Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

SUTURELESS CATH

Facility

$2,487.45

Hospital Charge Code	4471642
Hospital Revenue Code	270
Min. Negotiated Rate	$373.12
Max. Negotiated Rate	$1,989.96
Rate for Payer: Aetna of NY Commercial	$1,741.21
Rate for Payer: Aetna of NY Medicare	$1,144.23
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$994.98
Rate for Payer: Cash Price	$1,865.59
Rate for Payer: CDPHP Medicare	$920.36
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,989.96
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,989.96
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,989.96
Rate for Payer: EmblemHealth Medicaid	$1,989.96
Rate for Payer: EmblemHealth Medicare	$845.73
Rate for Payer: EmblemHealth Select Care	$1,790.96
Rate for Payer: Fidelis Medicare	$994.98
Rate for Payer: Galaxy Health Commercial	$1,616.84
Rate for Payer: Hamaspik Choice Medicare	$994.98
Rate for Payer: Humana Medicare	$994.98
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,741.21
Rate for Payer: Local 1199SEIU Medicare	$1,144.23
Rate for Payer: MVP Health Care of NY Commercial	$1,865.59
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,400.43
Rate for Payer: MVP Health Care of NY Medicare	$1,044.73
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$373.12
Rate for Payer: United Healthcare Medicare	$994.98
Rate for Payer: WellCare Medicare	$1,368.10

SUTURELESS CATH

Facility

$2,487.45

Hospital Charge Code	4471642
Hospital Revenue Code	270
Min. Negotiated Rate	$1,616.84
Max. Negotiated Rate	$1,616.84
Rate for Payer: Cash Price	$1,865.59
Rate for Payer: Galaxy Health Commercial	$1,616.84

SUTURE LOOP GUIDE RODS

Facility

$715.85

Hospital Charge Code	4471640
Hospital Revenue Code	270
Min. Negotiated Rate	$107.38
Max. Negotiated Rate	$572.68
Rate for Payer: Aetna of NY Commercial	$501.10
Rate for Payer: Aetna of NY Medicare	$329.29
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$286.34
Rate for Payer: Cash Price	$536.89
Rate for Payer: CDPHP Medicare	$264.86
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$572.68
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$572.68
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$572.68
Rate for Payer: EmblemHealth Medicaid	$572.68
Rate for Payer: EmblemHealth Medicare	$243.39
Rate for Payer: EmblemHealth Select Care	$515.41
Rate for Payer: Fidelis Medicare	$286.34
Rate for Payer: Galaxy Health Commercial	$465.30
Rate for Payer: Hamaspik Choice Medicare	$286.34
Rate for Payer: Humana Medicare	$286.34
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$501.10
Rate for Payer: Local 1199SEIU Medicare	$329.29
Rate for Payer: MVP Health Care of NY Commercial	$536.89
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$403.02
Rate for Payer: MVP Health Care of NY Medicare	$300.66
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$107.38
Rate for Payer: United Healthcare Medicare	$286.34
Rate for Payer: WellCare Medicare	$393.72

SUTURE LOOP GUIDE RODS

Facility

$715.85

Hospital Charge Code	4471640
Hospital Revenue Code	270
Min. Negotiated Rate	$465.30
Max. Negotiated Rate	$465.30
Rate for Payer: Cash Price	$536.89
Rate for Payer: Galaxy Health Commercial	$465.30

SUTURE POLYSORB 0 6X18IN VIO

Facility

$23.69

Hospital Charge Code	4471969
Hospital Revenue Code	270
Min. Negotiated Rate	$15.40
Max. Negotiated Rate	$15.40
Rate for Payer: Cash Price	$17.77
Rate for Payer: Galaxy Health Commercial	$15.40

SUTURE POLYSORB 0 6X18IN VIO

Facility

$23.69

Hospital Charge Code	4471969
Hospital Revenue Code	270
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$18.95
Rate for Payer: Aetna of NY Commercial	$16.58
Rate for Payer: Aetna of NY Medicare	$10.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$9.48
Rate for Payer: Cash Price	$17.77
Rate for Payer: CDPHP Medicare	$8.77
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$18.95
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$18.95
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$18.95
Rate for Payer: EmblemHealth Medicaid	$18.95
Rate for Payer: EmblemHealth Medicare	$8.05
Rate for Payer: EmblemHealth Select Care	$17.06
Rate for Payer: Fidelis Medicare	$9.48
Rate for Payer: Galaxy Health Commercial	$15.40
Rate for Payer: Hamaspik Choice Medicare	$9.48
Rate for Payer: Humana Medicare	$9.48
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$16.58
Rate for Payer: Local 1199SEIU Medicare	$10.90
Rate for Payer: MVP Health Care of NY Commercial	$17.77
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$13.34
Rate for Payer: MVP Health Care of NY Medicare	$9.95
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3.55
Rate for Payer: United Healthcare Medicare	$9.48
Rate for Payer: WellCare Medicare	$13.03

