Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

AMOXICILLIN TRIHYDRATE 500MG CAPS 100 EA

Facility

$6.18

Service Code	NDC 781261301
Hospital Charge Code	4400047
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

AMOXICILLIN TRIHYDRATE 500MG CAPS 100 EA

Facility

$6.18

Service Code	NDC 781261301
Hospital Charge Code	4400047
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

AMOXICILLIN TRIHYDRATE 875MG TABS 100 EA

Facility

$6.18

Service Code	NDC 93226401
Hospital Charge Code	4400048
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

AMOXICILLIN TRIHYDRATE 875MG TABS 100 EA

Facility

$6.18

Service Code	NDC 93226401
Hospital Charge Code	4400048
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

AMPICILLIN SODIUM INJ 500 MG

Facility

$9.27

Service Code	HCPCS J0290
Hospital Charge Code	4400053
Hospital Revenue Code	636
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$6.03
Rate for Payer: Aetna of NY Commercial	$5.10
Rate for Payer: Cash Price	$6.95
Rate for Payer: Cash Price	$6.95
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.64
Rate for Payer: EmblemHealth Select Care	$0.64
Rate for Payer: Galaxy Health Commercial	$6.03
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$5.10
Rate for Payer: WellCare Medicare	$5.10

AMPICILLIN SODIUM INJ 500 MG

Facility

$12.30

Service Code	HCPCS J0290
Hospital Charge Code	4400054
Hospital Revenue Code	636
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$8.00
Rate for Payer: Aetna of NY Commercial	$6.76
Rate for Payer: Cash Price	$9.23
Rate for Payer: Cash Price	$9.23
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.64
Rate for Payer: EmblemHealth Select Care	$0.64
Rate for Payer: Galaxy Health Commercial	$8.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$6.76
Rate for Payer: WellCare Medicare	$6.76

AMPICILLIN SODIUM INJ 500 MG

Facility

$9.27

Service Code	HCPCS J0290
Hospital Charge Code	4400053
Hospital Revenue Code	636
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$7.42
Rate for Payer: Aetna of NY Medicare	$4.26
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$3.71
Rate for Payer: Cash Price	$6.95
Rate for Payer: Cash Price	$6.95
Rate for Payer: CDPHP Medicare	$3.43
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.64
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$7.42
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$7.42
Rate for Payer: EmblemHealth Medicaid	$7.42
Rate for Payer: EmblemHealth Medicare	$3.15
Rate for Payer: EmblemHealth Select Care	$0.64
Rate for Payer: Fidelis Medicare	$3.71
Rate for Payer: Galaxy Health Commercial	$6.03
Rate for Payer: Hamaspik Choice Medicare	$3.71
Rate for Payer: Humana Medicare	$3.71
Rate for Payer: Local 1199SEIU Medicare	$4.26
Rate for Payer: MVP Health Care of NY Commercial	$6.95
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$5.22
Rate for Payer: MVP Health Care of NY Medicare	$3.89
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1.29
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.39
Rate for Payer: United Healthcare Commercial	$1.29
Rate for Payer: United Healthcare Medicare	$3.71
Rate for Payer: WellCare Medicare	$5.10

AMPICILLIN SODIUM INJ 500 MG

Facility

$12.30

Service Code	HCPCS J0290
Hospital Charge Code	4400054
Hospital Revenue Code	636
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$9.84
Rate for Payer: Aetna of NY Medicare	$5.66
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$4.92
Rate for Payer: Cash Price	$9.23
Rate for Payer: Cash Price	$9.23
Rate for Payer: CDPHP Medicare	$4.55
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.64
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$9.84
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$9.84
Rate for Payer: EmblemHealth Medicaid	$9.84
Rate for Payer: EmblemHealth Medicare	$4.18
Rate for Payer: EmblemHealth Select Care	$0.64
Rate for Payer: Fidelis Medicare	$4.92
Rate for Payer: Galaxy Health Commercial	$8.00
Rate for Payer: Hamaspik Choice Medicare	$4.92
Rate for Payer: Humana Medicare	$4.92
Rate for Payer: Local 1199SEIU Medicare	$5.66
Rate for Payer: MVP Health Care of NY Commercial	$9.22
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$6.92
Rate for Payer: MVP Health Care of NY Medicare	$5.17
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1.29
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.84
Rate for Payer: United Healthcare Commercial	$1.29
Rate for Payer: United Healthcare Medicare	$4.92
Rate for Payer: WellCare Medicare	$6.76

