Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

AMPICILLIN SODIUM PER 1.5 GM

Facility

$59.23

Service Code	HCPCS J0295
Hospital Charge Code	4400058
Hospital Revenue Code	636
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$38.50
Rate for Payer: Aetna of NY Commercial	$32.58
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$2.12
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$2.12
Rate for Payer: Cash Price	$44.42
Rate for Payer: Cash Price	$44.42
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$2.12
Rate for Payer: EmblemHealth Select Care	$2.12
Rate for Payer: Galaxy Health Commercial	$38.50
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$32.58
Rate for Payer: WellCare Medicare	$32.58

AMPICILLIN SODIUM PER 1.5 GM

Facility

$11.07

Service Code	HCPCS J0295
Hospital Charge Code	4400056
Hospital Revenue Code	636
Min. Negotiated Rate	$2.12
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of NY Commercial	$6.09
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$2.12
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$2.12
Rate for Payer: Cash Price	$8.30
Rate for Payer: Cash Price	$8.30
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$2.12
Rate for Payer: EmblemHealth Select Care	$2.12
Rate for Payer: Galaxy Health Commercial	$7.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$6.09
Rate for Payer: WellCare Medicare	$6.09

AMYLASE SERUM

Facility

$38.00

Service Code	HCPCS 82150
Hospital Charge Code	4300052
Hospital Revenue Code	301
Min. Negotiated Rate	$5.08
Max. Negotiated Rate	$30.59
Rate for Payer: Aetna of NY Commercial	$24.70
Rate for Payer: Aetna of NY Medicare	$17.48
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$28.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$28.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$14.06
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$19.00
Rate for Payer: Cash Price	$28.50
Rate for Payer: Cash Price	$28.50
Rate for Payer: CDPHP Commercial	$30.59
Rate for Payer: CDPHP Medicare	$14.06
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$22.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$30.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$30.40
Rate for Payer: EmblemHealth Medicaid	$30.40
Rate for Payer: EmblemHealth Medicare	$12.92
Rate for Payer: EmblemHealth Select Care	$22.80
Rate for Payer: Fidelis Medicare	$14.48
Rate for Payer: Galaxy Health Commercial	$24.70
Rate for Payer: Hamaspik Choice Medicare	$14.06
Rate for Payer: Humana Medicare	$14.06
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$24.70
Rate for Payer: Local 1199SEIU Medicare	$17.48
Rate for Payer: MVP Health Care of NY Commercial	$28.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$21.39
Rate for Payer: MVP Health Care of NY Medicare	$14.76
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$28.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.08
Rate for Payer: United Healthcare Commercial	$28.50
Rate for Payer: United Healthcare Medicare	$14.06
Rate for Payer: WellCare Medicare	$20.90

AMYLASE SERUM

Facility

$38.00

Service Code	HCPCS 82150
Hospital Charge Code	4300052
Hospital Revenue Code	301
Min. Negotiated Rate	$24.70
Max. Negotiated Rate	$24.70
Rate for Payer: Cash Price	$28.50
Rate for Payer: Galaxy Health Commercial	$24.70

ANASTROZOLE 1MG TABS 3X10EA

Facility

$6.44

Service Code	NDC 60687011221
Hospital Charge Code	4400060
Hospital Revenue Code	250
Min. Negotiated Rate	$2.19
Max. Negotiated Rate	$5.18
Rate for Payer: Aetna of NY Commercial	$4.51
Rate for Payer: Aetna of NY Medicare	$2.96
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$4.83
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$4.83
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2.38
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$3.22
Rate for Payer: Cash Price	$4.83
Rate for Payer: CDPHP Commercial	$5.18
Rate for Payer: CDPHP Medicare	$2.38
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$5.15
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$5.15
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$5.15
Rate for Payer: EmblemHealth Medicaid	$5.15
Rate for Payer: EmblemHealth Medicare	$2.19
Rate for Payer: EmblemHealth Select Care	$4.64
Rate for Payer: Fidelis Medicare	$2.45
Rate for Payer: Galaxy Health Commercial	$4.19
Rate for Payer: Hamaspik Choice Medicare	$2.38
Rate for Payer: Humana Medicare	$2.38
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$4.51
Rate for Payer: Local 1199SEIU Medicare	$2.96
Rate for Payer: MVP Health Care of NY Commercial	$4.83
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$3.63
Rate for Payer: MVP Health Care of NY Medicare	$2.50
Rate for Payer: United Healthcare Medicare	$2.38
Rate for Payer: WellCare Medicare	$3.54

