Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

PRAZOSIN 1 MG CAPSULE 1 mg, 100 eaches

Facility

$6.00

Service Code	NDC 68084099601
Hospital Charge Code	4401567
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

PRAZOSIN 1 MG CAPSULE 1 mg, 100 eaches

Facility

$6.00

Service Code	NDC 68084099601
Hospital Charge Code	4401567
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

PREALBUMIN

Facility

$44.00

Service Code	HCPCS 84134
Hospital Charge Code	4300647
Hospital Revenue Code	301
Min. Negotiated Rate	$28.60
Max. Negotiated Rate	$28.60
Rate for Payer: Cash Price	$33.00
Rate for Payer: Galaxy Health Commercial	$28.60

PREALBUMIN

Facility

$44.00

Service Code	HCPCS 84134
Hospital Charge Code	4300647
Hospital Revenue Code	301
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$35.20
Rate for Payer: Aetna of NY Commercial	$28.60
Rate for Payer: Aetna of NY Medicare	$20.24
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$17.60
Rate for Payer: Cash Price	$33.00
Rate for Payer: CDPHP Medicare	$16.28
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$26.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$35.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$35.20
Rate for Payer: EmblemHealth Medicaid	$35.20
Rate for Payer: EmblemHealth Medicare	$14.96
Rate for Payer: EmblemHealth Select Care	$26.40
Rate for Payer: Fidelis Medicare	$17.60
Rate for Payer: Galaxy Health Commercial	$28.60
Rate for Payer: Hamaspik Choice Medicare	$17.60
Rate for Payer: Humana Medicare	$17.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$28.60
Rate for Payer: Local 1199SEIU Medicare	$20.24
Rate for Payer: MVP Health Care of NY Commercial	$33.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$24.77
Rate for Payer: MVP Health Care of NY Medicare	$18.48
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$33.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$6.60
Rate for Payer: United Healthcare Commercial	$33.00
Rate for Payer: United Healthcare Medicare	$17.60
Rate for Payer: WellCare Medicare	$24.20

PRECISION CHARGING KIT 2.0 SN128768

Facility

$7,260.47

Hospital Charge Code	4472066
Hospital Revenue Code	270
Min. Negotiated Rate	$1,089.07
Max. Negotiated Rate	$5,808.38
Rate for Payer: Aetna of NY Commercial	$5,082.33
Rate for Payer: Aetna of NY Medicare	$3,339.82
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2,904.19
Rate for Payer: Cash Price	$5,445.35
Rate for Payer: CDPHP Medicare	$2,686.37
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$5,808.38
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$5,808.38
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$5,808.38
Rate for Payer: EmblemHealth Medicaid	$5,808.38
Rate for Payer: EmblemHealth Medicare	$2,468.56
Rate for Payer: EmblemHealth Select Care	$5,227.54
Rate for Payer: Fidelis Medicare	$2,904.19
Rate for Payer: Galaxy Health Commercial	$4,719.31
Rate for Payer: Hamaspik Choice Medicare	$2,904.19
Rate for Payer: Humana Medicare	$2,904.19
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$5,082.33
Rate for Payer: Local 1199SEIU Medicare	$3,339.82
Rate for Payer: MVP Health Care of NY Commercial	$5,445.35
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$4,087.64
Rate for Payer: MVP Health Care of NY Medicare	$3,049.40
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,089.07
Rate for Payer: United Healthcare Medicare	$2,904.19
Rate for Payer: WellCare Medicare	$3,993.26

PRECISION CHARGING KIT 2.0 SN128768

Facility

$7,260.47

Hospital Charge Code	4472066
Hospital Revenue Code	270
Min. Negotiated Rate	$4,719.31
Max. Negotiated Rate	$4,719.31
Rate for Payer: Cash Price	$5,445.35
Rate for Payer: Galaxy Health Commercial	$4,719.31

