Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

SILVER ALGINATE DRESSING

Facility

$63.86

Hospital Charge Code	4479194
Hospital Revenue Code	270
Min. Negotiated Rate	$41.51
Max. Negotiated Rate	$41.51
Rate for Payer: Cash Price	$47.90
Rate for Payer: Galaxy Health Commercial	$41.51

SILVER ALGINATE DRESSING

Facility

$63.86

Hospital Charge Code	4479201
Hospital Revenue Code	270
Min. Negotiated Rate	$41.51
Max. Negotiated Rate	$41.51
Rate for Payer: Cash Price	$47.90
Rate for Payer: Galaxy Health Commercial	$41.51

SILVER DRESSING GEL 45 GM

Facility

$106.09

Hospital Charge Code	4400698
Hospital Revenue Code	250
Min. Negotiated Rate	$15.91
Max. Negotiated Rate	$84.87
Rate for Payer: Aetna of NY Commercial	$74.26
Rate for Payer: Aetna of NY Medicare	$48.80
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$42.44
Rate for Payer: Cash Price	$79.57
Rate for Payer: CDPHP Medicare	$39.25
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$84.87
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$84.87
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$84.87
Rate for Payer: EmblemHealth Medicaid	$84.87
Rate for Payer: EmblemHealth Medicare	$36.07
Rate for Payer: EmblemHealth Select Care	$76.38
Rate for Payer: Fidelis Medicare	$42.44
Rate for Payer: Galaxy Health Commercial	$68.96
Rate for Payer: Hamaspik Choice Medicare	$42.44
Rate for Payer: Humana Medicare	$42.44
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$74.26
Rate for Payer: Local 1199SEIU Medicare	$48.80
Rate for Payer: MVP Health Care of NY Commercial	$79.57
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$59.73
Rate for Payer: MVP Health Care of NY Medicare	$44.56
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$15.91
Rate for Payer: United Healthcare Medicare	$42.44
Rate for Payer: WellCare Medicare	$58.35

SILVER DRESSING GEL 45 GM

Facility

$106.09

Hospital Charge Code	4400698
Hospital Revenue Code	250
Min. Negotiated Rate	$58.35
Max. Negotiated Rate	$68.96
Rate for Payer: Cash Price	$79.57
Rate for Payer: Galaxy Health Commercial	$68.96
Rate for Payer: WellCare Medicare	$58.35

SILVER NITRATE STCK 100 EA

Facility

$6.18

Service Code	NDC 12870000102
Hospital Charge Code	4400699
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

SILVER NITRATE STCK 100 EA

Facility

$6.18

Service Code	NDC 12870000102
Hospital Charge Code	4400699
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

SILVER SULFADIAZINE 0.01 CRM 50 GM

Facility

$46.61

Service Code	NDC 67877012450
Hospital Charge Code	4400720
Hospital Revenue Code	250
Min. Negotiated Rate	$6.99
Max. Negotiated Rate	$37.29
Rate for Payer: Aetna of NY Commercial	$32.63
Rate for Payer: Aetna of NY Medicare	$21.44
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$18.64
Rate for Payer: Cash Price	$34.96
Rate for Payer: CDPHP Medicare	$17.25
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$37.29
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$37.29
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$37.29
Rate for Payer: EmblemHealth Medicaid	$37.29
Rate for Payer: EmblemHealth Medicare	$15.85
Rate for Payer: EmblemHealth Select Care	$33.56
Rate for Payer: Fidelis Medicare	$18.64
Rate for Payer: Galaxy Health Commercial	$30.30
Rate for Payer: Hamaspik Choice Medicare	$18.64
Rate for Payer: Humana Medicare	$18.64
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$32.63
Rate for Payer: Local 1199SEIU Medicare	$21.44
Rate for Payer: MVP Health Care of NY Commercial	$34.96
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$26.24
Rate for Payer: MVP Health Care of NY Medicare	$19.58
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$6.99
Rate for Payer: United Healthcare Medicare	$18.64
Rate for Payer: WellCare Medicare	$25.64

SILVER SULFADIAZINE 0.01 CRM 50 GM

Facility

$46.61

Service Code	NDC 67877012450
Hospital Charge Code	4400720
Hospital Revenue Code	250
Min. Negotiated Rate	$25.64
Max. Negotiated Rate	$30.30
Rate for Payer: Cash Price	$34.96
Rate for Payer: Galaxy Health Commercial	$30.30
Rate for Payer: WellCare Medicare	$25.64

SILVER SULFADIAZINE 1% CREAM 1 ea, 25 g

Facility

$16.00

Service Code	NDC 67877012425
Hospital Charge Code	4401299
Hospital Revenue Code	250
Min. Negotiated Rate	$8.80
Max. Negotiated Rate	$10.40
Rate for Payer: Cash Price	$12.00
Rate for Payer: Galaxy Health Commercial	$10.40
Rate for Payer: WellCare Medicare	$8.80

