Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

TPN, UP TO ONE LITER PER DAY, ALL SUPPLIES/EQUIPMENT

Facility

$425.39

Hospital Charge Code	1050100
Hospital Revenue Code	250
Min. Negotiated Rate	$63.81
Max. Negotiated Rate	$340.31
Rate for Payer: Aetna of NY Commercial	$297.77
Rate for Payer: Aetna of NY Medicare	$195.68
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$170.16
Rate for Payer: Cash Price	$319.04
Rate for Payer: CDPHP Medicare	$157.39
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$340.31
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$340.31
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$340.31
Rate for Payer: EmblemHealth Medicaid	$340.31
Rate for Payer: EmblemHealth Medicare	$144.63
Rate for Payer: EmblemHealth Select Care	$306.28
Rate for Payer: Fidelis Medicare	$170.16
Rate for Payer: Galaxy Health Commercial	$276.50
Rate for Payer: Hamaspik Choice Medicare	$170.16
Rate for Payer: Humana Medicare	$170.16
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$297.77
Rate for Payer: Local 1199SEIU Medicare	$195.68
Rate for Payer: MVP Health Care of NY Commercial	$319.04
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$239.49
Rate for Payer: MVP Health Care of NY Medicare	$178.66
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$63.81
Rate for Payer: United Healthcare Medicare	$170.16
Rate for Payer: WellCare Medicare	$233.96

TRADJENTA 5 MG TABLET 1 ea, 30 eaches

Facility

$56.00

Service Code	NDC 597014030
Hospital Charge Code	4401417
Hospital Revenue Code	250
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$44.80
Rate for Payer: Aetna of NY Commercial	$39.20
Rate for Payer: Aetna of NY Medicare	$25.76
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$22.40
Rate for Payer: Cash Price	$42.00
Rate for Payer: CDPHP Medicare	$20.72
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$44.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$44.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$44.80
Rate for Payer: EmblemHealth Medicaid	$44.80
Rate for Payer: EmblemHealth Medicare	$19.04
Rate for Payer: EmblemHealth Select Care	$40.32
Rate for Payer: Fidelis Medicare	$22.40
Rate for Payer: Galaxy Health Commercial	$36.40
Rate for Payer: Hamaspik Choice Medicare	$22.40
Rate for Payer: Humana Medicare	$22.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$39.20
Rate for Payer: Local 1199SEIU Medicare	$25.76
Rate for Payer: MVP Health Care of NY Commercial	$42.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$31.53
Rate for Payer: MVP Health Care of NY Medicare	$23.52
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$8.40
Rate for Payer: United Healthcare Medicare	$22.40
Rate for Payer: WellCare Medicare	$30.80

TRADJENTA 5 MG TABLET 1 ea, 30 eaches

Facility

$56.00

Service Code	NDC 597014030
Hospital Charge Code	4401417
Hospital Revenue Code	250
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$36.40
Rate for Payer: Cash Price	$42.00
Rate for Payer: Galaxy Health Commercial	$36.40
Rate for Payer: WellCare Medicare	$30.80

TRAECHEOSTOMY SET 3.5MM

Facility

$594.31

Hospital Charge Code	4471105
Hospital Revenue Code	270
Min. Negotiated Rate	$386.30
Max. Negotiated Rate	$386.30
Rate for Payer: Cash Price	$445.73
Rate for Payer: Galaxy Health Commercial	$386.30

TRAECHEOSTOMY SET 3.5MM

Facility

$594.31

Hospital Charge Code	4471105
Hospital Revenue Code	270
Min. Negotiated Rate	$89.15
Max. Negotiated Rate	$475.45
Rate for Payer: Aetna of NY Commercial	$416.02
Rate for Payer: Aetna of NY Medicare	$273.38
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$237.72
Rate for Payer: Cash Price	$445.73
Rate for Payer: CDPHP Medicare	$219.89
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$475.45
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$475.45
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$475.45
Rate for Payer: EmblemHealth Medicaid	$475.45
Rate for Payer: EmblemHealth Medicare	$202.07
Rate for Payer: EmblemHealth Select Care	$427.90
Rate for Payer: Fidelis Medicare	$237.72
Rate for Payer: Galaxy Health Commercial	$386.30
Rate for Payer: Hamaspik Choice Medicare	$237.72
Rate for Payer: Humana Medicare	$237.72
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$416.02
Rate for Payer: Local 1199SEIU Medicare	$273.38
Rate for Payer: MVP Health Care of NY Commercial	$445.73
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$334.60
Rate for Payer: MVP Health Care of NY Medicare	$249.61
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$89.15
Rate for Payer: United Healthcare Medicare	$237.72
Rate for Payer: WellCare Medicare	$326.87

