: Humana Medicare	$376.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,000.00
Rate for Payer: Local 1199SEIU Medicare	$432.86
Rate for Payer: MVP Health Care of NY Commercial	$1,234.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$925.00
Rate for Payer: MVP Health Care of NY Medicare	$395.22
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,009.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$141.15
Rate for Payer: United Healthcare Commercial	$1,009.00
Rate for Payer: United Healthcare Medicare	$376.40
Rate for Payer: WellCare Medicare	$517.55

INJECT TRIGGER POINTS 3/>

Facility

$941.00

Service Code	HCPCS 20553
Hospital Charge Code	4601196
Hospital Revenue Code	450
Min. Negotiated Rate	$611.65
Max. Negotiated Rate	$611.65
Rate for Payer: Cash Price	$705.75
Rate for Payer: Galaxy Health Commercial	$611.65

INJ FORAMEN EPIDURAL C/T

Facility

$2,711.00

Service Code	HCPCS 64479
Hospital Charge Code	4850198
Hospital Revenue Code	761
Min. Negotiated Rate	$406.65
Max. Negotiated Rate	$2,168.80
Rate for Payer: Aetna of NY Commercial	$1,897.70
Rate for Payer: Aetna of NY Medicare	$1,247.06
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,084.40
Rate for Payer: Cash Price	$2,033.25
Rate for Payer: CDPHP Medicare	$1,003.07
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$2,168.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,168.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,168.80
Rate for Payer: EmblemHealth Medicaid	$2,168.80
Rate for Payer: EmblemHealth Medicare	$921.74
Rate for Payer: EmblemHealth Select Care	$1,951.92
Rate for Payer: Fidelis Medicare	$1,084.40
Rate for Payer: Galaxy Health Commercial	$1,762.15
Rate for Payer: Hamaspik Choice Medicare	$1,084.40
Rate for Payer: Humana Medicare	$1,084.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,897.70
Rate for Payer: Local 1199SEIU Medicare	$1,247.06
Rate for Payer: MVP Health Care of NY Commercial	$2,033.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,526.29
Rate for Payer: MVP Health Care of NY Medicare	$1,138.62
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$406.65
Rate for Payer: United Healthcare Medicare	$1,084.40
Rate for Payer: WellCare Medicare	$1,491.05

INJ FORAMEN EPIDURAL C/T

Facility

$2,711.00

Service Code	HCPCS 64479
Hospital Charge Code	4850198
Hospital Revenue Code	761
Min. Negotiated Rate	$1,762.15
Max. Negotiated Rate	$1,762.15
Rate for Payer: Cash Price	$2,033.25
Rate for Payer: Galaxy Health Commercial	$1,762.15

INJ, FUROSEMIDE, 1 MG

Facility

$0.30

Service Code	HCPCS J1938
Hospital Charge Code	4401957
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.24
Rate for Payer: Aetna of NY Medicare	$0.14
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$0.12
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cash Price	$0.22
Rate for Payer: CDPHP Medicare	$0.11
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.02
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$0.24
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$0.24
Rate for Payer: EmblemHealth Medicaid	$0.24
Rate for Payer: EmblemHealth Medicare	$0.10
Rate for Payer: EmblemHealth Select Care	$0.02
Rate for Payer: Fidelis Medicare	$0.12
Rate for Payer: Galaxy Health Commercial	$0.20
Rate for Payer: Hamaspik Choice Medicare	$0.12
Rate for Payer: Humana Medicare	$0.12
Rate for Payer: Local 1199SEIU Medicare	$0.14
Rate for Payer: MVP Health Care of NY Commercial	$0.23
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$0.17
Rate for Payer: MVP Health Care of NY Medicare	$0.13
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.05
Rate for Payer: United Healthcare Medicare	$0.12
Rate for Payer: WellCare Medicare	$0.17

INJ, FUROSEMIDE, 1 MG

Facility

$0.30

Service Code	HCPCS J1938
Hospital Charge Code	4401957
Hospital Revenue Code	636
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$0.20
Rate for Payer: Aetna of NY Commercial	$0.17
Rate for Payer: Cash Price	$0.22
Rate for Payer: Cash Price	$0.22
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.02
Rate for Payer: EmblemHealth Select Care	$0.02
Rate for Payer: Galaxy Health Commercial	$0.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$0.17
Rate for Payer: WellCare Medicare	$0.17

