Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

TENJET HYDROTENOTOMY SET

Facility

$2,429.77

Hospital Charge Code	4473017
Hospital Revenue Code	272
Min. Negotiated Rate	$1,579.35
Max. Negotiated Rate	$1,579.35
Rate for Payer: Cash Price	$1,822.33
Rate for Payer: Galaxy Health Commercial	$1,579.35

TENJET HYDROTENOTOMY SET

Facility

$2,429.77

Hospital Charge Code	4473017
Hospital Revenue Code	272
Min. Negotiated Rate	$364.47
Max. Negotiated Rate	$1,943.82
Rate for Payer: Aetna of NY Commercial	$1,700.84
Rate for Payer: Aetna of NY Medicare	$1,117.69
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$971.91
Rate for Payer: Cash Price	$1,822.33
Rate for Payer: CDPHP Medicare	$899.01
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,943.82
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,943.82
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,943.82
Rate for Payer: EmblemHealth Medicaid	$1,943.82
Rate for Payer: EmblemHealth Medicare	$826.12
Rate for Payer: EmblemHealth Select Care	$1,749.43
Rate for Payer: Fidelis Medicare	$971.91
Rate for Payer: Galaxy Health Commercial	$1,579.35
Rate for Payer: Hamaspik Choice Medicare	$971.91
Rate for Payer: Humana Medicare	$971.91
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,700.84
Rate for Payer: Local 1199SEIU Medicare	$1,117.69
Rate for Payer: MVP Health Care of NY Commercial	$1,822.33
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,367.96
Rate for Payer: MVP Health Care of NY Medicare	$1,020.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$364.47
Rate for Payer: United Healthcare Medicare	$971.91
Rate for Payer: WellCare Medicare	$1,336.37

TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S ELBOW); DEBRIDEMENT, SOFT TISSUE AND/OR BONE, OPEN

Facility

$3,084.03

Service Code	CPT 24358
Hospital Revenue Code	490
Min. Negotiated Rate	$1,900.00
Max. Negotiated Rate	$3,084.03
Rate for Payer: Aetna of NY Commercial	$1,900.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,900.00
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$2,097.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3,084.03
Rate for Payer: United Healthcare Commercial	$2,097.00

TENOTOMY, ELBOW, LATERAL OR MEDIAL (EG, EPICONDYLITIS, TENNIS ELBOW, GOLFER'S ELBOW); PERCUTANEOUS

Facility

$3,084.03

Service Code	CPT 24357
Hospital Revenue Code	490
Min. Negotiated Rate	$1,900.00
Max. Negotiated Rate	$3,084.03
Rate for Payer: Aetna of NY Commercial	$1,900.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,900.00
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$2,097.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3,084.03
Rate for Payer: United Healthcare Commercial	$2,097.00

TENOTOMY, OPEN, ELBOW TO SHOULDER, EACH TENDON

Facility

$3,084.03

Service Code	CPT 24310
Hospital Revenue Code	490
Min. Negotiated Rate	$1,900.00
Max. Negotiated Rate	$3,084.03
Rate for Payer: Aetna of NY Commercial	$1,900.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,900.00
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$2,097.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3,084.03
Rate for Payer: United Healthcare Commercial	$2,097.00

TENSION BAND WIRE

Facility

$31.93

Hospital Charge Code	4479271
Hospital Revenue Code	270
Min. Negotiated Rate	$20.75
Max. Negotiated Rate	$20.75
Rate for Payer: Cash Price	$23.95
Rate for Payer: Galaxy Health Commercial	$20.75

TENSION BAND WIRE

Facility

$31.93

Hospital Charge Code	4479271
Hospital Revenue Code	270
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$25.54
Rate for Payer: Aetna of NY Commercial	$22.35
Rate for Payer: Aetna of NY Medicare	$14.69
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$12.77
Rate for Payer: Cash Price	$23.95
Rate for Payer: CDPHP Medicare	$11.81
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$25.54
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$25.54
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$25.54
Rate for Payer: EmblemHealth Medicaid	$25.54
Rate for Payer: EmblemHealth Medicare	$10.86
Rate for Payer: EmblemHealth Select Care	$22.99
Rate for Payer: Fidelis Medicare	$12.77
Rate for Payer: Galaxy Health Commercial	$20.75
Rate for Payer: Hamaspik Choice Medicare	$12.77
Rate for Payer: Humana Medicare	$12.77
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$22.35
Rate for Payer: Local 1199SEIU Medicare	$14.69
Rate for Payer: MVP Health Care of NY Commercial	$23.95
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$17.98
Rate for Payer: MVP Health Care of NY Medicare	$13.41
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4.79
Rate for Payer: United Healthcare Medicare	$12.77
Rate for Payer: WellCare Medicare	$17.56