TRAECHEOSTOMY SET 4.0MM

Facility

$594.31

Hospital Charge Code	4471106
Hospital Revenue Code	270
Min. Negotiated Rate	$89.15
Max. Negotiated Rate	$475.45
Rate for Payer: Aetna of NY Commercial	$416.02
Rate for Payer: Aetna of NY Medicare	$273.38
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$237.72
Rate for Payer: Cash Price	$445.73
Rate for Payer: CDPHP Medicare	$219.89
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$475.45
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$475.45
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$475.45
Rate for Payer: EmblemHealth Medicaid	$475.45
Rate for Payer: EmblemHealth Medicare	$202.07
Rate for Payer: EmblemHealth Select Care	$427.90
Rate for Payer: Fidelis Medicare	$237.72
Rate for Payer: Galaxy Health Commercial	$386.30
Rate for Payer: Hamaspik Choice Medicare	$237.72
Rate for Payer: Humana Medicare	$237.72
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$416.02
Rate for Payer: Local 1199SEIU Medicare	$273.38
Rate for Payer: MVP Health Care of NY Commercial	$445.73
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$334.60
Rate for Payer: MVP Health Care of NY Medicare	$249.61
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$89.15
Rate for Payer: United Healthcare Medicare	$237.72
Rate for Payer: WellCare Medicare	$326.87

TRAECHEOSTOMY SET 4.0MM

Facility

$594.31

Hospital Charge Code	4471106
Hospital Revenue Code	270
Min. Negotiated Rate	$386.30
Max. Negotiated Rate	$386.30
Rate for Payer: Cash Price	$445.73
Rate for Payer: Galaxy Health Commercial	$386.30

TRAECHEOSTOMY SET 6MM

Facility

$600.49

Hospital Charge Code	4471820
Hospital Revenue Code	270
Min. Negotiated Rate	$390.32
Max. Negotiated Rate	$390.32
Rate for Payer: Cash Price	$450.37
Rate for Payer: Galaxy Health Commercial	$390.32

TRAECHEOSTOMY SET 6MM

Facility

$600.49

Hospital Charge Code	4471820
Hospital Revenue Code	270
Min. Negotiated Rate	$90.07
Max. Negotiated Rate	$480.39
Rate for Payer: Aetna of NY Commercial	$420.34
Rate for Payer: Aetna of NY Medicare	$276.23
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$240.20
Rate for Payer: Cash Price	$450.37
Rate for Payer: CDPHP Medicare	$222.18
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$480.39
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$480.39
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$480.39
Rate for Payer: EmblemHealth Medicaid	$480.39
Rate for Payer: EmblemHealth Medicare	$204.17
Rate for Payer: EmblemHealth Select Care	$432.35
Rate for Payer: Fidelis Medicare	$240.20
Rate for Payer: Galaxy Health Commercial	$390.32
Rate for Payer: Hamaspik Choice Medicare	$240.20
Rate for Payer: Humana Medicare	$240.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$420.34
Rate for Payer: Local 1199SEIU Medicare	$276.23
Rate for Payer: MVP Health Care of NY Commercial	$450.37
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$338.08
Rate for Payer: MVP Health Care of NY Medicare	$252.21
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$90.07
Rate for Payer: United Healthcare Medicare	$240.20
Rate for Payer: WellCare Medicare	$330.27

TRAMADOL HCL 50MG TABS 100 EA

Facility

$6.18

Service Code	NDC 65162062710
Hospital Charge Code	4400768
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

TRAMADOL HCL 50MG TABS 100 EA

Facility

$6.18

Service Code	NDC 65162062710
Hospital Charge Code	4400768
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

