Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

SODIUM POLYSTYRENE SULFONATE 15GM/60ML S

Facility

$34.76

Service Code	NDC 46287000660
Hospital Charge Code	4400719
Hospital Revenue Code	250
Min. Negotiated Rate	$19.12
Max. Negotiated Rate	$22.59
Rate for Payer: Cash Price	$26.07
Rate for Payer: Galaxy Health Commercial	$22.59
Rate for Payer: WellCare Medicare	$19.12

SODIUM POLYSTYRENE SULFONATE 15GM/60ML S

Facility

$34.76

Service Code	NDC 46287000660
Hospital Charge Code	4400719
Hospital Revenue Code	250
Min. Negotiated Rate	$5.21
Max. Negotiated Rate	$27.81
Rate for Payer: Aetna of NY Commercial	$24.33
Rate for Payer: Aetna of NY Medicare	$15.99
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$13.90
Rate for Payer: Cash Price	$26.07
Rate for Payer: CDPHP Medicare	$12.86
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$27.81
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$27.81
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$27.81
Rate for Payer: EmblemHealth Medicaid	$27.81
Rate for Payer: EmblemHealth Medicare	$11.82
Rate for Payer: EmblemHealth Select Care	$25.03
Rate for Payer: Fidelis Medicare	$13.90
Rate for Payer: Galaxy Health Commercial	$22.59
Rate for Payer: Hamaspik Choice Medicare	$13.90
Rate for Payer: Humana Medicare	$13.90
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$24.33
Rate for Payer: Local 1199SEIU Medicare	$15.99
Rate for Payer: MVP Health Care of NY Commercial	$26.07
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$19.57
Rate for Payer: MVP Health Care of NY Medicare	$14.60
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.21
Rate for Payer: United Healthcare Medicare	$13.90
Rate for Payer: WellCare Medicare	$19.12

SODIUM SERUM

Facility

$14.00

Service Code	HCPCS 84295
Hospital Charge Code	4300734
Hospital Revenue Code	301
Min. Negotiated Rate	$9.10
Max. Negotiated Rate	$9.10
Rate for Payer: Cash Price	$10.50
Rate for Payer: Galaxy Health Commercial	$9.10

SODIUM SERUM

Facility

$14.00

Service Code	HCPCS 84295
Hospital Charge Code	4300734
Hospital Revenue Code	301
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$11.20
Rate for Payer: Aetna of NY Commercial	$9.10
Rate for Payer: Aetna of NY Medicare	$6.44
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$5.60
Rate for Payer: Cash Price	$10.50
Rate for Payer: CDPHP Medicare	$5.18
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$8.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$11.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$11.20
Rate for Payer: EmblemHealth Medicaid	$11.20
Rate for Payer: EmblemHealth Medicare	$4.76
Rate for Payer: EmblemHealth Select Care	$8.40
Rate for Payer: Fidelis Medicare	$5.60
Rate for Payer: Galaxy Health Commercial	$9.10
Rate for Payer: Hamaspik Choice Medicare	$5.60
Rate for Payer: Humana Medicare	$5.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$9.10
Rate for Payer: Local 1199SEIU Medicare	$6.44
Rate for Payer: MVP Health Care of NY Commercial	$10.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$7.88
Rate for Payer: MVP Health Care of NY Medicare	$5.88
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$10.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.10
Rate for Payer: United Healthcare Commercial	$10.50
Rate for Payer: United Healthcare Medicare	$5.60
Rate for Payer: WellCare Medicare	$7.70

