Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

ANESTHESIA 300 MIN

Facility

$859.00

Hospital Charge Code	4120019
Hospital Revenue Code	370
Min. Negotiated Rate	$128.85
Max. Negotiated Rate	$687.20
Rate for Payer: Aetna of NY Commercial	$601.30
Rate for Payer: Aetna of NY Medicare	$395.14
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$343.60
Rate for Payer: Cash Price	$644.25
Rate for Payer: CDPHP Medicare	$317.83
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$687.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$687.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$687.20
Rate for Payer: EmblemHealth Medicaid	$687.20
Rate for Payer: EmblemHealth Medicare	$292.06
Rate for Payer: EmblemHealth Select Care	$618.48
Rate for Payer: Fidelis Medicare	$343.60
Rate for Payer: Galaxy Health Commercial	$558.35
Rate for Payer: Hamaspik Choice Medicare	$343.60
Rate for Payer: Humana Medicare	$343.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$601.30
Rate for Payer: Local 1199SEIU Medicare	$395.14
Rate for Payer: MVP Health Care of NY Commercial	$644.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$483.62
Rate for Payer: MVP Health Care of NY Medicare	$360.78
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$128.85
Rate for Payer: United Healthcare Medicare	$343.60
Rate for Payer: WellCare Medicare	$472.45

ANESTHESIA 300 MIN

Facility

$859.00

Hospital Charge Code	4120019
Hospital Revenue Code	370
Min. Negotiated Rate	$558.35
Max. Negotiated Rate	$558.35
Rate for Payer: Cash Price	$644.25
Rate for Payer: Galaxy Health Commercial	$558.35

ANESTHESIA 30 MINUTES

Facility

$115.00

Hospital Charge Code	4120003
Hospital Revenue Code	370
Min. Negotiated Rate	$74.75
Max. Negotiated Rate	$74.75
Rate for Payer: Cash Price	$86.25
Rate for Payer: Galaxy Health Commercial	$74.75

ANESTHESIA 30 MINUTES

Facility

$115.00

Hospital Charge Code	4120003
Hospital Revenue Code	370
Min. Negotiated Rate	$17.25
Max. Negotiated Rate	$92.00
Rate for Payer: Aetna of NY Commercial	$80.50
Rate for Payer: Aetna of NY Medicare	$52.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$46.00
Rate for Payer: Cash Price	$86.25
Rate for Payer: CDPHP Medicare	$42.55
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$92.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$92.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$92.00
Rate for Payer: EmblemHealth Medicaid	$92.00
Rate for Payer: EmblemHealth Medicare	$39.10
Rate for Payer: EmblemHealth Select Care	$82.80
Rate for Payer: Fidelis Medicare	$46.00
Rate for Payer: Galaxy Health Commercial	$74.75
Rate for Payer: Hamaspik Choice Medicare	$46.00
Rate for Payer: Humana Medicare	$46.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$80.50
Rate for Payer: Local 1199SEIU Medicare	$52.90
Rate for Payer: MVP Health Care of NY Commercial	$86.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$64.75
Rate for Payer: MVP Health Care of NY Medicare	$48.30
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$17.25
Rate for Payer: United Healthcare Medicare	$46.00
Rate for Payer: WellCare Medicare	$63.25

ANESTHESIA 45 MINS

Facility

$172.00

Hospital Charge Code	4120010
Hospital Revenue Code	370
Min. Negotiated Rate	$111.80
Max. Negotiated Rate	$111.80
Rate for Payer: Cash Price	$129.00
Rate for Payer: Galaxy Health Commercial	$111.80