INJ INTERLAM CRV/THRC W/ IMG

Facility

$2,164.00

Service Code	HCPCS 62321
Hospital Charge Code	4853001
Hospital Revenue Code	761
Min. Negotiated Rate	$324.60
Max. Negotiated Rate	$1,731.20
Rate for Payer: Aetna of NY Commercial	$1,514.80
Rate for Payer: Aetna of NY Medicare	$995.44
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$865.60
Rate for Payer: Cash Price	$1,623.00
Rate for Payer: CDPHP Medicare	$800.68
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,731.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,731.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,731.20
Rate for Payer: EmblemHealth Medicaid	$1,731.20
Rate for Payer: EmblemHealth Medicare	$735.76
Rate for Payer: EmblemHealth Select Care	$1,558.08
Rate for Payer: Fidelis Medicare	$865.60
Rate for Payer: Galaxy Health Commercial	$1,406.60
Rate for Payer: Hamaspik Choice Medicare	$865.60
Rate for Payer: Humana Medicare	$865.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,514.80
Rate for Payer: Local 1199SEIU Medicare	$995.44
Rate for Payer: MVP Health Care of NY Commercial	$1,623.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,218.33
Rate for Payer: MVP Health Care of NY Medicare	$908.88
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$324.60
Rate for Payer: United Healthcare Medicare	$865.60
Rate for Payer: WellCare Medicare	$1,190.20

INJ INTERLAM CRV/THRC W/ IMG

Facility

$2,164.00

Service Code	HCPCS 62321
Hospital Charge Code	4853001
Hospital Revenue Code	761
Min. Negotiated Rate	$1,406.60
Max. Negotiated Rate	$1,406.60
Rate for Payer: Cash Price	$1,623.00
Rate for Payer: Galaxy Health Commercial	$1,406.60

INJ INTERLAM CRV/THRC W/O IMG

Facility

$2,164.00

Service Code	HCPCS 62320
Hospital Charge Code	4853000
Hospital Revenue Code	761
Min. Negotiated Rate	$1,406.60
Max. Negotiated Rate	$1,406.60
Rate for Payer: Cash Price	$1,623.00
Rate for Payer: Galaxy Health Commercial	$1,406.60

INJ INTERLAM CRV/THRC W/O IMG

Facility

$2,164.00

Service Code	HCPCS 62320
Hospital Charge Code	4853000
Hospital Revenue Code	761
Min. Negotiated Rate	$324.60
Max. Negotiated Rate	$1,731.20
Rate for Payer: Aetna of NY Commercial	$1,514.80
Rate for Payer: Aetna of NY Medicare	$995.44
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$865.60
Rate for Payer: Cash Price	$1,623.00
Rate for Payer: CDPHP Medicare	$800.68
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,731.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,731.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,731.20
Rate for Payer: EmblemHealth Medicaid	$1,731.20
Rate for Payer: EmblemHealth Medicare	$735.76
Rate for Payer: EmblemHealth Select Care	$1,558.08
Rate for Payer: Fidelis Medicare	$865.60
Rate for Payer: Galaxy Health Commercial	$1,406.60
Rate for Payer: Hamaspik Choice Medicare	$865.60
Rate for Payer: Humana Medicare	$865.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,514.80
Rate for Payer: Local 1199SEIU Medicare	$995.44
Rate for Payer: MVP Health Care of NY Commercial	$1,623.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,218.33
Rate for Payer: MVP Health Care of NY Medicare	$908.88
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$324.60
Rate for Payer: United Healthcare Medicare	$865.60
Rate for Payer: WellCare Medicare	$1,190.20