SODIUM URINE 24 HR

Facility

$15.00

Service Code	HCPCS 84300
Hospital Charge Code	4300735
Hospital Revenue Code	301
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna of NY Commercial	$9.75
Rate for Payer: Aetna of NY Medicare	$6.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$6.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: CDPHP Medicare	$5.55
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$9.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$12.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$12.00
Rate for Payer: EmblemHealth Medicaid	$12.00
Rate for Payer: EmblemHealth Medicare	$5.10
Rate for Payer: EmblemHealth Select Care	$9.00
Rate for Payer: Fidelis Medicare	$6.00
Rate for Payer: Galaxy Health Commercial	$9.75
Rate for Payer: Hamaspik Choice Medicare	$6.00
Rate for Payer: Humana Medicare	$6.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$9.75
Rate for Payer: Local 1199SEIU Medicare	$6.90
Rate for Payer: MVP Health Care of NY Commercial	$11.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$8.45
Rate for Payer: MVP Health Care of NY Medicare	$6.30
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$11.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.25
Rate for Payer: United Healthcare Commercial	$11.25
Rate for Payer: United Healthcare Medicare	$6.00
Rate for Payer: WellCare Medicare	$8.25

SODIUM URINE 24 HR

Facility

$15.00

Service Code	HCPCS 84300
Hospital Charge Code	4300735
Hospital Revenue Code	301
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Cash Price	$11.25
Rate for Payer: Galaxy Health Commercial	$9.75

SOFSILK 4-0

Facility

$15.45

Hospital Charge Code	4479301
Hospital Revenue Code	270
Min. Negotiated Rate	$2.32
Max. Negotiated Rate	$12.36
Rate for Payer: Aetna of NY Commercial	$10.81
Rate for Payer: Aetna of NY Medicare	$7.11
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$6.18
Rate for Payer: Cash Price	$11.59
Rate for Payer: CDPHP Medicare	$5.72
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$12.36
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$12.36
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$12.36
Rate for Payer: EmblemHealth Medicaid	$12.36
Rate for Payer: EmblemHealth Medicare	$5.25
Rate for Payer: EmblemHealth Select Care	$11.12
Rate for Payer: Fidelis Medicare	$6.18
Rate for Payer: Galaxy Health Commercial	$10.04
Rate for Payer: Hamaspik Choice Medicare	$6.18
Rate for Payer: Humana Medicare	$6.18
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$10.81
Rate for Payer: Local 1199SEIU Medicare	$7.11
Rate for Payer: MVP Health Care of NY Commercial	$11.59
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$8.70
Rate for Payer: MVP Health Care of NY Medicare	$6.49
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.32
Rate for Payer: United Healthcare Medicare	$6.18
Rate for Payer: WellCare Medicare	$8.50

SOFSILK 4-0

Facility

$15.45

Hospital Charge Code	4479301
Hospital Revenue Code	270
Min. Negotiated Rate	$10.04
Max. Negotiated Rate	$10.04
Rate for Payer: Cash Price	$11.59
Rate for Payer: Galaxy Health Commercial	$10.04

SOLIFENACIN SUCCINATE 5MG TABS 30 EA

Facility

$35.79

Service Code	NDC 51248015052
Hospital Charge Code	4400800
Hospital Revenue Code	250
Min. Negotiated Rate	$19.68
Max. Negotiated Rate	$23.26
Rate for Payer: Cash Price	$26.84
Rate for Payer: Galaxy Health Commercial	$23.26
Rate for Payer: WellCare Medicare	$19.68

SOLIFENACIN SUCCINATE 5MG TABS 30 EA

Facility

$35.79

Service Code	NDC 51248015052
Hospital Charge Code	4400800
Hospital Revenue Code	250
Min. Negotiated Rate	$5.37
Max. Negotiated Rate	$28.63
Rate for Payer: Aetna of NY Commercial	$25.05
Rate for Payer: Aetna of NY Medicare	$16.46
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$14.32
Rate for Payer: Cash Price	$26.84
Rate for Payer: CDPHP Medicare	$13.24
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$28.63
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$28.63
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$28.63
Rate for Payer: EmblemHealth Medicaid	$28.63
Rate for Payer: EmblemHealth Medicare	$12.17
Rate for Payer: EmblemHealth Select Care	$25.77
Rate for Payer: Fidelis Medicare	$14.32
Rate for Payer: Galaxy Health Commercial	$23.26
Rate for Payer: Hamaspik Choice Medicare	$14.32
Rate for Payer: Humana Medicare	$14.32
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$25.05
Rate for Payer: Local 1199SEIU Medicare	$16.46
Rate for Payer: MVP Health Care of NY Commercial	$26.84
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$20.15
Rate for Payer: MVP Health Care of NY Medicare	$15.03
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.37
Rate for Payer: United Healthcare Medicare	$14.32
Rate for Payer: WellCare Medicare	$19.68

