Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

NITROGLYCERIN 0.02 OINT 48X1GM

Facility

$7.73

Service Code	NDC 281032608
Hospital Charge Code	4400565
Hospital Revenue Code	250
Min. Negotiated Rate	$1.16
Max. Negotiated Rate	$6.18
Rate for Payer: Aetna of NY Commercial	$5.41
Rate for Payer: Aetna of NY Medicare	$3.56
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$3.09
Rate for Payer: Cash Price	$5.80
Rate for Payer: CDPHP Medicare	$2.86
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$6.18
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$6.18
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$6.18
Rate for Payer: EmblemHealth Medicaid	$6.18
Rate for Payer: EmblemHealth Medicare	$2.63
Rate for Payer: EmblemHealth Select Care	$5.57
Rate for Payer: Fidelis Medicare	$3.09
Rate for Payer: Galaxy Health Commercial	$5.02
Rate for Payer: Hamaspik Choice Medicare	$3.09
Rate for Payer: Humana Medicare	$3.09
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$5.41
Rate for Payer: Local 1199SEIU Medicare	$3.56
Rate for Payer: MVP Health Care of NY Commercial	$5.80
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$4.35
Rate for Payer: MVP Health Care of NY Medicare	$3.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.16
Rate for Payer: United Healthcare Medicare	$3.09
Rate for Payer: WellCare Medicare	$4.25

NITROGLYCERIN 0.02 OINT 48X1GM

Facility

$7.73

Service Code	NDC 281032608
Hospital Charge Code	4400565
Hospital Revenue Code	250
Min. Negotiated Rate	$4.25
Max. Negotiated Rate	$5.02
Rate for Payer: Cash Price	$5.80
Rate for Payer: Galaxy Health Commercial	$5.02
Rate for Payer: WellCare Medicare	$4.25

NITROGLYCERIN 0.4MG/HR PTCH 30 EA

Facility

$6.18

Service Code	NDC 47781029803
Hospital Charge Code	4400567
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

NITROGLYCERIN 0.4MG/HR PTCH 30 EA

Facility

$6.18

Service Code	NDC 47781029803
Hospital Charge Code	4400567
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

NITROGLYCERIN 0.4MG TABS 4X25EA

Facility

$6.18

Service Code	NDC 71041813
Hospital Charge Code	4400573
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

NITROGLYCERIN 0.4MG TABS 4X25EA

Facility

$6.18

Service Code	NDC 71041813
Hospital Charge Code	4400573
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

NITROGLYCERIN 5MG/ML SDV 25X10ML

Facility

$38.63

Service Code	NDC 517481025
Hospital Charge Code	4400568
Hospital Revenue Code	250
Min. Negotiated Rate	$5.79
Max. Negotiated Rate	$30.90
Rate for Payer: Aetna of NY Commercial	$27.04
Rate for Payer: Aetna of NY Medicare	$17.77
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$15.45
Rate for Payer: Cash Price	$28.97
Rate for Payer: CDPHP Medicare	$14.29
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$30.90
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$30.90
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$30.90
Rate for Payer: EmblemHealth Medicaid	$30.90
Rate for Payer: EmblemHealth Medicare	$13.13
Rate for Payer: EmblemHealth Select Care	$27.81
Rate for Payer: Fidelis Medicare	$15.45
Rate for Payer: Galaxy Health Commercial	$25.11
Rate for Payer: Hamaspik Choice Medicare	$15.45
Rate for Payer: Humana Medicare	$15.45
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$27.04
Rate for Payer: Local 1199SEIU Medicare	$17.77
Rate for Payer: MVP Health Care of NY Commercial	$28.97
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$21.75
Rate for Payer: MVP Health Care of NY Medicare	$16.22
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.79
Rate for Payer: United Healthcare Medicare	$15.45
Rate for Payer: WellCare Medicare	$21.25