AMPICILLIN SODIUM PER 1.5 GM

Facility

$59.23

Service Code	HCPCS J0295
Hospital Charge Code	4400058
Hospital Revenue Code	636
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$38.50
Rate for Payer: Aetna of NY Commercial	$32.58
Rate for Payer: Cash Price	$44.42
Rate for Payer: Cash Price	$44.42
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1.35
Rate for Payer: EmblemHealth Select Care	$1.35
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	$1.35
Max. Negotiated Rate	$8.86
Rate for Payer: Aetna of NY Medicare	$5.09
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$4.43
Rate for Payer: Cash Price	$8.30
Rate for Payer: Cash Price	$8.30
Rate for Payer: CDPHP Medicare	$4.10
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1.35
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$8.86
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$8.86
Rate for Payer: EmblemHealth Medicaid	$8.86
Rate for Payer: EmblemHealth Medicare	$3.76
Rate for Payer: EmblemHealth Select Care	$1.35
Rate for Payer: Fidelis Medicare	$4.43
Rate for Payer: Galaxy Health Commercial	$7.20
Rate for Payer: Hamaspik Choice Medicare	$4.43
Rate for Payer: Humana Medicare	$4.43
Rate for Payer: Local 1199SEIU Medicare	$5.09
Rate for Payer: MVP Health Care of NY Commercial	$8.30
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$6.23
Rate for Payer: MVP Health Care of NY Medicare	$4.65
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$3.12
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.66
Rate for Payer: United Healthcare Commercial	$3.12
Rate for Payer: United Healthcare Medicare	$4.43
Rate for Payer: WellCare Medicare	$6.09

AMPICILLIN SODIUM PER 1.5 GM

Facility

$59.23

Service Code	HCPCS J0295
Hospital Charge Code	4400058
Hospital Revenue Code	636
Min. Negotiated Rate	$1.35
Max. Negotiated Rate	$47.38
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: Cash Price	$44.42
Rate for Payer: CDPHP Medicare	$21.92
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1.35
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	$1.35
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 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: Oxford Health Plans Freedom/Liberty/Metro	$3.12
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$8.88
Rate for Payer: United Healthcare Commercial	$3.12
Rate for Payer: United Healthcare Medicare	$23.69
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	$1.35
Max. Negotiated Rate	$7.20
Rate for Payer: Aetna of NY Commercial	$6.09
Rate for Payer: Cash Price	$8.30
Rate for Payer: Cash Price	$8.30
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1.35
Rate for Payer: EmblemHealth Select Care	$1.35
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

$19.00

Service Code	HCPCS 82150
Hospital Charge Code	4300052
Hospital Revenue Code	301
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$15.20
Rate for Payer: Aetna of NY Commercial	$12.35
Rate for Payer: Aetna of NY Medicare	$8.74
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$7.60
Rate for Payer: Cash Price	$14.25
Rate for Payer: CDPHP Medicare	$7.03
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$11.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$15.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$15.20
Rate for Payer: EmblemHealth Medicaid	$15.20
Rate for Payer: EmblemHealth Medicare	$6.46
Rate for Payer: EmblemHealth Select Care	$11.40
Rate for Payer: Fidelis Medicare	$7.60
Rate for Payer: Galaxy Health Commercial	$12.35
Rate for Payer: Hamaspik Choice Medicare	$7.60
Rate for Payer: Humana Medicare	$7.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$12.35
Rate for Payer: Local 1199SEIU Medicare	$8.74
Rate for Payer: MVP Health Care of NY Commercial	$14.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$10.70
Rate for Payer: MVP Health Care of NY Medicare	$7.98
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$14.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.85
Rate for Payer: United Healthcare Commercial	$14.25
Rate for Payer: United Healthcare Medicare	$7.60
Rate for Payer: WellCare Medicare	$10.45

AMYLASE SERUM

Facility

$19.00

Service Code	HCPCS 82150
Hospital Charge Code	4300052
Hospital Revenue Code	301
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$12.35
Rate for Payer: Cash Price	$14.25
Rate for Payer: Galaxy Health Commercial	$12.35

