Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

MEDTRONIC LEAD KIT

Facility

$9,215.41

Service Code	HCPCS C1778
Hospital Charge Code	4471320
Hospital Revenue Code	278
Min. Negotiated Rate	$1,382.31
Max. Negotiated Rate	$7,372.33
Rate for Payer: Aetna of NY Commercial	$6,450.79
Rate for Payer: Aetna of NY Medicare	$4,239.09
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$3,686.16
Rate for Payer: Cash Price	$6,911.56
Rate for Payer: CDPHP Medicare	$3,409.70
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$4,607.70
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$7,372.33
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$7,372.33
Rate for Payer: EmblemHealth Medicaid	$7,372.33
Rate for Payer: EmblemHealth Medicare	$3,133.24
Rate for Payer: EmblemHealth Select Care	$4,607.70
Rate for Payer: Fidelis Medicare	$3,686.16
Rate for Payer: Galaxy Health Commercial	$5,990.02
Rate for Payer: Hamaspik Choice Medicare	$3,686.16
Rate for Payer: Humana Medicare	$3,686.16
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$6,450.79
Rate for Payer: Local 1199SEIU Medicare	$4,239.09
Rate for Payer: MVP Health Care of NY Commercial	$5,990.02
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$5,990.02
Rate for Payer: MVP Health Care of NY Medicare	$3,870.47
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,382.31
Rate for Payer: United Healthcare Medicare	$3,686.16
Rate for Payer: WellCare Medicare	$5,068.48

MEDTRONIC LEAD KIT

Facility

$9,215.41

Service Code	HCPCS C1778
Hospital Charge Code	4471320
Hospital Revenue Code	278
Min. Negotiated Rate	$4,146.93
Max. Negotiated Rate	$6,450.79
Rate for Payer: Aetna of NY Commercial	$6,450.79
Rate for Payer: Cash Price	$6,911.56
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$4,607.70
Rate for Payer: EmblemHealth Select Care	$4,607.70
Rate for Payer: Galaxy Health Commercial	$5,990.02
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$6,450.79
Rate for Payer: Multiplan Commercial	$4,146.93
Rate for Payer: MVP Health Care of NY Commercial	$5,990.02
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$5,990.02
Rate for Payer: WellCare Medicare	$5,068.48

MEDTRONIC POCKET ADAPTOR

Facility

$1,771.60

Hospital Charge Code	4471486
Hospital Revenue Code	270
Min. Negotiated Rate	$1,151.54
Max. Negotiated Rate	$1,151.54
Rate for Payer: Cash Price	$1,328.70
Rate for Payer: Galaxy Health Commercial	$1,151.54

MEDTRONIC POCKET ADAPTOR

Facility

$1,771.60

Hospital Charge Code	4471486
Hospital Revenue Code	270
Min. Negotiated Rate	$265.74
Max. Negotiated Rate	$1,417.28
Rate for Payer: Aetna of NY Commercial	$1,240.12
Rate for Payer: Aetna of NY Medicare	$814.94
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$708.64
Rate for Payer: Cash Price	$1,328.70
Rate for Payer: CDPHP Medicare	$655.49
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,417.28
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,417.28
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,417.28
Rate for Payer: EmblemHealth Medicaid	$1,417.28
Rate for Payer: EmblemHealth Medicare	$602.34
Rate for Payer: EmblemHealth Select Care	$1,275.55
Rate for Payer: Fidelis Medicare	$708.64
Rate for Payer: Galaxy Health Commercial	$1,151.54
Rate for Payer: Hamaspik Choice Medicare	$708.64
Rate for Payer: Humana Medicare	$708.64
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,240.12
Rate for Payer: Local 1199SEIU Medicare	$814.94
Rate for Payer: MVP Health Care of NY Commercial	$1,328.70
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$997.41
Rate for Payer: MVP Health Care of NY Medicare	$744.07
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$265.74
Rate for Payer: United Healthcare Medicare	$708.64
Rate for Payer: WellCare Medicare	$974.38

MEDTRONIC SCS IMPLANT

Facility

$78,056.49

Hospital Charge Code	4479088
Hospital Revenue Code	278
Min. Negotiated Rate	$35,125.42
Max. Negotiated Rate	$54,639.54
Rate for Payer: Aetna of NY Commercial	$54,639.54
Rate for Payer: Cash Price	$58,542.37
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$39,028.25
Rate for Payer: EmblemHealth Select Care	$39,028.25
Rate for Payer: Galaxy Health Commercial	$50,736.72
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$54,639.54
Rate for Payer: Multiplan Commercial	$35,125.42
Rate for Payer: MVP Health Care of NY Commercial	$50,736.72
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$50,736.72
Rate for Payer: WellCare Medicare	$42,931.07