NITROGLYCERIN 5MG/ML SDV 25X10ML

Facility

$38.63

Service Code	NDC 517481025
Hospital Charge Code	4400568
Hospital Revenue Code	250
Min. Negotiated Rate	$21.25
Max. Negotiated Rate	$25.11
Rate for Payer: Cash Price	$28.97
Rate for Payer: Galaxy Health Commercial	$25.11
Rate for Payer: WellCare Medicare	$21.25

NITROGLYCERIN/D5W 0.1MG/ML BTTL 12X250ML

Facility

$59.23

Service Code	NDC 338104702
Hospital Charge Code	4400570
Hospital Revenue Code	250
Min. Negotiated Rate	$8.88
Max. Negotiated Rate	$47.38
Rate for Payer: Aetna of NY Commercial	$41.46
Rate for Payer: Aetna of NY Medicare	$27.25
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$23.69
Rate for Payer: Cash Price	$44.42
Rate for Payer: CDPHP Medicare	$21.92
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$47.38
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$47.38
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$47.38
Rate for Payer: EmblemHealth Medicaid	$47.38
Rate for Payer: EmblemHealth Medicare	$20.14
Rate for Payer: EmblemHealth Select Care	$42.65
Rate for Payer: Fidelis Medicare	$23.69
Rate for Payer: Galaxy Health Commercial	$38.50
Rate for Payer: Hamaspik Choice Medicare	$23.69
Rate for Payer: Humana Medicare	$23.69
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$41.46
Rate for Payer: Local 1199SEIU Medicare	$27.25
Rate for Payer: MVP Health Care of NY Commercial	$44.42
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$33.35
Rate for Payer: MVP Health Care of NY Medicare	$24.88
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$8.88
Rate for Payer: United Healthcare Medicare	$23.69
Rate for Payer: WellCare Medicare	$32.58

NITROGLYCERIN/D5W 0.1MG/ML BTTL 12X250ML

Facility

$59.23

Service Code	NDC 338104702
Hospital Charge Code	4400570
Hospital Revenue Code	250
Min. Negotiated Rate	$32.58
Max. Negotiated Rate	$38.50
Rate for Payer: Cash Price	$44.42
Rate for Payer: Galaxy Health Commercial	$38.50
Rate for Payer: WellCare Medicare	$32.58

NITROPRUSSIDE SODIUM 25MG/ML SDV 2 ML

Facility

$970.92

Service Code	NDC 409302401
Hospital Charge Code	4400572
Hospital Revenue Code	250
Min. Negotiated Rate	$534.01
Max. Negotiated Rate	$631.10
Rate for Payer: Cash Price	$728.19
Rate for Payer: Galaxy Health Commercial	$631.10
Rate for Payer: WellCare Medicare	$534.01

NITROPRUSSIDE SODIUM 25MG/ML SDV 2 ML

Facility

$970.92

Service Code	NDC 409302401
Hospital Charge Code	4400572
Hospital Revenue Code	250
Min. Negotiated Rate	$145.64
Max. Negotiated Rate	$776.74
Rate for Payer: Aetna of NY Commercial	$679.64
Rate for Payer: Aetna of NY Medicare	$446.62
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$388.37
Rate for Payer: Cash Price	$728.19
Rate for Payer: CDPHP Medicare	$359.24
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$776.74
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$776.74
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$776.74
Rate for Payer: EmblemHealth Medicaid	$776.74
Rate for Payer: EmblemHealth Medicare	$330.11
Rate for Payer: EmblemHealth Select Care	$699.06
Rate for Payer: Fidelis Medicare	$388.37
Rate for Payer: Galaxy Health Commercial	$631.10
Rate for Payer: Hamaspik Choice Medicare	$388.37
Rate for Payer: Humana Medicare	$388.37
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$679.64
Rate for Payer: Local 1199SEIU Medicare	$446.62
Rate for Payer: MVP Health Care of NY Commercial	$728.19
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$546.63
Rate for Payer: MVP Health Care of NY Medicare	$407.79
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$145.64
Rate for Payer: United Healthcare Medicare	$388.37
Rate for Payer: WellCare Medicare	$534.01

NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY

Facility

$681.00

Service Code	HCPCS 51600
Hospital Charge Code	4002008
Hospital Revenue Code	490
Min. Negotiated Rate	$442.65
Max. Negotiated Rate	$442.65
Rate for Payer: Cash Price	$510.75
Rate for Payer: Galaxy Health Commercial	$442.65

NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY

Facility

$681.00

Service Code	HCPCS 51600
Hospital Charge Code	4002008
Hospital Revenue Code	490
Min. Negotiated Rate	$102.15
Max. Negotiated Rate	$1,900.00
Rate for Payer: Aetna of NY Commercial	$1,900.00
Rate for Payer: Aetna of NY Medicare	$313.26
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$272.40
Rate for Payer: Cash Price	$510.75
Rate for Payer: Cash Price	$510.75
Rate for Payer: CDPHP Medicare	$251.97
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$544.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$544.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$544.80
Rate for Payer: EmblemHealth Medicaid	$544.80
Rate for Payer: EmblemHealth Medicare	$231.54
Rate for Payer: EmblemHealth Select Care	$490.32
Rate for Payer: Fidelis Medicare	$272.40
Rate for Payer: Galaxy Health Commercial	$442.65
Rate for Payer: Hamaspik Choice Medicare	$272.40
Rate for Payer: Humana Medicare	$272.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,900.00
Rate for Payer: Local 1199SEIU Medicare	$313.26
Rate for Payer: Multiplan Commercial	$544.80
Rate for Payer: MVP Health Care of NY Commercial	$510.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$383.40
Rate for Payer: MVP Health Care of NY Medicare	$286.02
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,828.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$102.15
Rate for Payer: United Healthcare Commercial	$1,828.00
Rate for Payer: United Healthcare Medicare	$272.40
Rate for Payer: WellCare Medicare	$374.55

NJX RETROGRADE URETHROCSTOGRAPY

Facility

$420.00

Service Code	HCPCS 51610
Hospital Charge Code	4002009
Hospital Revenue Code	490
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$1,900.00
Rate for Payer: Aetna of NY Commercial	$1,900.00
Rate for Payer: Aetna of NY Medicare	$193.20
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$168.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: CDPHP Medicare	$155.40
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$336.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$336.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$336.00
Rate for Payer: EmblemHealth Medicaid	$336.00
Rate for Payer: EmblemHealth Medicare	$142.80
Rate for Payer: EmblemHealth Select Care	$302.40
Rate for Payer: Fidelis Medicare	$168.00
Rate for Payer: Galaxy Health Commercial	$273.00
Rate for Payer: Hamaspik Choice Medicare	$168.00
Rate for Payer: Humana Medicare	$168.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,900.00
Rate for Payer: Local 1199SEIU Medicare	$193.20
Rate for Payer: Multiplan Commercial	$336.00
Rate for Payer: MVP Health Care of NY Commercial	$315.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$236.46
Rate for Payer: MVP Health Care of NY Medicare	$176.40
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,828.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$63.00
Rate for Payer: United Healthcare Commercial	$1,828.00
Rate for Payer: United Healthcare Medicare	$168.00
Rate for Payer: WellCare Medicare	$231.00

NJX RETROGRADE URETHROCSTOGRAPY

Facility

$420.00

Service Code	HCPCS 51610
Hospital Charge Code	4002009
Hospital Revenue Code	490
Min. Negotiated Rate	$273.00
Max. Negotiated Rate	$273.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Galaxy Health Commercial	$273.00