TRANEXAMIC ACID 100 MG / ML INJECTION, 1

Facility

$113.82

Service Code	NDC 39822100001
Hospital Charge Code	4409212
Hospital Revenue Code	250
Min. Negotiated Rate	$62.60
Max. Negotiated Rate	$73.98
Rate for Payer: Cash Price	$85.36
Rate for Payer: Galaxy Health Commercial	$73.98
Rate for Payer: WellCare Medicare	$62.60

TRANEXAMIC ACID 100 MG / ML INJECTION, 1

Facility

$113.82

Service Code	NDC 39822100001
Hospital Charge Code	4409212
Hospital Revenue Code	250
Min. Negotiated Rate	$17.07
Max. Negotiated Rate	$91.06
Rate for Payer: Aetna of NY Commercial	$79.67
Rate for Payer: Aetna of NY Medicare	$52.36
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$45.53
Rate for Payer: Cash Price	$85.36
Rate for Payer: CDPHP Medicare	$42.11
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$91.06
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$91.06
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$91.06
Rate for Payer: EmblemHealth Medicaid	$91.06
Rate for Payer: EmblemHealth Medicare	$38.70
Rate for Payer: EmblemHealth Select Care	$81.95
Rate for Payer: Fidelis Medicare	$45.53
Rate for Payer: Galaxy Health Commercial	$73.98
Rate for Payer: Hamaspik Choice Medicare	$45.53
Rate for Payer: Humana Medicare	$45.53
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$79.67
Rate for Payer: Local 1199SEIU Medicare	$52.36
Rate for Payer: MVP Health Care of NY Commercial	$85.36
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$64.08
Rate for Payer: MVP Health Care of NY Medicare	$47.80
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$17.07
Rate for Payer: United Healthcare Medicare	$45.53
Rate for Payer: WellCare Medicare	$62.60

TRANSCUTANEOUS PACING TEMPORAR

Facility

$2,026.00

Service Code	HCPCS 92953
Hospital Charge Code	4600172
Hospital Revenue Code	450
Min. Negotiated Rate	$1,316.90
Max. Negotiated Rate	$1,316.90
Rate for Payer: Cash Price	$1,519.50
Rate for Payer: Galaxy Health Commercial	$1,316.90

TRANSCUTANEOUS PACING TEMPORAR

Facility

$2,026.00

Service Code	HCPCS 92953
Hospital Charge Code	4600172
Hospital Revenue Code	450
Min. Negotiated Rate	$303.90
Max. Negotiated Rate	$1,620.80
Rate for Payer: Aetna of NY Commercial	$1,000.00
Rate for Payer: Aetna of NY Medicare	$931.96
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$810.40
Rate for Payer: Cash Price	$1,519.50
Rate for Payer: Cash Price	$1,519.50
Rate for Payer: Cash Price	$1,519.50
Rate for Payer: CDPHP Medicare	$749.62
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,206.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,620.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,620.80
Rate for Payer: EmblemHealth Medicaid	$1,620.80
Rate for Payer: EmblemHealth Medicare	$688.84
Rate for Payer: EmblemHealth Select Care	$1,085.00
Rate for Payer: Fidelis Medicare	$810.40
Rate for Payer: Galaxy Health Commercial	$1,316.90
Rate for Payer: Hamaspik Choice Medicare	$810.40
Rate for Payer: Humana Medicare	$810.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,000.00
Rate for Payer: Local 1199SEIU Medicare	$931.96
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	$850.92
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,009.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$303.90
Rate for Payer: United Healthcare Commercial	$1,009.00
Rate for Payer: United Healthcare Medicare	$810.40
Rate for Payer: WellCare Medicare	$1,114.30

TRANSDISCAL INTRODUCER TDIB-17-150

Facility

$418.18

Hospital Charge Code	4479254
Hospital Revenue Code	270
Min. Negotiated Rate	$271.82
Max. Negotiated Rate	$271.82
Rate for Payer: Cash Price	$313.64
Rate for Payer: Galaxy Health Commercial	$271.82

