Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

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

ANESTHESIA 210 MIN

Facility

$581.00

Hospital Charge Code	4120009
Hospital Revenue Code	370
Min. Negotiated Rate	$377.65
Max. Negotiated Rate	$377.65
Rate for Payer: Cash Price	$435.75
Rate for Payer: Galaxy Health Commercial	$377.65

ANESTHESIA 210 MIN

Facility

$581.00

Hospital Charge Code	4120009
Hospital Revenue Code	370
Min. Negotiated Rate	$197.54
Max. Negotiated Rate	$467.70
Rate for Payer: Aetna of NY Commercial	$406.70
Rate for Payer: Aetna of NY Medicare	$267.26
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$435.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$435.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$214.97
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$290.50
Rate for Payer: Cash Price	$435.75
Rate for Payer: CDPHP Commercial	$467.70
Rate for Payer: CDPHP Medicare	$214.97
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$464.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$464.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$464.80
Rate for Payer: EmblemHealth Medicaid	$464.80
Rate for Payer: EmblemHealth Medicare	$197.54
Rate for Payer: EmblemHealth Select Care	$418.32
Rate for Payer: Fidelis Medicare	$221.42
Rate for Payer: Galaxy Health Commercial	$377.65
Rate for Payer: Hamaspik Choice Medicare	$214.97
Rate for Payer: Humana Medicare	$214.97
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$406.70
Rate for Payer: Local 1199SEIU Medicare	$267.26
Rate for Payer: MVP Health Care of NY Commercial	$435.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$327.10
Rate for Payer: MVP Health Care of NY Medicare	$225.72
Rate for Payer: United Healthcare Medicare	$214.97
Rate for Payer: WellCare Medicare	$319.55

ANESTHESIA 225 MINS

Facility

$613.00

Hospital Charge Code	4120020
Hospital Revenue Code	370
Min. Negotiated Rate	$398.45
Max. Negotiated Rate	$398.45
Rate for Payer: Cash Price	$459.75
Rate for Payer: Galaxy Health Commercial	$398.45

ANESTHESIA 225 MINS

Facility

$613.00

Hospital Charge Code	4120020
Hospital Revenue Code	370
Min. Negotiated Rate	$208.42
Max. Negotiated Rate	$493.46
Rate for Payer: Aetna of NY Commercial	$429.10
Rate for Payer: Aetna of NY Medicare	$281.98
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$459.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$459.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$226.81
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$306.50
Rate for Payer: Cash Price	$459.75
Rate for Payer: CDPHP Commercial	$493.46
Rate for Payer: CDPHP Medicare	$226.81
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$490.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$490.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$490.40
Rate for Payer: EmblemHealth Medicaid	$490.40
Rate for Payer: EmblemHealth Medicare	$208.42
Rate for Payer: EmblemHealth Select Care	$441.36
Rate for Payer: Fidelis Medicare	$233.61
Rate for Payer: Galaxy Health Commercial	$398.45
Rate for Payer: Hamaspik Choice Medicare	$226.81
Rate for Payer: Humana Medicare	$226.81
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$429.10
Rate for Payer: Local 1199SEIU Medicare	$281.98
Rate for Payer: MVP Health Care of NY Commercial	$459.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$345.12
Rate for Payer: MVP Health Care of NY Medicare	$238.15
Rate for Payer: United Healthcare Medicare	$226.81
Rate for Payer: WellCare Medicare	$337.15

ANESTHESIA 240 MIN

Facility

$645.00

Hospital Charge Code	4120017
Hospital Revenue Code	370
Min. Negotiated Rate	$419.25
Max. Negotiated Rate	$419.25
Rate for Payer: Cash Price	$483.75
Rate for Payer: Galaxy Health Commercial	$419.25