PRECISION CHARGING SYSTEM KIT

Facility

$14,855.69

Hospital Charge Code	4472068
Hospital Revenue Code	270
Min. Negotiated Rate	$2,228.35
Max. Negotiated Rate	$11,884.55
Rate for Payer: Aetna of NY Commercial	$10,398.98
Rate for Payer: Aetna of NY Medicare	$6,833.62
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$5,942.28
Rate for Payer: Cash Price	$11,141.77
Rate for Payer: CDPHP Medicare	$5,496.61
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$11,884.55
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$11,884.55
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$11,884.55
Rate for Payer: EmblemHealth Medicaid	$11,884.55
Rate for Payer: EmblemHealth Medicare	$5,050.93
Rate for Payer: EmblemHealth Select Care	$10,696.10
Rate for Payer: Fidelis Medicare	$5,942.28
Rate for Payer: Galaxy Health Commercial	$9,656.20
Rate for Payer: Hamaspik Choice Medicare	$5,942.28
Rate for Payer: Humana Medicare	$5,942.28
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$10,398.98
Rate for Payer: Local 1199SEIU Medicare	$6,833.62
Rate for Payer: MVP Health Care of NY Commercial	$11,141.77
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$8,363.75
Rate for Payer: MVP Health Care of NY Medicare	$6,239.39
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,228.35
Rate for Payer: United Healthcare Medicare	$5,942.28
Rate for Payer: WellCare Medicare	$8,170.63

PRECISION CHARGING SYSTEM KIT

Facility

$14,855.69

Hospital Charge Code	4472068
Hospital Revenue Code	270
Min. Negotiated Rate	$9,656.20
Max. Negotiated Rate	$9,656.20
Rate for Payer: Cash Price	$11,141.77
Rate for Payer: Galaxy Health Commercial	$9,656.20

PRECISION CHARGING SYSTEM KIT SN128768

Facility

$12,125.16

Hospital Charge Code	4472067
Hospital Revenue Code	270
Min. Negotiated Rate	$1,818.77
Max. Negotiated Rate	$9,700.13
Rate for Payer: Aetna of NY Commercial	$8,487.61
Rate for Payer: Aetna of NY Medicare	$5,577.57
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$4,850.06
Rate for Payer: Cash Price	$9,093.87
Rate for Payer: CDPHP Medicare	$4,486.31
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$9,700.13
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$9,700.13
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$9,700.13
Rate for Payer: EmblemHealth Medicaid	$9,700.13
Rate for Payer: EmblemHealth Medicare	$4,122.55
Rate for Payer: EmblemHealth Select Care	$8,730.12
Rate for Payer: Fidelis Medicare	$4,850.06
Rate for Payer: Galaxy Health Commercial	$7,881.35
Rate for Payer: Hamaspik Choice Medicare	$4,850.06
Rate for Payer: Humana Medicare	$4,850.06
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$8,487.61
Rate for Payer: Local 1199SEIU Medicare	$5,577.57
Rate for Payer: MVP Health Care of NY Commercial	$9,093.87
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$6,826.47
Rate for Payer: MVP Health Care of NY Medicare	$5,092.57
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,818.77
Rate for Payer: United Healthcare Medicare	$4,850.06
Rate for Payer: WellCare Medicare	$6,668.84

PRECISION CHARGING SYSTEM KIT SN128768

Facility

$12,125.16

Hospital Charge Code	4472067
Hospital Revenue Code	270
Min. Negotiated Rate	$7,881.35
Max. Negotiated Rate	$7,881.35
Rate for Payer: Cash Price	$9,093.87
Rate for Payer: Galaxy Health Commercial	$7,881.35

PRECISION IMPLANTABLE PULSE GE

Facility

$104,256.60

Service Code	HCPCS C1820
Hospital Charge Code	4472054
Hospital Revenue Code	278
Min. Negotiated Rate	$15,638.49
Max. Negotiated Rate	$83,405.28
Rate for Payer: Aetna of NY Commercial	$72,979.62
Rate for Payer: Aetna of NY Medicare	$47,958.04
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$41,702.64
Rate for Payer: Cash Price	$78,192.45
Rate for Payer: CDPHP Medicare	$38,574.94
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$52,128.30
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$83,405.28
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$83,405.28
Rate for Payer: EmblemHealth Medicaid	$83,405.28
Rate for Payer: EmblemHealth Medicare	$35,447.24
Rate for Payer: EmblemHealth Select Care	$52,128.30
Rate for Payer: Fidelis Medicare	$41,702.64
Rate for Payer: Galaxy Health Commercial	$67,766.79
Rate for Payer: Hamaspik Choice Medicare	$41,702.64
Rate for Payer: Humana Medicare	$41,702.64
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$72,979.62
Rate for Payer: Local 1199SEIU Medicare	$47,958.04
Rate for Payer: MVP Health Care of NY Commercial	$67,766.79
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$67,766.79
Rate for Payer: MVP Health Care of NY Medicare	$43,787.77
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$15,638.49
Rate for Payer: United Healthcare Medicare	$41,702.64
Rate for Payer: WellCare Medicare	$57,341.13