ANASTROZOLE 1MG TABS 3X10EA

Facility

$6.44

Service Code	NDC 60687011221
Hospital Charge Code	4400060
Hospital Revenue Code	250
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$4.19
Rate for Payer: Cash Price	$4.83
Rate for Payer: Galaxy Health Commercial	$4.19
Rate for Payer: WellCare Medicare	$3.54

ANCHOR (ICONIX 2.3MM)

Facility

$1,547.00

Service Code	HCPCS C1713
Hospital Charge Code	4473010
Hospital Revenue Code	278
Min. Negotiated Rate	$696.15
Max. Negotiated Rate	$1,082.90
Rate for Payer: Aetna of NY Commercial	$1,082.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$696.15
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$696.15
Rate for Payer: Cash Price	$1,160.25
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$773.50
Rate for Payer: EmblemHealth Select Care	$773.50
Rate for Payer: Galaxy Health Commercial	$1,005.55
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,082.90
Rate for Payer: Multiplan Commercial	$696.15
Rate for Payer: MVP Health Care of NY Commercial	$1,005.55
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,005.55
Rate for Payer: WellCare Medicare	$850.85

ANCHOR (ICONIX 2.3MM)

Facility

$1,547.00

Service Code	HCPCS C1713
Hospital Charge Code	4473010
Hospital Revenue Code	278
Min. Negotiated Rate	$525.98
Max. Negotiated Rate	$1,245.34
Rate for Payer: Aetna of NY Commercial	$1,082.90
Rate for Payer: Aetna of NY Medicare	$711.62
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$696.15
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$696.15
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$572.39
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$773.50
Rate for Payer: Cash Price	$1,160.25
Rate for Payer: CDPHP Commercial	$1,245.34
Rate for Payer: CDPHP Medicare	$572.39
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$773.50
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,237.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,237.60
Rate for Payer: EmblemHealth Medicaid	$1,237.60
Rate for Payer: EmblemHealth Medicare	$525.98
Rate for Payer: EmblemHealth Select Care	$773.50
Rate for Payer: Fidelis Medicare	$589.56
Rate for Payer: Galaxy Health Commercial	$1,005.55
Rate for Payer: Hamaspik Choice Medicare	$572.39
Rate for Payer: Humana Medicare	$572.39
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,082.90
Rate for Payer: Local 1199SEIU Medicare	$711.62
Rate for Payer: MVP Health Care of NY Commercial	$1,005.55
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,005.55
Rate for Payer: MVP Health Care of NY Medicare	$601.01
Rate for Payer: United Healthcare Medicare	$572.39
Rate for Payer: WellCare Medicare	$850.85

ANEST. BREATHING CIRCUIT

Facility

$8.00

Hospital Charge Code	4478195
Hospital Revenue Code	270
Min. Negotiated Rate	$2.72
Max. Negotiated Rate	$6.44
Rate for Payer: Aetna of NY Commercial	$5.60
Rate for Payer: Aetna of NY Medicare	$3.68
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$6.00
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$6.00
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2.96
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$4.00
Rate for Payer: Cash Price	$6.00
Rate for Payer: CDPHP Commercial	$6.44
Rate for Payer: CDPHP Medicare	$2.96
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$6.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$6.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$6.40
Rate for Payer: EmblemHealth Medicaid	$6.40
Rate for Payer: EmblemHealth Medicare	$2.72
Rate for Payer: EmblemHealth Select Care	$5.76
Rate for Payer: Fidelis Medicare	$3.05
Rate for Payer: Galaxy Health Commercial	$5.20
Rate for Payer: Hamaspik Choice Medicare	$2.96
Rate for Payer: Humana Medicare	$2.96
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$5.60
Rate for Payer: Local 1199SEIU Medicare	$3.68
Rate for Payer: MVP Health Care of NY Commercial	$6.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$4.50
Rate for Payer: MVP Health Care of NY Medicare	$3.11
Rate for Payer: United Healthcare Medicare	$2.96
Rate for Payer: WellCare Medicare	$4.40