INJ INTERLAM LMBR/SAC W/ IMG

Facility

$2,164.00

Service Code	HCPCS 62323
Hospital Charge Code	4853003
Hospital Revenue Code	761
Min. Negotiated Rate	$324.60
Max. Negotiated Rate	$1,731.20
Rate for Payer: Aetna of NY Commercial	$1,514.80
Rate for Payer: Aetna of NY Medicare	$995.44
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$865.60
Rate for Payer: Cash Price	$1,623.00
Rate for Payer: CDPHP Medicare	$800.68
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,731.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,731.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,731.20
Rate for Payer: EmblemHealth Medicaid	$1,731.20
Rate for Payer: EmblemHealth Medicare	$735.76
Rate for Payer: EmblemHealth Select Care	$1,558.08
Rate for Payer: Fidelis Medicare	$865.60
Rate for Payer: Galaxy Health Commercial	$1,406.60
Rate for Payer: Hamaspik Choice Medicare	$865.60
Rate for Payer: Humana Medicare	$865.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,514.80
Rate for Payer: Local 1199SEIU Medicare	$995.44
Rate for Payer: MVP Health Care of NY Commercial	$1,623.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,218.33
Rate for Payer: MVP Health Care of NY Medicare	$908.88
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$324.60
Rate for Payer: United Healthcare Medicare	$865.60
Rate for Payer: WellCare Medicare	$1,190.20

INJ INTERLAM LMBR/SAC W/ IMG

Facility

$2,164.00

Service Code	HCPCS 62323
Hospital Charge Code	4853003
Hospital Revenue Code	761
Min. Negotiated Rate	$1,406.60
Max. Negotiated Rate	$1,406.60
Rate for Payer: Cash Price	$1,623.00
Rate for Payer: Galaxy Health Commercial	$1,406.60

INJ INTERLAM LMBR/SAC W/O IMG

Facility

$2,711.00

Service Code	HCPCS 62322
Hospital Charge Code	4853002
Hospital Revenue Code	761
Min. Negotiated Rate	$1,762.15
Max. Negotiated Rate	$1,762.15
Rate for Payer: Cash Price	$2,033.25
Rate for Payer: Galaxy Health Commercial	$1,762.15

INJ INTERLAM LMBR/SAC W/O IMG

Facility

$2,711.00

Service Code	HCPCS 62322
Hospital Charge Code	4853002
Hospital Revenue Code	761
Min. Negotiated Rate	$406.65
Max. Negotiated Rate	$2,168.80
Rate for Payer: Aetna of NY Commercial	$1,897.70
Rate for Payer: Aetna of NY Medicare	$1,247.06
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,084.40
Rate for Payer: Cash Price	$2,033.25
Rate for Payer: CDPHP Medicare	$1,003.07
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$2,168.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,168.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,168.80
Rate for Payer: EmblemHealth Medicaid	$2,168.80
Rate for Payer: EmblemHealth Medicare	$921.74
Rate for Payer: EmblemHealth Select Care	$1,951.92
Rate for Payer: Fidelis Medicare	$1,084.40
Rate for Payer: Galaxy Health Commercial	$1,762.15
Rate for Payer: Hamaspik Choice Medicare	$1,084.40
Rate for Payer: Humana Medicare	$1,084.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,897.70
Rate for Payer: Local 1199SEIU Medicare	$1,247.06
Rate for Payer: MVP Health Care of NY Commercial	$2,033.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,526.29
Rate for Payer: MVP Health Care of NY Medicare	$1,138.62
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$406.65
Rate for Payer: United Healthcare Medicare	$1,084.40
Rate for Payer: WellCare Medicare	$1,491.05

INJ INTLAM W/ CATH C/T W/ IMG

Facility

$2,711.00

Service Code	HCPCS 62325
Hospital Charge Code	4853005
Hospital Revenue Code	761
Min. Negotiated Rate	$1,762.15
Max. Negotiated Rate	$1,762.15
Rate for Payer: Cash Price	$2,033.25
Rate for Payer: Galaxy Health Commercial	$1,762.15

INJ INTLAM W/ CATH C/T W/ IMG

Facility

$2,711.00

Service Code	HCPCS 62325
Hospital Charge Code	4853005
Hospital Revenue Code	761
Min. Negotiated Rate	$406.65
Max. Negotiated Rate	$2,168.80
Rate for Payer: Aetna of NY Commercial	$1,897.70
Rate for Payer: Aetna of NY Medicare	$1,247.06
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,084.40
Rate for Payer: Cash Price	$2,033.25
Rate for Payer: CDPHP Medicare	$1,003.07
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$2,168.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,168.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,168.80
Rate for Payer: EmblemHealth Medicaid	$2,168.80
Rate for Payer: EmblemHealth Medicare	$921.74
Rate for Payer: EmblemHealth Select Care	$1,951.92
Rate for Payer: Fidelis Medicare	$1,084.40
Rate for Payer: Galaxy Health Commercial	$1,762.15
Rate for Payer: Hamaspik Choice Medicare	$1,084.40
Rate for Payer: Humana Medicare	$1,084.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,897.70
Rate for Payer: Local 1199SEIU Medicare	$1,247.06
Rate for Payer: MVP Health Care of NY Commercial	$2,033.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,526.29
Rate for Payer: MVP Health Care of NY Medicare	$1,138.62
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$406.65
Rate for Payer: United Healthcare Medicare	$1,084.40
Rate for Payer: WellCare Medicare	$1,491.05