SILVER SULFADIAZINE 1% CREAM 1 ea, 25 g

Facility

$16.00

Service Code	NDC 67877012425
Hospital Charge Code	4401299
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$12.80
Rate for Payer: Aetna of NY Commercial	$11.20
Rate for Payer: Aetna of NY Medicare	$7.36
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$6.40
Rate for Payer: Cash Price	$12.00
Rate for Payer: CDPHP Medicare	$5.92
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$12.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$12.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$12.80
Rate for Payer: EmblemHealth Medicaid	$12.80
Rate for Payer: EmblemHealth Medicare	$5.44
Rate for Payer: EmblemHealth Select Care	$11.52
Rate for Payer: Fidelis Medicare	$6.40
Rate for Payer: Galaxy Health Commercial	$10.40
Rate for Payer: Hamaspik Choice Medicare	$6.40
Rate for Payer: Humana Medicare	$6.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$11.20
Rate for Payer: Local 1199SEIU Medicare	$7.36
Rate for Payer: MVP Health Care of NY Commercial	$12.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$9.01
Rate for Payer: MVP Health Care of NY Medicare	$6.72
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.40
Rate for Payer: United Healthcare Medicare	$6.40
Rate for Payer: WellCare Medicare	$8.80

SIMETHICONE 80MG CHEW 10X10EA

Facility

$6.18

Service Code	NDC 63739022510
Hospital Charge Code	4400700
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

SIMETHICONE 80MG CHEW 10X10EA

Facility

$6.18

Service Code	NDC 63739022510
Hospital Charge Code	4400700
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

SIMPLE REPAIR-12.6 TO 20.0CM

Facility

$1,246.00

Service Code	HCPCS 12016
Hospital Charge Code	4600144
Hospital Revenue Code	450
Min. Negotiated Rate	$809.90
Max. Negotiated Rate	$809.90
Rate for Payer: Cash Price	$934.50
Rate for Payer: Galaxy Health Commercial	$809.90

SIMPLE REPAIR-12.6 TO 20.0CM

Facility

$1,246.00

Service Code	HCPCS 12016
Hospital Charge Code	4600144
Hospital Revenue Code	450
Min. Negotiated Rate	$186.90
Max. Negotiated Rate	$1,234.00
Rate for Payer: Aetna of NY Commercial	$1,000.00
Rate for Payer: Aetna of NY Medicare	$573.16
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$498.40
Rate for Payer: Cash Price	$934.50
Rate for Payer: Cash Price	$934.50
Rate for Payer: Cash Price	$934.50
Rate for Payer: CDPHP Medicare	$461.02
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,206.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$996.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$996.80
Rate for Payer: EmblemHealth Medicaid	$996.80
Rate for Payer: EmblemHealth Medicare	$423.64
Rate for Payer: EmblemHealth Select Care	$1,085.00
Rate for Payer: Fidelis Medicare	$498.40
Rate for Payer: Galaxy Health Commercial	$809.90
Rate for Payer: Hamaspik Choice Medicare	$498.40
Rate for Payer: Humana Medicare	$498.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,000.00
Rate for Payer: Local 1199SEIU Medicare	$573.16
Rate for Payer: MVP Health Care of NY Commercial	$1,234.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$925.00
Rate for Payer: MVP Health Care of NY Medicare	$523.32
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,009.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$186.90
Rate for Payer: United Healthcare Commercial	$1,009.00
Rate for Payer: United Healthcare Medicare	$498.40
Rate for Payer: WellCare Medicare	$685.30

SIMPLE REPAIR-2.5 OR LESS

Facility

$615.00

Service Code	HCPCS 12011
Hospital Charge Code	4600146
Hospital Revenue Code	450
Min. Negotiated Rate	$92.25
Max. Negotiated Rate	$1,234.00
Rate for Payer: Aetna of NY Commercial	$1,000.00
Rate for Payer: Aetna of NY Medicare	$282.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$246.00
Rate for Payer: Cash Price	$461.25
Rate for Payer: Cash Price	$461.25
Rate for Payer: Cash Price	$461.25
Rate for Payer: CDPHP Medicare	$227.55
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,206.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$492.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$492.00
Rate for Payer: EmblemHealth Medicaid	$492.00
Rate for Payer: EmblemHealth Medicare	$209.10
Rate for Payer: EmblemHealth Select Care	$1,085.00
Rate for Payer: Fidelis Medicare	$246.00
Rate for Payer: Galaxy Health Commercial	$399.75
Rate for Payer: Hamaspik Choice Medicare	$246.00
Rate for Payer: Humana Medicare	$246.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,000.00
Rate for Payer: Local 1199SEIU Medicare	$282.90
Rate for Payer: MVP Health Care of NY Commercial	$1,234.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$925.00
Rate for Payer: MVP Health Care of NY Medicare	$258.30
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,009.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$92.25
Rate for Payer: United Healthcare Commercial	$1,009.00
Rate for Payer: United Healthcare Medicare	$246.00
Rate for Payer: WellCare Medicare	$338.25