ANEST. BREATHING CIRCUIT

Facility

$8.00

Hospital Charge Code	4478195
Hospital Revenue Code	270
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$5.20
Rate for Payer: Cash Price	$6.00
Rate for Payer: Galaxy Health Commercial	$5.20

ANESTHESIA 105 MINS

Facility

$354.00

Hospital Charge Code	4120012
Hospital Revenue Code	370
Min. Negotiated Rate	$230.10
Max. Negotiated Rate	$230.10
Rate for Payer: Cash Price	$265.50
Rate for Payer: Galaxy Health Commercial	$230.10

ANESTHESIA 105 MINS

Facility

$354.00

Hospital Charge Code	4120012
Hospital Revenue Code	370
Min. Negotiated Rate	$120.36
Max. Negotiated Rate	$284.97
Rate for Payer: Aetna of NY Commercial	$247.80
Rate for Payer: Aetna of NY Medicare	$162.84
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$265.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$265.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$130.98
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$177.00
Rate for Payer: Cash Price	$265.50
Rate for Payer: CDPHP Commercial	$284.97
Rate for Payer: CDPHP Medicare	$130.98
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$283.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$283.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$283.20
Rate for Payer: EmblemHealth Medicaid	$283.20
Rate for Payer: EmblemHealth Medicare	$120.36
Rate for Payer: EmblemHealth Select Care	$254.88
Rate for Payer: Fidelis Medicare	$134.91
Rate for Payer: Galaxy Health Commercial	$230.10
Rate for Payer: Hamaspik Choice Medicare	$130.98
Rate for Payer: Humana Medicare	$130.98
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$247.80
Rate for Payer: Local 1199SEIU Medicare	$162.84
Rate for Payer: MVP Health Care of NY Commercial	$265.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$199.30
Rate for Payer: MVP Health Care of NY Medicare	$137.53
Rate for Payer: United Healthcare Medicare	$130.98
Rate for Payer: WellCare Medicare	$194.70

ANESTHESIA 120 MIN

Facility

$386.00

Hospital Charge Code	4120006
Hospital Revenue Code	370
Min. Negotiated Rate	$250.90
Max. Negotiated Rate	$250.90
Rate for Payer: Cash Price	$289.50
Rate for Payer: Galaxy Health Commercial	$250.90

ANESTHESIA 120 MIN

Facility

$386.00

Hospital Charge Code	4120006
Hospital Revenue Code	370
Min. Negotiated Rate	$131.24
Max. Negotiated Rate	$310.73
Rate for Payer: Aetna of NY Commercial	$270.20
Rate for Payer: Aetna of NY Medicare	$177.56
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$289.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$289.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$142.82
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$193.00
Rate for Payer: Cash Price	$289.50
Rate for Payer: CDPHP Commercial	$310.73
Rate for Payer: CDPHP Medicare	$142.82
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$308.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$308.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$308.80
Rate for Payer: EmblemHealth Medicaid	$308.80
Rate for Payer: EmblemHealth Medicare	$131.24
Rate for Payer: EmblemHealth Select Care	$277.92
Rate for Payer: Fidelis Medicare	$147.10
Rate for Payer: Galaxy Health Commercial	$250.90
Rate for Payer: Hamaspik Choice Medicare	$142.82
Rate for Payer: Humana Medicare	$142.82
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$270.20
Rate for Payer: Local 1199SEIU Medicare	$177.56
Rate for Payer: MVP Health Care of NY Commercial	$289.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$217.32
Rate for Payer: MVP Health Care of NY Medicare	$149.96
Rate for Payer: United Healthcare Medicare	$142.82
Rate for Payer: WellCare Medicare	$212.30

ANESTHESIA 135 MINS

Facility

$418.00

Hospital Charge Code	4120013
Hospital Revenue Code	370
Min. Negotiated Rate	$271.70
Max. Negotiated Rate	$271.70
Rate for Payer: Cash Price	$313.50
Rate for Payer: Galaxy Health Commercial	$271.70