ANESTHESIA 45 MINS

Facility

$172.00

Hospital Charge Code	4120010
Hospital Revenue Code	370
Min. Negotiated Rate	$25.80
Max. Negotiated Rate	$137.60
Rate for Payer: Aetna of NY Commercial	$120.40
Rate for Payer: Aetna of NY Medicare	$79.12
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$68.80
Rate for Payer: Cash Price	$129.00
Rate for Payer: CDPHP Medicare	$63.64
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$137.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$137.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$137.60
Rate for Payer: EmblemHealth Medicaid	$137.60
Rate for Payer: EmblemHealth Medicare	$58.48
Rate for Payer: EmblemHealth Select Care	$123.84
Rate for Payer: Fidelis Medicare	$68.80
Rate for Payer: Galaxy Health Commercial	$111.80
Rate for Payer: Hamaspik Choice Medicare	$68.80
Rate for Payer: Humana Medicare	$68.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$120.40
Rate for Payer: Local 1199SEIU Medicare	$79.12
Rate for Payer: MVP Health Care of NY Commercial	$129.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$96.84
Rate for Payer: MVP Health Care of NY Medicare	$72.24
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$25.80
Rate for Payer: United Healthcare Medicare	$68.80
Rate for Payer: WellCare Medicare	$94.60

ANESTHESIA 60 MINUTES

Facility

$232.00

Hospital Charge Code	4120004
Hospital Revenue Code	370
Min. Negotiated Rate	$150.80
Max. Negotiated Rate	$150.80
Rate for Payer: Cash Price	$174.00
Rate for Payer: Galaxy Health Commercial	$150.80

ANESTHESIA 60 MINUTES

Facility

$232.00

Hospital Charge Code	4120004
Hospital Revenue Code	370
Min. Negotiated Rate	$34.80
Max. Negotiated Rate	$185.60
Rate for Payer: Aetna of NY Commercial	$162.40
Rate for Payer: Aetna of NY Medicare	$106.72
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$92.80
Rate for Payer: Cash Price	$174.00
Rate for Payer: CDPHP Medicare	$85.84
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$185.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$185.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$185.60
Rate for Payer: EmblemHealth Medicaid	$185.60
Rate for Payer: EmblemHealth Medicare	$78.88
Rate for Payer: EmblemHealth Select Care	$167.04
Rate for Payer: Fidelis Medicare	$92.80
Rate for Payer: Galaxy Health Commercial	$150.80
Rate for Payer: Hamaspik Choice Medicare	$92.80
Rate for Payer: Humana Medicare	$92.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$162.40
Rate for Payer: Local 1199SEIU Medicare	$106.72
Rate for Payer: MVP Health Care of NY Commercial	$174.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$130.62
Rate for Payer: MVP Health Care of NY Medicare	$97.44
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$34.80
Rate for Payer: United Healthcare Medicare	$92.80
Rate for Payer: WellCare Medicare	$127.60

ANESTHESIA 75 MINS

Facility

$288.00

Hospital Charge Code	4120011
Hospital Revenue Code	370
Min. Negotiated Rate	$43.20
Max. Negotiated Rate	$230.40
Rate for Payer: Aetna of NY Commercial	$201.60
Rate for Payer: Aetna of NY Medicare	$132.48
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$115.20
Rate for Payer: Cash Price	$216.00
Rate for Payer: CDPHP Medicare	$106.56
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$230.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$230.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$230.40
Rate for Payer: EmblemHealth Medicaid	$230.40
Rate for Payer: EmblemHealth Medicare	$97.92
Rate for Payer: EmblemHealth Select Care	$207.36
Rate for Payer: Fidelis Medicare	$115.20
Rate for Payer: Galaxy Health Commercial	$187.20
Rate for Payer: Hamaspik Choice Medicare	$115.20
Rate for Payer: Humana Medicare	$115.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$201.60
Rate for Payer: Local 1199SEIU Medicare	$132.48
Rate for Payer: MVP Health Care of NY Commercial	$216.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$162.14
Rate for Payer: MVP Health Care of NY Medicare	$120.96
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$43.20
Rate for Payer: United Healthcare Medicare	$115.20
Rate for Payer: WellCare Medicare	$158.40

ANESTHESIA 75 MINS

Facility

$288.00

Hospital Charge Code	4120011
Hospital Revenue Code	370
Min. Negotiated Rate	$187.20
Max. Negotiated Rate	$187.20
Rate for Payer: Cash Price	$216.00
Rate for Payer: Galaxy Health Commercial	$187.20