PRECISION IMPLANTABLE PULSE GE

Facility

$104,256.60

Service Code	HCPCS C1820
Hospital Charge Code	4472054
Hospital Revenue Code	278
Min. Negotiated Rate	$46,915.47
Max. Negotiated Rate	$72,979.62
Rate for Payer: Aetna of NY Commercial	$72,979.62
Rate for Payer: Cash Price	$78,192.45
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$52,128.30
Rate for Payer: EmblemHealth Select Care	$52,128.30
Rate for Payer: Galaxy Health Commercial	$67,766.79
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$72,979.62
Rate for Payer: Multiplan Commercial	$46,915.47
Rate for Payer: MVP Health Care of NY Commercial	$67,766.79
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$67,766.79
Rate for Payer: WellCare Medicare	$57,341.13

PRECISION IMPLANTABLE PULSE GE SN115645

Facility

$114,590.59

Hospital Charge Code	4472053
Hospital Revenue Code	270
Min. Negotiated Rate	$74,483.88
Max. Negotiated Rate	$74,483.88
Rate for Payer: Cash Price	$85,942.94
Rate for Payer: Galaxy Health Commercial	$74,483.88

PRECISION IMPLANTABLE PULSE GE SN115645

Facility

$114,590.59

Hospital Charge Code	4472053
Hospital Revenue Code	270
Min. Negotiated Rate	$17,188.59
Max. Negotiated Rate	$91,672.47
Rate for Payer: Aetna of NY Commercial	$80,213.41
Rate for Payer: Aetna of NY Medicare	$52,711.67
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$45,836.24
Rate for Payer: Cash Price	$85,942.94
Rate for Payer: CDPHP Medicare	$42,398.52
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$91,672.47
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$91,672.47
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$91,672.47
Rate for Payer: EmblemHealth Medicaid	$91,672.47
Rate for Payer: EmblemHealth Medicare	$38,960.80
Rate for Payer: EmblemHealth Select Care	$82,505.22
Rate for Payer: Fidelis Medicare	$45,836.24
Rate for Payer: Galaxy Health Commercial	$74,483.88
Rate for Payer: Hamaspik Choice Medicare	$45,836.24
Rate for Payer: Humana Medicare	$45,836.24
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$80,213.41
Rate for Payer: Local 1199SEIU Medicare	$52,711.67
Rate for Payer: MVP Health Care of NY Commercial	$85,942.94
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$64,514.50
Rate for Payer: MVP Health Care of NY Medicare	$48,128.05
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$17,188.59
Rate for Payer: United Healthcare Medicare	$45,836.24
Rate for Payer: WellCare Medicare	$63,024.82

PREC SPEC REMOTE CONTROL KIT SN201138

Facility

$5,927.65

Hospital Charge Code	4479297
Hospital Revenue Code	278
Min. Negotiated Rate	$889.15
Max. Negotiated Rate	$4,742.12
Rate for Payer: Aetna of NY Commercial	$4,149.35
Rate for Payer: Aetna of NY Medicare	$2,726.72
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2,371.06
Rate for Payer: Cash Price	$4,445.74
Rate for Payer: CDPHP Medicare	$2,193.23
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$2,963.82
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$4,742.12
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$4,742.12
Rate for Payer: EmblemHealth Medicaid	$4,742.12
Rate for Payer: EmblemHealth Medicare	$2,015.40
Rate for Payer: EmblemHealth Select Care	$2,963.82
Rate for Payer: Fidelis Medicare	$2,371.06
Rate for Payer: Galaxy Health Commercial	$3,852.97
Rate for Payer: Hamaspik Choice Medicare	$2,371.06
Rate for Payer: Humana Medicare	$2,371.06
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$4,149.35
Rate for Payer: Local 1199SEIU Medicare	$2,726.72
Rate for Payer: MVP Health Care of NY Commercial	$3,852.97
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$3,852.97
Rate for Payer: MVP Health Care of NY Medicare	$2,489.61
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$889.15
Rate for Payer: United Healthcare Medicare	$2,371.06
Rate for Payer: WellCare Medicare	$3,260.21

