Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

KIDNEY IMAGING MORPHOL

Facility

$65.00

Service Code	HCPCS 78700 26
Hospital Charge Code	5210093
Hospital Revenue Code	960
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$52.00
Rate for Payer: Aetna of NY Commercial	$45.50
Rate for Payer: Aetna of NY Medicare	$29.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$26.00
Rate for Payer: Cash Price	$48.75
Rate for Payer: CDPHP Medicare	$24.05
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$52.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$52.00
Rate for Payer: EmblemHealth Medicaid	$52.00
Rate for Payer: EmblemHealth Medicare	$22.10
Rate for Payer: Fidelis Medicare	$26.00
Rate for Payer: Galaxy Health Commercial	$42.25
Rate for Payer: Hamaspik Choice Medicare	$26.00
Rate for Payer: Humana Medicare	$26.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$45.50
Rate for Payer: Local 1199SEIU Medicare	$29.90
Rate for Payer: MVP Health Care of NY Commercial	$48.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$36.59
Rate for Payer: MVP Health Care of NY Medicare	$27.30
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$9.75
Rate for Payer: United Healthcare Medicare	$26.00
Rate for Payer: WellCare Medicare	$35.75

KIDNEY IMAGING MORPHOL

Facility

$1,225.00

Service Code	HCPCS 78700
Hospital Charge Code	4210093
Hospital Revenue Code	341
Min. Negotiated Rate	$183.75
Max. Negotiated Rate	$1,545.00
Rate for Payer: Aetna of NY Commercial	$857.50
Rate for Payer: Aetna of NY Medicare	$563.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$490.00
Rate for Payer: Cash Price	$918.75
Rate for Payer: Cash Price	$918.75
Rate for Payer: CDPHP Medicare	$453.25
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$857.50
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$980.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$980.00
Rate for Payer: EmblemHealth Medicaid	$980.00
Rate for Payer: EmblemHealth Medicare	$416.50
Rate for Payer: EmblemHealth Select Care	$796.25
Rate for Payer: Fidelis Medicare	$490.00
Rate for Payer: Galaxy Health Commercial	$796.25
Rate for Payer: Hamaspik Choice Medicare	$490.00
Rate for Payer: Humana Medicare	$490.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$857.50
Rate for Payer: Local 1199SEIU Medicare	$563.50
Rate for Payer: MVP Health Care of NY Commercial	$918.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$689.67
Rate for Payer: MVP Health Care of NY Medicare	$514.50
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,545.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$183.75
Rate for Payer: United Healthcare Commercial	$1,545.00
Rate for Payer: United Healthcare Medicare	$490.00
Rate for Payer: WellCare Medicare	$673.75

KIDNEY IMAGING WITH FLOW

Facility

$72.00

Service Code	HCPCS 78701 26
Hospital Charge Code	5210094
Hospital Revenue Code	960
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$57.60
Rate for Payer: Aetna of NY Commercial	$50.40
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: CDPHP Medicare	$26.64
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: 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 Aetna Signature Administrators	$50.40
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: United Healthcare CHIP/Family Health Plus/Medicaid	$10.80
Rate for Payer: United Healthcare Medicare	$28.80
Rate for Payer: WellCare Medicare	$39.60

KIDNEY IMAGING WITH FLOW

Facility

$1,225.00

Service Code	HCPCS 78701
Hospital Charge Code	4210094
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

KIDNEY IMAGING WITH FLOW

Facility

$72.00

Service Code	HCPCS 78701 26
Hospital Charge Code	5210094
Hospital Revenue Code	960
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

KIDNEY IMAGING WITH FLOW

Facility

$1,225.00

Service Code	HCPCS 78701
Hospital Charge Code	4210094
Hospital Revenue Code	341
Min. Negotiated Rate	$183.75
Max. Negotiated Rate	$1,545.00
Rate for Payer: Aetna of NY Commercial	$857.50
Rate for Payer: Aetna of NY Medicare	$563.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$490.00
Rate for Payer: Cash Price	$918.75
Rate for Payer: Cash Price	$918.75
Rate for Payer: CDPHP Medicare	$453.25
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$857.50
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$980.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$980.00
Rate for Payer: EmblemHealth Medicaid	$980.00
Rate for Payer: EmblemHealth Medicare	$416.50
Rate for Payer: EmblemHealth Select Care	$796.25
Rate for Payer: Fidelis Medicare	$490.00
Rate for Payer: Galaxy Health Commercial	$796.25
Rate for Payer: Hamaspik Choice Medicare	$490.00
Rate for Payer: Humana Medicare	$490.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$857.50
Rate for Payer: Local 1199SEIU Medicare	$563.50
Rate for Payer: MVP Health Care of NY Commercial	$918.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$689.67
Rate for Payer: MVP Health Care of NY Medicare	$514.50
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,545.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$183.75
Rate for Payer: United Healthcare Commercial	$1,545.00
Rate for Payer: United Healthcare Medicare	$490.00
Rate for Payer: WellCare Medicare	$673.75