SOLUTION SURGICAL DURAPREP 26M

Facility

$22.66

Hospital Charge Code	4471994
Hospital Revenue Code	270
Min. Negotiated Rate	$14.73
Max. Negotiated Rate	$14.73
Rate for Payer: Cash Price	$17.00
Rate for Payer: Galaxy Health Commercial	$14.73

SOLUTION SURGICAL DURAPREP 26M

Facility

$22.66

Hospital Charge Code	4471994
Hospital Revenue Code	270
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$18.13
Rate for Payer: Aetna of NY Commercial	$15.86
Rate for Payer: Aetna of NY Medicare	$10.42
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$9.06
Rate for Payer: Cash Price	$17.00
Rate for Payer: CDPHP Medicare	$8.38
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$18.13
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$18.13
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$18.13
Rate for Payer: EmblemHealth Medicaid	$18.13
Rate for Payer: EmblemHealth Medicare	$7.70
Rate for Payer: EmblemHealth Select Care	$16.32
Rate for Payer: Fidelis Medicare	$9.06
Rate for Payer: Galaxy Health Commercial	$14.73
Rate for Payer: Hamaspik Choice Medicare	$9.06
Rate for Payer: Humana Medicare	$9.06
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$15.86
Rate for Payer: Local 1199SEIU Medicare	$10.42
Rate for Payer: MVP Health Care of NY Commercial	$17.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$12.76
Rate for Payer: MVP Health Care of NY Medicare	$9.52
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3.40
Rate for Payer: United Healthcare Medicare	$9.06
Rate for Payer: WellCare Medicare	$12.46

SOLUTION SURGICAL DURAPREP 6M

Facility

$10.30

Hospital Charge Code	4471995
Hospital Revenue Code	270
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$8.24
Rate for Payer: Aetna of NY Commercial	$7.21
Rate for Payer: Aetna of NY Medicare	$4.74
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$4.12
Rate for Payer: Cash Price	$7.72
Rate for Payer: CDPHP Medicare	$3.81
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$8.24
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$8.24
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$8.24
Rate for Payer: EmblemHealth Medicaid	$8.24
Rate for Payer: EmblemHealth Medicare	$3.50
Rate for Payer: EmblemHealth Select Care	$7.42
Rate for Payer: Fidelis Medicare	$4.12
Rate for Payer: Galaxy Health Commercial	$6.70
Rate for Payer: Hamaspik Choice Medicare	$4.12
Rate for Payer: Humana Medicare	$4.12
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$7.21
Rate for Payer: Local 1199SEIU Medicare	$4.74
Rate for Payer: MVP Health Care of NY Commercial	$7.72
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$5.80
Rate for Payer: MVP Health Care of NY Medicare	$4.33
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.54
Rate for Payer: United Healthcare Medicare	$4.12
Rate for Payer: WellCare Medicare	$5.67

SOLUTION SURGICAL DURAPREP 6M

Facility

$10.30

Hospital Charge Code	4471995
Hospital Revenue Code	270
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$6.70
Rate for Payer: Cash Price	$7.72
Rate for Payer: Galaxy Health Commercial	$6.70

