Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

RALOXIFENE HCL 60MG TABS 30 EA

Facility

$24.46

Service Code	NDC 60687026621
Hospital Charge Code	4400282
Hospital Revenue Code	250
Min. Negotiated Rate	$3.67
Max. Negotiated Rate	$19.57
Rate for Payer: Aetna of NY Commercial	$17.12
Rate for Payer: Aetna of NY Medicare	$11.25
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$9.78
Rate for Payer: Cash Price	$18.34
Rate for Payer: CDPHP Medicare	$9.05
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$19.57
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$19.57
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$19.57
Rate for Payer: EmblemHealth Medicaid	$19.57
Rate for Payer: EmblemHealth Medicare	$8.32
Rate for Payer: EmblemHealth Select Care	$17.61
Rate for Payer: Fidelis Medicare	$9.78
Rate for Payer: Galaxy Health Commercial	$15.90
Rate for Payer: Hamaspik Choice Medicare	$9.78
Rate for Payer: Humana Medicare	$9.78
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$17.12
Rate for Payer: Local 1199SEIU Medicare	$11.25
Rate for Payer: MVP Health Care of NY Commercial	$18.34
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$13.77
Rate for Payer: MVP Health Care of NY Medicare	$10.27
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3.67
Rate for Payer: United Healthcare Medicare	$9.78
Rate for Payer: WellCare Medicare	$13.45

RANOLAZINE 500MG TABS 60 EA

Facility

$20.60

Service Code	NDC 61958100301
Hospital Charge Code	4400676
Hospital Revenue Code	250
Min. Negotiated Rate	$3.09
Max. Negotiated Rate	$16.48
Rate for Payer: Aetna of NY Commercial	$14.42
Rate for Payer: Aetna of NY Medicare	$9.48
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$8.24
Rate for Payer: Cash Price	$15.45
Rate for Payer: CDPHP Medicare	$7.62
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$16.48
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$16.48
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$16.48
Rate for Payer: EmblemHealth Medicaid	$16.48
Rate for Payer: EmblemHealth Medicare	$7.00
Rate for Payer: EmblemHealth Select Care	$14.83
Rate for Payer: Fidelis Medicare	$8.24
Rate for Payer: Galaxy Health Commercial	$13.39
Rate for Payer: Hamaspik Choice Medicare	$8.24
Rate for Payer: Humana Medicare	$8.24
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$14.42
Rate for Payer: Local 1199SEIU Medicare	$9.48
Rate for Payer: MVP Health Care of NY Commercial	$15.45
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$11.60
Rate for Payer: MVP Health Care of NY Medicare	$8.65
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3.09
Rate for Payer: United Healthcare Medicare	$8.24
Rate for Payer: WellCare Medicare	$11.33

RANOLAZINE 500MG TABS 60 EA

Facility

$20.60

Service Code	NDC 61958100301
Hospital Charge Code	4400676
Hospital Revenue Code	250
Min. Negotiated Rate	$11.33
Max. Negotiated Rate	$13.39
Rate for Payer: Cash Price	$15.45
Rate for Payer: Galaxy Health Commercial	$13.39
Rate for Payer: WellCare Medicare	$11.33

RANOLAZINE ER 500 MG TABLET 500 mg, 60 eaches

Facility

$6.00

Service Code	NDC 68462031960
Hospital Charge Code	4401475
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

RANOLAZINE ER 500 MG TABLET 500 mg, 60 eaches

Facility

$6.00

Service Code	NDC 68462031960
Hospital Charge Code	4401475
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

RAPID FIRE LIGATOR

Facility

$272.95

Hospital Charge Code	4471003
Hospital Revenue Code	270
Min. Negotiated Rate	$177.42
Max. Negotiated Rate	$177.42
Rate for Payer: Cash Price	$204.71
Rate for Payer: Galaxy Health Commercial	$177.42

