Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

LUMBAR PUNCTURE TRAY ADULT 2

Facility

$37.08

Hospital Charge Code	4471222
Hospital Revenue Code	270
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$24.10
Rate for Payer: Cash Price	$27.81
Rate for Payer: Galaxy Health Commercial	$24.10

_LUMBAR PUNCTURE TRAY PEDIATR

Facility

$47.38

Hospital Charge Code	4471223
Hospital Revenue Code	270
Min. Negotiated Rate	$7.11
Max. Negotiated Rate	$37.90
Rate for Payer: Aetna of NY Commercial	$33.17
Rate for Payer: Aetna of NY Medicare	$21.79
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$18.95
Rate for Payer: Cash Price	$35.54
Rate for Payer: CDPHP Medicare	$17.53
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$37.90
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$37.90
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$37.90
Rate for Payer: EmblemHealth Medicaid	$37.90
Rate for Payer: EmblemHealth Medicare	$16.11
Rate for Payer: EmblemHealth Select Care	$34.11
Rate for Payer: Fidelis Medicare	$18.95
Rate for Payer: Galaxy Health Commercial	$30.80
Rate for Payer: Hamaspik Choice Medicare	$18.95
Rate for Payer: Humana Medicare	$18.95
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$33.17
Rate for Payer: Local 1199SEIU Medicare	$21.79
Rate for Payer: MVP Health Care of NY Commercial	$35.53
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$26.67
Rate for Payer: MVP Health Care of NY Medicare	$19.90
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$7.11
Rate for Payer: United Healthcare Medicare	$18.95
Rate for Payer: WellCare Medicare	$26.06

_LUMBAR PUNCTURE TRAY PEDIATR

Facility

$47.38

Hospital Charge Code	4471223
Hospital Revenue Code	270
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$30.80
Rate for Payer: Cash Price	$35.54
Rate for Payer: Galaxy Health Commercial	$30.80

LUMBAR RF KIT_LUK-17-150-4

Facility

$3,131.20

Hospital Charge Code	4479242
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

LUMBAR RF KIT_LUK-17-150-4

Facility

$3,131.20

Hospital Charge Code	4479242
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

LUNG PERF W VENTIL, RB W WO

Facility

$153.00

Service Code	HCPCS 78582 26
Hospital Charge Code	5210095
Hospital Revenue Code	960
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$99.45
Rate for Payer: Cash Price	$114.75
Rate for Payer: Galaxy Health Commercial	$99.45

LUNG PERF W VENTIL, RB W WO

Facility

$153.00

Service Code	HCPCS 78582 26
Hospital Charge Code	5210095
Hospital Revenue Code	960
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$122.40
Rate for Payer: Aetna of NY Commercial	$107.10
Rate for Payer: Aetna of NY Medicare	$70.38
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$61.20
Rate for Payer: Cash Price	$114.75
Rate for Payer: CDPHP Medicare	$56.61
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$122.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$122.40
Rate for Payer: EmblemHealth Medicaid	$122.40
Rate for Payer: EmblemHealth Medicare	$52.02
Rate for Payer: Fidelis Medicare	$61.20
Rate for Payer: Galaxy Health Commercial	$99.45
Rate for Payer: Hamaspik Choice Medicare	$61.20
Rate for Payer: Humana Medicare	$61.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$107.10
Rate for Payer: Local 1199SEIU Medicare	$70.38
Rate for Payer: MVP Health Care of NY Commercial	$114.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$86.14
Rate for Payer: MVP Health Care of NY Medicare	$64.26
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$22.95
Rate for Payer: United Healthcare Medicare	$61.20
Rate for Payer: WellCare Medicare	$84.15

LUNG PERF W VENTIL; RB W WO

Facility

$1,664.00

Service Code	HCPCS 78582
Hospital Charge Code	4210095
Hospital Revenue Code	341
Min. Negotiated Rate	$1,081.60
Max. Negotiated Rate	$1,081.60
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: Galaxy Health Commercial	$1,081.60