SONNET SHORT THROW SNARE STAND

Facility

$103.00

Hospital Charge Code	4470911
Hospital Revenue Code	270
Min. Negotiated Rate	$15.45
Max. Negotiated Rate	$82.40
Rate for Payer: Aetna of NY Commercial	$72.10
Rate for Payer: Aetna of NY Medicare	$47.38
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$41.20
Rate for Payer: Cash Price	$77.25
Rate for Payer: CDPHP Medicare	$38.11
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$82.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$82.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$82.40
Rate for Payer: EmblemHealth Medicaid	$82.40
Rate for Payer: EmblemHealth Medicare	$35.02
Rate for Payer: EmblemHealth Select Care	$74.16
Rate for Payer: Fidelis Medicare	$41.20
Rate for Payer: Galaxy Health Commercial	$66.95
Rate for Payer: Hamaspik Choice Medicare	$41.20
Rate for Payer: Humana Medicare	$41.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$72.10
Rate for Payer: Local 1199SEIU Medicare	$47.38
Rate for Payer: MVP Health Care of NY Commercial	$77.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$57.99
Rate for Payer: MVP Health Care of NY Medicare	$43.26
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$15.45
Rate for Payer: United Healthcare Medicare	$41.20
Rate for Payer: WellCare Medicare	$56.65

SONNET SHORT THROW SNARE STAND

Facility

$103.00

Hospital Charge Code	4470911
Hospital Revenue Code	270
Min. Negotiated Rate	$66.95
Max. Negotiated Rate	$66.95
Rate for Payer: Cash Price	$77.25
Rate for Payer: Galaxy Health Commercial	$66.95

SOTALOL HCL 80MG TABS 100 EA

Facility

$6.18

Service Code	NDC 93106101
Hospital Charge Code	4400715
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

SOTALOL HCL 80MG TABS 100 EA

Facility

$6.18

Service Code	NDC 93106101
Hospital Charge Code	4400715
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

SPECIAL STAIN GROUP 1 MICROORGANISMS I&R

Facility

$160.00

Service Code	HCPCS 88312 TC
Hospital Charge Code	4008312
Hospital Revenue Code	310
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$128.00
Rate for Payer: Aetna of NY Commercial	$104.00
Rate for Payer: Aetna of NY Medicare	$73.60
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$64.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: CDPHP Medicare	$59.20
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$96.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$128.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$128.00
Rate for Payer: EmblemHealth Medicaid	$128.00
Rate for Payer: EmblemHealth Medicare	$54.40
Rate for Payer: EmblemHealth Select Care	$96.00
Rate for Payer: Fidelis Medicare	$64.00
Rate for Payer: Galaxy Health Commercial	$104.00
Rate for Payer: Hamaspik Choice Medicare	$64.00
Rate for Payer: Humana Medicare	$64.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$104.00
Rate for Payer: Local 1199SEIU Medicare	$73.60
Rate for Payer: MVP Health Care of NY Commercial	$120.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$90.08
Rate for Payer: MVP Health Care of NY Medicare	$67.20
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$120.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$24.00
Rate for Payer: United Healthcare Commercial	$120.00
Rate for Payer: United Healthcare Medicare	$64.00
Rate for Payer: WellCare Medicare	$88.00

SPECIAL STAIN GROUP 1 MICROORGANISMS I&R

Facility

$160.00

Service Code	HCPCS 88312 TC
Hospital Charge Code	4008312
Hospital Revenue Code	310
Min. Negotiated Rate	$104.00
Max. Negotiated Rate	$104.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Galaxy Health Commercial	$104.00