PREC SPEC REMOTE CONTROL KIT SN201138

Facility

$5,927.65

Hospital Charge Code	4479297
Hospital Revenue Code	278
Min. Negotiated Rate	$2,667.44
Max. Negotiated Rate	$4,149.35
Rate for Payer: Aetna of NY Commercial	$4,149.35
Rate for Payer: Cash Price	$4,445.74
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$2,963.82
Rate for Payer: EmblemHealth Select Care	$2,963.82
Rate for Payer: Galaxy Health Commercial	$3,852.97
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$4,149.35
Rate for Payer: Multiplan Commercial	$2,667.44
Rate for Payer: MVP Health Care of NY Commercial	$3,852.97
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$3,852.97
Rate for Payer: WellCare Medicare	$3,260.21

PREDNISOLONE ACETATE 0.01 DROP 5 ML

Facility

$170.98

Service Code	NDC 61314063705
Hospital Charge Code	4400645
Hospital Revenue Code	250
Min. Negotiated Rate	$25.65
Max. Negotiated Rate	$136.78
Rate for Payer: Aetna of NY Commercial	$119.69
Rate for Payer: Aetna of NY Medicare	$78.65
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$68.39
Rate for Payer: Cash Price	$128.23
Rate for Payer: CDPHP Medicare	$63.26
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$136.78
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$136.78
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$136.78
Rate for Payer: EmblemHealth Medicaid	$136.78
Rate for Payer: EmblemHealth Medicare	$58.13
Rate for Payer: EmblemHealth Select Care	$123.11
Rate for Payer: Fidelis Medicare	$68.39
Rate for Payer: Galaxy Health Commercial	$111.14
Rate for Payer: Hamaspik Choice Medicare	$68.39
Rate for Payer: Humana Medicare	$68.39
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$119.69
Rate for Payer: Local 1199SEIU Medicare	$78.65
Rate for Payer: MVP Health Care of NY Commercial	$128.24
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$96.26
Rate for Payer: MVP Health Care of NY Medicare	$71.81
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$25.65
Rate for Payer: United Healthcare Medicare	$68.39
Rate for Payer: WellCare Medicare	$94.04

PREDNISOLONE ACETATE 0.01 DROP 5 ML

Facility

$170.98

Service Code	NDC 61314063705
Hospital Charge Code	4400645
Hospital Revenue Code	250
Min. Negotiated Rate	$94.04
Max. Negotiated Rate	$111.14
Rate for Payer: Cash Price	$128.23
Rate for Payer: Galaxy Health Commercial	$111.14
Rate for Payer: WellCare Medicare	$94.04

PREDNISOLONE ORAL PER 5 MG

Facility

$7.47

Service Code	HCPCS J7510
Hospital Charge Code	4400644
Hospital Revenue Code	636
Min. Negotiated Rate	$0.74
Max. Negotiated Rate	$4.86
Rate for Payer: Aetna of NY Commercial	$4.11
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cash Price	$5.60
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.74
Rate for Payer: EmblemHealth Select Care	$0.74
Rate for Payer: Galaxy Health Commercial	$4.86
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$4.11
Rate for Payer: WellCare Medicare	$4.11

