Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

THYROID ANTIMICROSOMAL AB

Facility

$57.00

Service Code	HCPCS 86376
Hospital Charge Code	4300774
Hospital Revenue Code	302
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

THYROID ANTIMICROSOMAL AB

Facility

$57.00

Service Code	HCPCS 86376
Hospital Charge Code	4300774
Hospital Revenue Code	302
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

THYROID METS UPTAKE

Facility

$625.00

Service Code	HCPCS 78020
Hospital Charge Code	4210101
Hospital Revenue Code	341
Min. Negotiated Rate	$93.75
Max. Negotiated Rate	$1,545.00
Rate for Payer: Aetna of NY Commercial	$437.50
Rate for Payer: Aetna of NY Medicare	$287.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$250.00
Rate for Payer: Cash Price	$468.75
Rate for Payer: Cash Price	$468.75
Rate for Payer: CDPHP Medicare	$231.25
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$437.50
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$500.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$500.00
Rate for Payer: EmblemHealth Medicaid	$500.00
Rate for Payer: EmblemHealth Medicare	$212.50
Rate for Payer: EmblemHealth Select Care	$406.25
Rate for Payer: Fidelis Medicare	$250.00
Rate for Payer: Galaxy Health Commercial	$406.25
Rate for Payer: Hamaspik Choice Medicare	$250.00
Rate for Payer: Humana Medicare	$250.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$437.50
Rate for Payer: Local 1199SEIU Medicare	$287.50
Rate for Payer: MVP Health Care of NY Commercial	$468.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$351.88
Rate for Payer: MVP Health Care of NY Medicare	$262.50
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,545.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$93.75
Rate for Payer: United Healthcare Commercial	$1,545.00
Rate for Payer: United Healthcare Medicare	$250.00
Rate for Payer: WellCare Medicare	$343.75

THYROID METS UPTAKE

Facility

$625.00

Service Code	HCPCS 78020
Hospital Charge Code	4210101
Hospital Revenue Code	341
Min. Negotiated Rate	$406.25
Max. Negotiated Rate	$406.25
Rate for Payer: Cash Price	$468.75
Rate for Payer: Galaxy Health Commercial	$406.25

THYROID METS UPTAKE

Facility

$81.00

Service Code	HCPCS 78020 26
Hospital Charge Code	5210101
Hospital Revenue Code	960
Min. Negotiated Rate	$12.15
Max. Negotiated Rate	$64.80
Rate for Payer: Aetna of NY Commercial	$56.70
Rate for Payer: Aetna of NY Medicare	$37.26
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$32.40
Rate for Payer: Cash Price	$60.75
Rate for Payer: CDPHP Medicare	$29.97
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$64.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$64.80
Rate for Payer: EmblemHealth Medicaid	$64.80
Rate for Payer: EmblemHealth Medicare	$27.54
Rate for Payer: Fidelis Medicare	$32.40
Rate for Payer: Galaxy Health Commercial	$52.65
Rate for Payer: Hamaspik Choice Medicare	$32.40
Rate for Payer: Humana Medicare	$32.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$56.70
Rate for Payer: Local 1199SEIU Medicare	$37.26
Rate for Payer: MVP Health Care of NY Commercial	$60.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$45.60
Rate for Payer: MVP Health Care of NY Medicare	$34.02
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$12.15
Rate for Payer: United Healthcare Medicare	$32.40
Rate for Payer: WellCare Medicare	$44.55

THYROID METS UPTAKE

Facility

$81.00

Service Code	HCPCS 78020 26
Hospital Charge Code	5210101
Hospital Revenue Code	960
Min. Negotiated Rate	$52.65
Max. Negotiated Rate	$52.65
Rate for Payer: Cash Price	$60.75
Rate for Payer: Galaxy Health Commercial	$52.65

THYROID STIM HORM (TSH)

Facility

$89.00

Service Code	HCPCS 84443
Hospital Charge Code	4300771
Hospital Revenue Code	301
Min. Negotiated Rate	$13.35
Max. Negotiated Rate	$71.20
Rate for Payer: Aetna of NY Commercial	$57.85
Rate for Payer: Aetna of NY Medicare	$40.94
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$35.60
Rate for Payer: Cash Price	$66.75
Rate for Payer: CDPHP Medicare	$32.93
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$53.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$71.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$71.20
Rate for Payer: EmblemHealth Medicaid	$71.20
Rate for Payer: EmblemHealth Medicare	$30.26
Rate for Payer: EmblemHealth Select Care	$53.40
Rate for Payer: Fidelis Medicare	$35.60
Rate for Payer: Galaxy Health Commercial	$57.85
Rate for Payer: Hamaspik Choice Medicare	$35.60
Rate for Payer: Humana Medicare	$35.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$57.85
Rate for Payer: Local 1199SEIU Medicare	$40.94
Rate for Payer: MVP Health Care of NY Commercial	$66.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$50.11
Rate for Payer: MVP Health Care of NY Medicare	$37.38
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$66.75
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$13.35
Rate for Payer: United Healthcare Commercial	$66.75
Rate for Payer: United Healthcare Medicare	$35.60
Rate for Payer: WellCare Medicare	$48.95