LUNG PERF W VENTIL; RB W WO

Facility

$1,664.00

Service Code	HCPCS 78582
Hospital Charge Code	4210095
Hospital Revenue Code	341
Min. Negotiated Rate	$249.60
Max. Negotiated Rate	$1,545.00
Rate for Payer: Aetna of NY Commercial	$1,164.80
Rate for Payer: Aetna of NY Medicare	$765.44
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$665.60
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: CDPHP Medicare	$615.68
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,164.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,331.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,331.20
Rate for Payer: EmblemHealth Medicaid	$1,331.20
Rate for Payer: EmblemHealth Medicare	$565.76
Rate for Payer: EmblemHealth Select Care	$1,081.60
Rate for Payer: Fidelis Medicare	$665.60
Rate for Payer: Galaxy Health Commercial	$1,081.60
Rate for Payer: Hamaspik Choice Medicare	$665.60
Rate for Payer: Humana Medicare	$665.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,164.80
Rate for Payer: Local 1199SEIU Medicare	$765.44
Rate for Payer: MVP Health Care of NY Commercial	$1,248.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$936.83
Rate for Payer: MVP Health Care of NY Medicare	$698.88
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,545.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$249.60
Rate for Payer: United Healthcare Commercial	$1,545.00
Rate for Payer: United Healthcare Medicare	$665.60
Rate for Payer: WellCare Medicare	$915.20

LUNG PERF W VENTIL, SGL BRTH

Facility

$153.00

Service Code	HCPCS 78582 26
Hospital Charge Code	5210096
Hospital Revenue Code	960
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$122.40
Rate for Payer: Aetna of NY Commercial	$107.10
Rate for Payer: Aetna of NY Medicare	$70.38
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$61.20
Rate for Payer: Cash Price	$114.75
Rate for Payer: CDPHP Medicare	$56.61
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$122.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$122.40
Rate for Payer: EmblemHealth Medicaid	$122.40
Rate for Payer: EmblemHealth Medicare	$52.02
Rate for Payer: Fidelis Medicare	$61.20
Rate for Payer: Galaxy Health Commercial	$99.45
Rate for Payer: Hamaspik Choice Medicare	$61.20
Rate for Payer: Humana Medicare	$61.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$107.10
Rate for Payer: Local 1199SEIU Medicare	$70.38
Rate for Payer: MVP Health Care of NY Commercial	$114.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$86.14
Rate for Payer: MVP Health Care of NY Medicare	$64.26
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$22.95
Rate for Payer: United Healthcare Medicare	$61.20
Rate for Payer: WellCare Medicare	$84.15

LUNG PERF W VENTIL, SGL BRTH

Facility

$153.00

Service Code	HCPCS 78582 26
Hospital Charge Code	5210096
Hospital Revenue Code	960
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$99.45
Rate for Payer: Cash Price	$114.75
Rate for Payer: Galaxy Health Commercial	$99.45

LUNG PERF W VENTIL; SGL BRTH

Facility

$1,664.00

Service Code	HCPCS 78582
Hospital Charge Code	4210096
Hospital Revenue Code	341
Min. Negotiated Rate	$249.60
Max. Negotiated Rate	$1,545.00
Rate for Payer: Aetna of NY Commercial	$1,164.80
Rate for Payer: Aetna of NY Medicare	$765.44
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$665.60
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: CDPHP Medicare	$615.68
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,164.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,331.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,331.20
Rate for Payer: EmblemHealth Medicaid	$1,331.20
Rate for Payer: EmblemHealth Medicare	$565.76
Rate for Payer: EmblemHealth Select Care	$1,081.60
Rate for Payer: Fidelis Medicare	$665.60
Rate for Payer: Galaxy Health Commercial	$1,081.60
Rate for Payer: Hamaspik Choice Medicare	$665.60
Rate for Payer: Humana Medicare	$665.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,164.80
Rate for Payer: Local 1199SEIU Medicare	$765.44
Rate for Payer: MVP Health Care of NY Commercial	$1,248.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$936.83
Rate for Payer: MVP Health Care of NY Medicare	$698.88
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,545.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$249.60
Rate for Payer: United Healthcare Commercial	$1,545.00
Rate for Payer: United Healthcare Medicare	$665.60
Rate for Payer: WellCare Medicare	$915.20

LUNG PERF W VENTIL; SGL BRTH

Facility

$1,664.00

Service Code	HCPCS 78582
Hospital Charge Code	4210096
Hospital Revenue Code	341
Min. Negotiated Rate	$1,081.60
Max. Negotiated Rate	$1,081.60
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: Galaxy Health Commercial	$1,081.60

LUNG VENT AEROSOL ; MULTIPLE

Facility

$1,664.00

Service Code	HCPCS 78582
Hospital Charge Code	4210031
Hospital Revenue Code	341
Min. Negotiated Rate	$1,081.60
Max. Negotiated Rate	$1,081.60
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: Galaxy Health Commercial	$1,081.60

