Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

TECHNETIUM TC99M AUTO WBC EXAME PER DOSE

Facility

$3,121.00

Service Code	HCPCS A9569
Hospital Charge Code	4210085
Hospital Revenue Code	343
Min. Negotiated Rate	$468.15
Max. Negotiated Rate	$2,851.61
Rate for Payer: Aetna of NY Medicare	$1,435.66
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,248.40
Rate for Payer: Cash Price	$2,340.75
Rate for Payer: Cash Price	$2,340.75
Rate for Payer: CDPHP Medicare	$1,154.77
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$2,496.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,496.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,496.80
Rate for Payer: EmblemHealth Medicaid	$2,496.80
Rate for Payer: EmblemHealth Medicare	$1,061.14
Rate for Payer: EmblemHealth Select Care	$2,247.12
Rate for Payer: Fidelis Medicare	$1,248.40
Rate for Payer: Galaxy Health Commercial	$2,028.65
Rate for Payer: Hamaspik Choice Medicare	$1,248.40
Rate for Payer: Humana Medicare	$1,248.40
Rate for Payer: Local 1199SEIU Medicare	$1,435.66
Rate for Payer: MVP Health Care of NY Commercial	$2,340.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,757.12
Rate for Payer: MVP Health Care of NY Medicare	$1,310.82
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$2,851.61
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$468.15
Rate for Payer: United Healthcare Commercial	$2,851.61
Rate for Payer: United Healthcare Medicare	$1,248.40
Rate for Payer: WellCare Medicare	$1,716.55

TECHNETIUM TC99M TEBOROXIME PER DOSE

Facility

$528.39

Service Code	HCPCS A9501
Hospital Charge Code	4210086
Hospital Revenue Code	343
Min. Negotiated Rate	$79.26
Max. Negotiated Rate	$422.71
Rate for Payer: Aetna of NY Medicare	$243.06
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$211.36
Rate for Payer: Cash Price	$396.29
Rate for Payer: CDPHP Medicare	$195.50
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$422.71
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$422.71
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$422.71
Rate for Payer: EmblemHealth Medicaid	$422.71
Rate for Payer: EmblemHealth Medicare	$179.65
Rate for Payer: EmblemHealth Select Care	$380.44
Rate for Payer: Fidelis Medicare	$211.36
Rate for Payer: Galaxy Health Commercial	$343.45
Rate for Payer: Hamaspik Choice Medicare	$211.36
Rate for Payer: Humana Medicare	$211.36
Rate for Payer: Local 1199SEIU Medicare	$243.06
Rate for Payer: MVP Health Care of NY Commercial	$396.29
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$297.48
Rate for Payer: MVP Health Care of NY Medicare	$221.92
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$79.26
Rate for Payer: United Healthcare Medicare	$211.36
Rate for Payer: WellCare Medicare	$290.61

TECHNETIUM TC99M TEBOROXIME PER DOSE

Facility

$528.39

Service Code	HCPCS A9501
Hospital Charge Code	4210086
Hospital Revenue Code	343
Min. Negotiated Rate	$343.45
Max. Negotiated Rate	$343.45
Rate for Payer: Cash Price	$396.29
Rate for Payer: Galaxy Health Commercial	$343.45

TEGADERM DRESSING

Facility

$200.85

Hospital Charge Code	4479239
Hospital Revenue Code	270
Min. Negotiated Rate	$30.13
Max. Negotiated Rate	$160.68
Rate for Payer: Aetna of NY Commercial	$140.59
Rate for Payer: Aetna of NY Medicare	$92.39
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$80.34
Rate for Payer: Cash Price	$150.64
Rate for Payer: CDPHP Medicare	$74.31
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$160.68
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$160.68
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$160.68
Rate for Payer: EmblemHealth Medicaid	$160.68
Rate for Payer: EmblemHealth Medicare	$68.29
Rate for Payer: EmblemHealth Select Care	$144.61
Rate for Payer: Fidelis Medicare	$80.34
Rate for Payer: Galaxy Health Commercial	$130.55
Rate for Payer: Hamaspik Choice Medicare	$80.34
Rate for Payer: Humana Medicare	$80.34
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$140.59
Rate for Payer: Local 1199SEIU Medicare	$92.39
Rate for Payer: MVP Health Care of NY Commercial	$150.64
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$113.08
Rate for Payer: MVP Health Care of NY Medicare	$84.36
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$30.13
Rate for Payer: United Healthcare Medicare	$80.34
Rate for Payer: WellCare Medicare	$110.47