THYROID STIM HORM (TSH)

Facility

$89.00

Service Code	HCPCS 84443
Hospital Charge Code	4300771
Hospital Revenue Code	301
Min. Negotiated Rate	$57.85
Max. Negotiated Rate	$57.85
Rate for Payer: Cash Price	$66.75
Rate for Payer: Galaxy Health Commercial	$57.85

THYROID UPDATE MULTIPLE

Facility

$27.00

Service Code	HCPCS 78012 26
Hospital Charge Code	5210039
Hospital Revenue Code	960
Min. Negotiated Rate	$4.05
Max. Negotiated Rate	$21.60
Rate for Payer: Aetna of NY Commercial	$18.90
Rate for Payer: Aetna of NY Medicare	$12.42
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$10.80
Rate for Payer: Cash Price	$20.25
Rate for Payer: CDPHP Medicare	$9.99
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$21.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$21.60
Rate for Payer: EmblemHealth Medicaid	$21.60
Rate for Payer: EmblemHealth Medicare	$9.18
Rate for Payer: Fidelis Medicare	$10.80
Rate for Payer: Galaxy Health Commercial	$17.55
Rate for Payer: Hamaspik Choice Medicare	$10.80
Rate for Payer: Humana Medicare	$10.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$18.90
Rate for Payer: Local 1199SEIU Medicare	$12.42
Rate for Payer: MVP Health Care of NY Commercial	$20.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$15.20
Rate for Payer: MVP Health Care of NY Medicare	$11.34
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4.05
Rate for Payer: United Healthcare Medicare	$10.80
Rate for Payer: WellCare Medicare	$14.85

THYROID UPDATE MULTIPLE

Facility

$27.00

Service Code	HCPCS 78012 26
Hospital Charge Code	5210039
Hospital Revenue Code	960
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$17.55
Rate for Payer: Cash Price	$20.25
Rate for Payer: Galaxy Health Commercial	$17.55

THYROID UPTAKE MULTIPLE

Facility

$1,225.00

Service Code	HCPCS 78012
Hospital Charge Code	4210039
Hospital Revenue Code	341
Min. Negotiated Rate	$796.25
Max. Negotiated Rate	$796.25
Rate for Payer: Cash Price	$918.75
Rate for Payer: Galaxy Health Commercial	$796.25

THYROID UPTAKE MULTIPLE

Facility

$1,225.00

Service Code	HCPCS 78012
Hospital Charge Code	4210039
Hospital Revenue Code	341
Min. Negotiated Rate	$183.75
Max. Negotiated Rate	$1,545.00
Rate for Payer: Aetna of NY Commercial	$857.50
Rate for Payer: Aetna of NY Medicare	$563.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$490.00
Rate for Payer: Cash Price	$918.75
Rate for Payer: Cash Price	$918.75
Rate for Payer: CDPHP Medicare	$453.25
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$857.50
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$980.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$980.00
Rate for Payer: EmblemHealth Medicaid	$980.00
Rate for Payer: EmblemHealth Medicare	$416.50
Rate for Payer: EmblemHealth Select Care	$796.25
Rate for Payer: Fidelis Medicare	$490.00
Rate for Payer: Galaxy Health Commercial	$796.25
Rate for Payer: Hamaspik Choice Medicare	$490.00
Rate for Payer: Humana Medicare	$490.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$857.50
Rate for Payer: Local 1199SEIU Medicare	$563.50
Rate for Payer: MVP Health Care of NY Commercial	$918.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$689.67
Rate for Payer: MVP Health Care of NY Medicare	$514.50
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,545.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$183.75
Rate for Payer: United Healthcare Commercial	$1,545.00
Rate for Payer: United Healthcare Medicare	$490.00
Rate for Payer: WellCare Medicare	$673.75