TRANSDISCAL INTRODUCER TDIB-17-150

Facility

$418.18

Hospital Charge Code	4479254
Hospital Revenue Code	270
Min. Negotiated Rate	$62.73
Max. Negotiated Rate	$334.54
Rate for Payer: Aetna of NY Commercial	$292.73
Rate for Payer: Aetna of NY Medicare	$192.36
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$167.27
Rate for Payer: Cash Price	$313.64
Rate for Payer: CDPHP Medicare	$154.73
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$334.54
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$334.54
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$334.54
Rate for Payer: EmblemHealth Medicaid	$334.54
Rate for Payer: EmblemHealth Medicare	$142.18
Rate for Payer: EmblemHealth Select Care	$301.09
Rate for Payer: Fidelis Medicare	$167.27
Rate for Payer: Galaxy Health Commercial	$271.82
Rate for Payer: Hamaspik Choice Medicare	$167.27
Rate for Payer: Humana Medicare	$167.27
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$292.73
Rate for Payer: Local 1199SEIU Medicare	$192.36
Rate for Payer: MVP Health Care of NY Commercial	$313.63
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$235.44
Rate for Payer: MVP Health Care of NY Medicare	$175.64
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$62.73
Rate for Payer: United Healthcare Medicare	$167.27
Rate for Payer: WellCare Medicare	$230.00

TRANSDISCAL PROBE KIT TDK2-17-150-6

Facility

$5,217.98

Hospital Charge Code	4479251
Hospital Revenue Code	270
Min. Negotiated Rate	$782.70
Max. Negotiated Rate	$4,174.38
Rate for Payer: Aetna of NY Commercial	$3,652.59
Rate for Payer: Aetna of NY Medicare	$2,400.27
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2,087.19
Rate for Payer: Cash Price	$3,913.48
Rate for Payer: CDPHP Medicare	$1,930.65
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$4,174.38
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$4,174.38
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$4,174.38
Rate for Payer: EmblemHealth Medicaid	$4,174.38
Rate for Payer: EmblemHealth Medicare	$1,774.11
Rate for Payer: EmblemHealth Select Care	$3,756.95
Rate for Payer: Fidelis Medicare	$2,087.19
Rate for Payer: Galaxy Health Commercial	$3,391.69
Rate for Payer: Hamaspik Choice Medicare	$2,087.19
Rate for Payer: Humana Medicare	$2,087.19
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$3,652.59
Rate for Payer: Local 1199SEIU Medicare	$2,400.27
Rate for Payer: MVP Health Care of NY Commercial	$3,913.49
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$2,937.72
Rate for Payer: MVP Health Care of NY Medicare	$2,191.55
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$782.70
Rate for Payer: United Healthcare Medicare	$2,087.19
Rate for Payer: WellCare Medicare	$2,869.89

TRANSDISCAL PROBE KIT TDK2-17-150-6

Facility

$5,217.98

Hospital Charge Code	4479251
Hospital Revenue Code	270
Min. Negotiated Rate	$3,391.69
Max. Negotiated Rate	$3,391.69
Rate for Payer: Cash Price	$3,913.48
Rate for Payer: Galaxy Health Commercial	$3,391.69

TRANSDISCAL PROBETIP TDP-17-150-6

Facility

$2,190.81

Hospital Charge Code	4479252
Hospital Revenue Code	270
Min. Negotiated Rate	$328.62
Max. Negotiated Rate	$1,752.65
Rate for Payer: Aetna of NY Commercial	$1,533.57
Rate for Payer: Aetna of NY Medicare	$1,007.77
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$876.32
Rate for Payer: Cash Price	$1,643.11
Rate for Payer: CDPHP Medicare	$810.60
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,752.65
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,752.65
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,752.65
Rate for Payer: EmblemHealth Medicaid	$1,752.65
Rate for Payer: EmblemHealth Medicare	$744.88
Rate for Payer: EmblemHealth Select Care	$1,577.38
Rate for Payer: Fidelis Medicare	$876.32
Rate for Payer: Galaxy Health Commercial	$1,424.03
Rate for Payer: Hamaspik Choice Medicare	$876.32
Rate for Payer: Humana Medicare	$876.32
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,533.57
Rate for Payer: Local 1199SEIU Medicare	$1,007.77
Rate for Payer: MVP Health Care of NY Commercial	$1,643.11
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,233.43
Rate for Payer: MVP Health Care of NY Medicare	$920.14
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$328.62
Rate for Payer: United Healthcare Medicare	$876.32
Rate for Payer: WellCare Medicare	$1,204.95