RAPID FIRE LIGATOR

Facility

$272.95

Hospital Charge Code	4471003
Hospital Revenue Code	270
Min. Negotiated Rate	$40.94
Max. Negotiated Rate	$218.36
Rate for Payer: Aetna of NY Commercial	$191.06
Rate for Payer: Aetna of NY Medicare	$125.56
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$109.18
Rate for Payer: Cash Price	$204.71
Rate for Payer: CDPHP Medicare	$100.99
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$218.36
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$218.36
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$218.36
Rate for Payer: EmblemHealth Medicaid	$218.36
Rate for Payer: EmblemHealth Medicare	$92.80
Rate for Payer: EmblemHealth Select Care	$196.52
Rate for Payer: Fidelis Medicare	$109.18
Rate for Payer: Galaxy Health Commercial	$177.42
Rate for Payer: Hamaspik Choice Medicare	$109.18
Rate for Payer: Humana Medicare	$109.18
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$191.06
Rate for Payer: Local 1199SEIU Medicare	$125.56
Rate for Payer: MVP Health Care of NY Commercial	$204.71
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$153.67
Rate for Payer: MVP Health Care of NY Medicare	$114.64
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$40.94
Rate for Payer: United Healthcare Medicare	$109.18
Rate for Payer: WellCare Medicare	$150.12

RASAGILINE MESYLATE 1 MG TAB 1 mg, 30 eaches

Facility

$75.00

Service Code	NDC 67877026030
Hospital Charge Code	4401568
Hospital Revenue Code	250
Min. Negotiated Rate	$41.25
Max. Negotiated Rate	$48.75
Rate for Payer: Cash Price	$56.25
Rate for Payer: Galaxy Health Commercial	$48.75
Rate for Payer: WellCare Medicare	$41.25

RASAGILINE MESYLATE 1 MG TAB 1 mg, 30 eaches

Facility

$75.00

Service Code	NDC 67877026030
Hospital Charge Code	4401568
Hospital Revenue Code	250
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna of NY Commercial	$52.50
Rate for Payer: Aetna of NY Medicare	$34.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$30.00
Rate for Payer: Cash Price	$56.25
Rate for Payer: CDPHP Medicare	$27.75
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$60.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$60.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$60.00
Rate for Payer: EmblemHealth Medicaid	$60.00
Rate for Payer: EmblemHealth Medicare	$25.50
Rate for Payer: EmblemHealth Select Care	$54.00
Rate for Payer: Fidelis Medicare	$30.00
Rate for Payer: Galaxy Health Commercial	$48.75
Rate for Payer: Hamaspik Choice Medicare	$30.00
Rate for Payer: Humana Medicare	$30.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$52.50
Rate for Payer: Local 1199SEIU Medicare	$34.50
Rate for Payer: MVP Health Care of NY Commercial	$56.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$42.23
Rate for Payer: MVP Health Care of NY Medicare	$31.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$11.25
Rate for Payer: United Healthcare Medicare	$30.00
Rate for Payer: WellCare Medicare	$41.25

RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS

Facility

$10,804.00

Service Code	HCPCS 54600
Hospital Charge Code	4002052
Hospital Revenue Code	490
Min. Negotiated Rate	$1,620.60
Max. Negotiated Rate	$8,643.20
Rate for Payer: Aetna of NY Commercial	$1,900.00
Rate for Payer: Aetna of NY Medicare	$4,969.84
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$4,321.60
Rate for Payer: Cash Price	$8,103.00
Rate for Payer: Cash Price	$8,103.00
Rate for Payer: CDPHP Medicare	$3,997.48
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$8,643.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$8,643.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$8,643.20
Rate for Payer: EmblemHealth Medicaid	$8,643.20
Rate for Payer: EmblemHealth Medicare	$3,673.36
Rate for Payer: EmblemHealth Select Care	$7,778.88
Rate for Payer: Fidelis Medicare	$4,321.60
Rate for Payer: Galaxy Health Commercial	$7,022.60
Rate for Payer: Hamaspik Choice Medicare	$4,321.60
Rate for Payer: Humana Medicare	$4,321.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,900.00
Rate for Payer: Local 1199SEIU Medicare	$4,969.84
Rate for Payer: Multiplan Commercial	$8,643.20
Rate for Payer: MVP Health Care of NY Commercial	$8,103.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$6,082.65
Rate for Payer: MVP Health Care of NY Medicare	$4,537.68
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$2,097.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,620.60
Rate for Payer: United Healthcare Commercial	$2,097.00
Rate for Payer: United Healthcare Medicare	$4,321.60
Rate for Payer: WellCare Medicare	$5,942.20

RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS

Facility

$10,804.00

Service Code	HCPCS 54600
Hospital Charge Code	4002052
Hospital Revenue Code	490
Min. Negotiated Rate	$7,022.60
Max. Negotiated Rate	$7,022.60
Rate for Payer: Cash Price	$8,103.00
Rate for Payer: Galaxy Health Commercial	$7,022.60

RECOVER ROOM LEVEL3 10+ HOURS

Facility

$2,738.00

Hospital Charge Code	4000216
Hospital Revenue Code	710
Min. Negotiated Rate	$1,779.70
Max. Negotiated Rate	$1,779.70
Rate for Payer: Cash Price	$2,053.50
Rate for Payer: Galaxy Health Commercial	$1,779.70

RECOVER ROOM LEVEL3 10+ HOURS

Facility

$2,738.00

Hospital Charge Code	4000216
Hospital Revenue Code	710
Min. Negotiated Rate	$410.70
Max. Negotiated Rate	$2,190.40
Rate for Payer: Aetna of NY Commercial	$1,916.60
Rate for Payer: Aetna of NY Medicare	$1,259.48
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,095.20
Rate for Payer: Cash Price	$2,053.50
Rate for Payer: CDPHP Medicare	$1,013.06
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,190.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,190.40
Rate for Payer: EmblemHealth Medicaid	$2,190.40
Rate for Payer: EmblemHealth Medicare	$930.92
Rate for Payer: Fidelis Medicare	$1,095.20
Rate for Payer: Galaxy Health Commercial	$1,779.70
Rate for Payer: Hamaspik Choice Medicare	$1,095.20
Rate for Payer: Humana Medicare	$1,095.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,916.60
Rate for Payer: Local 1199SEIU Medicare	$1,259.48
Rate for Payer: MVP Health Care of NY Commercial	$2,053.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,541.49
Rate for Payer: MVP Health Care of NY Medicare	$1,149.96
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$410.70
Rate for Payer: United Healthcare Medicare	$1,095.20
Rate for Payer: WellCare Medicare	$1,505.90

RECOVERY ROOM - 121-150 MINS

Facility

$1,094.00

Hospital Charge Code	4007614
Hospital Revenue Code	710
Min. Negotiated Rate	$711.10
Max. Negotiated Rate	$711.10
Rate for Payer: Cash Price	$820.50
Rate for Payer: Galaxy Health Commercial	$711.10

RECOVERY ROOM - 121-150 MINS

Facility

$1,094.00

Hospital Charge Code	4007614
Hospital Revenue Code	710
Min. Negotiated Rate	$164.10
Max. Negotiated Rate	$875.20
Rate for Payer: Aetna of NY Commercial	$765.80
Rate for Payer: Aetna of NY Medicare	$503.24
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$437.60
Rate for Payer: Cash Price	$820.50
Rate for Payer: CDPHP Medicare	$404.78
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$875.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$875.20
Rate for Payer: EmblemHealth Medicaid	$875.20
Rate for Payer: EmblemHealth Medicare	$371.96
Rate for Payer: Fidelis Medicare	$437.60
Rate for Payer: Galaxy Health Commercial	$711.10
Rate for Payer: Hamaspik Choice Medicare	$437.60
Rate for Payer: Humana Medicare	$437.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$765.80
Rate for Payer: Local 1199SEIU Medicare	$503.24
Rate for Payer: MVP Health Care of NY Commercial	$820.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$615.92
Rate for Payer: MVP Health Care of NY Medicare	$459.48
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$164.10
Rate for Payer: United Healthcare Medicare	$437.60
Rate for Payer: WellCare Medicare	$601.70