PREDNISOLONE ORAL PER 5 MG

Facility

$7.47

Service Code	HCPCS J7510
Hospital Charge Code	4400644
Hospital Revenue Code	636
Min. Negotiated Rate	$0.41
Max. Negotiated Rate	$5.98
Rate for Payer: Aetna of NY Medicare	$3.44
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2.99
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cash Price	$5.60
Rate for Payer: CDPHP Medicare	$2.76
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.74
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$5.98
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$5.98
Rate for Payer: EmblemHealth Medicaid	$5.98
Rate for Payer: EmblemHealth Medicare	$2.54
Rate for Payer: EmblemHealth Select Care	$0.74
Rate for Payer: Fidelis Medicare	$2.99
Rate for Payer: Galaxy Health Commercial	$4.86
Rate for Payer: Hamaspik Choice Medicare	$2.99
Rate for Payer: Humana Medicare	$2.99
Rate for Payer: Local 1199SEIU Medicare	$3.44
Rate for Payer: MVP Health Care of NY Commercial	$5.60
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$4.21
Rate for Payer: MVP Health Care of NY Medicare	$3.14
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$0.41
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.12
Rate for Payer: United Healthcare Commercial	$0.41
Rate for Payer: United Healthcare Medicare	$2.99
Rate for Payer: WellCare Medicare	$4.11

PREDNISONE IR OR DR ORAL 1MG

Facility

$0.03

Service Code	HCPCS J7512
Hospital Charge Code	4400646
Hospital Revenue Code	636
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of NY Commercial	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.00
Rate for Payer: EmblemHealth Select Care	$0.00
Rate for Payer: Galaxy Health Commercial	$0.02
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$0.02
Rate for Payer: WellCare Medicare	$0.02

PREDNISONE IR OR DR ORAL 1MG

Facility

$0.03

Service Code	HCPCS J7512
Hospital Charge Code	4400646
Hospital Revenue Code	636
Max. Negotiated Rate	$0.02
Rate for Payer: Aetna of NY Medicare	$0.01
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$0.01
Rate for Payer: Cash Price	$0.02
Rate for Payer: Cash Price	$0.02
Rate for Payer: CDPHP Medicare	$0.01
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$0.02
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$0.02
Rate for Payer: EmblemHealth Medicaid	$0.02
Rate for Payer: EmblemHealth Medicare	$0.01
Rate for Payer: EmblemHealth Select Care	$0.00
Rate for Payer: Fidelis Medicare	$0.01
Rate for Payer: Galaxy Health Commercial	$0.02
Rate for Payer: Hamaspik Choice Medicare	$0.01
Rate for Payer: Humana Medicare	$0.01
Rate for Payer: Local 1199SEIU Medicare	$0.01
Rate for Payer: MVP Health Care of NY Commercial	$0.02
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$0.02
Rate for Payer: MVP Health Care of NY Medicare	$0.01
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$0.02
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.00
Rate for Payer: United Healthcare Commercial	$0.02
Rate for Payer: United Healthcare Medicare	$0.01
Rate for Payer: WellCare Medicare	$0.02

PREDNISONE IR OR DR ORAL 1MG

Facility

$6.00

Service Code	HCPCS J7512
Hospital Charge Code	4400647
Hospital Revenue Code	636
Max. Negotiated Rate	$3.90
Rate for Payer: Aetna of NY Commercial	$3.30
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cash Price	$4.50
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.00
Rate for Payer: EmblemHealth Select Care	$0.00
Rate for Payer: Galaxy Health Commercial	$3.90
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$3.30
Rate for Payer: WellCare Medicare	$3.30

PREDNISONE IR OR DR ORAL 1MG

Facility

$6.00

Service Code	HCPCS J7512
Hospital Charge Code	4400648
Hospital Revenue Code	636
Max. Negotiated Rate	$4.80
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: Cash Price	$4.50
Rate for Payer: CDPHP Medicare	$2.22
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.00
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	$0.00
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 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: Oxford Health Plans Freedom/Liberty/Metro	$0.02
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.90
Rate for Payer: United Healthcare Commercial	$0.02
Rate for Payer: United Healthcare Medicare	$2.40
Rate for Payer: WellCare Medicare	$3.30

PREDNISONE IR OR DR ORAL 1MG

Facility

$6.00

Service Code	HCPCS J7512
Hospital Charge Code	4400647
Hospital Revenue Code	636
Max. Negotiated Rate	$4.80
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: Cash Price	$4.50
Rate for Payer: CDPHP Medicare	$2.22
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.00
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	$0.00
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 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: Oxford Health Plans Freedom/Liberty/Metro	$0.02
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.90
Rate for Payer: United Healthcare Commercial	$0.02
Rate for Payer: United Healthcare Medicare	$2.40
Rate for Payer: WellCare Medicare	$3.30

Know your out-of-pocket cost for care.

All Charges