LUNG VENT AEROSOL ; MULTIPLE

Facility

$1,664.00

Service Code	HCPCS 78582
Hospital Charge Code	4210031
Hospital Revenue Code	341
Min. Negotiated Rate	$249.60
Max. Negotiated Rate	$1,545.00
Rate for Payer: Aetna of NY Commercial	$1,164.80
Rate for Payer: Aetna of NY Medicare	$765.44
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$665.60
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: CDPHP Medicare	$615.68
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,164.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,331.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,331.20
Rate for Payer: EmblemHealth Medicaid	$1,331.20
Rate for Payer: EmblemHealth Medicare	$565.76
Rate for Payer: EmblemHealth Select Care	$1,081.60
Rate for Payer: Fidelis Medicare	$665.60
Rate for Payer: Galaxy Health Commercial	$1,081.60
Rate for Payer: Hamaspik Choice Medicare	$665.60
Rate for Payer: Humana Medicare	$665.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,164.80
Rate for Payer: Local 1199SEIU Medicare	$765.44
Rate for Payer: MVP Health Care of NY Commercial	$1,248.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$936.83
Rate for Payer: MVP Health Care of NY Medicare	$698.88
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,545.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$249.60
Rate for Payer: United Healthcare Commercial	$1,545.00
Rate for Payer: United Healthcare Medicare	$665.60
Rate for Payer: WellCare Medicare	$915.20

LUNG VENT AEROSOL, MULTIPLE

Facility

$153.00

Service Code	HCPCS 78582 26
Hospital Charge Code	5210031
Hospital Revenue Code	960
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$99.45
Rate for Payer: Cash Price	$114.75
Rate for Payer: Galaxy Health Commercial	$99.45

LUNG VENT AEROSOL, MULTIPLE

Facility

$153.00

Service Code	HCPCS 78582 26
Hospital Charge Code	5210031
Hospital Revenue Code	960
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$122.40
Rate for Payer: Aetna of NY Commercial	$107.10
Rate for Payer: Aetna of NY Medicare	$70.38
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$61.20
Rate for Payer: Cash Price	$114.75
Rate for Payer: CDPHP Medicare	$56.61
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$122.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$122.40
Rate for Payer: EmblemHealth Medicaid	$122.40
Rate for Payer: EmblemHealth Medicare	$52.02
Rate for Payer: Fidelis Medicare	$61.20
Rate for Payer: Galaxy Health Commercial	$99.45
Rate for Payer: Hamaspik Choice Medicare	$61.20
Rate for Payer: Humana Medicare	$61.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$107.10
Rate for Payer: Local 1199SEIU Medicare	$70.38
Rate for Payer: MVP Health Care of NY Commercial	$114.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$86.14
Rate for Payer: MVP Health Care of NY Medicare	$64.26
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$22.95
Rate for Payer: United Healthcare Medicare	$61.20
Rate for Payer: WellCare Medicare	$84.15

LUNG VENTILATION/PERFUSION STUDY

Facility

$1,664.00

Service Code	HCPCS 78582
Hospital Charge Code	4210032
Hospital Revenue Code	341
Min. Negotiated Rate	$249.60
Max. Negotiated Rate	$1,545.00
Rate for Payer: Aetna of NY Commercial	$1,164.80
Rate for Payer: Aetna of NY Medicare	$765.44
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$665.60
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: CDPHP Medicare	$615.68
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,164.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,331.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,331.20
Rate for Payer: EmblemHealth Medicaid	$1,331.20
Rate for Payer: EmblemHealth Medicare	$565.76
Rate for Payer: EmblemHealth Select Care	$1,081.60
Rate for Payer: Fidelis Medicare	$665.60
Rate for Payer: Galaxy Health Commercial	$1,081.60
Rate for Payer: Hamaspik Choice Medicare	$665.60
Rate for Payer: Humana Medicare	$665.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,164.80
Rate for Payer: Local 1199SEIU Medicare	$765.44
Rate for Payer: MVP Health Care of NY Commercial	$1,248.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$936.83
Rate for Payer: MVP Health Care of NY Medicare	$698.88
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,545.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$249.60
Rate for Payer: United Healthcare Commercial	$1,545.00
Rate for Payer: United Healthcare Medicare	$665.60
Rate for Payer: WellCare Medicare	$915.20

LUNG VENTILATION/PERFUSION STUDY

Facility

$153.00

Service Code	HCPCS 78582 26
Hospital Charge Code	5210032
Hospital Revenue Code	960
Min. Negotiated Rate	$22.95
Max. Negotiated Rate	$122.40
Rate for Payer: Aetna of NY Commercial	$107.10
Rate for Payer: Aetna of NY Medicare	$70.38
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$61.20
Rate for Payer: Cash Price	$114.75
Rate for Payer: CDPHP Medicare	$56.61
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$122.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$122.40
Rate for Payer: EmblemHealth Medicaid	$122.40
Rate for Payer: EmblemHealth Medicare	$52.02
Rate for Payer: Fidelis Medicare	$61.20
Rate for Payer: Galaxy Health Commercial	$99.45
Rate for Payer: Hamaspik Choice Medicare	$61.20
Rate for Payer: Humana Medicare	$61.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$107.10
Rate for Payer: Local 1199SEIU Medicare	$70.38
Rate for Payer: MVP Health Care of NY Commercial	$114.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$86.14
Rate for Payer: MVP Health Care of NY Medicare	$64.26
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$22.95
Rate for Payer: United Healthcare Medicare	$61.20
Rate for Payer: WellCare Medicare	$84.15

