Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

SPINAL NEEDLE 22G X 5.0

Facility

$28.84

Hospital Charge Code	4473035
Hospital Revenue Code	272
Min. Negotiated Rate	$18.75
Max. Negotiated Rate	$18.75
Rate for Payer: Cash Price	$21.63
Rate for Payer: Galaxy Health Commercial	$18.75

SPINAL PUNCTURE LUMBAR DIAGNOSTIC

Facility

$2,164.00

Service Code	HCPCS 62270
Hospital Charge Code	4600155
Hospital Revenue Code	450
Min. Negotiated Rate	$1,406.60
Max. Negotiated Rate	$1,406.60
Rate for Payer: Cash Price	$1,623.00
Rate for Payer: Galaxy Health Commercial	$1,406.60

SPINAL PUNCTURE LUMBAR DIAGNOSTIC

Facility

$2,164.00

Service Code	HCPCS 62270
Hospital Charge Code	4600155
Hospital Revenue Code	450
Min. Negotiated Rate	$324.60
Max. Negotiated Rate	$1,731.20
Rate for Payer: Aetna of NY Commercial	$1,000.00
Rate for Payer: Aetna of NY Medicare	$995.44
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$865.60
Rate for Payer: Cash Price	$1,623.00
Rate for Payer: Cash Price	$1,623.00
Rate for Payer: Cash Price	$1,623.00
Rate for Payer: CDPHP Medicare	$800.68
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,206.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,731.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,731.20
Rate for Payer: EmblemHealth Medicaid	$1,731.20
Rate for Payer: EmblemHealth Medicare	$735.76
Rate for Payer: EmblemHealth Select Care	$1,085.00
Rate for Payer: Fidelis Medicare	$865.60
Rate for Payer: Galaxy Health Commercial	$1,406.60
Rate for Payer: Hamaspik Choice Medicare	$865.60
Rate for Payer: Humana Medicare	$865.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,000.00
Rate for Payer: Local 1199SEIU Medicare	$995.44
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	$908.88
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,009.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$324.60
Rate for Payer: United Healthcare Commercial	$1,009.00
Rate for Payer: United Healthcare Medicare	$865.60
Rate for Payer: WellCare Medicare	$1,190.20

SPINAL TRAY 25GA WHITACRE

Facility

$58.71

Hospital Charge Code	4471393
Hospital Revenue Code	270
Min. Negotiated Rate	$8.81
Max. Negotiated Rate	$46.97
Rate for Payer: Aetna of NY Commercial	$41.10
Rate for Payer: Aetna of NY Medicare	$27.01
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$23.48
Rate for Payer: Cash Price	$44.03
Rate for Payer: CDPHP Medicare	$21.72
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$46.97
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$46.97
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$46.97
Rate for Payer: EmblemHealth Medicaid	$46.97
Rate for Payer: EmblemHealth Medicare	$19.96
Rate for Payer: EmblemHealth Select Care	$42.27
Rate for Payer: Fidelis Medicare	$23.48
Rate for Payer: Galaxy Health Commercial	$38.16
Rate for Payer: Hamaspik Choice Medicare	$23.48
Rate for Payer: Humana Medicare	$23.48
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$41.10
Rate for Payer: Local 1199SEIU Medicare	$27.01
Rate for Payer: MVP Health Care of NY Commercial	$44.03
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$33.05
Rate for Payer: MVP Health Care of NY Medicare	$24.66
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$8.81
Rate for Payer: United Healthcare Medicare	$23.48
Rate for Payer: WellCare Medicare	$32.29

SPINAL TRAY 25GA WHITACRE

Facility

$58.71

Hospital Charge Code	4471393
Hospital Revenue Code	270
Min. Negotiated Rate	$38.16
Max. Negotiated Rate	$38.16
Rate for Payer: Cash Price	$44.03
Rate for Payer: Galaxy Health Commercial	$38.16

Spiriva RESPIMAT 2.5 MCG INH 2.5 mcg, 4 g

Facility

$270.00

Service Code	NDC 597010051
Hospital Charge Code	4401402
Hospital Revenue Code	250
Min. Negotiated Rate	$148.50
Max. Negotiated Rate	$175.50
Rate for Payer: Cash Price	$202.50
Rate for Payer: Galaxy Health Commercial	$175.50
Rate for Payer: WellCare Medicare	$148.50