ANESTHESIA 90 MIN

Facility

$345.00

Hospital Charge Code	4120005
Hospital Revenue Code	370
Min. Negotiated Rate	$51.75
Max. Negotiated Rate	$276.00
Rate for Payer: Aetna of NY Commercial	$241.50
Rate for Payer: Aetna of NY Medicare	$158.70
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$138.00
Rate for Payer: Cash Price	$258.75
Rate for Payer: CDPHP Medicare	$127.65
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$276.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$276.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$276.00
Rate for Payer: EmblemHealth Medicaid	$276.00
Rate for Payer: EmblemHealth Medicare	$117.30
Rate for Payer: EmblemHealth Select Care	$248.40
Rate for Payer: Fidelis Medicare	$138.00
Rate for Payer: Galaxy Health Commercial	$224.25
Rate for Payer: Hamaspik Choice Medicare	$138.00
Rate for Payer: Humana Medicare	$138.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$241.50
Rate for Payer: Local 1199SEIU Medicare	$158.70
Rate for Payer: MVP Health Care of NY Commercial	$258.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$194.24
Rate for Payer: MVP Health Care of NY Medicare	$144.90
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$51.75
Rate for Payer: United Healthcare Medicare	$138.00
Rate for Payer: WellCare Medicare	$189.75

ANESTHESIA 90 MIN

Facility

$345.00

Hospital Charge Code	4120005
Hospital Revenue Code	370
Min. Negotiated Rate	$224.25
Max. Negotiated Rate	$224.25
Rate for Payer: Cash Price	$258.75
Rate for Payer: Galaxy Health Commercial	$224.25

ANGLED TOMCAT 4.5MM 3805451

Facility

$211.15

Hospital Charge Code	4479299
Hospital Revenue Code	270
Min. Negotiated Rate	$31.67
Max. Negotiated Rate	$168.92
Rate for Payer: Aetna of NY Commercial	$147.81
Rate for Payer: Aetna of NY Medicare	$97.13
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$84.46
Rate for Payer: Cash Price	$158.36
Rate for Payer: CDPHP Medicare	$78.13
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$168.92
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$168.92
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$168.92
Rate for Payer: EmblemHealth Medicaid	$168.92
Rate for Payer: EmblemHealth Medicare	$71.79
Rate for Payer: EmblemHealth Select Care	$152.03
Rate for Payer: Fidelis Medicare	$84.46
Rate for Payer: Galaxy Health Commercial	$137.25
Rate for Payer: Hamaspik Choice Medicare	$84.46
Rate for Payer: Humana Medicare	$84.46
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$147.81
Rate for Payer: Local 1199SEIU Medicare	$97.13
Rate for Payer: MVP Health Care of NY Commercial	$158.36
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$118.88
Rate for Payer: MVP Health Care of NY Medicare	$88.68
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$31.67
Rate for Payer: United Healthcare Medicare	$84.46
Rate for Payer: WellCare Medicare	$116.13

ANGLED TOMCAT 4.5MM 3805451

Facility

$211.15

Hospital Charge Code	4479299
Hospital Revenue Code	270
Min. Negotiated Rate	$137.25
Max. Negotiated Rate	$137.25
Rate for Payer: Cash Price	$158.36
Rate for Payer: Galaxy Health Commercial	$137.25

ANORO ELLIPTA 62.5-25 MCG INH 14 ea, 14 eaches

Facility

$363.00

Service Code	NDC 173086906
Hospital Charge Code	4401425
Hospital Revenue Code	250
Min. Negotiated Rate	$54.45
Max. Negotiated Rate	$290.40
Rate for Payer: Aetna of NY Commercial	$254.10
Rate for Payer: Aetna of NY Medicare	$166.98
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$145.20
Rate for Payer: Cash Price	$272.25
Rate for Payer: CDPHP Medicare	$134.31
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$290.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$290.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$290.40
Rate for Payer: EmblemHealth Medicaid	$290.40
Rate for Payer: EmblemHealth Medicare	$123.42
Rate for Payer: EmblemHealth Select Care	$261.36
Rate for Payer: Fidelis Medicare	$145.20
Rate for Payer: Galaxy Health Commercial	$235.95
Rate for Payer: Hamaspik Choice Medicare	$145.20
Rate for Payer: Humana Medicare	$145.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$254.10
Rate for Payer: Local 1199SEIU Medicare	$166.98
Rate for Payer: MVP Health Care of NY Commercial	$272.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$204.37
Rate for Payer: MVP Health Care of NY Medicare	$152.46
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$54.45
Rate for Payer: United Healthcare Medicare	$145.20
Rate for Payer: WellCare Medicare	$199.65