ANESTHESIA 135 MINS

Facility

$418.00

Hospital Charge Code	4120013
Hospital Revenue Code	370
Min. Negotiated Rate	$142.12
Max. Negotiated Rate	$336.49
Rate for Payer: Aetna of NY Commercial	$292.60
Rate for Payer: Aetna of NY Medicare	$192.28
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$313.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$313.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$154.66
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$209.00
Rate for Payer: Cash Price	$313.50
Rate for Payer: CDPHP Commercial	$336.49
Rate for Payer: CDPHP Medicare	$154.66
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$334.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$334.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$334.40
Rate for Payer: EmblemHealth Medicaid	$334.40
Rate for Payer: EmblemHealth Medicare	$142.12
Rate for Payer: EmblemHealth Select Care	$300.96
Rate for Payer: Fidelis Medicare	$159.30
Rate for Payer: Galaxy Health Commercial	$271.70
Rate for Payer: Hamaspik Choice Medicare	$154.66
Rate for Payer: Humana Medicare	$154.66
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$292.60
Rate for Payer: Local 1199SEIU Medicare	$192.28
Rate for Payer: MVP Health Care of NY Commercial	$313.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$235.33
Rate for Payer: MVP Health Care of NY Medicare	$162.39
Rate for Payer: United Healthcare Medicare	$154.66
Rate for Payer: WellCare Medicare	$229.90

ANESTHESIA 150 MIN

Facility

$451.00

Hospital Charge Code	4120007
Hospital Revenue Code	370
Min. Negotiated Rate	$153.34
Max. Negotiated Rate	$363.06
Rate for Payer: Aetna of NY Commercial	$315.70
Rate for Payer: Aetna of NY Medicare	$207.46
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$338.25
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$338.25
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$166.87
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$225.50
Rate for Payer: Cash Price	$338.25
Rate for Payer: CDPHP Commercial	$363.06
Rate for Payer: CDPHP Medicare	$166.87
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$360.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$360.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$360.80
Rate for Payer: EmblemHealth Medicaid	$360.80
Rate for Payer: EmblemHealth Medicare	$153.34
Rate for Payer: EmblemHealth Select Care	$324.72
Rate for Payer: Fidelis Medicare	$171.88
Rate for Payer: Galaxy Health Commercial	$293.15
Rate for Payer: Hamaspik Choice Medicare	$166.87
Rate for Payer: Humana Medicare	$166.87
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$315.70
Rate for Payer: Local 1199SEIU Medicare	$207.46
Rate for Payer: MVP Health Care of NY Commercial	$338.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$253.91
Rate for Payer: MVP Health Care of NY Medicare	$175.21
Rate for Payer: United Healthcare Medicare	$166.87
Rate for Payer: WellCare Medicare	$248.05

ANESTHESIA 150 MIN

Facility

$451.00

Hospital Charge Code	4120007
Hospital Revenue Code	370
Min. Negotiated Rate	$293.15
Max. Negotiated Rate	$293.15
Rate for Payer: Cash Price	$338.25
Rate for Payer: Galaxy Health Commercial	$293.15

ANESTHESIA 15 MINS

Facility

$82.00

Hospital Charge Code	4120002
Hospital Revenue Code	370
Min. Negotiated Rate	$27.88
Max. Negotiated Rate	$66.01
Rate for Payer: Aetna of NY Commercial	$57.40
Rate for Payer: Aetna of NY Medicare	$37.72
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$61.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$61.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$30.34
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$41.00
Rate for Payer: Cash Price	$61.50
Rate for Payer: CDPHP Commercial	$66.01
Rate for Payer: CDPHP Medicare	$30.34
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$65.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$65.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$65.60
Rate for Payer: EmblemHealth Medicaid	$65.60
Rate for Payer: EmblemHealth Medicare	$27.88
Rate for Payer: EmblemHealth Select Care	$59.04
Rate for Payer: Fidelis Medicare	$31.25
Rate for Payer: Galaxy Health Commercial	$53.30
Rate for Payer: Hamaspik Choice Medicare	$30.34
Rate for Payer: Humana Medicare	$30.34
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$57.40
Rate for Payer: Local 1199SEIU Medicare	$37.72
Rate for Payer: MVP Health Care of NY Commercial	$61.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$46.17
Rate for Payer: MVP Health Care of NY Medicare	$31.86
Rate for Payer: United Healthcare Medicare	$30.34
Rate for Payer: WellCare Medicare	$45.10