TENSOGRIP STOCKINETTE 3 1/2" E

Facility

$138.02

Hospital Charge Code	4471698
Hospital Revenue Code	270
Min. Negotiated Rate	$20.70
Max. Negotiated Rate	$110.42
Rate for Payer: Aetna of NY Commercial	$96.61
Rate for Payer: Aetna of NY Medicare	$63.49
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$55.21
Rate for Payer: Cash Price	$103.52
Rate for Payer: CDPHP Medicare	$51.07
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$110.42
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$110.42
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$110.42
Rate for Payer: EmblemHealth Medicaid	$110.42
Rate for Payer: EmblemHealth Medicare	$46.93
Rate for Payer: EmblemHealth Select Care	$99.37
Rate for Payer: Fidelis Medicare	$55.21
Rate for Payer: Galaxy Health Commercial	$89.71
Rate for Payer: Hamaspik Choice Medicare	$55.21
Rate for Payer: Humana Medicare	$55.21
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$96.61
Rate for Payer: Local 1199SEIU Medicare	$63.49
Rate for Payer: MVP Health Care of NY Commercial	$103.52
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$77.71
Rate for Payer: MVP Health Care of NY Medicare	$57.97
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$20.70
Rate for Payer: United Healthcare Medicare	$55.21
Rate for Payer: WellCare Medicare	$75.91

TENSOGRIP STOCKINETTE 3 1/2" E

Facility

$138.02

Hospital Charge Code	4471698
Hospital Revenue Code	270
Min. Negotiated Rate	$89.71
Max. Negotiated Rate	$89.71
Rate for Payer: Cash Price	$103.52
Rate for Payer: Galaxy Health Commercial	$89.71

TENSOGRIP STOCKINETTE 3 1/2" F

Facility

$149.35

Hospital Charge Code	4471699
Hospital Revenue Code	270
Min. Negotiated Rate	$97.08
Max. Negotiated Rate	$97.08
Rate for Payer: Cash Price	$112.01
Rate for Payer: Galaxy Health Commercial	$97.08

TENSOGRIP STOCKINETTE 3 1/2" F

Facility

$149.35

Hospital Charge Code	4471699
Hospital Revenue Code	270
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$119.48
Rate for Payer: Aetna of NY Commercial	$104.55
Rate for Payer: Aetna of NY Medicare	$68.70
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$59.74
Rate for Payer: Cash Price	$112.01
Rate for Payer: CDPHP Medicare	$55.26
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$119.48
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$119.48
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$119.48
Rate for Payer: EmblemHealth Medicaid	$119.48
Rate for Payer: EmblemHealth Medicare	$50.78
Rate for Payer: EmblemHealth Select Care	$107.53
Rate for Payer: Fidelis Medicare	$59.74
Rate for Payer: Galaxy Health Commercial	$97.08
Rate for Payer: Hamaspik Choice Medicare	$59.74
Rate for Payer: Humana Medicare	$59.74
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$104.55
Rate for Payer: Local 1199SEIU Medicare	$68.70
Rate for Payer: MVP Health Care of NY Commercial	$112.01
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$84.08
Rate for Payer: MVP Health Care of NY Medicare	$62.73
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$22.40
Rate for Payer: United Healthcare Medicare	$59.74
Rate for Payer: WellCare Medicare	$82.14

TENSOGRIP STOCKINETTE 3" D

Facility

$109.18

Hospital Charge Code	4471701
Hospital Revenue Code	270
Min. Negotiated Rate	$70.97
Max. Negotiated Rate	$70.97
Rate for Payer: Cash Price	$81.89
Rate for Payer: Galaxy Health Commercial	$70.97