MEDTRONIC SCS IMPLANT

Facility

$78,056.49

Hospital Charge Code	4479088
Hospital Revenue Code	278
Min. Negotiated Rate	$11,708.47
Max. Negotiated Rate	$62,445.19
Rate for Payer: Aetna of NY Commercial	$54,639.54
Rate for Payer: Aetna of NY Medicare	$35,905.99
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$31,222.60
Rate for Payer: Cash Price	$58,542.37
Rate for Payer: CDPHP Medicare	$28,880.90
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$39,028.25
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$62,445.19
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$62,445.19
Rate for Payer: EmblemHealth Medicaid	$62,445.19
Rate for Payer: EmblemHealth Medicare	$26,539.21
Rate for Payer: EmblemHealth Select Care	$39,028.25
Rate for Payer: Fidelis Medicare	$31,222.60
Rate for Payer: Galaxy Health Commercial	$50,736.72
Rate for Payer: Hamaspik Choice Medicare	$31,222.60
Rate for Payer: Humana Medicare	$31,222.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$54,639.54
Rate for Payer: Local 1199SEIU Medicare	$35,905.99
Rate for Payer: MVP Health Care of NY Commercial	$50,736.72
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$50,736.72
Rate for Payer: MVP Health Care of NY Medicare	$32,783.73
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$11,708.47
Rate for Payer: United Healthcare Medicare	$31,222.60
Rate for Payer: WellCare Medicare	$42,931.07

MEDTRONIC TRIAL LEAD

Facility

$1,251.45

Hospital Charge Code	4471325
Hospital Revenue Code	270
Min. Negotiated Rate	$813.44
Max. Negotiated Rate	$813.44
Rate for Payer: Cash Price	$938.59
Rate for Payer: Galaxy Health Commercial	$813.44

MEDTRONIC TRIAL LEAD

Facility

$1,251.45

Hospital Charge Code	4471325
Hospital Revenue Code	270
Min. Negotiated Rate	$187.72
Max. Negotiated Rate	$1,001.16
Rate for Payer: Aetna of NY Commercial	$876.01
Rate for Payer: Aetna of NY Medicare	$575.67
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$500.58
Rate for Payer: Cash Price	$938.59
Rate for Payer: CDPHP Medicare	$463.04
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,001.16
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,001.16
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,001.16
Rate for Payer: EmblemHealth Medicaid	$1,001.16
Rate for Payer: EmblemHealth Medicare	$425.49
Rate for Payer: EmblemHealth Select Care	$901.04
Rate for Payer: Fidelis Medicare	$500.58
Rate for Payer: Galaxy Health Commercial	$813.44
Rate for Payer: Hamaspik Choice Medicare	$500.58
Rate for Payer: Humana Medicare	$500.58
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$876.01
Rate for Payer: Local 1199SEIU Medicare	$575.67
Rate for Payer: MVP Health Care of NY Commercial	$938.59
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$704.57
Rate for Payer: MVP Health Care of NY Medicare	$525.61
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$187.72
Rate for Payer: United Healthcare Medicare	$500.58
Rate for Payer: WellCare Medicare	$688.30

MEGESTEROL UNIT DOSE 400 MG / 10 ML

Facility

$7.50

Service Code	NDC 121477610
Hospital Charge Code	4409223
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna of NY Commercial	$5.25
Rate for Payer: Aetna of NY Medicare	$3.45
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$3.00
Rate for Payer: Cash Price	$5.62
Rate for Payer: CDPHP Medicare	$2.77
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$6.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$6.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$6.00
Rate for Payer: EmblemHealth Medicaid	$6.00
Rate for Payer: EmblemHealth Medicare	$2.55
Rate for Payer: EmblemHealth Select Care	$5.40
Rate for Payer: Fidelis Medicare	$3.00
Rate for Payer: Galaxy Health Commercial	$4.88
Rate for Payer: Hamaspik Choice Medicare	$3.00
Rate for Payer: Humana Medicare	$3.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$5.25
Rate for Payer: Local 1199SEIU Medicare	$3.45
Rate for Payer: MVP Health Care of NY Commercial	$5.62
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$4.22
Rate for Payer: MVP Health Care of NY Medicare	$3.15
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.12
Rate for Payer: United Healthcare Medicare	$3.00
Rate for Payer: WellCare Medicare	$4.12

MEGESTEROL UNIT DOSE 400 MG / 10 ML

Facility

$7.50

Service Code	NDC 121477610
Hospital Charge Code	4409223
Hospital Revenue Code	250
Min. Negotiated Rate	$4.12
Max. Negotiated Rate	$4.88
Rate for Payer: Cash Price	$5.62
Rate for Payer: Galaxy Health Commercial	$4.88
Rate for Payer: WellCare Medicare	$4.12

MELATONIN 5 MG

Facility

$6.18

Service Code	NDC 50268052415
Hospital Charge Code	4409028
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