ANESTHESIA 15 MINS

Facility

$82.00

Hospital Charge Code	4120002
Hospital Revenue Code	370
Min. Negotiated Rate	$53.30
Max. Negotiated Rate	$53.30
Rate for Payer: Cash Price	$61.50
Rate for Payer: Galaxy Health Commercial	$53.30

ANESTHESIA 165 MINS

Facility

$484.00

Hospital Charge Code	4120014
Hospital Revenue Code	370
Min. Negotiated Rate	$164.56
Max. Negotiated Rate	$389.62
Rate for Payer: Aetna of NY Commercial	$338.80
Rate for Payer: Aetna of NY Medicare	$222.64
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$363.00
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$363.00
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$179.08
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$242.00
Rate for Payer: Cash Price	$363.00
Rate for Payer: CDPHP Commercial	$389.62
Rate for Payer: CDPHP Medicare	$179.08
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$387.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$387.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$387.20
Rate for Payer: EmblemHealth Medicaid	$387.20
Rate for Payer: EmblemHealth Medicare	$164.56
Rate for Payer: EmblemHealth Select Care	$348.48
Rate for Payer: Fidelis Medicare	$184.45
Rate for Payer: Galaxy Health Commercial	$314.60
Rate for Payer: Hamaspik Choice Medicare	$179.08
Rate for Payer: Humana Medicare	$179.08
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$338.80
Rate for Payer: Local 1199SEIU Medicare	$222.64
Rate for Payer: MVP Health Care of NY Commercial	$363.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$272.49
Rate for Payer: MVP Health Care of NY Medicare	$188.03
Rate for Payer: United Healthcare Medicare	$179.08
Rate for Payer: WellCare Medicare	$266.20

ANESTHESIA 165 MINS

Facility

$484.00

Hospital Charge Code	4120014
Hospital Revenue Code	370
Min. Negotiated Rate	$314.60
Max. Negotiated Rate	$314.60
Rate for Payer: Cash Price	$363.00
Rate for Payer: Galaxy Health Commercial	$314.60

ANESTHESIA 180 MIN

Facility

$517.00

Hospital Charge Code	4120008
Hospital Revenue Code	370
Min. Negotiated Rate	$175.78
Max. Negotiated Rate	$416.18
Rate for Payer: Aetna of NY Commercial	$361.90
Rate for Payer: Aetna of NY Medicare	$237.82
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$387.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$387.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$191.29
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$258.50
Rate for Payer: Cash Price	$387.75
Rate for Payer: CDPHP Commercial	$416.18
Rate for Payer: CDPHP Medicare	$191.29
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$413.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$413.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$413.60
Rate for Payer: EmblemHealth Medicaid	$413.60
Rate for Payer: EmblemHealth Medicare	$175.78
Rate for Payer: EmblemHealth Select Care	$372.24
Rate for Payer: Fidelis Medicare	$197.03
Rate for Payer: Galaxy Health Commercial	$336.05
Rate for Payer: Hamaspik Choice Medicare	$191.29
Rate for Payer: Humana Medicare	$191.29
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$361.90
Rate for Payer: Local 1199SEIU Medicare	$237.82
Rate for Payer: MVP Health Care of NY Commercial	$387.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$291.07
Rate for Payer: MVP Health Care of NY Medicare	$200.85
Rate for Payer: United Healthcare Medicare	$191.29
Rate for Payer: WellCare Medicare	$284.35

ANESTHESIA 180 MIN

Facility

$517.00

Hospital Charge Code	4120008
Hospital Revenue Code	370
Min. Negotiated Rate	$336.05
Max. Negotiated Rate	$336.05
Rate for Payer: Cash Price	$387.75
Rate for Payer: Galaxy Health Commercial	$336.05

ANESTHESIA 195 MINS

Facility

$549.00

Hospital Charge Code	4120015
Hospital Revenue Code	370
Min. Negotiated Rate	$356.85
Max. Negotiated Rate	$356.85
Rate for Payer: Cash Price	$411.75
Rate for Payer: Galaxy Health Commercial	$356.85

Know your out-of-pocket cost for care.

All Charges