SUTURE/REPAIR TESTICULAR INJURY

Facility

$10,804.00

Service Code	HCPCS 54670
Hospital Charge Code	4002054
Hospital Revenue Code	490
Min. Negotiated Rate	$1,620.60
Max. Negotiated Rate	$8,643.20
Rate for Payer: Aetna of NY Commercial	$1,900.00
Rate for Payer: Aetna of NY Medicare	$4,969.84
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$4,321.60
Rate for Payer: Cash Price	$8,103.00
Rate for Payer: Cash Price	$8,103.00
Rate for Payer: CDPHP Medicare	$3,997.48
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$8,643.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$8,643.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$8,643.20
Rate for Payer: EmblemHealth Medicaid	$8,643.20
Rate for Payer: EmblemHealth Medicare	$3,673.36
Rate for Payer: EmblemHealth Select Care	$7,778.88
Rate for Payer: Fidelis Medicare	$4,321.60
Rate for Payer: Galaxy Health Commercial	$7,022.60
Rate for Payer: Hamaspik Choice Medicare	$4,321.60
Rate for Payer: Humana Medicare	$4,321.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,900.00
Rate for Payer: Local 1199SEIU Medicare	$4,969.84
Rate for Payer: Multiplan Commercial	$8,643.20
Rate for Payer: MVP Health Care of NY Commercial	$8,103.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$6,082.65
Rate for Payer: MVP Health Care of NY Medicare	$4,537.68
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$2,097.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,620.60
Rate for Payer: United Healthcare Commercial	$2,097.00
Rate for Payer: United Healthcare Medicare	$4,321.60
Rate for Payer: WellCare Medicare	$5,942.20

SUTURE/REPAIR TESTICULAR INJURY

Facility

$10,804.00

Service Code	HCPCS 54670
Hospital Charge Code	4002054
Hospital Revenue Code	490
Min. Negotiated Rate	$7,022.60
Max. Negotiated Rate	$7,022.60
Rate for Payer: Cash Price	$8,103.00
Rate for Payer: Galaxy Health Commercial	$7,022.60

SUTURES POLYSORB

Facility

$11.33

Hospital Charge Code	4472186
Hospital Revenue Code	270
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$7.36
Rate for Payer: Cash Price	$8.50
Rate for Payer: Galaxy Health Commercial	$7.36

SUTURES POLYSORB

Facility

$11.33

Hospital Charge Code	4472186
Hospital Revenue Code	270
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$9.06
Rate for Payer: Aetna of NY Commercial	$7.93
Rate for Payer: Aetna of NY Medicare	$5.21
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$4.53
Rate for Payer: Cash Price	$8.50
Rate for Payer: CDPHP Medicare	$4.19
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$9.06
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$9.06
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$9.06
Rate for Payer: EmblemHealth Medicaid	$9.06
Rate for Payer: EmblemHealth Medicare	$3.85
Rate for Payer: EmblemHealth Select Care	$8.16
Rate for Payer: Fidelis Medicare	$4.53
Rate for Payer: Galaxy Health Commercial	$7.36
Rate for Payer: Hamaspik Choice Medicare	$4.53
Rate for Payer: Humana Medicare	$4.53
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$7.93
Rate for Payer: Local 1199SEIU Medicare	$5.21
Rate for Payer: MVP Health Care of NY Commercial	$8.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$6.38
Rate for Payer: MVP Health Care of NY Medicare	$4.76
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.70
Rate for Payer: United Healthcare Medicare	$4.53
Rate for Payer: WellCare Medicare	$6.23