ANESTHESIA 240 MIN

Facility

$645.00

Hospital Charge Code	4120017
Hospital Revenue Code	370
Min. Negotiated Rate	$219.30
Max. Negotiated Rate	$519.22
Rate for Payer: Aetna of NY Commercial	$451.50
Rate for Payer: Aetna of NY Medicare	$296.70
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$483.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$483.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$238.65
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$322.50
Rate for Payer: Cash Price	$483.75
Rate for Payer: CDPHP Commercial	$519.22
Rate for Payer: CDPHP Medicare	$238.65
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$516.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$516.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$516.00
Rate for Payer: EmblemHealth Medicaid	$516.00
Rate for Payer: EmblemHealth Medicare	$219.30
Rate for Payer: EmblemHealth Select Care	$464.40
Rate for Payer: Fidelis Medicare	$245.81
Rate for Payer: Galaxy Health Commercial	$419.25
Rate for Payer: Hamaspik Choice Medicare	$238.65
Rate for Payer: Humana Medicare	$238.65
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$451.50
Rate for Payer: Local 1199SEIU Medicare	$296.70
Rate for Payer: MVP Health Care of NY Commercial	$483.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$363.14
Rate for Payer: MVP Health Care of NY Medicare	$250.58
Rate for Payer: United Healthcare Medicare	$238.65
Rate for Payer: WellCare Medicare	$354.75

ANESTHESIA 255 MINS

Facility

$684.00

Hospital Charge Code	4120021
Hospital Revenue Code	370
Min. Negotiated Rate	$444.60
Max. Negotiated Rate	$444.60
Rate for Payer: Cash Price	$513.00
Rate for Payer: Galaxy Health Commercial	$444.60

ANESTHESIA 255 MINS

Facility

$684.00

Hospital Charge Code	4120021
Hospital Revenue Code	370
Min. Negotiated Rate	$232.56
Max. Negotiated Rate	$550.62
Rate for Payer: Aetna of NY Commercial	$478.80
Rate for Payer: Aetna of NY Medicare	$314.64
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$513.00
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$513.00
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$253.08
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$342.00
Rate for Payer: Cash Price	$513.00
Rate for Payer: CDPHP Commercial	$550.62
Rate for Payer: CDPHP Medicare	$253.08
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$547.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$547.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$547.20
Rate for Payer: EmblemHealth Medicaid	$547.20
Rate for Payer: EmblemHealth Medicare	$232.56
Rate for Payer: EmblemHealth Select Care	$492.48
Rate for Payer: Fidelis Medicare	$260.67
Rate for Payer: Galaxy Health Commercial	$444.60
Rate for Payer: Hamaspik Choice Medicare	$253.08
Rate for Payer: Humana Medicare	$253.08
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$478.80
Rate for Payer: Local 1199SEIU Medicare	$314.64
Rate for Payer: MVP Health Care of NY Commercial	$513.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$385.09
Rate for Payer: MVP Health Care of NY Medicare	$265.73
Rate for Payer: United Healthcare Medicare	$253.08
Rate for Payer: WellCare Medicare	$376.20

ANESTHESIA 270 MIN

Facility

$722.00

Hospital Charge Code	4120018
Hospital Revenue Code	370
Min. Negotiated Rate	$469.30
Max. Negotiated Rate	$469.30
Rate for Payer: Cash Price	$541.50
Rate for Payer: Galaxy Health Commercial	$469.30

ANESTHESIA 270 MIN

Facility

$722.00

Hospital Charge Code	4120018
Hospital Revenue Code	370
Min. Negotiated Rate	$245.48
Max. Negotiated Rate	$581.21
Rate for Payer: Aetna of NY Commercial	$505.40
Rate for Payer: Aetna of NY Medicare	$332.12
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$541.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$541.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$267.14
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$361.00
Rate for Payer: Cash Price	$541.50
Rate for Payer: CDPHP Commercial	$581.21
Rate for Payer: CDPHP Medicare	$267.14
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$577.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$577.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$577.60
Rate for Payer: EmblemHealth Medicaid	$577.60
Rate for Payer: EmblemHealth Medicare	$245.48
Rate for Payer: EmblemHealth Select Care	$519.84
Rate for Payer: Fidelis Medicare	$275.15
Rate for Payer: Galaxy Health Commercial	$469.30
Rate for Payer: Hamaspik Choice Medicare	$267.14
Rate for Payer: Humana Medicare	$267.14
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$505.40
Rate for Payer: Local 1199SEIU Medicare	$332.12
Rate for Payer: MVP Health Care of NY Commercial	$541.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$406.49
Rate for Payer: MVP Health Care of NY Medicare	$280.50
Rate for Payer: United Healthcare Medicare	$267.14
Rate for Payer: WellCare Medicare	$397.10