RECOVERY ROOM - 151-180 MINS

Facility

$1,287.00

Hospital Charge Code	4007615
Hospital Revenue Code	710
Min. Negotiated Rate	$193.05
Max. Negotiated Rate	$1,029.60
Rate for Payer: Aetna of NY Commercial	$900.90
Rate for Payer: Aetna of NY Medicare	$592.02
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$514.80
Rate for Payer: Cash Price	$965.25
Rate for Payer: CDPHP Medicare	$476.19
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,029.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,029.60
Rate for Payer: EmblemHealth Medicaid	$1,029.60
Rate for Payer: EmblemHealth Medicare	$437.58
Rate for Payer: Fidelis Medicare	$514.80
Rate for Payer: Galaxy Health Commercial	$836.55
Rate for Payer: Hamaspik Choice Medicare	$514.80
Rate for Payer: Humana Medicare	$514.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$900.90
Rate for Payer: Local 1199SEIU Medicare	$592.02
Rate for Payer: MVP Health Care of NY Commercial	$965.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$724.58
Rate for Payer: MVP Health Care of NY Medicare	$540.54
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$193.05
Rate for Payer: United Healthcare Medicare	$514.80
Rate for Payer: WellCare Medicare	$707.85

RECOVERY ROOM - 151-180 MINS

Facility

$1,287.00

Hospital Charge Code	4007615
Hospital Revenue Code	710
Min. Negotiated Rate	$836.55
Max. Negotiated Rate	$836.55
Rate for Payer: Cash Price	$965.25
Rate for Payer: Galaxy Health Commercial	$836.55

RECOVERY ROOM - 31-60 MINS

Facility

$521.00

Hospital Charge Code	4007611
Hospital Revenue Code	710
Min. Negotiated Rate	$78.15
Max. Negotiated Rate	$416.80
Rate for Payer: Aetna of NY Commercial	$364.70
Rate for Payer: Aetna of NY Medicare	$239.66
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$208.40
Rate for Payer: Cash Price	$390.75
Rate for Payer: CDPHP Medicare	$192.77
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$416.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$416.80
Rate for Payer: EmblemHealth Medicaid	$416.80
Rate for Payer: EmblemHealth Medicare	$177.14
Rate for Payer: Fidelis Medicare	$208.40
Rate for Payer: Galaxy Health Commercial	$338.65
Rate for Payer: Hamaspik Choice Medicare	$208.40
Rate for Payer: Humana Medicare	$208.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$364.70
Rate for Payer: Local 1199SEIU Medicare	$239.66
Rate for Payer: MVP Health Care of NY Commercial	$390.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$293.32
Rate for Payer: MVP Health Care of NY Medicare	$218.82
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$78.15
Rate for Payer: United Healthcare Medicare	$208.40
Rate for Payer: WellCare Medicare	$286.55

RECOVERY ROOM - 31-60 MINS

Facility

$521.00

Hospital Charge Code	4007611
Hospital Revenue Code	710
Min. Negotiated Rate	$338.65
Max. Negotiated Rate	$338.65
Rate for Payer: Cash Price	$390.75
Rate for Payer: Galaxy Health Commercial	$338.65

RECOVERY ROOM - 61-90 MINS

Facility

$709.00

Hospital Charge Code	4007612
Hospital Revenue Code	710
Min. Negotiated Rate	$106.35
Max. Negotiated Rate	$567.20
Rate for Payer: Aetna of NY Commercial	$496.30
Rate for Payer: Aetna of NY Medicare	$326.14
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$283.60
Rate for Payer: Cash Price	$531.75
Rate for Payer: CDPHP Medicare	$262.33
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$567.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$567.20
Rate for Payer: EmblemHealth Medicaid	$567.20
Rate for Payer: EmblemHealth Medicare	$241.06
Rate for Payer: Fidelis Medicare	$283.60
Rate for Payer: Galaxy Health Commercial	$460.85
Rate for Payer: Hamaspik Choice Medicare	$283.60
Rate for Payer: Humana Medicare	$283.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$496.30
Rate for Payer: Local 1199SEIU Medicare	$326.14
Rate for Payer: MVP Health Care of NY Commercial	$531.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$399.17
Rate for Payer: MVP Health Care of NY Medicare	$297.78
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$106.35
Rate for Payer: United Healthcare Medicare	$283.60
Rate for Payer: WellCare Medicare	$389.95