TENSOGRIP STOCKINETTE 3" D

Facility

$109.18

Hospital Charge Code	4471701
Hospital Revenue Code	270
Min. Negotiated Rate	$16.38
Max. Negotiated Rate	$87.34
Rate for Payer: Aetna of NY Commercial	$76.43
Rate for Payer: Aetna of NY Medicare	$50.22
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$43.67
Rate for Payer: Cash Price	$81.89
Rate for Payer: CDPHP Medicare	$40.40
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$87.34
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$87.34
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$87.34
Rate for Payer: EmblemHealth Medicaid	$87.34
Rate for Payer: EmblemHealth Medicare	$37.12
Rate for Payer: EmblemHealth Select Care	$78.61
Rate for Payer: Fidelis Medicare	$43.67
Rate for Payer: Galaxy Health Commercial	$70.97
Rate for Payer: Hamaspik Choice Medicare	$43.67
Rate for Payer: Humana Medicare	$43.67
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$76.43
Rate for Payer: Local 1199SEIU Medicare	$50.22
Rate for Payer: MVP Health Care of NY Commercial	$81.89
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$61.47
Rate for Payer: MVP Health Care of NY Medicare	$45.86
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$16.38
Rate for Payer: United Healthcare Medicare	$43.67
Rate for Payer: WellCare Medicare	$60.05

TENSOGRIP STOCKINETTE 4.5" G

Facility

$175.10

Hospital Charge Code	4471700
Hospital Revenue Code	270
Min. Negotiated Rate	$113.81
Max. Negotiated Rate	$113.81
Rate for Payer: Cash Price	$131.32
Rate for Payer: Galaxy Health Commercial	$113.81

TENSOGRIP STOCKINETTE 4.5" G

Facility

$175.10

Hospital Charge Code	4471700
Hospital Revenue Code	270
Min. Negotiated Rate	$26.27
Max. Negotiated Rate	$140.08
Rate for Payer: Aetna of NY Commercial	$122.57
Rate for Payer: Aetna of NY Medicare	$80.55
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$70.04
Rate for Payer: Cash Price	$131.32
Rate for Payer: CDPHP Medicare	$64.79
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$140.08
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$140.08
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$140.08
Rate for Payer: EmblemHealth Medicaid	$140.08
Rate for Payer: EmblemHealth Medicare	$59.53
Rate for Payer: EmblemHealth Select Care	$126.07
Rate for Payer: Fidelis Medicare	$70.04
Rate for Payer: Galaxy Health Commercial	$113.81
Rate for Payer: Hamaspik Choice Medicare	$70.04
Rate for Payer: Humana Medicare	$70.04
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$122.57
Rate for Payer: Local 1199SEIU Medicare	$80.55
Rate for Payer: MVP Health Care of NY Commercial	$131.32
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$98.58
Rate for Payer: MVP Health Care of NY Medicare	$73.54
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$26.27
Rate for Payer: United Healthcare Medicare	$70.04
Rate for Payer: WellCare Medicare	$96.31

TERAZOSIN 1 MG CAP

Facility

$6.18

Service Code	NDC 51079093620
Hospital Charge Code	4409049
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

TERAZOSIN 1 MG CAP

Facility

$6.18

Service Code	NDC 51079093620
Hospital Charge Code	4409049
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

TERAZOSIN 5 MG CAPSULE

Facility

$6.18

Service Code	NDC 51079093820
Hospital Charge Code	4409095
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

TERAZOSIN 5 MG CAPSULE

Facility

$6.18

Service Code	NDC 51079093820
Hospital Charge Code	4409095
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

TERBINAFINE CR 1%

Facility

$24.72

Service Code	NDC 51672208001
Hospital Charge Code	4408969
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$16.07
Rate for Payer: Cash Price	$18.54
Rate for Payer: Galaxy Health Commercial	$16.07
Rate for Payer: WellCare Medicare	$13.60

TERBINAFINE CR 1%

Facility

$24.72

Service Code	NDC 51672208001
Hospital Charge Code	4408969
Hospital Revenue Code	250
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$19.78
Rate for Payer: Aetna of NY Commercial	$17.30
Rate for Payer: Aetna of NY Medicare	$11.37
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$9.89
Rate for Payer: Cash Price	$18.54
Rate for Payer: CDPHP Medicare	$9.15
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$19.78
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$19.78
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$19.78
Rate for Payer: EmblemHealth Medicaid	$19.78
Rate for Payer: EmblemHealth Medicare	$8.40
Rate for Payer: EmblemHealth Select Care	$17.80
Rate for Payer: Fidelis Medicare	$9.89
Rate for Payer: Galaxy Health Commercial	$16.07
Rate for Payer: Hamaspik Choice Medicare	$9.89
Rate for Payer: Humana Medicare	$9.89
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$17.30
Rate for Payer: Local 1199SEIU Medicare	$11.37
Rate for Payer: MVP Health Care of NY Commercial	$18.54
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$13.92
Rate for Payer: MVP Health Care of NY Medicare	$10.38
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3.71
Rate for Payer: United Healthcare Medicare	$9.89
Rate for Payer: WellCare Medicare	$13.60