SIMPLE REPAIR-2.5 OR LESS

Facility

$615.00

Service Code	HCPCS 12011
Hospital Charge Code	4600146
Hospital Revenue Code	450
Min. Negotiated Rate	$399.75
Max. Negotiated Rate	$399.75
Rate for Payer: Cash Price	$461.25
Rate for Payer: Galaxy Health Commercial	$399.75

SIMPLE REPAIR-2.6-5.0CM

Facility

$615.00

Service Code	HCPCS 12013
Hospital Charge Code	4600148
Hospital Revenue Code	450
Min. Negotiated Rate	$399.75
Max. Negotiated Rate	$399.75
Rate for Payer: Cash Price	$461.25
Rate for Payer: Galaxy Health Commercial	$399.75

SIMPLE REPAIR-2.6-5.0CM

Facility

$615.00

Service Code	HCPCS 12013
Hospital Charge Code	4600148
Hospital Revenue Code	450
Min. Negotiated Rate	$92.25
Max. Negotiated Rate	$1,234.00
Rate for Payer: Aetna of NY Commercial	$1,000.00
Rate for Payer: Aetna of NY Medicare	$282.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$246.00
Rate for Payer: Cash Price	$461.25
Rate for Payer: Cash Price	$461.25
Rate for Payer: Cash Price	$461.25
Rate for Payer: CDPHP Medicare	$227.55
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,206.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$492.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$492.00
Rate for Payer: EmblemHealth Medicaid	$492.00
Rate for Payer: EmblemHealth Medicare	$209.10
Rate for Payer: EmblemHealth Select Care	$1,085.00
Rate for Payer: Fidelis Medicare	$246.00
Rate for Payer: Galaxy Health Commercial	$399.75
Rate for Payer: Hamaspik Choice Medicare	$246.00
Rate for Payer: Humana Medicare	$246.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,000.00
Rate for Payer: Local 1199SEIU Medicare	$282.90
Rate for Payer: MVP Health Care of NY Commercial	$1,234.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$925.00
Rate for Payer: MVP Health Care of NY Medicare	$258.30
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,009.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$92.25
Rate for Payer: United Healthcare Commercial	$1,009.00
Rate for Payer: United Healthcare Medicare	$246.00
Rate for Payer: WellCare Medicare	$338.25

SIMPLE REPAIR-2.6-7.5CM

Facility

$615.00

Service Code	HCPCS 12002
Hospital Charge Code	4600149
Hospital Revenue Code	450
Min. Negotiated Rate	$399.75
Max. Negotiated Rate	$399.75
Rate for Payer: Cash Price	$461.25
Rate for Payer: Galaxy Health Commercial	$399.75

SIMPLE REPAIR-2.6-7.5CM

Facility

$615.00

Service Code	HCPCS 12002
Hospital Charge Code	4600149
Hospital Revenue Code	450
Min. Negotiated Rate	$92.25
Max. Negotiated Rate	$1,234.00
Rate for Payer: Aetna of NY Commercial	$1,000.00
Rate for Payer: Aetna of NY Medicare	$282.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$246.00
Rate for Payer: Cash Price	$461.25
Rate for Payer: Cash Price	$461.25
Rate for Payer: Cash Price	$461.25
Rate for Payer: CDPHP Medicare	$227.55
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,206.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$492.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$492.00
Rate for Payer: EmblemHealth Medicaid	$492.00
Rate for Payer: EmblemHealth Medicare	$209.10
Rate for Payer: EmblemHealth Select Care	$1,085.00
Rate for Payer: Fidelis Medicare	$246.00
Rate for Payer: Galaxy Health Commercial	$399.75
Rate for Payer: Hamaspik Choice Medicare	$246.00
Rate for Payer: Humana Medicare	$246.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,000.00
Rate for Payer: Local 1199SEIU Medicare	$282.90
Rate for Payer: MVP Health Care of NY Commercial	$1,234.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$925.00
Rate for Payer: MVP Health Care of NY Medicare	$258.30
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,009.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$92.25
Rate for Payer: United Healthcare Commercial	$1,009.00
Rate for Payer: United Healthcare Medicare	$246.00
Rate for Payer: WellCare Medicare	$338.25