Spiriva RESPIMAT 2.5 MCG INH 2.5 mcg, 4 g

Facility

$270.00

Service Code	NDC 597010051
Hospital Charge Code	4401402
Hospital Revenue Code	250
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$216.00
Rate for Payer: Aetna of NY Commercial	$189.00
Rate for Payer: Aetna of NY Medicare	$124.20
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$108.00
Rate for Payer: Cash Price	$202.50
Rate for Payer: CDPHP Medicare	$99.90
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$216.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$216.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$216.00
Rate for Payer: EmblemHealth Medicaid	$216.00
Rate for Payer: EmblemHealth Medicare	$91.80
Rate for Payer: EmblemHealth Select Care	$194.40
Rate for Payer: Fidelis Medicare	$108.00
Rate for Payer: Galaxy Health Commercial	$175.50
Rate for Payer: Hamaspik Choice Medicare	$108.00
Rate for Payer: Humana Medicare	$108.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$189.00
Rate for Payer: Local 1199SEIU Medicare	$124.20
Rate for Payer: MVP Health Care of NY Commercial	$202.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$152.01
Rate for Payer: MVP Health Care of NY Medicare	$113.40
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$40.50
Rate for Payer: United Healthcare Medicare	$108.00
Rate for Payer: WellCare Medicare	$148.50

SPIROMETER COACH-2

Facility

$35.02

Hospital Charge Code	4472096
Hospital Revenue Code	270
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$28.02
Rate for Payer: Aetna of NY Commercial	$24.51
Rate for Payer: Aetna of NY Medicare	$16.11
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$14.01
Rate for Payer: Cash Price	$26.26
Rate for Payer: CDPHP Medicare	$12.96
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$28.02
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$28.02
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$28.02
Rate for Payer: EmblemHealth Medicaid	$28.02
Rate for Payer: EmblemHealth Medicare	$11.91
Rate for Payer: EmblemHealth Select Care	$25.21
Rate for Payer: Fidelis Medicare	$14.01
Rate for Payer: Galaxy Health Commercial	$22.76
Rate for Payer: Hamaspik Choice Medicare	$14.01
Rate for Payer: Humana Medicare	$14.01
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$24.51
Rate for Payer: Local 1199SEIU Medicare	$16.11
Rate for Payer: MVP Health Care of NY Commercial	$26.27
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$19.72
Rate for Payer: MVP Health Care of NY Medicare	$14.71
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.25
Rate for Payer: United Healthcare Medicare	$14.01
Rate for Payer: WellCare Medicare	$19.26

SPIROMETER COACH-2

Facility

$35.02

Hospital Charge Code	4472096
Hospital Revenue Code	270
Min. Negotiated Rate	$22.76
Max. Negotiated Rate	$22.76
Rate for Payer: Cash Price	$26.26
Rate for Payer: Galaxy Health Commercial	$22.76

SPIROMETRY

Facility

$662.00

Service Code	HCPCS 94010
Hospital Charge Code	4530044
Hospital Revenue Code	460
Min. Negotiated Rate	$430.30
Max. Negotiated Rate	$430.30
Rate for Payer: Cash Price	$496.50
Rate for Payer: Galaxy Health Commercial	$430.30

SPIROMETRY

Facility

$662.00

Service Code	HCPCS 94010
Hospital Charge Code	4530044
Hospital Revenue Code	460
Min. Negotiated Rate	$99.30
Max. Negotiated Rate	$529.60
Rate for Payer: Aetna of NY Commercial	$463.40
Rate for Payer: Aetna of NY Medicare	$304.52
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$264.80
Rate for Payer: Cash Price	$496.50
Rate for Payer: CDPHP Medicare	$244.94
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$463.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$529.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$529.60
Rate for Payer: EmblemHealth Medicaid	$529.60
Rate for Payer: EmblemHealth Medicare	$225.08
Rate for Payer: EmblemHealth Select Care	$430.30
Rate for Payer: Fidelis Medicare	$264.80
Rate for Payer: Galaxy Health Commercial	$430.30
Rate for Payer: Hamaspik Choice Medicare	$264.80
Rate for Payer: Humana Medicare	$264.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$463.40
Rate for Payer: Local 1199SEIU Medicare	$304.52
Rate for Payer: MVP Health Care of NY Commercial	$496.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$372.71
Rate for Payer: MVP Health Care of NY Medicare	$278.04
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$99.30
Rate for Payer: United Healthcare Medicare	$264.80
Rate for Payer: WellCare Medicare	$364.10