ANAPLSMA PHGCYTOPHLM AMP PRB

Facility

$106.00

Service Code	HCPCS 87468
Hospital Charge Code	4302031
Hospital Revenue Code	300
Min. Negotiated Rate	$15.90
Max. Negotiated Rate	$84.80
Rate for Payer: Aetna of NY Commercial	$68.90
Rate for Payer: Aetna of NY Medicare	$48.76
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$42.40
Rate for Payer: Cash Price	$79.50
Rate for Payer: CDPHP Medicare	$39.22
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$63.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$84.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$84.80
Rate for Payer: EmblemHealth Medicaid	$84.80
Rate for Payer: EmblemHealth Medicare	$36.04
Rate for Payer: EmblemHealth Select Care	$63.60
Rate for Payer: Fidelis Medicare	$42.40
Rate for Payer: Galaxy Health Commercial	$68.90
Rate for Payer: Hamaspik Choice Medicare	$42.40
Rate for Payer: Humana Medicare	$42.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$68.90
Rate for Payer: Local 1199SEIU Medicare	$48.76
Rate for Payer: MVP Health Care of NY Commercial	$79.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$59.68
Rate for Payer: MVP Health Care of NY Medicare	$44.52
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$79.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$15.90
Rate for Payer: United Healthcare Commercial	$79.50
Rate for Payer: United Healthcare Medicare	$42.40
Rate for Payer: WellCare Medicare	$58.30

ANAPLSMA PHGCYTOPHLM AMP PRB

Facility

$106.00

Service Code	HCPCS 87468
Hospital Charge Code	4302031
Hospital Revenue Code	300
Min. Negotiated Rate	$68.90
Max. Negotiated Rate	$68.90
Rate for Payer: Cash Price	$79.50
Rate for Payer: Galaxy Health Commercial	$68.90

ANASTROZOLE 1MG TABS 3X10EA

Facility

$6.44

Service Code	NDC 60687011221
Hospital Charge Code	4400060
Hospital Revenue Code	250
Min. Negotiated Rate	$0.97
Max. Negotiated Rate	$5.15
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) Medicare	$2.58
Rate for Payer: Cash Price	$4.83
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	$2.58
Rate for Payer: Galaxy Health Commercial	$4.19
Rate for Payer: Hamaspik Choice Medicare	$2.58
Rate for Payer: Humana Medicare	$2.58
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	$2.70
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.97
Rate for Payer: United Healthcare Medicare	$2.58
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

$1,593.41

Service Code	HCPCS C1713
Hospital Charge Code	4473010
Hospital Revenue Code	278
Min. Negotiated Rate	$717.03
Max. Negotiated Rate	$1,115.39
Rate for Payer: Aetna of NY Commercial	$1,115.39
Rate for Payer: Cash Price	$1,195.06
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$796.71
Rate for Payer: EmblemHealth Select Care	$796.71
Rate for Payer: Galaxy Health Commercial	$1,035.72
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,115.39
Rate for Payer: Multiplan Commercial	$717.03
Rate for Payer: MVP Health Care of NY Commercial	$1,035.72
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,035.72
Rate for Payer: WellCare Medicare	$876.38

ANCHOR (ICONIX 2.3MM)

Facility

$1,593.41

Service Code	HCPCS C1713
Hospital Charge Code	4473010
Hospital Revenue Code	278
Min. Negotiated Rate	$239.01
Max. Negotiated Rate	$1,274.73
Rate for Payer: Aetna of NY Commercial	$1,115.39
Rate for Payer: Aetna of NY Medicare	$732.97
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$637.36
Rate for Payer: Cash Price	$1,195.06
Rate for Payer: CDPHP Medicare	$589.56
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$796.71
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,274.73
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,274.73
Rate for Payer: EmblemHealth Medicaid	$1,274.73
Rate for Payer: EmblemHealth Medicare	$541.76
Rate for Payer: EmblemHealth Select Care	$796.71
Rate for Payer: Fidelis Medicare	$637.36
Rate for Payer: Galaxy Health Commercial	$1,035.72
Rate for Payer: Hamaspik Choice Medicare	$637.36
Rate for Payer: Humana Medicare	$637.36
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,115.39
Rate for Payer: Local 1199SEIU Medicare	$732.97
Rate for Payer: MVP Health Care of NY Commercial	$1,035.72
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,035.72
Rate for Payer: MVP Health Care of NY Medicare	$669.23
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$239.01
Rate for Payer: United Healthcare Medicare	$637.36
Rate for Payer: WellCare Medicare	$876.38

