Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

ISONIAZID 100 MG

Facility

$6.18

Service Code	NDC 555006602
Hospital Charge Code	4409042
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

ISONIAZID 100 MG

Facility

$6.18

Service Code	NDC 555006602
Hospital Charge Code	4409042
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

ISOSORBIDE DINITRATE 10 MG TAB 10 mg, 100 eaches

Facility

$6.00

Service Code	NDC 904661961
Hospital Charge Code	4401435
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$4.80
Rate for Payer: Aetna of NY Commercial	$4.20
Rate for Payer: Aetna of NY Medicare	$2.76
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2.40
Rate for Payer: Cash Price	$4.50
Rate for Payer: CDPHP Medicare	$2.22
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$4.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$4.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$4.80
Rate for Payer: EmblemHealth Medicaid	$4.80
Rate for Payer: EmblemHealth Medicare	$2.04
Rate for Payer: EmblemHealth Select Care	$4.32
Rate for Payer: Fidelis Medicare	$2.40
Rate for Payer: Galaxy Health Commercial	$3.90
Rate for Payer: Hamaspik Choice Medicare	$2.40
Rate for Payer: Humana Medicare	$2.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$4.20
Rate for Payer: Local 1199SEIU Medicare	$2.76
Rate for Payer: MVP Health Care of NY Commercial	$4.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$3.38
Rate for Payer: MVP Health Care of NY Medicare	$2.52
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.90
Rate for Payer: United Healthcare Medicare	$2.40
Rate for Payer: WellCare Medicare	$3.30

ISOSORBIDE DINITRATE 10 MG TAB 10 mg, 100 eaches

Facility

$6.00

Service Code	NDC 904661961
Hospital Charge Code	4401435
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.90
Rate for Payer: Cash Price	$4.50
Rate for Payer: Galaxy Health Commercial	$3.90
Rate for Payer: WellCare Medicare	$3.30

ISOSORBIDE MONONITRATE 30MG TABS 10X10EA

Facility

$6.18

Service Code	NDC 904644961
Hospital Charge Code	4400394
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

ISOSORBIDE MONONITRATE 30MG TABS 10X10EA

Facility

$6.18

Service Code	NDC 904644961
Hospital Charge Code	4400394
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

ISOVUE 200M 10ML

Facility

$29.87

Hospital Charge Code	4471150
Hospital Revenue Code	250
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$23.90
Rate for Payer: Aetna of NY Commercial	$20.91
Rate for Payer: Aetna of NY Medicare	$13.74
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$11.95
Rate for Payer: Cash Price	$22.40
Rate for Payer: CDPHP Medicare	$11.05
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$23.90
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$23.90
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$23.90
Rate for Payer: EmblemHealth Medicaid	$23.90
Rate for Payer: EmblemHealth Medicare	$10.16
Rate for Payer: EmblemHealth Select Care	$21.51
Rate for Payer: Fidelis Medicare	$11.95
Rate for Payer: Galaxy Health Commercial	$19.42
Rate for Payer: Hamaspik Choice Medicare	$11.95
Rate for Payer: Humana Medicare	$11.95
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$20.91
Rate for Payer: Local 1199SEIU Medicare	$13.74
Rate for Payer: MVP Health Care of NY Commercial	$22.40
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$16.82
Rate for Payer: MVP Health Care of NY Medicare	$12.55
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4.48
Rate for Payer: United Healthcare Medicare	$11.95
Rate for Payer: WellCare Medicare	$16.43

ISOVUE 200M 10ML

Facility

$29.87

Hospital Charge Code	4471150
Hospital Revenue Code	250
Min. Negotiated Rate	$16.43
Max. Negotiated Rate	$19.42
Rate for Payer: Cash Price	$22.40
Rate for Payer: Galaxy Health Commercial	$19.42
Rate for Payer: WellCare Medicare	$16.43