TICRON BLUE 5 X 18" GS-22 TAPER

Facility

$38.11

Hospital Charge Code	4472214
Hospital Revenue Code	270
Min. Negotiated Rate	$24.77
Max. Negotiated Rate	$24.77
Rate for Payer: Cash Price	$28.58
Rate for Payer: Galaxy Health Commercial	$24.77

TICRON BLUE 5 X 18" GS-22 TAPER

Facility

$38.11

Hospital Charge Code	4472214
Hospital Revenue Code	270
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$30.49
Rate for Payer: Aetna of NY Commercial	$26.68
Rate for Payer: Aetna of NY Medicare	$17.53
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$15.24
Rate for Payer: Cash Price	$28.58
Rate for Payer: CDPHP Medicare	$14.10
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$30.49
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$30.49
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$30.49
Rate for Payer: EmblemHealth Medicaid	$30.49
Rate for Payer: EmblemHealth Medicare	$12.96
Rate for Payer: EmblemHealth Select Care	$27.44
Rate for Payer: Fidelis Medicare	$15.24
Rate for Payer: Galaxy Health Commercial	$24.77
Rate for Payer: Hamaspik Choice Medicare	$15.24
Rate for Payer: Humana Medicare	$15.24
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$26.68
Rate for Payer: Local 1199SEIU Medicare	$17.53
Rate for Payer: MVP Health Care of NY Commercial	$28.58
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$21.46
Rate for Payer: MVP Health Care of NY Medicare	$16.01
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.72
Rate for Payer: United Healthcare Medicare	$15.24
Rate for Payer: WellCare Medicare	$20.96

TIMOLOL MALEATE 0.005 DROP 5 ML

Facility

$55.62

Service Code	NDC 61314022705
Hospital Charge Code	4400761
Hospital Revenue Code	250
Min. Negotiated Rate	$30.59
Max. Negotiated Rate	$36.15
Rate for Payer: Cash Price	$41.72
Rate for Payer: Galaxy Health Commercial	$36.15
Rate for Payer: WellCare Medicare	$30.59

TIMOLOL MALEATE 0.005 DROP 5 ML

Facility

$55.62

Service Code	NDC 61314022705
Hospital Charge Code	4400761
Hospital Revenue Code	250
Min. Negotiated Rate	$8.34
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna of NY Commercial	$38.93
Rate for Payer: Aetna of NY Medicare	$25.59
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$22.25
Rate for Payer: Cash Price	$41.72
Rate for Payer: CDPHP Medicare	$20.58
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$44.50
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$44.50
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$44.50
Rate for Payer: EmblemHealth Medicaid	$44.50
Rate for Payer: EmblemHealth Medicare	$18.91
Rate for Payer: EmblemHealth Select Care	$40.05
Rate for Payer: Fidelis Medicare	$22.25
Rate for Payer: Galaxy Health Commercial	$36.15
Rate for Payer: Hamaspik Choice Medicare	$22.25
Rate for Payer: Humana Medicare	$22.25
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$38.93
Rate for Payer: Local 1199SEIU Medicare	$25.59
Rate for Payer: MVP Health Care of NY Commercial	$41.72
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$31.31
Rate for Payer: MVP Health Care of NY Medicare	$23.36
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$8.34
Rate for Payer: United Healthcare Medicare	$22.25
Rate for Payer: WellCare Medicare	$30.59

TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX

Facility

$422.00

Service Code	HCPCS 88233
Hospital Charge Code	4302026
Hospital Revenue Code	310
Min. Negotiated Rate	$274.30
Max. Negotiated Rate	$274.30
Rate for Payer: Cash Price	$316.50
Rate for Payer: Galaxy Health Commercial	$274.30

TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX

Facility

$422.00

Service Code	HCPCS 88233
Hospital Charge Code	4302026
Hospital Revenue Code	310
Min. Negotiated Rate	$63.30
Max. Negotiated Rate	$337.60
Rate for Payer: Aetna of NY Commercial	$274.30
Rate for Payer: Aetna of NY Medicare	$194.12
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$168.80
Rate for Payer: Cash Price	$316.50
Rate for Payer: CDPHP Medicare	$156.14
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$253.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$337.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$337.60
Rate for Payer: EmblemHealth Medicaid	$337.60
Rate for Payer: EmblemHealth Medicare	$143.48
Rate for Payer: EmblemHealth Select Care	$253.20
Rate for Payer: Fidelis Medicare	$168.80
Rate for Payer: Galaxy Health Commercial	$274.30
Rate for Payer: Hamaspik Choice Medicare	$168.80
Rate for Payer: Humana Medicare	$168.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$274.30
Rate for Payer: Local 1199SEIU Medicare	$194.12
Rate for Payer: MVP Health Care of NY Commercial	$316.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$237.59
Rate for Payer: MVP Health Care of NY Medicare	$177.24
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$316.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$63.30
Rate for Payer: United Healthcare Commercial	$316.50
Rate for Payer: United Healthcare Medicare	$168.80
Rate for Payer: WellCare Medicare	$232.10