SUTURE SURGILON 1 5X18IN BLAC

Facility

$37.08

Hospital Charge Code	4471183
Hospital Revenue Code	270
Min. Negotiated Rate	$5.56
Max. Negotiated Rate	$29.66
Rate for Payer: Aetna of NY Commercial	$25.96
Rate for Payer: Aetna of NY Medicare	$17.06
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$14.83
Rate for Payer: Cash Price	$27.81
Rate for Payer: CDPHP Medicare	$13.72
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$29.66
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$29.66
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$29.66
Rate for Payer: EmblemHealth Medicaid	$29.66
Rate for Payer: EmblemHealth Medicare	$12.61
Rate for Payer: EmblemHealth Select Care	$26.70
Rate for Payer: Fidelis Medicare	$14.83
Rate for Payer: Galaxy Health Commercial	$24.10
Rate for Payer: Hamaspik Choice Medicare	$14.83
Rate for Payer: Humana Medicare	$14.83
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$25.96
Rate for Payer: Local 1199SEIU Medicare	$17.06
Rate for Payer: MVP Health Care of NY Commercial	$27.81
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$20.88
Rate for Payer: MVP Health Care of NY Medicare	$15.57
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.56
Rate for Payer: United Healthcare Medicare	$14.83
Rate for Payer: WellCare Medicare	$20.39

SUTURE SURGILON 1 5X18IN BLAC

Facility

$37.08

Hospital Charge Code	4471183
Hospital Revenue Code	270
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$24.10
Rate for Payer: Cash Price	$27.81
Rate for Payer: Galaxy Health Commercial	$24.10

SUTURE TRAY ER

Facility

$39.14

Hospital Charge Code	4609638
Hospital Revenue Code	270
Min. Negotiated Rate	$25.44
Max. Negotiated Rate	$25.44
Rate for Payer: Cash Price	$29.36
Rate for Payer: Galaxy Health Commercial	$25.44

SUTURE TRAY ER

Facility

$39.14

Hospital Charge Code	4609638
Hospital Revenue Code	270
Min. Negotiated Rate	$5.87
Max. Negotiated Rate	$31.31
Rate for Payer: Aetna of NY Commercial	$27.40
Rate for Payer: Aetna of NY Medicare	$18.00
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$15.66
Rate for Payer: Cash Price	$29.36
Rate for Payer: CDPHP Medicare	$14.48
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$31.31
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$31.31
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$31.31
Rate for Payer: EmblemHealth Medicaid	$31.31
Rate for Payer: EmblemHealth Medicare	$13.31
Rate for Payer: EmblemHealth Select Care	$28.18
Rate for Payer: Fidelis Medicare	$15.66
Rate for Payer: Galaxy Health Commercial	$25.44
Rate for Payer: Hamaspik Choice Medicare	$15.66
Rate for Payer: Humana Medicare	$15.66
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$27.40
Rate for Payer: Local 1199SEIU Medicare	$18.00
Rate for Payer: MVP Health Care of NY Commercial	$29.36
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$22.04
Rate for Payer: MVP Health Care of NY Medicare	$16.44
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.87
Rate for Payer: United Healthcare Medicare	$15.66
Rate for Payer: WellCare Medicare	$21.53

SUTURE VICRYL 0 18IN VIOLET

Facility

$503.67

Hospital Charge Code	4471860
Hospital Revenue Code	270
Min. Negotiated Rate	$75.55
Max. Negotiated Rate	$402.94
Rate for Payer: Aetna of NY Commercial	$352.57
Rate for Payer: Aetna of NY Medicare	$231.69
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$201.47
Rate for Payer: Cash Price	$377.75
Rate for Payer: CDPHP Medicare	$186.36
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$402.94
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$402.94
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$402.94
Rate for Payer: EmblemHealth Medicaid	$402.94
Rate for Payer: EmblemHealth Medicare	$171.25
Rate for Payer: EmblemHealth Select Care	$362.64
Rate for Payer: Fidelis Medicare	$201.47
Rate for Payer: Galaxy Health Commercial	$327.39
Rate for Payer: Hamaspik Choice Medicare	$201.47
Rate for Payer: Humana Medicare	$201.47
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$352.57
Rate for Payer: Local 1199SEIU Medicare	$231.69
Rate for Payer: MVP Health Care of NY Commercial	$377.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$283.57
Rate for Payer: MVP Health Care of NY Medicare	$211.54
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$75.55
Rate for Payer: United Healthcare Medicare	$201.47
Rate for Payer: WellCare Medicare	$277.02

SUTURE VICRYL 0 18IN VIOLET

Facility

$503.67

Hospital Charge Code	4471860
Hospital Revenue Code	270
Min. Negotiated Rate	$327.39
Max. Negotiated Rate	$327.39
Rate for Payer: Cash Price	$377.75
Rate for Payer: Galaxy Health Commercial	$327.39