KINEVAC (CCK)

Facility

$210.12

Service Code	HCPCS J2805
Hospital Charge Code	4409053
Hospital Revenue Code	636
Min. Negotiated Rate	$108.20
Max. Negotiated Rate	$136.58
Rate for Payer: Aetna of NY Commercial	$115.57
Rate for Payer: Cash Price	$157.59
Rate for Payer: Cash Price	$157.59
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$108.20
Rate for Payer: EmblemHealth Select Care	$108.20
Rate for Payer: Galaxy Health Commercial	$136.58
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$115.57
Rate for Payer: WellCare Medicare	$115.57

KINEVAC (CCK)

Facility

$210.12

Service Code	HCPCS J2805
Hospital Charge Code	4409053
Hospital Revenue Code	636
Min. Negotiated Rate	$31.52
Max. Negotiated Rate	$220.34
Rate for Payer: Aetna of NY Medicare	$96.66
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$84.05
Rate for Payer: Cash Price	$157.59
Rate for Payer: Cash Price	$157.59
Rate for Payer: CDPHP Medicare	$77.74
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$108.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$168.10
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$168.10
Rate for Payer: EmblemHealth Medicaid	$168.10
Rate for Payer: EmblemHealth Medicare	$71.44
Rate for Payer: EmblemHealth Select Care	$108.20
Rate for Payer: Fidelis Medicare	$84.05
Rate for Payer: Galaxy Health Commercial	$136.58
Rate for Payer: Hamaspik Choice Medicare	$84.05
Rate for Payer: Humana Medicare	$84.05
Rate for Payer: Local 1199SEIU Medicare	$96.66
Rate for Payer: MVP Health Care of NY Commercial	$157.59
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$118.30
Rate for Payer: MVP Health Care of NY Medicare	$88.25
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$220.34
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$31.52
Rate for Payer: United Healthcare Commercial	$220.34
Rate for Payer: United Healthcare Medicare	$84.05
Rate for Payer: WellCare Medicare	$115.57

KNEE KIT:CRK-17-100-4

Facility

$3,131.20

Hospital Charge Code	4479208
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

KNEE KIT:CRK-17-100-4

Facility

$3,131.20

Hospital Charge Code	4479208
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

KNOT PUSHER / SUTURE CUTTER (AR-5845)

Facility

$720.00

Hospital Charge Code	4473046
Hospital Revenue Code	272
Min. Negotiated Rate	$468.00
Max. Negotiated Rate	$468.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Galaxy Health Commercial	$468.00

KNOT PUSHER / SUTURE CUTTER (AR-5845)

Facility

$720.00

Hospital Charge Code	4473046
Hospital Revenue Code	272
Min. Negotiated Rate	$108.00
Max. Negotiated Rate	$576.00
Rate for Payer: Aetna of NY Commercial	$504.00
Rate for Payer: Aetna of NY Medicare	$331.20
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$288.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: CDPHP Medicare	$266.40
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$576.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$576.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$576.00
Rate for Payer: EmblemHealth Medicaid	$576.00
Rate for Payer: EmblemHealth Medicare	$244.80
Rate for Payer: EmblemHealth Select Care	$518.40
Rate for Payer: Fidelis Medicare	$288.00
Rate for Payer: Galaxy Health Commercial	$468.00
Rate for Payer: Hamaspik Choice Medicare	$288.00
Rate for Payer: Humana Medicare	$288.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$504.00
Rate for Payer: Local 1199SEIU Medicare	$331.20
Rate for Payer: MVP Health Care of NY Commercial	$540.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$405.36
Rate for Payer: MVP Health Care of NY Medicare	$302.40
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$108.00
Rate for Payer: United Healthcare Medicare	$288.00
Rate for Payer: WellCare Medicare	$396.00