MELATONIN 5 MG

Facility

$6.18

Service Code	NDC 50268052415
Hospital Charge Code	4409028
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

MELATONON 5MG TABLET

Facility

$6.18

Hospital Charge Code	4408025
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

MELATONON 5MG TABLET

Facility

$6.18

Hospital Charge Code	4408025
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

MELOXICAM TAB 7.5 MG

Facility

$9.79

Service Code	NDC 50268052511
Hospital Charge Code	4409146
Hospital Revenue Code	250
Min. Negotiated Rate	$5.38
Max. Negotiated Rate	$6.36
Rate for Payer: Cash Price	$7.34
Rate for Payer: Galaxy Health Commercial	$6.36
Rate for Payer: WellCare Medicare	$5.38

MELOXICAM TAB 7.5 MG

Facility

$9.79

Service Code	NDC 50268052511
Hospital Charge Code	4409146
Hospital Revenue Code	250
Min. Negotiated Rate	$1.47
Max. Negotiated Rate	$7.83
Rate for Payer: Aetna of NY Commercial	$6.85
Rate for Payer: Aetna of NY Medicare	$4.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$3.92
Rate for Payer: Cash Price	$7.34
Rate for Payer: CDPHP Medicare	$3.62
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$7.83
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$7.83
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$7.83
Rate for Payer: EmblemHealth Medicaid	$7.83
Rate for Payer: EmblemHealth Medicare	$3.33
Rate for Payer: EmblemHealth Select Care	$7.05
Rate for Payer: Fidelis Medicare	$3.92
Rate for Payer: Galaxy Health Commercial	$6.36
Rate for Payer: Hamaspik Choice Medicare	$3.92
Rate for Payer: Humana Medicare	$3.92
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$6.85
Rate for Payer: Local 1199SEIU Medicare	$4.50
Rate for Payer: MVP Health Care of NY Commercial	$7.34
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$5.51
Rate for Payer: MVP Health Care of NY Medicare	$4.11
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.47
Rate for Payer: United Healthcare Medicare	$3.92
Rate for Payer: WellCare Medicare	$5.38

MEMANTINE HCL 5MG TABS 10X10EA

Facility

$22.92

Service Code	NDC 591387045
Hospital Charge Code	4400540
Hospital Revenue Code	250
Min. Negotiated Rate	$3.44
Max. Negotiated Rate	$18.34
Rate for Payer: Aetna of NY Commercial	$16.04
Rate for Payer: Aetna of NY Medicare	$10.54
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$9.17
Rate for Payer: Cash Price	$17.19
Rate for Payer: CDPHP Medicare	$8.48
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$18.34
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$18.34
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$18.34
Rate for Payer: EmblemHealth Medicaid	$18.34
Rate for Payer: EmblemHealth Medicare	$7.79
Rate for Payer: EmblemHealth Select Care	$16.50
Rate for Payer: Fidelis Medicare	$9.17
Rate for Payer: Galaxy Health Commercial	$14.90
Rate for Payer: Hamaspik Choice Medicare	$9.17
Rate for Payer: Humana Medicare	$9.17
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$16.04
Rate for Payer: Local 1199SEIU Medicare	$10.54
Rate for Payer: MVP Health Care of NY Commercial	$17.19
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$12.90
Rate for Payer: MVP Health Care of NY Medicare	$9.63
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3.44
Rate for Payer: United Healthcare Medicare	$9.17
Rate for Payer: WellCare Medicare	$12.61

MEMANTINE HCL 5MG TABS 10X10EA

Facility

$22.92

Service Code	NDC 591387045
Hospital Charge Code	4400540
Hospital Revenue Code	250
Min. Negotiated Rate	$12.61
Max. Negotiated Rate	$14.90
Rate for Payer: Cash Price	$17.19
Rate for Payer: Galaxy Health Commercial	$14.90
Rate for Payer: WellCare Medicare	$12.61

MEMANTINE HCL ER 14 MG CAPSULE 14 mg, 30 eaches

Facility

$46.00

Service Code	NDC 60505620903
Hospital Charge Code	4401404
Hospital Revenue Code	250
Min. Negotiated Rate	$6.90
Max. Negotiated Rate	$36.80
Rate for Payer: Aetna of NY Commercial	$32.20
Rate for Payer: Aetna of NY Medicare	$21.16
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$18.40
Rate for Payer: Cash Price	$34.50
Rate for Payer: CDPHP Medicare	$17.02
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$36.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$36.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$36.80
Rate for Payer: EmblemHealth Medicaid	$36.80
Rate for Payer: EmblemHealth Medicare	$15.64
Rate for Payer: EmblemHealth Select Care	$33.12
Rate for Payer: Fidelis Medicare	$18.40
Rate for Payer: Galaxy Health Commercial	$29.90
Rate for Payer: Hamaspik Choice Medicare	$18.40
Rate for Payer: Humana Medicare	$18.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$32.20
Rate for Payer: Local 1199SEIU Medicare	$21.16
Rate for Payer: MVP Health Care of NY Commercial	$34.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$25.90
Rate for Payer: MVP Health Care of NY Medicare	$19.32
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$6.90
Rate for Payer: United Healthcare Medicare	$18.40
Rate for Payer: WellCare Medicare	$25.30