TERBUTALINE SULFATE INJ TO 1 MG

Facility

$66.69

Service Code	HCPCS J3105
Hospital Charge Code	4400748
Hospital Revenue Code	636
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$43.35
Rate for Payer: Aetna of NY Commercial	$36.68
Rate for Payer: Cash Price	$50.02
Rate for Payer: Cash Price	$50.02
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$2.96
Rate for Payer: EmblemHealth Select Care	$2.96
Rate for Payer: Galaxy Health Commercial	$43.35
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$36.68
Rate for Payer: WellCare Medicare	$36.68

TERBUTALINE SULFATE INJ TO 1 MG

Facility

$66.69

Service Code	HCPCS J3105
Hospital Charge Code	4400748
Hospital Revenue Code	636
Min. Negotiated Rate	$2.96
Max. Negotiated Rate	$53.35
Rate for Payer: Aetna of NY Medicare	$30.68
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$26.68
Rate for Payer: Cash Price	$50.02
Rate for Payer: Cash Price	$50.02
Rate for Payer: CDPHP Medicare	$24.68
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$2.96
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$53.35
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$53.35
Rate for Payer: EmblemHealth Medicaid	$53.35
Rate for Payer: EmblemHealth Medicare	$22.67
Rate for Payer: EmblemHealth Select Care	$2.96
Rate for Payer: Fidelis Medicare	$26.68
Rate for Payer: Galaxy Health Commercial	$43.35
Rate for Payer: Hamaspik Choice Medicare	$26.68
Rate for Payer: Humana Medicare	$26.68
Rate for Payer: Local 1199SEIU Medicare	$30.68
Rate for Payer: MVP Health Care of NY Commercial	$50.02
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$37.55
Rate for Payer: MVP Health Care of NY Medicare	$28.01
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$3.78
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$10.00
Rate for Payer: United Healthcare Commercial	$3.78
Rate for Payer: United Healthcare Medicare	$26.68
Rate for Payer: WellCare Medicare	$36.68

TEST FOR ACETONE/KETONES

Facility

$21.00

Service Code	HCPCS 82009
Hospital Charge Code	4302008
Hospital Revenue Code	300
Min. Negotiated Rate	$3.15
Max. Negotiated Rate	$16.80
Rate for Payer: Aetna of NY Commercial	$13.65
Rate for Payer: Aetna of NY Medicare	$9.66
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$8.40
Rate for Payer: Cash Price	$15.75
Rate for Payer: CDPHP Medicare	$7.77
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$12.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$16.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$16.80
Rate for Payer: EmblemHealth Medicaid	$16.80
Rate for Payer: EmblemHealth Medicare	$7.14
Rate for Payer: EmblemHealth Select Care	$12.60
Rate for Payer: Fidelis Medicare	$8.40
Rate for Payer: Galaxy Health Commercial	$13.65
Rate for Payer: Hamaspik Choice Medicare	$8.40
Rate for Payer: Humana Medicare	$8.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$13.65
Rate for Payer: Local 1199SEIU Medicare	$9.66
Rate for Payer: MVP Health Care of NY Commercial	$15.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$11.82
Rate for Payer: MVP Health Care of NY Medicare	$8.82
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$15.75
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3.15
Rate for Payer: United Healthcare Commercial	$15.75
Rate for Payer: United Healthcare Medicare	$8.40
Rate for Payer: WellCare Medicare	$11.55

TEST FOR ACETONE/KETONES

Facility

$21.00

Service Code	HCPCS 82009
Hospital Charge Code	4302008
Hospital Revenue Code	300
Min. Negotiated Rate	$13.65
Max. Negotiated Rate	$13.65
Rate for Payer: Cash Price	$15.75
Rate for Payer: Galaxy Health Commercial	$13.65

Know your out-of-pocket cost for care.

All Charges