ISOVUE 200M 20ML

Facility

$92.70

Hospital Charge Code	4471151
Hospital Revenue Code	250
Min. Negotiated Rate	$13.90
Max. Negotiated Rate	$74.16
Rate for Payer: Aetna of NY Commercial	$64.89
Rate for Payer: Aetna of NY Medicare	$42.64
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$37.08
Rate for Payer: Cash Price	$69.53
Rate for Payer: CDPHP Medicare	$34.30
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$74.16
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$74.16
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$74.16
Rate for Payer: EmblemHealth Medicaid	$74.16
Rate for Payer: EmblemHealth Medicare	$31.52
Rate for Payer: EmblemHealth Select Care	$66.74
Rate for Payer: Fidelis Medicare	$37.08
Rate for Payer: Galaxy Health Commercial	$60.26
Rate for Payer: Hamaspik Choice Medicare	$37.08
Rate for Payer: Humana Medicare	$37.08
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$64.89
Rate for Payer: Local 1199SEIU Medicare	$42.64
Rate for Payer: MVP Health Care of NY Commercial	$69.53
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$52.19
Rate for Payer: MVP Health Care of NY Medicare	$38.93
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$13.90
Rate for Payer: United Healthcare Medicare	$37.08
Rate for Payer: WellCare Medicare	$50.98

ISOVUE 200M 20ML

Facility

$92.70

Hospital Charge Code	4471151
Hospital Revenue Code	250
Min. Negotiated Rate	$50.98
Max. Negotiated Rate	$60.26
Rate for Payer: Cash Price	$69.53
Rate for Payer: Galaxy Health Commercial	$60.26
Rate for Payer: WellCare Medicare	$50.98

ISOVUE 300 100ML

Facility

$110.21

Hospital Charge Code	4471129
Hospital Revenue Code	250
Min. Negotiated Rate	$16.53
Max. Negotiated Rate	$88.17
Rate for Payer: Aetna of NY Commercial	$77.15
Rate for Payer: Aetna of NY Medicare	$50.70
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$44.08
Rate for Payer: Cash Price	$82.66
Rate for Payer: CDPHP Medicare	$40.78
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$88.17
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$88.17
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$88.17
Rate for Payer: EmblemHealth Medicaid	$88.17
Rate for Payer: EmblemHealth Medicare	$37.47
Rate for Payer: EmblemHealth Select Care	$79.35
Rate for Payer: Fidelis Medicare	$44.08
Rate for Payer: Galaxy Health Commercial	$71.64
Rate for Payer: Hamaspik Choice Medicare	$44.08
Rate for Payer: Humana Medicare	$44.08
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$77.15
Rate for Payer: Local 1199SEIU Medicare	$50.70
Rate for Payer: MVP Health Care of NY Commercial	$82.66
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$62.05
Rate for Payer: MVP Health Care of NY Medicare	$46.29
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$16.53
Rate for Payer: United Healthcare Medicare	$44.08
Rate for Payer: WellCare Medicare	$60.62

ISOVUE 300 100ML

Facility

$110.21

Hospital Charge Code	4471129
Hospital Revenue Code	250
Min. Negotiated Rate	$60.62
Max. Negotiated Rate	$71.64
Rate for Payer: Cash Price	$82.66
Rate for Payer: Galaxy Health Commercial	$71.64
Rate for Payer: WellCare Medicare	$60.62

ISOVUE 300 50 ML

Facility

$29.87

Hospital Charge Code	4471128
Hospital Revenue Code	250
Min. Negotiated Rate	$16.43
Max. Negotiated Rate	$19.42
Rate for Payer: Cash Price	$22.40
Rate for Payer: Galaxy Health Commercial	$19.42
Rate for Payer: WellCare Medicare	$16.43

ISOVUE 300 50 ML

Facility

$29.87

Hospital Charge Code	4471128
Hospital Revenue Code	250
Min. Negotiated Rate	$4.48
Max. Negotiated Rate	$23.90
Rate for Payer: Aetna of NY Commercial	$20.91
Rate for Payer: Aetna of NY Medicare	$13.74
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$11.95
Rate for Payer: Cash Price	$22.40
Rate for Payer: CDPHP Medicare	$11.05
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$23.90
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$23.90
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$23.90
Rate for Payer: EmblemHealth Medicaid	$23.90
Rate for Payer: EmblemHealth Medicare	$10.16
Rate for Payer: EmblemHealth Select Care	$21.51
Rate for Payer: Fidelis Medicare	$11.95
Rate for Payer: Galaxy Health Commercial	$19.42
Rate for Payer: Hamaspik Choice Medicare	$11.95
Rate for Payer: Humana Medicare	$11.95
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$20.91
Rate for Payer: Local 1199SEIU Medicare	$13.74
Rate for Payer: MVP Health Care of NY Commercial	$22.40
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$16.82
Rate for Payer: MVP Health Care of NY Medicare	$12.55
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4.48
Rate for Payer: United Healthcare Medicare	$11.95
Rate for Payer: WellCare Medicare	$16.43