ANEST. BREATHING CIRCUIT

Facility

$8.24

Hospital Charge Code	4478195
Hospital Revenue Code	270
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$6.59
Rate for Payer: Aetna of NY Commercial	$5.77
Rate for Payer: Aetna of NY Medicare	$3.79
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$3.30
Rate for Payer: Cash Price	$6.18
Rate for Payer: CDPHP Medicare	$3.05
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$6.59
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$6.59
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$6.59
Rate for Payer: EmblemHealth Medicaid	$6.59
Rate for Payer: EmblemHealth Medicare	$2.80
Rate for Payer: EmblemHealth Select Care	$5.93
Rate for Payer: Fidelis Medicare	$3.30
Rate for Payer: Galaxy Health Commercial	$5.36
Rate for Payer: Hamaspik Choice Medicare	$3.30
Rate for Payer: Humana Medicare	$3.30
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$5.77
Rate for Payer: Local 1199SEIU Medicare	$3.79
Rate for Payer: MVP Health Care of NY Commercial	$6.18
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$4.64
Rate for Payer: MVP Health Care of NY Medicare	$3.46
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.24
Rate for Payer: United Healthcare Medicare	$3.30
Rate for Payer: WellCare Medicare	$4.53

ANEST. BREATHING CIRCUIT

Facility

$8.24

Hospital Charge Code	4478195
Hospital Revenue Code	270
Min. Negotiated Rate	$5.36
Max. Negotiated Rate	$5.36
Rate for Payer: Cash Price	$6.18
Rate for Payer: Galaxy Health Commercial	$5.36

ANESTHESIA 105 MINS

Facility

$379.00

Hospital Charge Code	4120012
Hospital Revenue Code	370
Min. Negotiated Rate	$246.35
Max. Negotiated Rate	$246.35
Rate for Payer: Cash Price	$284.25
Rate for Payer: Galaxy Health Commercial	$246.35

ANESTHESIA 105 MINS

Facility

$379.00

Hospital Charge Code	4120012
Hospital Revenue Code	370
Min. Negotiated Rate	$56.85
Max. Negotiated Rate	$303.20
Rate for Payer: Aetna of NY Commercial	$265.30
Rate for Payer: Aetna of NY Medicare	$174.34
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$151.60
Rate for Payer: Cash Price	$284.25
Rate for Payer: CDPHP Medicare	$140.23
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$303.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$303.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$303.20
Rate for Payer: EmblemHealth Medicaid	$303.20
Rate for Payer: EmblemHealth Medicare	$128.86
Rate for Payer: EmblemHealth Select Care	$272.88
Rate for Payer: Fidelis Medicare	$151.60
Rate for Payer: Galaxy Health Commercial	$246.35
Rate for Payer: Hamaspik Choice Medicare	$151.60
Rate for Payer: Humana Medicare	$151.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$265.30
Rate for Payer: Local 1199SEIU Medicare	$174.34
Rate for Payer: MVP Health Care of NY Commercial	$284.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$213.38
Rate for Payer: MVP Health Care of NY Medicare	$159.18
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$56.85
Rate for Payer: United Healthcare Medicare	$151.60
Rate for Payer: WellCare Medicare	$208.45

ANESTHESIA 120 MIN

Facility

$413.00

Hospital Charge Code	4120006
Hospital Revenue Code	370
Min. Negotiated Rate	$61.95
Max. Negotiated Rate	$330.40
Rate for Payer: Aetna of NY Commercial	$289.10
Rate for Payer: Aetna of NY Medicare	$189.98
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$165.20
Rate for Payer: Cash Price	$309.75
Rate for Payer: CDPHP Medicare	$152.81
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$330.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$330.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$330.40
Rate for Payer: EmblemHealth Medicaid	$330.40
Rate for Payer: EmblemHealth Medicare	$140.42
Rate for Payer: EmblemHealth Select Care	$297.36
Rate for Payer: Fidelis Medicare	$165.20
Rate for Payer: Galaxy Health Commercial	$268.45
Rate for Payer: Hamaspik Choice Medicare	$165.20
Rate for Payer: Humana Medicare	$165.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$289.10
Rate for Payer: Local 1199SEIU Medicare	$189.98
Rate for Payer: MVP Health Care of NY Commercial	$309.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$232.52
Rate for Payer: MVP Health Care of NY Medicare	$173.46
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$61.95
Rate for Payer: United Healthcare Medicare	$165.20
Rate for Payer: WellCare Medicare	$227.15

Know your out-of-pocket cost for care.

All Charges