Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

TRICHOMONAS VAGINALIS AMPLIF

Facility

$122.00

Service Code	HCPCS 87661
Hospital Charge Code	4302006
Hospital Revenue Code	300
Min. Negotiated Rate	$18.30
Max. Negotiated Rate	$97.60
Rate for Payer: Aetna of NY Commercial	$79.30
Rate for Payer: Aetna of NY Medicare	$56.12
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$48.80
Rate for Payer: Cash Price	$91.50
Rate for Payer: CDPHP Medicare	$45.14
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$73.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$97.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$97.60
Rate for Payer: EmblemHealth Medicaid	$97.60
Rate for Payer: EmblemHealth Medicare	$41.48
Rate for Payer: EmblemHealth Select Care	$73.20
Rate for Payer: Fidelis Medicare	$48.80
Rate for Payer: Galaxy Health Commercial	$79.30
Rate for Payer: Hamaspik Choice Medicare	$48.80
Rate for Payer: Humana Medicare	$48.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$79.30
Rate for Payer: Local 1199SEIU Medicare	$56.12
Rate for Payer: MVP Health Care of NY Commercial	$91.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$68.69
Rate for Payer: MVP Health Care of NY Medicare	$51.24
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$91.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$18.30
Rate for Payer: United Healthcare Commercial	$91.50
Rate for Payer: United Healthcare Medicare	$48.80
Rate for Payer: WellCare Medicare	$67.10

TRICHOMONAS VAGINALIS AMPLIF

Facility

$122.00

Service Code	HCPCS 87661
Hospital Charge Code	4302006
Hospital Revenue Code	300
Min. Negotiated Rate	$79.30
Max. Negotiated Rate	$79.30
Rate for Payer: Cash Price	$91.50
Rate for Payer: Galaxy Health Commercial	$79.30

TRICOR 145 MG

Facility

$15.97

Service Code	NDC 51079060820
Hospital Charge Code	4409040
Hospital Revenue Code	250
Min. Negotiated Rate	$8.78
Max. Negotiated Rate	$10.38
Rate for Payer: Cash Price	$11.98
Rate for Payer: Galaxy Health Commercial	$10.38
Rate for Payer: WellCare Medicare	$8.78

TRICOR 145 MG

Facility

$15.97

Service Code	NDC 51079060820
Hospital Charge Code	4409040
Hospital Revenue Code	250
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$12.78
Rate for Payer: Aetna of NY Commercial	$11.18
Rate for Payer: Aetna of NY Medicare	$7.35
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$6.39
Rate for Payer: Cash Price	$11.98
Rate for Payer: CDPHP Medicare	$5.91
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$12.78
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$12.78
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$12.78
Rate for Payer: EmblemHealth Medicaid	$12.78
Rate for Payer: EmblemHealth Medicare	$5.43
Rate for Payer: EmblemHealth Select Care	$11.50
Rate for Payer: Fidelis Medicare	$6.39
Rate for Payer: Galaxy Health Commercial	$10.38
Rate for Payer: Hamaspik Choice Medicare	$6.39
Rate for Payer: Humana Medicare	$6.39
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$11.18
Rate for Payer: Local 1199SEIU Medicare	$7.35
Rate for Payer: MVP Health Care of NY Commercial	$11.98
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$8.99
Rate for Payer: MVP Health Care of NY Medicare	$6.71
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.40
Rate for Payer: United Healthcare Medicare	$6.39
Rate for Payer: WellCare Medicare	$8.78

TRIGGER POINTS INJECTION

Facility

$941.00

Service Code	HCPCS 20552
Hospital Charge Code	4850028
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

TRIGGER POINTS INJECTION

Facility

$941.00

Service Code	HCPCS 20552
Hospital Charge Code	4850028
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

TRIGLYCERIDE

Facility

$17.00

Service Code	HCPCS 84478
Hospital Charge Code	4300796
Hospital Revenue Code	301
Min. Negotiated Rate	$11.05
Max. Negotiated Rate	$11.05
Rate for Payer: Cash Price	$12.75
Rate for Payer: Galaxy Health Commercial	$11.05