SPIROMTR,VOL INCENT4000ML W

Facility

$10.30

Hospital Charge Code	4471017
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

SPIROMTR,VOL INCENT4000ML W

Facility

$10.30

Hospital Charge Code	4471017
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

SPIRONOLACTONE 25MG TABS 10X10EA

Facility

$6.18

Service Code	NDC 51079010320
Hospital Charge Code	4400717
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

SPIRONOLACTONE 25MG TABS 10X10EA

Facility

$6.18

Service Code	NDC 51079010320
Hospital Charge Code	4400717
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

SPL AVULSE NP; EA ADDTL

Facility

$105.00

Service Code	HCPCS 11732
Hospital Charge Code	4856672
Hospital Revenue Code	761
Min. Negotiated Rate	$15.75
Max. Negotiated Rate	$84.00
Rate for Payer: Aetna of NY Commercial	$73.50
Rate for Payer: Aetna of NY Medicare	$48.30
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$42.00
Rate for Payer: Cash Price	$78.75
Rate for Payer: CDPHP Medicare	$38.85
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$84.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$84.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$84.00
Rate for Payer: EmblemHealth Medicaid	$84.00
Rate for Payer: EmblemHealth Medicare	$35.70
Rate for Payer: EmblemHealth Select Care	$75.60
Rate for Payer: Fidelis Medicare	$42.00
Rate for Payer: Galaxy Health Commercial	$68.25
Rate for Payer: Hamaspik Choice Medicare	$42.00
Rate for Payer: Humana Medicare	$42.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$73.50
Rate for Payer: Local 1199SEIU Medicare	$48.30
Rate for Payer: MVP Health Care of NY Commercial	$78.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$59.12
Rate for Payer: MVP Health Care of NY Medicare	$44.10
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$15.75
Rate for Payer: United Healthcare Medicare	$42.00
Rate for Payer: WellCare Medicare	$57.75

SPL AVULSE NP; EA ADDTL

Facility

$105.00

Service Code	HCPCS 11732
Hospital Charge Code	4856672
Hospital Revenue Code	761
Min. Negotiated Rate	$68.25
Max. Negotiated Rate	$68.25
Rate for Payer: Cash Price	$78.75
Rate for Payer: Galaxy Health Commercial	$68.25

SPONGE GAUZE CURITY 4X4IN 12-P

Facility

$2.06

Hospital Charge Code	4471631
Hospital Revenue Code	270
Min. Negotiated Rate	$1.34
Max. Negotiated Rate	$1.34
Rate for Payer: Cash Price	$1.54
Rate for Payer: Galaxy Health Commercial	$1.34

SPONGE GAUZE CURITY 4X4IN 12-P

Facility

$2.06

Hospital Charge Code	4471631
Hospital Revenue Code	270
Min. Negotiated Rate	$0.31
Max. Negotiated Rate	$1.65
Rate for Payer: Aetna of NY Commercial	$1.44
Rate for Payer: Aetna of NY Medicare	$0.95
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$0.82
Rate for Payer: Cash Price	$1.54
Rate for Payer: CDPHP Medicare	$0.76
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1.65
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1.65
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1.65
Rate for Payer: EmblemHealth Medicaid	$1.65
Rate for Payer: EmblemHealth Medicare	$0.70
Rate for Payer: EmblemHealth Select Care	$1.48
Rate for Payer: Fidelis Medicare	$0.82
Rate for Payer: Galaxy Health Commercial	$1.34
Rate for Payer: Hamaspik Choice Medicare	$0.82
Rate for Payer: Humana Medicare	$0.82
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1.44
Rate for Payer: Local 1199SEIU Medicare	$0.95
Rate for Payer: MVP Health Care of NY Commercial	$1.54
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1.16
Rate for Payer: MVP Health Care of NY Medicare	$0.87
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.31
Rate for Payer: United Healthcare Medicare	$0.82
Rate for Payer: WellCare Medicare	$1.13