LUNG VENTILATION/PERFUSION STUDY

Facility

$1,664.00

Service Code	HCPCS 78582
Hospital Charge Code	4210032
Hospital Revenue Code	341
Min. Negotiated Rate	$1,081.60
Max. Negotiated Rate	$1,081.60
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: Galaxy Health Commercial	$1,081.60

LUNG VENTILATION/PERFUSION STUDY

Facility

$153.00

Service Code	HCPCS 78582 26
Hospital Charge Code	5210032
Hospital Revenue Code	960
Min. Negotiated Rate	$99.45
Max. Negotiated Rate	$99.45
Rate for Payer: Cash Price	$114.75
Rate for Payer: Galaxy Health Commercial	$99.45

LVAD DRIVELINE KIT

Facility

$62.83

Hospital Charge Code	4473008
Hospital Revenue Code	270
Min. Negotiated Rate	$40.84
Max. Negotiated Rate	$40.84
Rate for Payer: Cash Price	$47.12
Rate for Payer: Galaxy Health Commercial	$40.84

LVAD DRIVELINE KIT

Facility

$62.83

Hospital Charge Code	4473008
Hospital Revenue Code	270
Min. Negotiated Rate	$9.42
Max. Negotiated Rate	$50.26
Rate for Payer: Aetna of NY Commercial	$43.98
Rate for Payer: Aetna of NY Medicare	$28.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$25.13
Rate for Payer: Cash Price	$47.12
Rate for Payer: CDPHP Medicare	$23.25
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$50.26
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$50.26
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$50.26
Rate for Payer: EmblemHealth Medicaid	$50.26
Rate for Payer: EmblemHealth Medicare	$21.36
Rate for Payer: EmblemHealth Select Care	$45.24
Rate for Payer: Fidelis Medicare	$25.13
Rate for Payer: Galaxy Health Commercial	$40.84
Rate for Payer: Hamaspik Choice Medicare	$25.13
Rate for Payer: Humana Medicare	$25.13
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$43.98
Rate for Payer: Local 1199SEIU Medicare	$28.90
Rate for Payer: MVP Health Care of NY Commercial	$47.12
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$35.37
Rate for Payer: MVP Health Care of NY Medicare	$26.39
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$9.42
Rate for Payer: United Healthcare Medicare	$25.13
Rate for Payer: WellCare Medicare	$34.56

LWR XTR VASC STDY BILAT

Facility

$74.00

Service Code	HCPCS 93924 26
Hospital Charge Code	5201053
Hospital Revenue Code	960
Min. Negotiated Rate	$11.10
Max. Negotiated Rate	$59.20
Rate for Payer: Aetna of NY Commercial	$48.10
Rate for Payer: Aetna of NY Medicare	$34.04
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$29.60
Rate for Payer: Cash Price	$55.50
Rate for Payer: CDPHP Medicare	$27.38
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$59.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$59.20
Rate for Payer: EmblemHealth Medicaid	$59.20
Rate for Payer: EmblemHealth Medicare	$25.16
Rate for Payer: Fidelis Medicare	$29.60
Rate for Payer: Galaxy Health Commercial	$48.10
Rate for Payer: Hamaspik Choice Medicare	$29.60
Rate for Payer: Humana Medicare	$29.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$48.10
Rate for Payer: Local 1199SEIU Medicare	$34.04
Rate for Payer: MVP Health Care of NY Commercial	$55.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$41.66
Rate for Payer: MVP Health Care of NY Medicare	$31.08
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$11.10
Rate for Payer: United Healthcare Medicare	$29.60
Rate for Payer: WellCare Medicare	$40.70

LWR XTR VASC STDY BILAT

Facility

$74.00

Service Code	HCPCS 93924 26
Hospital Charge Code	5201053
Hospital Revenue Code	960
Min. Negotiated Rate	$48.10
Max. Negotiated Rate	$48.10
Rate for Payer: Cash Price	$55.50
Rate for Payer: Galaxy Health Commercial	$48.10

Know your out-of-pocket cost for care.

All Charges