KOBYGARD SINGLE USE BLADES

Facility

$695.25

Hospital Charge Code	4472239
Hospital Revenue Code	270
Min. Negotiated Rate	$451.91
Max. Negotiated Rate	$451.91
Rate for Payer: Cash Price	$521.44
Rate for Payer: Galaxy Health Commercial	$451.91

KOBYGARD SINGLE USE BLADES

Facility

$695.25

Hospital Charge Code	4472239
Hospital Revenue Code	270
Min. Negotiated Rate	$104.29
Max. Negotiated Rate	$556.20
Rate for Payer: Aetna of NY Commercial	$486.68
Rate for Payer: Aetna of NY Medicare	$319.81
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$278.10
Rate for Payer: Cash Price	$521.44
Rate for Payer: CDPHP Medicare	$257.24
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$556.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$556.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$556.20
Rate for Payer: EmblemHealth Medicaid	$556.20
Rate for Payer: EmblemHealth Medicare	$236.38
Rate for Payer: EmblemHealth Select Care	$500.58
Rate for Payer: Fidelis Medicare	$278.10
Rate for Payer: Galaxy Health Commercial	$451.91
Rate for Payer: Hamaspik Choice Medicare	$278.10
Rate for Payer: Humana Medicare	$278.10
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$486.68
Rate for Payer: Local 1199SEIU Medicare	$319.81
Rate for Payer: MVP Health Care of NY Commercial	$521.44
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$391.43
Rate for Payer: MVP Health Care of NY Medicare	$292.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$104.29
Rate for Payer: United Healthcare Medicare	$278.10
Rate for Payer: WellCare Medicare	$382.39

K-Phos NeutraL TABLET 250 mg, 100 eaches

Facility

$6.00

Service Code	NDC 486112501
Hospital Charge Code	4401527
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

K-Phos NeutraL TABLET 250 mg, 100 eaches

Facility

$6.00

Service Code	NDC 486112501
Hospital Charge Code	4401527
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

K WIRE

Facility

$58.71

Hospital Charge Code	4479270
Hospital Revenue Code	270
Min. Negotiated Rate	$38.16
Max. Negotiated Rate	$38.16
Rate for Payer: Cash Price	$44.03
Rate for Payer: Galaxy Health Commercial	$38.16

K WIRE

Facility

$58.71

Hospital Charge Code	4479270
Hospital Revenue Code	270
Min. Negotiated Rate	$8.81
Max. Negotiated Rate	$46.97
Rate for Payer: Aetna of NY Commercial	$41.10
Rate for Payer: Aetna of NY Medicare	$27.01
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$23.48
Rate for Payer: Cash Price	$44.03
Rate for Payer: CDPHP Medicare	$21.72
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$46.97
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$46.97
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$46.97
Rate for Payer: EmblemHealth Medicaid	$46.97
Rate for Payer: EmblemHealth Medicare	$19.96
Rate for Payer: EmblemHealth Select Care	$42.27
Rate for Payer: Fidelis Medicare	$23.48
Rate for Payer: Galaxy Health Commercial	$38.16
Rate for Payer: Hamaspik Choice Medicare	$23.48
Rate for Payer: Humana Medicare	$23.48
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$41.10
Rate for Payer: Local 1199SEIU Medicare	$27.01
Rate for Payer: MVP Health Care of NY Commercial	$44.03
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$33.05
Rate for Payer: MVP Health Care of NY Medicare	$24.66
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$8.81
Rate for Payer: United Healthcare Medicare	$23.48
Rate for Payer: WellCare Medicare	$32.29

KYPHON EXPRESS CURETTE T-TIP 7.0MM SZ 2

Facility

$357.41

Hospital Charge Code	4479245
Hospital Revenue Code	270
Min. Negotiated Rate	$232.32
Max. Negotiated Rate	$232.32
Rate for Payer: Cash Price	$268.06
Rate for Payer: Galaxy Health Commercial	$232.32