INJ INTLAM W/ CATH C/T W/O IMG

Facility

$2,711.00

Service Code	HCPCS 62324
Hospital Charge Code	4853004
Hospital Revenue Code	761
Min. Negotiated Rate	$1,762.15
Max. Negotiated Rate	$1,762.15
Rate for Payer: Cash Price	$2,033.25
Rate for Payer: Galaxy Health Commercial	$1,762.15

INJ INTLAM W/ CATH C/T W/O IMG

Facility

$2,711.00

Service Code	HCPCS 62324
Hospital Charge Code	4853004
Hospital Revenue Code	761
Min. Negotiated Rate	$406.65
Max. Negotiated Rate	$2,168.80
Rate for Payer: Aetna of NY Commercial	$1,897.70
Rate for Payer: Aetna of NY Medicare	$1,247.06
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,084.40
Rate for Payer: Cash Price	$2,033.25
Rate for Payer: CDPHP Medicare	$1,003.07
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$2,168.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,168.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,168.80
Rate for Payer: EmblemHealth Medicaid	$2,168.80
Rate for Payer: EmblemHealth Medicare	$921.74
Rate for Payer: EmblemHealth Select Care	$1,951.92
Rate for Payer: Fidelis Medicare	$1,084.40
Rate for Payer: Galaxy Health Commercial	$1,762.15
Rate for Payer: Hamaspik Choice Medicare	$1,084.40
Rate for Payer: Humana Medicare	$1,084.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,897.70
Rate for Payer: Local 1199SEIU Medicare	$1,247.06
Rate for Payer: MVP Health Care of NY Commercial	$2,033.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,526.29
Rate for Payer: MVP Health Care of NY Medicare	$1,138.62
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$406.65
Rate for Payer: United Healthcare Medicare	$1,084.40
Rate for Payer: WellCare Medicare	$1,491.05

INJ INTLAM W/ CATH L/S W/ IMG

Facility

$2,711.00

Service Code	HCPCS 62327
Hospital Charge Code	4853007
Hospital Revenue Code	761
Min. Negotiated Rate	$406.65
Max. Negotiated Rate	$2,168.80
Rate for Payer: Aetna of NY Commercial	$1,897.70
Rate for Payer: Aetna of NY Medicare	$1,247.06
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,084.40
Rate for Payer: Cash Price	$2,033.25
Rate for Payer: CDPHP Medicare	$1,003.07
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$2,168.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,168.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,168.80
Rate for Payer: EmblemHealth Medicaid	$2,168.80
Rate for Payer: EmblemHealth Medicare	$921.74
Rate for Payer: EmblemHealth Select Care	$1,951.92
Rate for Payer: Fidelis Medicare	$1,084.40
Rate for Payer: Galaxy Health Commercial	$1,762.15
Rate for Payer: Hamaspik Choice Medicare	$1,084.40
Rate for Payer: Humana Medicare	$1,084.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,897.70
Rate for Payer: Local 1199SEIU Medicare	$1,247.06
Rate for Payer: MVP Health Care of NY Commercial	$2,033.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,526.29
Rate for Payer: MVP Health Care of NY Medicare	$1,138.62
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$406.65
Rate for Payer: United Healthcare Medicare	$1,084.40
Rate for Payer: WellCare Medicare	$1,491.05

INJ INTLAM W/ CATH L/S W/ IMG

Facility

$2,711.00

Service Code	HCPCS 62327
Hospital Charge Code	4853007
Hospital Revenue Code	761
Min. Negotiated Rate	$1,762.15
Max. Negotiated Rate	$1,762.15
Rate for Payer: Cash Price	$2,033.25
Rate for Payer: Galaxy Health Commercial	$1,762.15