SWALLOWING FCN W CINE/VIDEO

Facility

$78.00

Service Code	HCPCS 74230 26
Hospital Charge Code	5150350
Hospital Revenue Code	960
Min. Negotiated Rate	$50.70
Max. Negotiated Rate	$50.70
Rate for Payer: Cash Price	$58.50
Rate for Payer: Galaxy Health Commercial	$50.70

SWALLOWING FCN W CINE/VIDEO

Facility

$78.00

Service Code	HCPCS 74230 26
Hospital Charge Code	5150350
Hospital Revenue Code	960
Min. Negotiated Rate	$11.70
Max. Negotiated Rate	$62.40
Rate for Payer: Aetna of NY Commercial	$54.60
Rate for Payer: Aetna of NY Medicare	$35.88
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$31.20
Rate for Payer: Cash Price	$58.50
Rate for Payer: CDPHP Medicare	$28.86
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$62.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$62.40
Rate for Payer: EmblemHealth Medicaid	$62.40
Rate for Payer: EmblemHealth Medicare	$26.52
Rate for Payer: Fidelis Medicare	$31.20
Rate for Payer: Galaxy Health Commercial	$50.70
Rate for Payer: Hamaspik Choice Medicare	$31.20
Rate for Payer: Humana Medicare	$31.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$54.60
Rate for Payer: Local 1199SEIU Medicare	$35.88
Rate for Payer: MVP Health Care of NY Commercial	$58.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$43.91
Rate for Payer: MVP Health Care of NY Medicare	$32.76
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$11.70
Rate for Payer: United Healthcare Medicare	$31.20
Rate for Payer: WellCare Medicare	$42.90

SWALLOWING FCN W CINE/VIDEO

Facility

$538.00

Service Code	HCPCS 74230 TC
Hospital Charge Code	4150350
Hospital Revenue Code	320
Min. Negotiated Rate	$349.70
Max. Negotiated Rate	$349.70
Rate for Payer: Cash Price	$403.50
Rate for Payer: Galaxy Health Commercial	$349.70

SWALLOWING FCN W CINE/VIDEO

Facility

$538.00

Service Code	HCPCS 74230 TC
Hospital Charge Code	4150350
Hospital Revenue Code	320
Min. Negotiated Rate	$80.70
Max. Negotiated Rate	$430.40
Rate for Payer: Aetna of NY Commercial	$322.80
Rate for Payer: Aetna of NY Medicare	$247.48
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$215.20
Rate for Payer: Cash Price	$403.50
Rate for Payer: Cash Price	$403.50
Rate for Payer: CDPHP Medicare	$199.06
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$376.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$430.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$430.40
Rate for Payer: EmblemHealth Medicaid	$430.40
Rate for Payer: EmblemHealth Medicare	$182.92
Rate for Payer: EmblemHealth Select Care	$349.70
Rate for Payer: Fidelis Medicare	$215.20
Rate for Payer: Galaxy Health Commercial	$349.70
Rate for Payer: Hamaspik Choice Medicare	$215.20
Rate for Payer: Humana Medicare	$215.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$322.80
Rate for Payer: Local 1199SEIU Medicare	$247.48
Rate for Payer: MVP Health Care of NY Commercial	$403.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$302.89
Rate for Payer: MVP Health Care of NY Medicare	$225.96
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$402.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$80.70
Rate for Payer: United Healthcare Commercial	$402.00
Rate for Payer: United Healthcare Medicare	$215.20
Rate for Payer: WellCare Medicare	$295.90