TEGADERM DRESSING

Facility

$200.85

Hospital Charge Code	4479239
Hospital Revenue Code	270
Min. Negotiated Rate	$130.55
Max. Negotiated Rate	$130.55
Rate for Payer: Cash Price	$150.64
Rate for Payer: Galaxy Health Commercial	$130.55

TEGRETOL (CARBAMAZEPINE)

Facility

$57.00

Service Code	HCPCS 80156
Hospital Charge Code	4300761
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

TEGRETOL (CARBAMAZEPINE)

Facility

$57.00

Service Code	HCPCS 80156
Hospital Charge Code	4300761
Hospital Revenue Code	300
Min. Negotiated Rate	$8.55
Max. Negotiated Rate	$45.60
Rate for Payer: Aetna of NY Commercial	$37.05
Rate for Payer: Aetna of NY Medicare	$26.22
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$22.80
Rate for Payer: Cash Price	$42.75
Rate for Payer: CDPHP Medicare	$21.09
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$34.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$45.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$45.60
Rate for Payer: EmblemHealth Medicaid	$45.60
Rate for Payer: EmblemHealth Medicare	$19.38
Rate for Payer: EmblemHealth Select Care	$34.20
Rate for Payer: Fidelis Medicare	$22.80
Rate for Payer: Galaxy Health Commercial	$37.05
Rate for Payer: Hamaspik Choice Medicare	$22.80
Rate for Payer: Humana Medicare	$22.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$37.05
Rate for Payer: Local 1199SEIU Medicare	$26.22
Rate for Payer: MVP Health Care of NY Commercial	$42.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$32.09
Rate for Payer: MVP Health Care of NY Medicare	$23.94
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$42.75
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$8.55
Rate for Payer: United Healthcare Commercial	$42.75
Rate for Payer: United Healthcare Medicare	$22.80
Rate for Payer: WellCare Medicare	$31.35

TEMAZEPAM 15MG CAPS 100 EA

Facility

$6.18

Service Code	NDC 63739087710
Hospital Charge Code	4400747
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

TEMAZEPAM 15MG CAPS 100 EA

Facility

$6.18

Service Code	NDC 63739087710
Hospital Charge Code	4400747
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

TEMAZEPAM 7.5 MG CAPSULE 7.5 mg, 30 eaches

Facility

$14.00

Service Code	NDC 904643604
Hospital Charge Code	4401575
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$11.20
Rate for Payer: Aetna of NY Commercial	$9.80
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	$11.20
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	$10.08
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	$9.80
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: United Healthcare CHIP/Family Health Plus/Medicaid	$2.10
Rate for Payer: United Healthcare Medicare	$5.60
Rate for Payer: WellCare Medicare	$7.70

TEMAZEPAM 7.5 MG CAPSULE 7.5 mg, 30 eaches

Facility

$14.00

Service Code	NDC 904643604
Hospital Charge Code	4401575
Hospital Revenue Code	250
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$9.10
Rate for Payer: Cash Price	$10.50
Rate for Payer: Galaxy Health Commercial	$9.10
Rate for Payer: WellCare Medicare	$7.70

TEMP STABILIOZE PIN

Facility

$431.57

Hospital Charge Code	4473003
Hospital Revenue Code	272
Min. Negotiated Rate	$280.52
Max. Negotiated Rate	$280.52
Rate for Payer: Cash Price	$323.68
Rate for Payer: Galaxy Health Commercial	$280.52