ANESTHESIA 285 MINS

Facility

$762.00

Hospital Charge Code	4120022
Hospital Revenue Code	370
Min. Negotiated Rate	$259.08
Max. Negotiated Rate	$613.41
Rate for Payer: Aetna of NY Commercial	$533.40
Rate for Payer: Aetna of NY Medicare	$350.52
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$571.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$571.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$281.94
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$381.00
Rate for Payer: Cash Price	$571.50
Rate for Payer: CDPHP Commercial	$613.41
Rate for Payer: CDPHP Medicare	$281.94
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$609.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$609.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$609.60
Rate for Payer: EmblemHealth Medicaid	$609.60
Rate for Payer: EmblemHealth Medicare	$259.08
Rate for Payer: EmblemHealth Select Care	$548.64
Rate for Payer: Fidelis Medicare	$290.40
Rate for Payer: Galaxy Health Commercial	$495.30
Rate for Payer: Hamaspik Choice Medicare	$281.94
Rate for Payer: Humana Medicare	$281.94
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$533.40
Rate for Payer: Local 1199SEIU Medicare	$350.52
Rate for Payer: MVP Health Care of NY Commercial	$571.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$429.01
Rate for Payer: MVP Health Care of NY Medicare	$296.04
Rate for Payer: United Healthcare Medicare	$281.94
Rate for Payer: WellCare Medicare	$419.10

ANESTHESIA 285 MINS

Facility

$762.00

Hospital Charge Code	4120022
Hospital Revenue Code	370
Min. Negotiated Rate	$495.30
Max. Negotiated Rate	$495.30
Rate for Payer: Cash Price	$571.50
Rate for Payer: Galaxy Health Commercial	$495.30

ANESTHESIA 300 MIN

Facility

$802.00

Hospital Charge Code	4120019
Hospital Revenue Code	370
Min. Negotiated Rate	$521.30
Max. Negotiated Rate	$521.30
Rate for Payer: Cash Price	$601.50
Rate for Payer: Galaxy Health Commercial	$521.30

ANESTHESIA 300 MIN

Facility

$802.00

Hospital Charge Code	4120019
Hospital Revenue Code	370
Min. Negotiated Rate	$272.68
Max. Negotiated Rate	$645.61
Rate for Payer: Aetna of NY Commercial	$561.40
Rate for Payer: Aetna of NY Medicare	$368.92
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$601.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$601.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$296.74
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$401.00
Rate for Payer: Cash Price	$601.50
Rate for Payer: CDPHP Commercial	$645.61
Rate for Payer: CDPHP Medicare	$296.74
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$641.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$641.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$641.60
Rate for Payer: EmblemHealth Medicaid	$641.60
Rate for Payer: EmblemHealth Medicare	$272.68
Rate for Payer: EmblemHealth Select Care	$577.44
Rate for Payer: Fidelis Medicare	$305.64
Rate for Payer: Galaxy Health Commercial	$521.30
Rate for Payer: Hamaspik Choice Medicare	$296.74
Rate for Payer: Humana Medicare	$296.74
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$561.40
Rate for Payer: Local 1199SEIU Medicare	$368.92
Rate for Payer: MVP Health Care of NY Commercial	$601.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$451.53
Rate for Payer: MVP Health Care of NY Medicare	$311.58
Rate for Payer: United Healthcare Medicare	$296.74
Rate for Payer: WellCare Medicare	$441.10

ANESTHESIA 30 MINUTES

Facility

$107.00

Hospital Charge Code	4120003
Hospital Revenue Code	370
Min. Negotiated Rate	$69.55
Max. Negotiated Rate	$69.55
Rate for Payer: Cash Price	$80.25
Rate for Payer: Galaxy Health Commercial	$69.55