SPECIMEN COLLECNTION OR ONLY

Facility

$22.66

Hospital Charge Code	4000343
Hospital Revenue Code	270
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$18.13
Rate for Payer: Aetna of NY Commercial	$15.86
Rate for Payer: Aetna of NY Medicare	$10.42
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$9.06
Rate for Payer: Cash Price	$17.00
Rate for Payer: CDPHP Medicare	$8.38
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$18.13
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$18.13
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$18.13
Rate for Payer: EmblemHealth Medicaid	$18.13
Rate for Payer: EmblemHealth Medicare	$7.70
Rate for Payer: EmblemHealth Select Care	$16.32
Rate for Payer: Fidelis Medicare	$9.06
Rate for Payer: Galaxy Health Commercial	$14.73
Rate for Payer: Hamaspik Choice Medicare	$9.06
Rate for Payer: Humana Medicare	$9.06
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$15.86
Rate for Payer: Local 1199SEIU Medicare	$10.42
Rate for Payer: MVP Health Care of NY Commercial	$17.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$12.76
Rate for Payer: MVP Health Care of NY Medicare	$9.52
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3.40
Rate for Payer: United Healthcare Medicare	$9.06
Rate for Payer: WellCare Medicare	$12.46

SPECIMEN COLLECNTION OR ONLY

Facility

$22.66

Hospital Charge Code	4000343
Hospital Revenue Code	270
Min. Negotiated Rate	$14.73
Max. Negotiated Rate	$14.73
Rate for Payer: Cash Price	$17.00
Rate for Payer: Galaxy Health Commercial	$14.73

SPECTROPHOTOMETRY ANALYTE NES

Facility

$24.00

Service Code	HCPCS 84311
Hospital Charge Code	4301070
Hospital Revenue Code	301
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$19.20
Rate for Payer: Aetna of NY Commercial	$15.60
Rate for Payer: Aetna of NY Medicare	$11.04
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$9.60
Rate for Payer: Cash Price	$18.00
Rate for Payer: CDPHP Medicare	$8.88
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$14.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$19.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$19.20
Rate for Payer: EmblemHealth Medicaid	$19.20
Rate for Payer: EmblemHealth Medicare	$8.16
Rate for Payer: EmblemHealth Select Care	$14.40
Rate for Payer: Fidelis Medicare	$9.60
Rate for Payer: Galaxy Health Commercial	$15.60
Rate for Payer: Hamaspik Choice Medicare	$9.60
Rate for Payer: Humana Medicare	$9.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$15.60
Rate for Payer: Local 1199SEIU Medicare	$11.04
Rate for Payer: MVP Health Care of NY Commercial	$18.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$13.51
Rate for Payer: MVP Health Care of NY Medicare	$10.08
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$18.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3.60
Rate for Payer: United Healthcare Commercial	$18.00
Rate for Payer: United Healthcare Medicare	$9.60
Rate for Payer: WellCare Medicare	$13.20

SPECTROPHOTOMETRY ANALYTE NES

Facility

$24.00

Service Code	HCPCS 84311
Hospital Charge Code	4301070
Hospital Revenue Code	301
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$15.60
Rate for Payer: Cash Price	$18.00
Rate for Payer: Galaxy Health Commercial	$15.60

SPINAL NEEDLE 22G X 5.0

Facility

$28.84

Hospital Charge Code	4473035
Hospital Revenue Code	272
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$23.07
Rate for Payer: Aetna of NY Commercial	$20.19
Rate for Payer: Aetna of NY Medicare	$13.27
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$11.54
Rate for Payer: Cash Price	$21.63
Rate for Payer: CDPHP Medicare	$10.67
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$23.07
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$23.07
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$23.07
Rate for Payer: EmblemHealth Medicaid	$23.07
Rate for Payer: EmblemHealth Medicare	$9.81
Rate for Payer: EmblemHealth Select Care	$20.76
Rate for Payer: Fidelis Medicare	$11.54
Rate for Payer: Galaxy Health Commercial	$18.75
Rate for Payer: Hamaspik Choice Medicare	$11.54
Rate for Payer: Humana Medicare	$11.54
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$20.19
Rate for Payer: Local 1199SEIU Medicare	$13.27
Rate for Payer: MVP Health Care of NY Commercial	$21.63
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$16.24
Rate for Payer: MVP Health Care of NY Medicare	$12.11
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4.33
Rate for Payer: United Healthcare Medicare	$11.54
Rate for Payer: WellCare Medicare	$15.86

Know your out-of-pocket cost for care.

All Charges