ANORO ELLIPTA 62.5-25 MCG INH 14 ea, 14 eaches

Facility

$363.00

Service Code	NDC 173086906
Hospital Charge Code	4401425
Hospital Revenue Code	250
Min. Negotiated Rate	$199.65
Max. Negotiated Rate	$235.95
Rate for Payer: Cash Price	$272.25
Rate for Payer: Galaxy Health Commercial	$235.95
Rate for Payer: WellCare Medicare	$199.65

ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO

Facility

$15,332.00

Service Code	HCPCS 57240
Hospital Charge Code	4002041
Hospital Revenue Code	490
Min. Negotiated Rate	$1,900.00
Max. Negotiated Rate	$12,265.60
Rate for Payer: Aetna of NY Commercial	$1,900.00
Rate for Payer: Aetna of NY Medicare	$7,052.72
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$6,132.80
Rate for Payer: Cash Price	$11,499.00
Rate for Payer: Cash Price	$11,499.00
Rate for Payer: CDPHP Medicare	$5,672.84
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$12,265.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$12,265.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$12,265.60
Rate for Payer: EmblemHealth Medicaid	$12,265.60
Rate for Payer: EmblemHealth Medicare	$5,212.88
Rate for Payer: EmblemHealth Select Care	$11,039.04
Rate for Payer: Fidelis Medicare	$6,132.80
Rate for Payer: Galaxy Health Commercial	$9,965.80
Rate for Payer: Hamaspik Choice Medicare	$6,132.80
Rate for Payer: Humana Medicare	$6,132.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,900.00
Rate for Payer: Local 1199SEIU Medicare	$7,052.72
Rate for Payer: Multiplan Commercial	$12,265.60
Rate for Payer: MVP Health Care of NY Commercial	$11,499.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$8,631.92
Rate for Payer: MVP Health Care of NY Medicare	$6,439.44
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$2,097.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,299.80
Rate for Payer: United Healthcare Commercial	$2,097.00
Rate for Payer: United Healthcare Medicare	$6,132.80
Rate for Payer: WellCare Medicare	$8,432.60

ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO

Facility

$15,332.00

Service Code	HCPCS 57240
Hospital Charge Code	4002041
Hospital Revenue Code	490
Min. Negotiated Rate	$9,965.80
Max. Negotiated Rate	$9,965.80
Rate for Payer: Cash Price	$11,499.00
Rate for Payer: Galaxy Health Commercial	$9,965.80

ANTIBIOTIC SENSITIVITY

Facility

$26.00

Service Code	HCPCS 87186
Hospital Charge Code	4301136
Hospital Revenue Code	300
Min. Negotiated Rate	$3.90
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna of NY Commercial	$16.90
Rate for Payer: Aetna of NY Medicare	$11.96
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$10.40
Rate for Payer: Cash Price	$19.50
Rate for Payer: CDPHP Medicare	$9.62
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$15.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$20.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$20.80
Rate for Payer: EmblemHealth Medicaid	$20.80
Rate for Payer: EmblemHealth Medicare	$8.84
Rate for Payer: EmblemHealth Select Care	$15.60
Rate for Payer: Fidelis Medicare	$10.40
Rate for Payer: Galaxy Health Commercial	$16.90
Rate for Payer: Hamaspik Choice Medicare	$10.40
Rate for Payer: Humana Medicare	$10.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$16.90
Rate for Payer: Local 1199SEIU Medicare	$11.96
Rate for Payer: MVP Health Care of NY Commercial	$19.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$14.64
Rate for Payer: MVP Health Care of NY Medicare	$10.92
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$19.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3.90
Rate for Payer: United Healthcare Commercial	$19.50
Rate for Payer: United Healthcare Medicare	$10.40
Rate for Payer: WellCare Medicare	$14.30