TEMP STABILIOZE PIN

Facility

$431.57

Hospital Charge Code	4473003
Hospital Revenue Code	272
Min. Negotiated Rate	$64.74
Max. Negotiated Rate	$345.26
Rate for Payer: Aetna of NY Commercial	$302.10
Rate for Payer: Aetna of NY Medicare	$198.52
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$172.63
Rate for Payer: Cash Price	$323.68
Rate for Payer: CDPHP Medicare	$159.68
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$345.26
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$345.26
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$345.26
Rate for Payer: EmblemHealth Medicaid	$345.26
Rate for Payer: EmblemHealth Medicare	$146.73
Rate for Payer: EmblemHealth Select Care	$310.73
Rate for Payer: Fidelis Medicare	$172.63
Rate for Payer: Galaxy Health Commercial	$280.52
Rate for Payer: Hamaspik Choice Medicare	$172.63
Rate for Payer: Humana Medicare	$172.63
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$302.10
Rate for Payer: Local 1199SEIU Medicare	$198.52
Rate for Payer: MVP Health Care of NY Commercial	$323.68
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$242.97
Rate for Payer: MVP Health Care of NY Medicare	$181.26
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$64.74
Rate for Payer: United Healthcare Medicare	$172.63
Rate for Payer: WellCare Medicare	$237.36

TEMP THERAPY PAD

Facility

$16.48

Hospital Charge Code	4478238
Hospital Revenue Code	270
Min. Negotiated Rate	$2.47
Max. Negotiated Rate	$13.18
Rate for Payer: Aetna of NY Commercial	$11.54
Rate for Payer: Aetna of NY Medicare	$7.58
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$6.59
Rate for Payer: Cash Price	$12.36
Rate for Payer: CDPHP Medicare	$6.10
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$13.18
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$13.18
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$13.18
Rate for Payer: EmblemHealth Medicaid	$13.18
Rate for Payer: EmblemHealth Medicare	$5.60
Rate for Payer: EmblemHealth Select Care	$11.87
Rate for Payer: Fidelis Medicare	$6.59
Rate for Payer: Galaxy Health Commercial	$10.71
Rate for Payer: Hamaspik Choice Medicare	$6.59
Rate for Payer: Humana Medicare	$6.59
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$11.54
Rate for Payer: Local 1199SEIU Medicare	$7.58
Rate for Payer: MVP Health Care of NY Commercial	$12.36
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$9.28
Rate for Payer: MVP Health Care of NY Medicare	$6.92
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.47
Rate for Payer: United Healthcare Medicare	$6.59
Rate for Payer: WellCare Medicare	$9.06

TEMP THERAPY PAD

Facility

$16.48

Hospital Charge Code	4478238
Hospital Revenue Code	270
Min. Negotiated Rate	$10.71
Max. Negotiated Rate	$10.71
Rate for Payer: Cash Price	$12.36
Rate for Payer: Galaxy Health Commercial	$10.71

TENDON ORIGIN INJECTION

Facility

$941.00

Service Code	HCPCS 20551
Hospital Charge Code	4850027
Hospital Revenue Code	761
Min. Negotiated Rate	$141.15
Max. Negotiated Rate	$752.80
Rate for Payer: Aetna of NY Commercial	$658.70
Rate for Payer: Aetna of NY Medicare	$432.86
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$376.40
Rate for Payer: Cash Price	$705.75
Rate for Payer: CDPHP Medicare	$348.17
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$752.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$752.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$752.80
Rate for Payer: EmblemHealth Medicaid	$752.80
Rate for Payer: EmblemHealth Medicare	$319.94
Rate for Payer: EmblemHealth Select Care	$677.52
Rate for Payer: Fidelis Medicare	$376.40
Rate for Payer: Galaxy Health Commercial	$611.65
Rate for Payer: Hamaspik Choice Medicare	$376.40
Rate for Payer: Humana Medicare	$376.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$658.70
Rate for Payer: Local 1199SEIU Medicare	$432.86
Rate for Payer: MVP Health Care of NY Commercial	$705.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$529.78
Rate for Payer: MVP Health Care of NY Medicare	$395.22
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$141.15
Rate for Payer: United Healthcare Medicare	$376.40
Rate for Payer: WellCare Medicare	$517.55