IV BLOOD TRANSFUSION KIT

Facility

$83.43

Hospital Charge Code	4451247
Hospital Revenue Code	270
Min. Negotiated Rate	$12.51
Max. Negotiated Rate	$66.74
Rate for Payer: Aetna of NY Commercial	$58.40
Rate for Payer: Aetna of NY Medicare	$38.38
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$33.37
Rate for Payer: Cash Price	$62.57
Rate for Payer: CDPHP Medicare	$30.87
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$66.74
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$66.74
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$66.74
Rate for Payer: EmblemHealth Medicaid	$66.74
Rate for Payer: EmblemHealth Medicare	$28.37
Rate for Payer: EmblemHealth Select Care	$60.07
Rate for Payer: Fidelis Medicare	$33.37
Rate for Payer: Galaxy Health Commercial	$54.23
Rate for Payer: Hamaspik Choice Medicare	$33.37
Rate for Payer: Humana Medicare	$33.37
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$58.40
Rate for Payer: Local 1199SEIU Medicare	$38.38
Rate for Payer: MVP Health Care of NY Commercial	$62.57
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$46.97
Rate for Payer: MVP Health Care of NY Medicare	$35.04
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$12.51
Rate for Payer: United Healthcare Medicare	$33.37
Rate for Payer: WellCare Medicare	$45.89

IV BLOOD TRANSFUSION KIT

Facility

$83.43

Hospital Charge Code	4451247
Hospital Revenue Code	270
Min. Negotiated Rate	$54.23
Max. Negotiated Rate	$54.23
Rate for Payer: Cash Price	$62.57
Rate for Payer: Galaxy Health Commercial	$54.23

IV INFUSION KIT

Facility

$108.15

Hospital Charge Code	4451245
Hospital Revenue Code	270
Min. Negotiated Rate	$16.22
Max. Negotiated Rate	$86.52
Rate for Payer: Aetna of NY Commercial	$75.70
Rate for Payer: Aetna of NY Medicare	$49.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$43.26
Rate for Payer: Cash Price	$81.11
Rate for Payer: CDPHP Medicare	$40.02
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$86.52
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$86.52
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$86.52
Rate for Payer: EmblemHealth Medicaid	$86.52
Rate for Payer: EmblemHealth Medicare	$36.77
Rate for Payer: EmblemHealth Select Care	$77.87
Rate for Payer: Fidelis Medicare	$43.26
Rate for Payer: Galaxy Health Commercial	$70.30
Rate for Payer: Hamaspik Choice Medicare	$43.26
Rate for Payer: Humana Medicare	$43.26
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$75.70
Rate for Payer: Local 1199SEIU Medicare	$49.75
Rate for Payer: MVP Health Care of NY Commercial	$81.11
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$60.89
Rate for Payer: MVP Health Care of NY Medicare	$45.42
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$16.22
Rate for Payer: United Healthcare Medicare	$43.26
Rate for Payer: WellCare Medicare	$59.48

IV INFUSION KIT

Facility

$108.15

Hospital Charge Code	4451245
Hospital Revenue Code	270
Min. Negotiated Rate	$70.30
Max. Negotiated Rate	$70.30
Rate for Payer: Cash Price	$81.11
Rate for Payer: Galaxy Health Commercial	$70.30

IV PORT FLUSH KIT

Facility

$65.92

Hospital Charge Code	4451246
Hospital Revenue Code	270
Min. Negotiated Rate	$42.85
Max. Negotiated Rate	$42.85
Rate for Payer: Cash Price	$49.44
Rate for Payer: Galaxy Health Commercial	$42.85

IV PORT FLUSH KIT

Facility

$65.92

Hospital Charge Code	4451246
Hospital Revenue Code	270
Min. Negotiated Rate	$9.89
Max. Negotiated Rate	$52.74
Rate for Payer: Aetna of NY Commercial	$46.14
Rate for Payer: Aetna of NY Medicare	$30.32
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$26.37
Rate for Payer: Cash Price	$49.44
Rate for Payer: CDPHP Medicare	$24.39
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$52.74
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$52.74
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$52.74
Rate for Payer: EmblemHealth Medicaid	$52.74
Rate for Payer: EmblemHealth Medicare	$22.41
Rate for Payer: EmblemHealth Select Care	$47.46
Rate for Payer: Fidelis Medicare	$26.37
Rate for Payer: Galaxy Health Commercial	$42.85
Rate for Payer: Hamaspik Choice Medicare	$26.37
Rate for Payer: Humana Medicare	$26.37
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$46.14
Rate for Payer: Local 1199SEIU Medicare	$30.32
Rate for Payer: MVP Health Care of NY Commercial	$49.44
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$37.11
Rate for Payer: MVP Health Care of NY Medicare	$27.69
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$9.89
Rate for Payer: United Healthcare Medicare	$26.37
Rate for Payer: WellCare Medicare	$36.26