ANESTHESIA 30 MINUTES

Facility

$107.00

Hospital Charge Code	4120003
Hospital Revenue Code	370
Min. Negotiated Rate	$36.38
Max. Negotiated Rate	$86.14
Rate for Payer: Aetna of NY Commercial	$74.90
Rate for Payer: Aetna of NY Medicare	$49.22
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$80.25
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$80.25
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$39.59
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$53.50
Rate for Payer: Cash Price	$80.25
Rate for Payer: CDPHP Commercial	$86.14
Rate for Payer: CDPHP Medicare	$39.59
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$85.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$85.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$85.60
Rate for Payer: EmblemHealth Medicaid	$85.60
Rate for Payer: EmblemHealth Medicare	$36.38
Rate for Payer: EmblemHealth Select Care	$77.04
Rate for Payer: Fidelis Medicare	$40.78
Rate for Payer: Galaxy Health Commercial	$69.55
Rate for Payer: Hamaspik Choice Medicare	$39.59
Rate for Payer: Humana Medicare	$39.59
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$74.90
Rate for Payer: Local 1199SEIU Medicare	$49.22
Rate for Payer: MVP Health Care of NY Commercial	$80.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$60.24
Rate for Payer: MVP Health Care of NY Medicare	$41.57
Rate for Payer: United Healthcare Medicare	$39.59
Rate for Payer: WellCare Medicare	$58.85

ANESTHESIA 45 MINS

Facility

$161.00

Hospital Charge Code	4120010
Hospital Revenue Code	370
Min. Negotiated Rate	$104.65
Max. Negotiated Rate	$104.65
Rate for Payer: Cash Price	$120.75
Rate for Payer: Galaxy Health Commercial	$104.65

ANESTHESIA 45 MINS

Facility

$161.00

Hospital Charge Code	4120010
Hospital Revenue Code	370
Min. Negotiated Rate	$54.74
Max. Negotiated Rate	$129.60
Rate for Payer: Aetna of NY Commercial	$112.70
Rate for Payer: Aetna of NY Medicare	$74.06
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$120.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$120.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$59.57
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$80.50
Rate for Payer: Cash Price	$120.75
Rate for Payer: CDPHP Commercial	$129.60
Rate for Payer: CDPHP Medicare	$59.57
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$128.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$128.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$128.80
Rate for Payer: EmblemHealth Medicaid	$128.80
Rate for Payer: EmblemHealth Medicare	$54.74
Rate for Payer: EmblemHealth Select Care	$115.92
Rate for Payer: Fidelis Medicare	$61.36
Rate for Payer: Galaxy Health Commercial	$104.65
Rate for Payer: Hamaspik Choice Medicare	$59.57
Rate for Payer: Humana Medicare	$59.57
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$112.70
Rate for Payer: Local 1199SEIU Medicare	$74.06
Rate for Payer: MVP Health Care of NY Commercial	$120.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$90.64
Rate for Payer: MVP Health Care of NY Medicare	$62.55
Rate for Payer: United Healthcare Medicare	$59.57
Rate for Payer: WellCare Medicare	$88.55

ANESTHESIA 60 MINUTES

Facility

$217.00

Hospital Charge Code	4120004
Hospital Revenue Code	370
Min. Negotiated Rate	$73.78
Max. Negotiated Rate	$174.68
Rate for Payer: Aetna of NY Commercial	$151.90
Rate for Payer: Aetna of NY Medicare	$99.82
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$162.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$162.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$80.29
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$108.50
Rate for Payer: Cash Price	$162.75
Rate for Payer: CDPHP Commercial	$174.68
Rate for Payer: CDPHP Medicare	$80.29
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$173.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$173.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$173.60
Rate for Payer: EmblemHealth Medicaid	$173.60
Rate for Payer: EmblemHealth Medicare	$73.78
Rate for Payer: EmblemHealth Select Care	$156.24
Rate for Payer: Fidelis Medicare	$82.70
Rate for Payer: Galaxy Health Commercial	$141.05
Rate for Payer: Hamaspik Choice Medicare	$80.29
Rate for Payer: Humana Medicare	$80.29
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$151.90
Rate for Payer: Local 1199SEIU Medicare	$99.82
Rate for Payer: MVP Health Care of NY Commercial	$162.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$122.17
Rate for Payer: MVP Health Care of NY Medicare	$84.30
Rate for Payer: United Healthcare Medicare	$80.29
Rate for Payer: WellCare Medicare	$119.35