NM BONE MARROW IMAGING, LIMITED

Facility

$77.00

Service Code	HCPCS 78102 26
Hospital Charge Code	5211253
Hospital Revenue Code	960
Min. Negotiated Rate	$11.55
Max. Negotiated Rate	$61.60
Rate for Payer: Aetna of NY Commercial	$53.90
Rate for Payer: Aetna of NY Medicare	$35.42
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$30.80
Rate for Payer: Cash Price	$57.75
Rate for Payer: CDPHP Medicare	$28.49
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$61.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$61.60
Rate for Payer: EmblemHealth Medicaid	$61.60
Rate for Payer: EmblemHealth Medicare	$26.18
Rate for Payer: Fidelis Medicare	$30.80
Rate for Payer: Galaxy Health Commercial	$50.05
Rate for Payer: Hamaspik Choice Medicare	$30.80
Rate for Payer: Humana Medicare	$30.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$53.90
Rate for Payer: Local 1199SEIU Medicare	$35.42
Rate for Payer: MVP Health Care of NY Commercial	$57.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$43.35
Rate for Payer: MVP Health Care of NY Medicare	$32.34
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$11.55
Rate for Payer: United Healthcare Medicare	$30.80
Rate for Payer: WellCare Medicare	$42.35

NM BONE MARROW IMAGING, LIMITED

Facility

$77.00

Service Code	HCPCS 78102 26
Hospital Charge Code	5211253
Hospital Revenue Code	960
Min. Negotiated Rate	$50.05
Max. Negotiated Rate	$50.05
Rate for Payer: Cash Price	$57.75
Rate for Payer: Galaxy Health Commercial	$50.05

NM BONE MARROW IMAGING; LIMITED

Facility

$1,225.00

Service Code	HCPCS 78102
Hospital Charge Code	4211253
Hospital Revenue Code	340
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

NM BONE MARROW IMAGING; LIMITED

Facility

$1,225.00

Service Code	HCPCS 78102
Hospital Charge Code	4211253
Hospital Revenue Code	340
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

NM BRAIN W/FLOW <4 VIEWS

Facility

$73.00

Service Code	HCPCS 78601 26
Hospital Charge Code	5210088
Hospital Revenue Code	960
Min. Negotiated Rate	$47.45
Max. Negotiated Rate	$47.45
Rate for Payer: Cash Price	$54.75
Rate for Payer: Galaxy Health Commercial	$47.45

NM BRAIN W/FLOW <4 VIEWS

Facility

$73.00

Service Code	HCPCS 78601 26
Hospital Charge Code	5210088
Hospital Revenue Code	960
Min. Negotiated Rate	$10.95
Max. Negotiated Rate	$58.40
Rate for Payer: Aetna of NY Commercial	$51.10
Rate for Payer: Aetna of NY Medicare	$33.58
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$29.20
Rate for Payer: Cash Price	$54.75
Rate for Payer: CDPHP Medicare	$27.01
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$58.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$58.40
Rate for Payer: EmblemHealth Medicaid	$58.40
Rate for Payer: EmblemHealth Medicare	$24.82
Rate for Payer: Fidelis Medicare	$29.20
Rate for Payer: Galaxy Health Commercial	$47.45
Rate for Payer: Hamaspik Choice Medicare	$29.20
Rate for Payer: Humana Medicare	$29.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$51.10
Rate for Payer: Local 1199SEIU Medicare	$33.58
Rate for Payer: MVP Health Care of NY Commercial	$54.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$41.10
Rate for Payer: MVP Health Care of NY Medicare	$30.66
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$10.95
Rate for Payer: United Healthcare Medicare	$29.20
Rate for Payer: WellCare Medicare	$40.15

NM BRAIN W/FLOW <4 VIEWS

Facility

$1,225.00

Service Code	HCPCS 78601
Hospital Charge Code	4210088
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

NM BRAIN W/FLOW <4 VIEWS

Facility

$1,225.00

Service Code	HCPCS 78601
Hospital Charge Code	4210088
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

NM LUNG PERFUSION DIFFERENTIAL

Facility

$1,225.00

Service Code	HCPCS 78597
Hospital Charge Code	4211256
Hospital Revenue Code	340
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

Know your out-of-pocket cost for care.

All Charges