MEMANTINE HCL ER 14 MG CAPSULE 14 mg, 30 eaches

Facility

$46.00

Service Code	NDC 60505620903
Hospital Charge Code	4401404
Hospital Revenue Code	250
Min. Negotiated Rate	$25.30
Max. Negotiated Rate	$29.90
Rate for Payer: Cash Price	$34.50
Rate for Payer: Galaxy Health Commercial	$29.90
Rate for Payer: WellCare Medicare	$25.30

MEPERIDINE HYDROCHLORIDE INJ, PER 100 MG

Facility

$6.18

Service Code	HCPCS J2175
Hospital Charge Code	4409064
Hospital Revenue Code	636
Min. Negotiated Rate	$0.93
Max. Negotiated Rate	$12.06
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	$8.82
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	$8.82
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	$12.06
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.93
Rate for Payer: United Healthcare Commercial	$12.06
Rate for Payer: United Healthcare Medicare	$2.47
Rate for Payer: WellCare Medicare	$3.40

MEPERIDINE HYDROCHLORIDE INJ, PER 100 MG

Facility

$6.18

Service Code	HCPCS J2175
Hospital Charge Code	4409064
Hospital Revenue Code	636
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$8.82
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	$8.82
Rate for Payer: EmblemHealth Select Care	$8.82
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

MEROCEL NASAL PACKING 4.5CM

Facility

$141.11

Hospital Charge Code	4472003
Hospital Revenue Code	270
Min. Negotiated Rate	$21.17
Max. Negotiated Rate	$112.89
Rate for Payer: Aetna of NY Commercial	$98.78
Rate for Payer: Aetna of NY Medicare	$64.91
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$56.44
Rate for Payer: Cash Price	$105.83
Rate for Payer: CDPHP Medicare	$52.21
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$112.89
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$112.89
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$112.89
Rate for Payer: EmblemHealth Medicaid	$112.89
Rate for Payer: EmblemHealth Medicare	$47.98
Rate for Payer: EmblemHealth Select Care	$101.60
Rate for Payer: Fidelis Medicare	$56.44
Rate for Payer: Galaxy Health Commercial	$91.72
Rate for Payer: Hamaspik Choice Medicare	$56.44
Rate for Payer: Humana Medicare	$56.44
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$98.78
Rate for Payer: Local 1199SEIU Medicare	$64.91
Rate for Payer: MVP Health Care of NY Commercial	$105.83
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$79.44
Rate for Payer: MVP Health Care of NY Medicare	$59.27
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$21.17
Rate for Payer: United Healthcare Medicare	$56.44
Rate for Payer: WellCare Medicare	$77.61

MEROCEL NASAL PACKING 4.5CM

Facility

$141.11

Hospital Charge Code	4472003
Hospital Revenue Code	270
Min. Negotiated Rate	$91.72
Max. Negotiated Rate	$91.72
Rate for Payer: Cash Price	$105.83
Rate for Payer: Galaxy Health Commercial	$91.72

MEROCEL NASAL PACKING 8.0CM

Facility

$141.11

Hospital Charge Code	4472006
Hospital Revenue Code	270
Min. Negotiated Rate	$21.17
Max. Negotiated Rate	$112.89
Rate for Payer: Aetna of NY Commercial	$98.78
Rate for Payer: Aetna of NY Medicare	$64.91
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$56.44
Rate for Payer: Cash Price	$105.83
Rate for Payer: CDPHP Medicare	$52.21
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$112.89
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$112.89
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$112.89
Rate for Payer: EmblemHealth Medicaid	$112.89
Rate for Payer: EmblemHealth Medicare	$47.98
Rate for Payer: EmblemHealth Select Care	$101.60
Rate for Payer: Fidelis Medicare	$56.44
Rate for Payer: Galaxy Health Commercial	$91.72
Rate for Payer: Hamaspik Choice Medicare	$56.44
Rate for Payer: Humana Medicare	$56.44
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$98.78
Rate for Payer: Local 1199SEIU Medicare	$64.91
Rate for Payer: MVP Health Care of NY Commercial	$105.83
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$79.44
Rate for Payer: MVP Health Care of NY Medicare	$59.27
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$21.17
Rate for Payer: United Healthcare Medicare	$56.44
Rate for Payer: WellCare Medicare	$77.61

Know your out-of-pocket cost for care.

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