IV PORT FLUSH (OMP ONLY)

Facility

$181.00

Service Code	HCPCS 96523
Hospital Charge Code	4451248
Hospital Revenue Code	260
Min. Negotiated Rate	$27.15
Max. Negotiated Rate	$144.80
Rate for Payer: Aetna of NY Commercial	$126.70
Rate for Payer: Aetna of NY Medicare	$83.26
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$72.40
Rate for Payer: Cash Price	$135.75
Rate for Payer: CDPHP Medicare	$66.97
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$144.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$144.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$144.80
Rate for Payer: EmblemHealth Medicaid	$144.80
Rate for Payer: EmblemHealth Medicare	$61.54
Rate for Payer: EmblemHealth Select Care	$130.32
Rate for Payer: Fidelis Medicare	$72.40
Rate for Payer: Galaxy Health Commercial	$117.65
Rate for Payer: Hamaspik Choice Medicare	$72.40
Rate for Payer: Humana Medicare	$72.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$126.70
Rate for Payer: Local 1199SEIU Medicare	$83.26
Rate for Payer: MVP Health Care of NY Commercial	$135.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$101.90
Rate for Payer: MVP Health Care of NY Medicare	$76.02
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$135.75
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$27.15
Rate for Payer: United Healthcare Commercial	$135.75
Rate for Payer: United Healthcare Medicare	$72.40
Rate for Payer: WellCare Medicare	$99.55

IV PORT FLUSH (OMP ONLY)

Facility

$181.00

Service Code	HCPCS 96523
Hospital Charge Code	4451248
Hospital Revenue Code	260
Min. Negotiated Rate	$117.65
Max. Negotiated Rate	$117.65
Rate for Payer: Cash Price	$135.75
Rate for Payer: Galaxy Health Commercial	$117.65

IVP SINGLE DRUG OR SUBSTANCE

Facility

$652.00

Service Code	HCPCS 96374
Hospital Charge Code	4450107
Hospital Revenue Code	260
Min. Negotiated Rate	$97.80
Max. Negotiated Rate	$521.60
Rate for Payer: Aetna of NY Commercial	$456.40
Rate for Payer: Aetna of NY Medicare	$299.92
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$260.80
Rate for Payer: Cash Price	$489.00
Rate for Payer: CDPHP Medicare	$241.24
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$521.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$521.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$521.60
Rate for Payer: EmblemHealth Medicaid	$521.60
Rate for Payer: EmblemHealth Medicare	$221.68
Rate for Payer: EmblemHealth Select Care	$469.44
Rate for Payer: Fidelis Medicare	$260.80
Rate for Payer: Galaxy Health Commercial	$423.80
Rate for Payer: Hamaspik Choice Medicare	$260.80
Rate for Payer: Humana Medicare	$260.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$456.40
Rate for Payer: Local 1199SEIU Medicare	$299.92
Rate for Payer: MVP Health Care of NY Commercial	$489.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$367.08
Rate for Payer: MVP Health Care of NY Medicare	$273.84
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$489.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$97.80
Rate for Payer: United Healthcare Commercial	$489.00
Rate for Payer: United Healthcare Medicare	$260.80
Rate for Payer: WellCare Medicare	$358.60

IVP SINGLE DRUG OR SUBSTANCE

Facility

$652.00

Service Code	HCPCS 96374
Hospital Charge Code	4450107
Hospital Revenue Code	260
Min. Negotiated Rate	$423.80
Max. Negotiated Rate	$423.80
Rate for Payer: Cash Price	$489.00
Rate for Payer: Galaxy Health Commercial	$423.80

IV PUMP USAGE

Facility

$20.60

Hospital Charge Code	4451236
Hospital Revenue Code	270
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$13.39
Rate for Payer: Cash Price	$15.45
Rate for Payer: Galaxy Health Commercial	$13.39

Know your out-of-pocket cost for care.

All Charges