TENDON ORIGIN INJECTION

Facility

$941.00

Service Code	HCPCS 20551
Hospital Charge Code	4850027
Hospital Revenue Code	761
Min. Negotiated Rate	$611.65
Max. Negotiated Rate	$611.65
Rate for Payer: Cash Price	$705.75
Rate for Payer: Galaxy Health Commercial	$611.65

TENDON SHETH/LIGAMENT/CYST INJECTION

Facility

$941.00

Service Code	HCPCS 20550
Hospital Charge Code	4850026
Hospital Revenue Code	761
Min. Negotiated Rate	$611.65
Max. Negotiated Rate	$611.65
Rate for Payer: Cash Price	$705.75
Rate for Payer: Galaxy Health Commercial	$611.65

TENDON SHETH/LIGAMENT/CYST INJECTION

Facility

$941.00

Service Code	HCPCS 20550
Hospital Charge Code	4850026
Hospital Revenue Code	761
Min. Negotiated Rate	$141.15
Max. Negotiated Rate	$752.80
Rate for Payer: Aetna of NY Commercial	$658.70
Rate for Payer: Aetna of NY Medicare	$432.86
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$376.40
Rate for Payer: Cash Price	$705.75
Rate for Payer: CDPHP Medicare	$348.17
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$752.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$752.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$752.80
Rate for Payer: EmblemHealth Medicaid	$752.80
Rate for Payer: EmblemHealth Medicare	$319.94
Rate for Payer: EmblemHealth Select Care	$677.52
Rate for Payer: Fidelis Medicare	$376.40
Rate for Payer: Galaxy Health Commercial	$611.65
Rate for Payer: Hamaspik Choice Medicare	$376.40
Rate for Payer: Humana Medicare	$376.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$658.70
Rate for Payer: Local 1199SEIU Medicare	$432.86
Rate for Payer: MVP Health Care of NY Commercial	$705.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$529.78
Rate for Payer: MVP Health Care of NY Medicare	$395.22
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$141.15
Rate for Payer: United Healthcare Medicare	$376.40
Rate for Payer: WellCare Medicare	$517.55

TENECTEPLASE INJECTION 1 MG

Facility

$531.23

Service Code	HCPCS J3101
Hospital Charge Code	4400762
Hospital Revenue Code	636
Min. Negotiated Rate	$197.44
Max. Negotiated Rate	$345.30
Rate for Payer: Aetna of NY Commercial	$292.18
Rate for Payer: Cash Price	$398.42
Rate for Payer: Cash Price	$398.42
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$197.44
Rate for Payer: EmblemHealth Select Care	$197.44
Rate for Payer: Galaxy Health Commercial	$345.30
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$292.18
Rate for Payer: WellCare Medicare	$292.18

TENECTEPLASE INJECTION 1 MG

Facility

$531.23

Service Code	HCPCS J3101
Hospital Charge Code	4400762
Hospital Revenue Code	636
Min. Negotiated Rate	$79.68
Max. Negotiated Rate	$424.98
Rate for Payer: Aetna of NY Medicare	$244.37
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$212.49
Rate for Payer: Cash Price	$398.42
Rate for Payer: Cash Price	$398.42
Rate for Payer: CDPHP Medicare	$196.56
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$197.44
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$424.98
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$424.98
Rate for Payer: EmblemHealth Medicaid	$424.98
Rate for Payer: EmblemHealth Medicare	$180.62
Rate for Payer: EmblemHealth Select Care	$197.44
Rate for Payer: Fidelis Medicare	$212.49
Rate for Payer: Galaxy Health Commercial	$345.30
Rate for Payer: Hamaspik Choice Medicare	$212.49
Rate for Payer: Humana Medicare	$212.49
Rate for Payer: Local 1199SEIU Medicare	$244.37
Rate for Payer: MVP Health Care of NY Commercial	$398.42
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$299.08
Rate for Payer: MVP Health Care of NY Medicare	$223.12
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$251.96
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$79.68
Rate for Payer: United Healthcare Commercial	$251.96
Rate for Payer: United Healthcare Medicare	$212.49
Rate for Payer: WellCare Medicare	$292.18