TISSUE EXAM BY PATHOLOGIST LVL 3

Facility

$160.00

Service Code	HCPCS 88304 TC
Hospital Charge Code	4008304
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

TISSUE EXAM BY PATHOLOGIST LVL 3

Facility

$160.00

Service Code	HCPCS 88304 TC
Hospital Charge Code	4008304
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

TISSUE EXAM BY PATHOLOGIST LVL 4

Facility

$160.00

Service Code	HCPCS 88305 TC
Hospital Charge Code	4008305
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

TISSUE EXAM BY PATHOLOGIST LVL 4

Facility

$160.00

Service Code	HCPCS 88305 TC
Hospital Charge Code	4008305
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

TISSUE EXAM BY PATHOLOGIST LVL 5

Facility

$1,099.00

Service Code	HCPCS 88307 TC
Hospital Charge Code	4008307
Hospital Revenue Code	310
Min. Negotiated Rate	$714.35
Max. Negotiated Rate	$714.35
Rate for Payer: Cash Price	$824.25
Rate for Payer: Galaxy Health Commercial	$714.35

TISSUE EXAM BY PATHOLOGIST LVL 5

Facility

$1,099.00

Service Code	HCPCS 88307 TC
Hospital Charge Code	4008307
Hospital Revenue Code	310
Min. Negotiated Rate	$164.85
Max. Negotiated Rate	$879.20
Rate for Payer: Aetna of NY Commercial	$714.35
Rate for Payer: Aetna of NY Medicare	$505.54
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$439.60
Rate for Payer: Cash Price	$824.25
Rate for Payer: CDPHP Medicare	$406.63
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$659.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$879.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$879.20
Rate for Payer: EmblemHealth Medicaid	$879.20
Rate for Payer: EmblemHealth Medicare	$373.66
Rate for Payer: EmblemHealth Select Care	$659.40
Rate for Payer: Fidelis Medicare	$439.60
Rate for Payer: Galaxy Health Commercial	$714.35
Rate for Payer: Hamaspik Choice Medicare	$439.60
Rate for Payer: Humana Medicare	$439.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$714.35
Rate for Payer: Local 1199SEIU Medicare	$505.54
Rate for Payer: MVP Health Care of NY Commercial	$824.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$618.74
Rate for Payer: MVP Health Care of NY Medicare	$461.58
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$824.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$164.85
Rate for Payer: United Healthcare Commercial	$824.25
Rate for Payer: United Healthcare Medicare	$439.60
Rate for Payer: WellCare Medicare	$604.45

TISSUE EXAM BY PATHOLOGIST LVL 6

Facility

$2,469.00

Service Code	HCPCS 88309 TC
Hospital Charge Code	4008309
Hospital Revenue Code	310
Min. Negotiated Rate	$370.35
Max. Negotiated Rate	$1,975.20
Rate for Payer: Aetna of NY Commercial	$1,604.85
Rate for Payer: Aetna of NY Medicare	$1,135.74
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$987.60
Rate for Payer: Cash Price	$1,851.75
Rate for Payer: CDPHP Medicare	$913.53
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,481.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,975.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,975.20
Rate for Payer: EmblemHealth Medicaid	$1,975.20
Rate for Payer: EmblemHealth Medicare	$839.46
Rate for Payer: EmblemHealth Select Care	$1,481.40
Rate for Payer: Fidelis Medicare	$987.60
Rate for Payer: Galaxy Health Commercial	$1,604.85
Rate for Payer: Hamaspik Choice Medicare	$987.60
Rate for Payer: Humana Medicare	$987.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,604.85
Rate for Payer: Local 1199SEIU Medicare	$1,135.74
Rate for Payer: MVP Health Care of NY Commercial	$1,851.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,390.05
Rate for Payer: MVP Health Care of NY Medicare	$1,036.98
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,851.75
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$370.35
Rate for Payer: United Healthcare Commercial	$1,851.75
Rate for Payer: United Healthcare Medicare	$987.60
Rate for Payer: WellCare Medicare	$1,357.95

Know your out-of-pocket cost for care.

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