SYNCHROMED II PUMP

Facility

$43,119.92

Service Code	HCPCS C1772
Hospital Charge Code	4471639
Hospital Revenue Code	278
Min. Negotiated Rate	$6,467.99
Max. Negotiated Rate	$34,495.94
Rate for Payer: Aetna of NY Commercial	$30,183.94
Rate for Payer: Aetna of NY Medicare	$19,835.16
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$17,247.97
Rate for Payer: Cash Price	$32,339.94
Rate for Payer: CDPHP Medicare	$15,954.37
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$21,559.96
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$34,495.94
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$34,495.94
Rate for Payer: EmblemHealth Medicaid	$34,495.94
Rate for Payer: EmblemHealth Medicare	$14,660.77
Rate for Payer: EmblemHealth Select Care	$21,559.96
Rate for Payer: Fidelis Medicare	$17,247.97
Rate for Payer: Galaxy Health Commercial	$28,027.95
Rate for Payer: Hamaspik Choice Medicare	$17,247.97
Rate for Payer: Humana Medicare	$17,247.97
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$30,183.94
Rate for Payer: Local 1199SEIU Medicare	$19,835.16
Rate for Payer: MVP Health Care of NY Commercial	$28,027.95
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$28,027.95
Rate for Payer: MVP Health Care of NY Medicare	$18,110.37
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$6,467.99
Rate for Payer: United Healthcare Medicare	$17,247.97
Rate for Payer: WellCare Medicare	$23,715.96

SYNCHROMED II PUMP

Facility

$43,119.92

Service Code	HCPCS C1772
Hospital Charge Code	4471639
Hospital Revenue Code	278
Min. Negotiated Rate	$19,403.96
Max. Negotiated Rate	$30,183.94
Rate for Payer: Aetna of NY Commercial	$30,183.94
Rate for Payer: Cash Price	$32,339.94
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$21,559.96
Rate for Payer: EmblemHealth Select Care	$21,559.96
Rate for Payer: Galaxy Health Commercial	$28,027.95
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$30,183.94
Rate for Payer: Multiplan Commercial	$19,403.96
Rate for Payer: MVP Health Care of NY Commercial	$28,027.95
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$28,027.95
Rate for Payer: WellCare Medicare	$23,715.96

SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL

Facility

$30.00

Service Code	HCPCS 86592
Hospital Charge Code	4300749
Hospital Revenue Code	302
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna of NY Commercial	$19.50
Rate for Payer: Aetna of NY Medicare	$13.80
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$12.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: CDPHP Medicare	$11.10
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$18.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$24.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$24.00
Rate for Payer: EmblemHealth Medicaid	$24.00
Rate for Payer: EmblemHealth Medicare	$10.20
Rate for Payer: EmblemHealth Select Care	$18.00
Rate for Payer: Fidelis Medicare	$12.00
Rate for Payer: Galaxy Health Commercial	$19.50
Rate for Payer: Hamaspik Choice Medicare	$12.00
Rate for Payer: Humana Medicare	$12.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$19.50
Rate for Payer: Local 1199SEIU Medicare	$13.80
Rate for Payer: MVP Health Care of NY Commercial	$22.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$16.89
Rate for Payer: MVP Health Care of NY Medicare	$12.60
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$22.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4.50
Rate for Payer: United Healthcare Commercial	$22.50
Rate for Payer: United Healthcare Medicare	$12.00
Rate for Payer: WellCare Medicare	$16.50

SYPHILIS TEST NON-TREPONEMAL ANTIBODY QUAL

Facility

$30.00

Service Code	HCPCS 86592
Hospital Charge Code	4300749
Hospital Revenue Code	302
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$19.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Galaxy Health Commercial	$19.50

T3 FREE

Facility

$51.00

Service Code	HCPCS 84481
Hospital Charge Code	4300755
Hospital Revenue Code	301
Min. Negotiated Rate	$7.65
Max. Negotiated Rate	$40.80
Rate for Payer: Aetna of NY Commercial	$33.15
Rate for Payer: Aetna of NY Medicare	$23.46
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$20.40
Rate for Payer: Cash Price	$38.25
Rate for Payer: CDPHP Medicare	$18.87
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$30.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$40.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$40.80
Rate for Payer: EmblemHealth Medicaid	$40.80
Rate for Payer: EmblemHealth Medicare	$17.34
Rate for Payer: EmblemHealth Select Care	$30.60
Rate for Payer: Fidelis Medicare	$20.40
Rate for Payer: Galaxy Health Commercial	$33.15
Rate for Payer: Hamaspik Choice Medicare	$20.40
Rate for Payer: Humana Medicare	$20.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$33.15
Rate for Payer: Local 1199SEIU Medicare	$23.46
Rate for Payer: MVP Health Care of NY Commercial	$38.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$28.71
Rate for Payer: MVP Health Care of NY Medicare	$21.42
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$38.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$7.65
Rate for Payer: United Healthcare Commercial	$38.25
Rate for Payer: United Healthcare Medicare	$20.40
Rate for Payer: WellCare Medicare	$28.05

Know your out-of-pocket cost for care.

All Charges