TRANSDISCAL PROBETIP TDP-17-150-6

Facility

$2,190.81

Hospital Charge Code	4479252
Hospital Revenue Code	270
Min. Negotiated Rate	$1,424.03
Max. Negotiated Rate	$1,424.03
Rate for Payer: Cash Price	$1,643.11
Rate for Payer: Galaxy Health Commercial	$1,424.03

TRANSDISCAL + SINERGYCABLE TDX-Y-TSW-TDP

Facility

$1,773.66

Hospital Charge Code	4479253
Hospital Revenue Code	270
Min. Negotiated Rate	$266.05
Max. Negotiated Rate	$1,418.93
Rate for Payer: Aetna of NY Commercial	$1,241.56
Rate for Payer: Aetna of NY Medicare	$815.88
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$709.46
Rate for Payer: Cash Price	$1,330.24
Rate for Payer: CDPHP Medicare	$656.25
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,418.93
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,418.93
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,418.93
Rate for Payer: EmblemHealth Medicaid	$1,418.93
Rate for Payer: EmblemHealth Medicare	$603.04
Rate for Payer: EmblemHealth Select Care	$1,277.04
Rate for Payer: Fidelis Medicare	$709.46
Rate for Payer: Galaxy Health Commercial	$1,152.88
Rate for Payer: Hamaspik Choice Medicare	$709.46
Rate for Payer: Humana Medicare	$709.46
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,241.56
Rate for Payer: Local 1199SEIU Medicare	$815.88
Rate for Payer: MVP Health Care of NY Commercial	$1,330.24
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$998.57
Rate for Payer: MVP Health Care of NY Medicare	$744.94
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$266.05
Rate for Payer: United Healthcare Medicare	$709.46
Rate for Payer: WellCare Medicare	$975.51

TRANSDISCAL + SINERGYCABLE TDX-Y-TSW-TDP

Facility

$1,773.66

Hospital Charge Code	4479253
Hospital Revenue Code	270
Min. Negotiated Rate	$1,152.88
Max. Negotiated Rate	$1,152.88
Rate for Payer: Cash Price	$1,330.24
Rate for Payer: Galaxy Health Commercial	$1,152.88

TRANSDISCAL TUBING+BURETTE KIT TDA-TBK-1

Facility

$502.64

Hospital Charge Code	4479255
Hospital Revenue Code	270
Min. Negotiated Rate	$75.40
Max. Negotiated Rate	$402.11
Rate for Payer: Aetna of NY Commercial	$351.85
Rate for Payer: Aetna of NY Medicare	$231.21
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$201.06
Rate for Payer: Cash Price	$376.98
Rate for Payer: CDPHP Medicare	$185.98
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$402.11
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$402.11
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$402.11
Rate for Payer: EmblemHealth Medicaid	$402.11
Rate for Payer: EmblemHealth Medicare	$170.90
Rate for Payer: EmblemHealth Select Care	$361.90
Rate for Payer: Fidelis Medicare	$201.06
Rate for Payer: Galaxy Health Commercial	$326.72
Rate for Payer: Hamaspik Choice Medicare	$201.06
Rate for Payer: Humana Medicare	$201.06
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$351.85
Rate for Payer: Local 1199SEIU Medicare	$231.21
Rate for Payer: MVP Health Care of NY Commercial	$376.98
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$282.99
Rate for Payer: MVP Health Care of NY Medicare	$211.11
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$75.40
Rate for Payer: United Healthcare Medicare	$201.06
Rate for Payer: WellCare Medicare	$276.45

TRANSDISCAL TUBING+BURETTE KIT TDA-TBK-1

Facility

$502.64

Hospital Charge Code	4479255
Hospital Revenue Code	270
Min. Negotiated Rate	$326.72
Max. Negotiated Rate	$326.72
Rate for Payer: Cash Price	$376.98
Rate for Payer: Galaxy Health Commercial	$326.72

Know your out-of-pocket cost for care.

All Charges