RECOVERY ROOM - 61-90 MINS

Facility

$709.00

Hospital Charge Code	4007612
Hospital Revenue Code	710
Min. Negotiated Rate	$460.85
Max. Negotiated Rate	$460.85
Rate for Payer: Cash Price	$531.75
Rate for Payer: Galaxy Health Commercial	$460.85

RECOVERY ROOM - 91-120 MINS

Facility

$902.00

Hospital Charge Code	4007613
Hospital Revenue Code	710
Min. Negotiated Rate	$135.30
Max. Negotiated Rate	$721.60
Rate for Payer: Aetna of NY Commercial	$631.40
Rate for Payer: Aetna of NY Medicare	$414.92
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$360.80
Rate for Payer: Cash Price	$676.50
Rate for Payer: CDPHP Medicare	$333.74
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$721.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$721.60
Rate for Payer: EmblemHealth Medicaid	$721.60
Rate for Payer: EmblemHealth Medicare	$306.68
Rate for Payer: Fidelis Medicare	$360.80
Rate for Payer: Galaxy Health Commercial	$586.30
Rate for Payer: Hamaspik Choice Medicare	$360.80
Rate for Payer: Humana Medicare	$360.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$631.40
Rate for Payer: Local 1199SEIU Medicare	$414.92
Rate for Payer: MVP Health Care of NY Commercial	$676.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$507.83
Rate for Payer: MVP Health Care of NY Medicare	$378.84
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$135.30
Rate for Payer: United Healthcare Medicare	$360.80
Rate for Payer: WellCare Medicare	$496.10

RECOVERY ROOM - 91-120 MINS

Facility

$902.00

Hospital Charge Code	4007613
Hospital Revenue Code	710
Min. Negotiated Rate	$586.30
Max. Negotiated Rate	$586.30
Rate for Payer: Cash Price	$676.50
Rate for Payer: Galaxy Health Commercial	$586.30

RECOVERY ROOM - FIRST 30 MINS

Facility

$328.00

Hospital Charge Code	4007610
Hospital Revenue Code	710
Min. Negotiated Rate	$213.20
Max. Negotiated Rate	$213.20
Rate for Payer: Cash Price	$246.00
Rate for Payer: Galaxy Health Commercial	$213.20

RECOVERY ROOM - FIRST 30 MINS

Facility

$328.00

Hospital Charge Code	4007610
Hospital Revenue Code	710
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$262.40
Rate for Payer: Aetna of NY Commercial	$229.60
Rate for Payer: Aetna of NY Medicare	$150.88
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$131.20
Rate for Payer: Cash Price	$246.00
Rate for Payer: CDPHP Medicare	$121.36
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$262.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$262.40
Rate for Payer: EmblemHealth Medicaid	$262.40
Rate for Payer: EmblemHealth Medicare	$111.52
Rate for Payer: Fidelis Medicare	$131.20
Rate for Payer: Galaxy Health Commercial	$213.20
Rate for Payer: Hamaspik Choice Medicare	$131.20
Rate for Payer: Humana Medicare	$131.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$229.60
Rate for Payer: Local 1199SEIU Medicare	$150.88
Rate for Payer: MVP Health Care of NY Commercial	$246.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$184.66
Rate for Payer: MVP Health Care of NY Medicare	$137.76
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$49.20
Rate for Payer: United Healthcare Medicare	$131.20
Rate for Payer: WellCare Medicare	$180.40

Know your out-of-pocket cost for care.

All Charges