TRIGLYCERIDE

Facility

$17.00

Service Code	HCPCS 84478
Hospital Charge Code	4300796
Hospital Revenue Code	301
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$13.60
Rate for Payer: Aetna of NY Commercial	$11.05
Rate for Payer: Aetna of NY Medicare	$7.82
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$6.80
Rate for Payer: Cash Price	$12.75
Rate for Payer: CDPHP Medicare	$6.29
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$10.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$13.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$13.60
Rate for Payer: EmblemHealth Medicaid	$13.60
Rate for Payer: EmblemHealth Medicare	$5.78
Rate for Payer: EmblemHealth Select Care	$10.20
Rate for Payer: Fidelis Medicare	$6.80
Rate for Payer: Galaxy Health Commercial	$11.05
Rate for Payer: Hamaspik Choice Medicare	$6.80
Rate for Payer: Humana Medicare	$6.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$11.05
Rate for Payer: Local 1199SEIU Medicare	$7.82
Rate for Payer: MVP Health Care of NY Commercial	$12.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$9.57
Rate for Payer: MVP Health Care of NY Medicare	$7.14
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$12.75
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.55
Rate for Payer: United Healthcare Commercial	$12.75
Rate for Payer: United Healthcare Medicare	$6.80
Rate for Payer: WellCare Medicare	$9.35

TRIHEXYPHENIDYL HCL 2MG TABS 10X10EA

Facility

$6.18

Service Code	NDC 16571016010
Hospital Charge Code	4400774
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

TRIHEXYPHENIDYL HCL 2MG TABS 10X10EA

Facility

$6.18

Service Code	NDC 16571016010
Hospital Charge Code	4400774
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

TRIM ND NAILS

Facility

$181.00

Service Code	HCPCS 11719
Hospital Charge Code	4856656
Hospital Revenue Code	761
Min. Negotiated Rate	$117.65
Max. Negotiated Rate	$117.65
Rate for Payer: Cash Price	$135.75
Rate for Payer: Galaxy Health Commercial	$117.65

TRIM ND NAILS

Facility

$181.00

Service Code	HCPCS 11719
Hospital Charge Code	4856656
Hospital Revenue Code	761
Min. Negotiated Rate	$27.15
Max. Negotiated Rate	$144.80
Rate for Payer: Aetna of NY Commercial	$126.70
Rate for Payer: Aetna of NY Medicare	$83.26
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$72.40
Rate for Payer: Cash Price	$135.75
Rate for Payer: CDPHP Medicare	$66.97
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$144.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$144.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$144.80
Rate for Payer: EmblemHealth Medicaid	$144.80
Rate for Payer: EmblemHealth Medicare	$61.54
Rate for Payer: EmblemHealth Select Care	$130.32
Rate for Payer: Fidelis Medicare	$72.40
Rate for Payer: Galaxy Health Commercial	$117.65
Rate for Payer: Hamaspik Choice Medicare	$72.40
Rate for Payer: Humana Medicare	$72.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$126.70
Rate for Payer: Local 1199SEIU Medicare	$83.26
Rate for Payer: MVP Health Care of NY Commercial	$135.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$101.90
Rate for Payer: MVP Health Care of NY Medicare	$76.02
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$27.15
Rate for Payer: United Healthcare Medicare	$72.40
Rate for Payer: WellCare Medicare	$99.55

TRIM SKIN LESIONS 2 TO 4

Facility

$615.00

Service Code	HCPCS 11056
Hospital Charge Code	4856667
Hospital Revenue Code	761
Min. Negotiated Rate	$92.25
Max. Negotiated Rate	$492.00
Rate for Payer: Aetna of NY Commercial	$430.50
Rate for Payer: Aetna of NY Medicare	$282.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$246.00
Rate for Payer: Cash Price	$461.25
Rate for Payer: CDPHP Medicare	$227.55
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$492.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$492.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$492.00
Rate for Payer: EmblemHealth Medicaid	$492.00
Rate for Payer: EmblemHealth Medicare	$209.10
Rate for Payer: EmblemHealth Select Care	$442.80
Rate for Payer: Fidelis Medicare	$246.00
Rate for Payer: Galaxy Health Commercial	$399.75
Rate for Payer: Hamaspik Choice Medicare	$246.00
Rate for Payer: Humana Medicare	$246.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$430.50
Rate for Payer: Local 1199SEIU Medicare	$282.90
Rate for Payer: MVP Health Care of NY Commercial	$461.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$346.25
Rate for Payer: MVP Health Care of NY Medicare	$258.30
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$92.25
Rate for Payer: United Healthcare Medicare	$246.00
Rate for Payer: WellCare Medicare	$338.25

TRIM SKIN LESIONS 2 TO 4

Facility

$615.00

Service Code	HCPCS 11056
Hospital Charge Code	4856667
Hospital Revenue Code	761
Min. Negotiated Rate	$399.75
Max. Negotiated Rate	$399.75
Rate for Payer: Cash Price	$461.25
Rate for Payer: Galaxy Health Commercial	$399.75