SPOT INDIAN INK

Facility

$77.25

Hospital Charge Code	4479078
Hospital Revenue Code	270
Min. Negotiated Rate	$11.59
Max. Negotiated Rate	$61.80
Rate for Payer: Aetna of NY Commercial	$54.08
Rate for Payer: Aetna of NY Medicare	$35.53
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$30.90
Rate for Payer: Cash Price	$57.94
Rate for Payer: CDPHP Medicare	$28.58
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$61.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$61.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$61.80
Rate for Payer: EmblemHealth Medicaid	$61.80
Rate for Payer: EmblemHealth Medicare	$26.27
Rate for Payer: EmblemHealth Select Care	$55.62
Rate for Payer: Fidelis Medicare	$30.90
Rate for Payer: Galaxy Health Commercial	$50.21
Rate for Payer: Hamaspik Choice Medicare	$30.90
Rate for Payer: Humana Medicare	$30.90
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$54.08
Rate for Payer: Local 1199SEIU Medicare	$35.53
Rate for Payer: MVP Health Care of NY Commercial	$57.94
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$43.49
Rate for Payer: MVP Health Care of NY Medicare	$32.45
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$11.59
Rate for Payer: United Healthcare Medicare	$30.90
Rate for Payer: WellCare Medicare	$42.49

SPOT INDIAN INK

Facility

$77.25

Hospital Charge Code	4479078
Hospital Revenue Code	270
Min. Negotiated Rate	$50.21
Max. Negotiated Rate	$50.21
Rate for Payer: Cash Price	$57.94
Rate for Payer: Galaxy Health Commercial	$50.21

SREP S/N/A/G/TR/E; 2.5CM/<

Facility

$615.00

Service Code	HCPCS 12001
Hospital Charge Code	4852000
Hospital Revenue Code	761
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

SREP S/N/A/G/TR/E; 2.5CM/<

Facility

$615.00

Service Code	HCPCS 12001
Hospital Charge Code	4852000
Hospital Revenue Code	761
Min. Negotiated Rate	$92.25
Max. Negotiated Rate	$492.00
Rate for Payer: Aetna of NY Commercial	$430.50
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: CDPHP Medicare	$227.55
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$492.00
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	$442.80
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	$430.50
Rate for Payer: Local 1199SEIU Medicare	$282.90
Rate for Payer: MVP Health Care of NY Commercial	$461.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$346.25
Rate for Payer: MVP Health Care of NY Medicare	$258.30
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$92.25
Rate for Payer: United Healthcare Medicare	$246.00
Rate for Payer: WellCare Medicare	$338.25

STANDARD GRAFT JACKET

Facility

$8,709.68

Hospital Charge Code	4471638
Hospital Revenue Code	270
Min. Negotiated Rate	$5,661.29
Max. Negotiated Rate	$5,661.29
Rate for Payer: Cash Price	$6,532.26
Rate for Payer: Galaxy Health Commercial	$5,661.29

STANDARD GRAFT JACKET

Facility

$8,709.68

Hospital Charge Code	4471638
Hospital Revenue Code	270
Min. Negotiated Rate	$1,306.45
Max. Negotiated Rate	$6,967.74
Rate for Payer: Aetna of NY Commercial	$6,096.78
Rate for Payer: Aetna of NY Medicare	$4,006.45
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$3,483.87
Rate for Payer: Cash Price	$6,532.26
Rate for Payer: CDPHP Medicare	$3,222.58
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$6,967.74
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$6,967.74
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$6,967.74
Rate for Payer: EmblemHealth Medicaid	$6,967.74
Rate for Payer: EmblemHealth Medicare	$2,961.29
Rate for Payer: EmblemHealth Select Care	$6,270.97
Rate for Payer: Fidelis Medicare	$3,483.87
Rate for Payer: Galaxy Health Commercial	$5,661.29
Rate for Payer: Hamaspik Choice Medicare	$3,483.87
Rate for Payer: Humana Medicare	$3,483.87
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$6,096.78
Rate for Payer: Local 1199SEIU Medicare	$4,006.45
Rate for Payer: MVP Health Care of NY Commercial	$6,532.26
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$4,903.55
Rate for Payer: MVP Health Care of NY Medicare	$3,658.07
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,306.45
Rate for Payer: United Healthcare Medicare	$3,483.87
Rate for Payer: WellCare Medicare	$4,790.32

Know your out-of-pocket cost for care.

All Charges