SIMPLE REPAIR-7.6-12.5CM

Facility

$615.00

Service Code	HCPCS 12004
Hospital Charge Code	4600154
Hospital Revenue Code	450
Min. Negotiated Rate	$92.25
Max. Negotiated Rate	$1,234.00
Rate for Payer: Aetna of NY Commercial	$1,000.00
Rate for Payer: Aetna of NY Medicare	$282.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$246.00
Rate for Payer: Cash Price	$461.25
Rate for Payer: Cash Price	$461.25
Rate for Payer: Cash Price	$461.25
Rate for Payer: CDPHP Medicare	$227.55
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,206.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$492.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$492.00
Rate for Payer: EmblemHealth Medicaid	$492.00
Rate for Payer: EmblemHealth Medicare	$209.10
Rate for Payer: EmblemHealth Select Care	$1,085.00
Rate for Payer: Fidelis Medicare	$246.00
Rate for Payer: Galaxy Health Commercial	$399.75
Rate for Payer: Hamaspik Choice Medicare	$246.00
Rate for Payer: Humana Medicare	$246.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,000.00
Rate for Payer: Local 1199SEIU Medicare	$282.90
Rate for Payer: MVP Health Care of NY Commercial	$1,234.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$925.00
Rate for Payer: MVP Health Care of NY Medicare	$258.30
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,009.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$92.25
Rate for Payer: United Healthcare Commercial	$1,009.00
Rate for Payer: United Healthcare Medicare	$246.00
Rate for Payer: WellCare Medicare	$338.25

SIMPLE REPAIR-7.6-12.5CM

Facility

$615.00

Service Code	HCPCS 12004
Hospital Charge Code	4600154
Hospital Revenue Code	450
Min. Negotiated Rate	$399.75
Max. Negotiated Rate	$399.75
Rate for Payer: Cash Price	$461.25
Rate for Payer: Galaxy Health Commercial	$399.75

SIMVASTATIN 10MG TABS 10X10EA

Facility

$8.50

Service Code	NDC 51079045401
Hospital Charge Code	4400701
Hospital Revenue Code	250
Min. Negotiated Rate	$1.27
Max. Negotiated Rate	$6.80
Rate for Payer: Aetna of NY Commercial	$5.95
Rate for Payer: Aetna of NY Medicare	$3.91
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$3.40
Rate for Payer: Cash Price	$6.38
Rate for Payer: CDPHP Medicare	$3.15
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$6.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$6.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$6.80
Rate for Payer: EmblemHealth Medicaid	$6.80
Rate for Payer: EmblemHealth Medicare	$2.89
Rate for Payer: EmblemHealth Select Care	$6.12
Rate for Payer: Fidelis Medicare	$3.40
Rate for Payer: Galaxy Health Commercial	$5.53
Rate for Payer: Hamaspik Choice Medicare	$3.40
Rate for Payer: Humana Medicare	$3.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$5.95
Rate for Payer: Local 1199SEIU Medicare	$3.91
Rate for Payer: MVP Health Care of NY Commercial	$6.38
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$4.79
Rate for Payer: MVP Health Care of NY Medicare	$3.57
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.27
Rate for Payer: United Healthcare Medicare	$3.40
Rate for Payer: WellCare Medicare	$4.67

SIMVASTATIN 10MG TABS 10X10EA

Facility

$8.50

Service Code	NDC 51079045401
Hospital Charge Code	4400701
Hospital Revenue Code	250
Min. Negotiated Rate	$4.67
Max. Negotiated Rate	$5.53
Rate for Payer: Cash Price	$6.38
Rate for Payer: Galaxy Health Commercial	$5.53
Rate for Payer: WellCare Medicare	$4.67

SIMVASTATIN 20 MG

Facility

$15.19

Service Code	NDC 68084051201
Hospital Charge Code	4408940
Hospital Revenue Code	250
Min. Negotiated Rate	$2.28
Max. Negotiated Rate	$12.15
Rate for Payer: Aetna of NY Commercial	$10.63
Rate for Payer: Aetna of NY Medicare	$6.99
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$6.08
Rate for Payer: Cash Price	$11.39
Rate for Payer: CDPHP Medicare	$5.62
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$12.15
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$12.15
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$12.15
Rate for Payer: EmblemHealth Medicaid	$12.15
Rate for Payer: EmblemHealth Medicare	$5.16
Rate for Payer: EmblemHealth Select Care	$10.94
Rate for Payer: Fidelis Medicare	$6.08
Rate for Payer: Galaxy Health Commercial	$9.87
Rate for Payer: Hamaspik Choice Medicare	$6.08
Rate for Payer: Humana Medicare	$6.08
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$10.63
Rate for Payer: Local 1199SEIU Medicare	$6.99
Rate for Payer: MVP Health Care of NY Commercial	$11.39
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$8.55
Rate for Payer: MVP Health Care of NY Medicare	$6.38
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.28
Rate for Payer: United Healthcare Medicare	$6.08
Rate for Payer: WellCare Medicare	$8.35

Know your out-of-pocket cost for care.

All Charges