ANTIBIOTIC SENSITIVITY

Facility

$34.00

Service Code	HCPCS 87186
Hospital Charge Code	4301087
Hospital Revenue Code	300
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$22.10
Rate for Payer: Cash Price	$25.50
Rate for Payer: Galaxy Health Commercial	$22.10

ANTIBIOTIC SENSITIVITY

Facility

$26.00

Service Code	HCPCS 87186
Hospital Charge Code	4301136
Hospital Revenue Code	300
Min. Negotiated Rate	$16.90
Max. Negotiated Rate	$16.90
Rate for Payer: Cash Price	$19.50
Rate for Payer: Galaxy Health Commercial	$16.90

ANTIBIOTIC SENSITIVITY

Facility

$34.00

Service Code	HCPCS 87186
Hospital Charge Code	4304866
Hospital Revenue Code	300
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$22.10
Rate for Payer: Cash Price	$25.50
Rate for Payer: Galaxy Health Commercial	$22.10

ANTIBIOTIC SENSITIVITY

Facility

$34.00

Service Code	HCPCS 87186
Hospital Charge Code	4301087
Hospital Revenue Code	300
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$27.20
Rate for Payer: Aetna of NY Commercial	$22.10
Rate for Payer: Aetna of NY Medicare	$15.64
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$13.60
Rate for Payer: Cash Price	$25.50
Rate for Payer: CDPHP Medicare	$12.58
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$20.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$27.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$27.20
Rate for Payer: EmblemHealth Medicaid	$27.20
Rate for Payer: EmblemHealth Medicare	$11.56
Rate for Payer: EmblemHealth Select Care	$20.40
Rate for Payer: Fidelis Medicare	$13.60
Rate for Payer: Galaxy Health Commercial	$22.10
Rate for Payer: Hamaspik Choice Medicare	$13.60
Rate for Payer: Humana Medicare	$13.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$22.10
Rate for Payer: Local 1199SEIU Medicare	$15.64
Rate for Payer: MVP Health Care of NY Commercial	$25.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$19.14
Rate for Payer: MVP Health Care of NY Medicare	$14.28
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$25.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.10
Rate for Payer: United Healthcare Commercial	$25.50
Rate for Payer: United Healthcare Medicare	$13.60
Rate for Payer: WellCare Medicare	$18.70

ANTIBIOTIC SENSITIVITY

Facility

$34.00

Service Code	HCPCS 87186
Hospital Charge Code	4304866
Hospital Revenue Code	300
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$27.20
Rate for Payer: Aetna of NY Commercial	$22.10
Rate for Payer: Aetna of NY Medicare	$15.64
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$13.60
Rate for Payer: Cash Price	$25.50
Rate for Payer: CDPHP Medicare	$12.58
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$20.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$27.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$27.20
Rate for Payer: EmblemHealth Medicaid	$27.20
Rate for Payer: EmblemHealth Medicare	$11.56
Rate for Payer: EmblemHealth Select Care	$20.40
Rate for Payer: Fidelis Medicare	$13.60
Rate for Payer: Galaxy Health Commercial	$22.10
Rate for Payer: Hamaspik Choice Medicare	$13.60
Rate for Payer: Humana Medicare	$13.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$22.10
Rate for Payer: Local 1199SEIU Medicare	$15.64
Rate for Payer: MVP Health Care of NY Commercial	$25.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$19.14
Rate for Payer: MVP Health Care of NY Medicare	$14.28
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$25.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.10
Rate for Payer: United Healthcare Commercial	$25.50
Rate for Payer: United Healthcare Medicare	$13.60
Rate for Payer: WellCare Medicare	$18.70

ANTIBODY EPSTEIN-BARR EB VIRUS VIRAL CAPSID VCA

Facility

$57.00

Service Code	HCPCS 86665
Hospital Charge Code	4302023
Hospital Revenue Code	300
Min. Negotiated Rate	$37.05
Max. Negotiated Rate	$37.05
Rate for Payer: Cash Price	$42.75
Rate for Payer: Galaxy Health Commercial	$37.05

Know your out-of-pocket cost for care.

All Charges