ANESTHESIA 60 MINUTES

Facility

$217.00

Hospital Charge Code	4120004
Hospital Revenue Code	370
Min. Negotiated Rate	$141.05
Max. Negotiated Rate	$141.05
Rate for Payer: Cash Price	$162.75
Rate for Payer: Galaxy Health Commercial	$141.05

ANESTHESIA 75 MINS

Facility

$269.00

Hospital Charge Code	4120011
Hospital Revenue Code	370
Min. Negotiated Rate	$174.85
Max. Negotiated Rate	$174.85
Rate for Payer: Cash Price	$201.75
Rate for Payer: Galaxy Health Commercial	$174.85

ANESTHESIA 75 MINS

Facility

$269.00

Hospital Charge Code	4120011
Hospital Revenue Code	370
Min. Negotiated Rate	$91.46
Max. Negotiated Rate	$216.54
Rate for Payer: Aetna of NY Commercial	$188.30
Rate for Payer: Aetna of NY Medicare	$123.74
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$201.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$201.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$99.53
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$134.50
Rate for Payer: Cash Price	$201.75
Rate for Payer: CDPHP Commercial	$216.54
Rate for Payer: CDPHP Medicare	$99.53
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$215.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$215.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$215.20
Rate for Payer: EmblemHealth Medicaid	$215.20
Rate for Payer: EmblemHealth Medicare	$91.46
Rate for Payer: EmblemHealth Select Care	$193.68
Rate for Payer: Fidelis Medicare	$102.52
Rate for Payer: Galaxy Health Commercial	$174.85
Rate for Payer: Hamaspik Choice Medicare	$99.53
Rate for Payer: Humana Medicare	$99.53
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$188.30
Rate for Payer: Local 1199SEIU Medicare	$123.74
Rate for Payer: MVP Health Care of NY Commercial	$201.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$151.45
Rate for Payer: MVP Health Care of NY Medicare	$104.51
Rate for Payer: United Healthcare Medicare	$99.53
Rate for Payer: WellCare Medicare	$147.95

ANESTHESIA 90 MIN

Facility

$322.00

Hospital Charge Code	4120005
Hospital Revenue Code	370
Min. Negotiated Rate	$209.30
Max. Negotiated Rate	$209.30
Rate for Payer: Cash Price	$241.50
Rate for Payer: Galaxy Health Commercial	$209.30

ANESTHESIA 90 MIN

Facility

$322.00

Hospital Charge Code	4120005
Hospital Revenue Code	370
Min. Negotiated Rate	$109.48
Max. Negotiated Rate	$259.21
Rate for Payer: Aetna of NY Commercial	$225.40
Rate for Payer: Aetna of NY Medicare	$148.12
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$241.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$241.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$119.14
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$161.00
Rate for Payer: Cash Price	$241.50
Rate for Payer: CDPHP Commercial	$259.21
Rate for Payer: CDPHP Medicare	$119.14
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$257.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$257.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$257.60
Rate for Payer: EmblemHealth Medicaid	$257.60
Rate for Payer: EmblemHealth Medicare	$109.48
Rate for Payer: EmblemHealth Select Care	$231.84
Rate for Payer: Fidelis Medicare	$122.71
Rate for Payer: Galaxy Health Commercial	$209.30
Rate for Payer: Hamaspik Choice Medicare	$119.14
Rate for Payer: Humana Medicare	$119.14
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$225.40
Rate for Payer: Local 1199SEIU Medicare	$148.12
Rate for Payer: MVP Health Care of NY Commercial	$241.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$181.29
Rate for Payer: MVP Health Care of NY Medicare	$125.10
Rate for Payer: United Healthcare Medicare	$119.14
Rate for Payer: WellCare Medicare	$177.10

Know your out-of-pocket cost for care.

All Charges