KYPHON EXPRESS CURETTE T-TIP 7.0MM SZ 2

Facility

$357.41

Hospital Charge Code	4479245
Hospital Revenue Code	270
Min. Negotiated Rate	$53.61
Max. Negotiated Rate	$285.93
Rate for Payer: Aetna of NY Commercial	$250.19
Rate for Payer: Aetna of NY Medicare	$164.41
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$142.96
Rate for Payer: Cash Price	$268.06
Rate for Payer: CDPHP Medicare	$132.24
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$285.93
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$285.93
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$285.93
Rate for Payer: EmblemHealth Medicaid	$285.93
Rate for Payer: EmblemHealth Medicare	$121.52
Rate for Payer: EmblemHealth Select Care	$257.34
Rate for Payer: Fidelis Medicare	$142.96
Rate for Payer: Galaxy Health Commercial	$232.32
Rate for Payer: Hamaspik Choice Medicare	$142.96
Rate for Payer: Humana Medicare	$142.96
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$250.19
Rate for Payer: Local 1199SEIU Medicare	$164.41
Rate for Payer: MVP Health Care of NY Commercial	$268.06
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$201.22
Rate for Payer: MVP Health Care of NY Medicare	$150.11
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$53.61
Rate for Payer: United Healthcare Medicare	$142.96
Rate for Payer: WellCare Medicare	$196.58

LABETALOL HCL 100MG TABS 10X10EA

Facility

$6.18

Service Code	NDC 904592861
Hospital Charge Code	4400409
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

LABETALOL HCL 100MG TABS 10X10EA

Facility

$6.18

Service Code	NDC 904592861
Hospital Charge Code	4400409
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

LABETALOL HCL 5MG/ML CARP 10X4ML

Facility

$23.18

Service Code	NDC 409233934
Hospital Charge Code	4400411
Hospital Revenue Code	250
Min. Negotiated Rate	$12.75
Max. Negotiated Rate	$15.07
Rate for Payer: Cash Price	$17.38
Rate for Payer: Galaxy Health Commercial	$15.07
Rate for Payer: WellCare Medicare	$12.75

LABETALOL HCL 5MG/ML CARP 10X4ML

Facility

$23.18

Service Code	NDC 409233934
Hospital Charge Code	4400411
Hospital Revenue Code	250
Min. Negotiated Rate	$3.48
Max. Negotiated Rate	$18.54
Rate for Payer: Aetna of NY Commercial	$16.23
Rate for Payer: Aetna of NY Medicare	$10.66
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$9.27
Rate for Payer: Cash Price	$17.38
Rate for Payer: CDPHP Medicare	$8.58
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$18.54
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$18.54
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$18.54
Rate for Payer: EmblemHealth Medicaid	$18.54
Rate for Payer: EmblemHealth Medicare	$7.88
Rate for Payer: EmblemHealth Select Care	$16.69
Rate for Payer: Fidelis Medicare	$9.27
Rate for Payer: Galaxy Health Commercial	$15.07
Rate for Payer: Hamaspik Choice Medicare	$9.27
Rate for Payer: Humana Medicare	$9.27
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$16.23
Rate for Payer: Local 1199SEIU Medicare	$10.66
Rate for Payer: MVP Health Care of NY Commercial	$17.39
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$13.05
Rate for Payer: MVP Health Care of NY Medicare	$9.74
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3.48
Rate for Payer: United Healthcare Medicare	$9.27
Rate for Payer: WellCare Medicare	$12.75

LABETALOL HCL 5MG/ML MDV 20 ML

Facility

$45.00

Service Code	NDC 409226720
Hospital Charge Code	4400412
Hospital Revenue Code	250
Min. Negotiated Rate	$6.75
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna of NY Commercial	$31.50
Rate for Payer: Aetna of NY Medicare	$20.70
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$18.00
Rate for Payer: Cash Price	$33.75
Rate for Payer: CDPHP Medicare	$16.65
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$36.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$36.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$36.00
Rate for Payer: EmblemHealth Medicaid	$36.00
Rate for Payer: EmblemHealth Medicare	$15.30
Rate for Payer: EmblemHealth Select Care	$32.40
Rate for Payer: Fidelis Medicare	$18.00
Rate for Payer: Galaxy Health Commercial	$29.25
Rate for Payer: Hamaspik Choice Medicare	$18.00
Rate for Payer: Humana Medicare	$18.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$31.50
Rate for Payer: Local 1199SEIU Medicare	$20.70
Rate for Payer: MVP Health Care of NY Commercial	$33.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$25.34
Rate for Payer: MVP Health Care of NY Medicare	$18.90
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$6.75
Rate for Payer: United Healthcare Medicare	$18.00
Rate for Payer: WellCare Medicare	$24.75

Know your out-of-pocket cost for care.

All Charges