TENEX - BONE PROCEDURE PACK

Facility

$4,196.22

Hospital Charge Code	4473018
Hospital Revenue Code	272
Min. Negotiated Rate	$2,727.54
Max. Negotiated Rate	$2,727.54
Rate for Payer: Cash Price	$3,147.16
Rate for Payer: Galaxy Health Commercial	$2,727.54

TENEX - BONE PROCEDURE PACK

Facility

$4,196.22

Hospital Charge Code	4473018
Hospital Revenue Code	272
Min. Negotiated Rate	$629.43
Max. Negotiated Rate	$3,356.98
Rate for Payer: Aetna of NY Commercial	$2,937.35
Rate for Payer: Aetna of NY Medicare	$1,930.26
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,678.49
Rate for Payer: Cash Price	$3,147.16
Rate for Payer: CDPHP Medicare	$1,552.60
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$3,356.98
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$3,356.98
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$3,356.98
Rate for Payer: EmblemHealth Medicaid	$3,356.98
Rate for Payer: EmblemHealth Medicare	$1,426.71
Rate for Payer: EmblemHealth Select Care	$3,021.28
Rate for Payer: Fidelis Medicare	$1,678.49
Rate for Payer: Galaxy Health Commercial	$2,727.54
Rate for Payer: Hamaspik Choice Medicare	$1,678.49
Rate for Payer: Humana Medicare	$1,678.49
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$2,937.35
Rate for Payer: Local 1199SEIU Medicare	$1,930.26
Rate for Payer: MVP Health Care of NY Commercial	$3,147.16
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$2,362.47
Rate for Payer: MVP Health Care of NY Medicare	$1,762.41
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$629.43
Rate for Payer: United Healthcare Medicare	$1,678.49
Rate for Payer: WellCare Medicare	$2,307.92

TENIVAC 5-2 LFU INJ(TETANUS, DIPTHERIA)

Facility

$118.71

Service Code	HCPCS 90714
Hospital Charge Code	4409170
Hospital Revenue Code	636
Min. Negotiated Rate	$17.81
Max. Negotiated Rate	$94.97
Rate for Payer: Aetna of NY Commercial	$65.29
Rate for Payer: Aetna of NY Medicare	$54.61
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$47.48
Rate for Payer: Cash Price	$89.03
Rate for Payer: Cash Price	$89.03
Rate for Payer: CDPHP Medicare	$43.92
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$38.75
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$94.97
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$94.97
Rate for Payer: EmblemHealth Medicaid	$94.97
Rate for Payer: EmblemHealth Medicare	$40.36
Rate for Payer: EmblemHealth Select Care	$38.75
Rate for Payer: Fidelis Medicare	$47.48
Rate for Payer: Galaxy Health Commercial	$77.16
Rate for Payer: Hamaspik Choice Medicare	$47.48
Rate for Payer: Humana Medicare	$47.48
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$65.29
Rate for Payer: Local 1199SEIU Medicare	$54.61
Rate for Payer: MVP Health Care of NY Commercial	$89.03
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$66.83
Rate for Payer: MVP Health Care of NY Medicare	$49.86
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$51.23
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$17.81
Rate for Payer: United Healthcare Commercial	$51.23
Rate for Payer: United Healthcare Medicare	$47.48
Rate for Payer: WellCare Medicare	$65.29

TENIVAC 5-2 LFU INJ(TETANUS, DIPTHERIA)

Facility

$118.71

Service Code	HCPCS 90714
Hospital Charge Code	4409170
Hospital Revenue Code	636
Min. Negotiated Rate	$38.75
Max. Negotiated Rate	$77.16
Rate for Payer: Aetna of NY Commercial	$65.29
Rate for Payer: Cash Price	$89.03
Rate for Payer: Cash Price	$89.03
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$38.75
Rate for Payer: EmblemHealth Select Care	$38.75
Rate for Payer: Galaxy Health Commercial	$77.16
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$65.29
Rate for Payer: WellCare Medicare	$65.29

Know your out-of-pocket cost for care.

All Charges