INJ INTLAM W/ CATH L/S W/O IMG

Facility

$2,711.00

Service Code	HCPCS 62326
Hospital Charge Code	4853006
Hospital Revenue Code	761
Min. Negotiated Rate	$406.65
Max. Negotiated Rate	$2,168.80
Rate for Payer: Aetna of NY Commercial	$1,897.70
Rate for Payer: Aetna of NY Medicare	$1,247.06
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,084.40
Rate for Payer: Cash Price	$2,033.25
Rate for Payer: CDPHP Medicare	$1,003.07
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$2,168.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,168.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,168.80
Rate for Payer: EmblemHealth Medicaid	$2,168.80
Rate for Payer: EmblemHealth Medicare	$921.74
Rate for Payer: EmblemHealth Select Care	$1,951.92
Rate for Payer: Fidelis Medicare	$1,084.40
Rate for Payer: Galaxy Health Commercial	$1,762.15
Rate for Payer: Hamaspik Choice Medicare	$1,084.40
Rate for Payer: Humana Medicare	$1,084.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,897.70
Rate for Payer: Local 1199SEIU Medicare	$1,247.06
Rate for Payer: MVP Health Care of NY Commercial	$2,033.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,526.29
Rate for Payer: MVP Health Care of NY Medicare	$1,138.62
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$406.65
Rate for Payer: United Healthcare Medicare	$1,084.40
Rate for Payer: WellCare Medicare	$1,491.05

INJ INTLAM W/ CATH L/S W/O IMG

Facility

$2,711.00

Service Code	HCPCS 62326
Hospital Charge Code	4853006
Hospital Revenue Code	761
Min. Negotiated Rate	$1,762.15
Max. Negotiated Rate	$1,762.15
Rate for Payer: Cash Price	$2,033.25
Rate for Payer: Galaxy Health Commercial	$1,762.15

INJ MAGNESIUM SULFATE/500 MG

Facility

$6.18

Service Code	HCPCS J3475
Hospital Charge Code	4450011
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
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: Cash Price	$4.64
Rate for Payer: CDPHP Medicare	$2.29
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.43
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	$0.43
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: Oxford Health Plans Freedom/Liberty/Metro	$1.53
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.93
Rate for Payer: United Healthcare Commercial	$1.53
Rate for Payer: United Healthcare Medicare	$2.47
Rate for Payer: WellCare Medicare	$3.40

INJ MAGNESIUM SULFATE/500 MG

Facility

$6.18

Service Code	HCPCS J3475
Hospital Charge Code	4450011
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$4.02
Rate for Payer: Aetna of NY Commercial	$3.40
Rate for Payer: Cash Price	$4.64
Rate for Payer: Cash Price	$4.64
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.43
Rate for Payer: EmblemHealth Select Care	$0.43
Rate for Payer: Galaxy Health Commercial	$4.02
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$3.40
Rate for Payer: WellCare Medicare	$3.40

INJ PARAVERT F JNT L/S 1 LEV

Facility

$2,711.00

Service Code	HCPCS 64493
Hospital Charge Code	4850188
Hospital Revenue Code	361
Min. Negotiated Rate	$406.65
Max. Negotiated Rate	$2,168.80
Rate for Payer: Aetna of NY Commercial	$1,900.00
Rate for Payer: Aetna of NY Medicare	$1,247.06
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,084.40
Rate for Payer: Cash Price	$2,033.25
Rate for Payer: Cash Price	$2,033.25
Rate for Payer: CDPHP Medicare	$1,003.07
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$2,168.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,168.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,168.80
Rate for Payer: EmblemHealth Medicaid	$2,168.80
Rate for Payer: EmblemHealth Medicare	$921.74
Rate for Payer: EmblemHealth Select Care	$1,951.92
Rate for Payer: Fidelis Medicare	$1,084.40
Rate for Payer: Galaxy Health Commercial	$1,762.15
Rate for Payer: Hamaspik Choice Medicare	$1,084.40
Rate for Payer: Humana Medicare	$1,084.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,900.00
Rate for Payer: Local 1199SEIU Medicare	$1,247.06
Rate for Payer: Multiplan Commercial	$2,168.80
Rate for Payer: MVP Health Care of NY Commercial	$2,033.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,526.29
Rate for Payer: MVP Health Care of NY Medicare	$1,138.62
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,828.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$406.65
Rate for Payer: United Healthcare Commercial	$1,828.00
Rate for Payer: United Healthcare Medicare	$1,084.40
Rate for Payer: WellCare Medicare	$1,491.05

Know your out-of-pocket cost for care.

All Charges