TRINTELLIX 10 MG TABLET 10 mg, 30 eaches

Facility

$59.00

Service Code	NDC 64764073030
Hospital Charge Code	4401561
Hospital Revenue Code	250
Min. Negotiated Rate	$32.45
Max. Negotiated Rate	$38.35
Rate for Payer: Cash Price	$44.25
Rate for Payer: Galaxy Health Commercial	$38.35
Rate for Payer: WellCare Medicare	$32.45

TRINTELLIX 10 MG TABLET 10 mg, 30 eaches

Facility

$59.00

Service Code	NDC 64764073030
Hospital Charge Code	4401561
Hospital Revenue Code	250
Min. Negotiated Rate	$8.85
Max. Negotiated Rate	$47.20
Rate for Payer: Aetna of NY Commercial	$41.30
Rate for Payer: Aetna of NY Medicare	$27.14
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$23.60
Rate for Payer: Cash Price	$44.25
Rate for Payer: CDPHP Medicare	$21.83
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$47.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$47.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$47.20
Rate for Payer: EmblemHealth Medicaid	$47.20
Rate for Payer: EmblemHealth Medicare	$20.06
Rate for Payer: EmblemHealth Select Care	$42.48
Rate for Payer: Fidelis Medicare	$23.60
Rate for Payer: Galaxy Health Commercial	$38.35
Rate for Payer: Hamaspik Choice Medicare	$23.60
Rate for Payer: Humana Medicare	$23.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$41.30
Rate for Payer: Local 1199SEIU Medicare	$27.14
Rate for Payer: MVP Health Care of NY Commercial	$44.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$33.22
Rate for Payer: MVP Health Care of NY Medicare	$24.78
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$8.85
Rate for Payer: United Healthcare Medicare	$23.60
Rate for Payer: WellCare Medicare	$32.45

TRIPLE LUMEN TRAY

Facility

$388.31

Hospital Charge Code	4471822
Hospital Revenue Code	278
Min. Negotiated Rate	$58.25
Max. Negotiated Rate	$310.65
Rate for Payer: Aetna of NY Commercial	$271.82
Rate for Payer: Aetna of NY Medicare	$178.62
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$155.32
Rate for Payer: Cash Price	$291.23
Rate for Payer: CDPHP Medicare	$143.67
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$194.16
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$310.65
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$310.65
Rate for Payer: EmblemHealth Medicaid	$310.65
Rate for Payer: EmblemHealth Medicare	$132.03
Rate for Payer: EmblemHealth Select Care	$194.16
Rate for Payer: Fidelis Medicare	$155.32
Rate for Payer: Galaxy Health Commercial	$252.40
Rate for Payer: Hamaspik Choice Medicare	$155.32
Rate for Payer: Humana Medicare	$155.32
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$271.82
Rate for Payer: Local 1199SEIU Medicare	$178.62
Rate for Payer: MVP Health Care of NY Commercial	$252.40
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$252.40
Rate for Payer: MVP Health Care of NY Medicare	$163.09
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$58.25
Rate for Payer: United Healthcare Medicare	$155.32
Rate for Payer: WellCare Medicare	$213.57

TRIPLE LUMEN TRAY

Facility

$388.31

Hospital Charge Code	4471822
Hospital Revenue Code	278
Min. Negotiated Rate	$174.74
Max. Negotiated Rate	$271.82
Rate for Payer: Aetna of NY Commercial	$271.82
Rate for Payer: Cash Price	$291.23
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$194.16
Rate for Payer: EmblemHealth Select Care	$194.16
Rate for Payer: Galaxy Health Commercial	$252.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$271.82
Rate for Payer: Multiplan Commercial	$174.74
Rate for Payer: MVP Health Care of NY Commercial	$252.40
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$252.40
Rate for Payer: WellCare Medicare	$213.57

TROCAR BALLOON KIT

Facility

$356.38

Hospital Charge Code	4479184
Hospital Revenue Code	270
Min. Negotiated Rate	$231.65
Max. Negotiated Rate	$231.65
Rate for Payer: Cash Price	$267.28
Rate for Payer: Galaxy Health Commercial	$231.65

TROCAR BALLOON KIT

Facility

$356.38

Hospital Charge Code	4479184
Hospital Revenue Code	270
Min. Negotiated Rate	$53.46
Max. Negotiated Rate	$285.10
Rate for Payer: Aetna of NY Commercial	$249.47
Rate for Payer: Aetna of NY Medicare	$163.93
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$142.55
Rate for Payer: Cash Price	$267.28
Rate for Payer: CDPHP Medicare	$131.86
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$285.10
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$285.10
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$285.10
Rate for Payer: EmblemHealth Medicaid	$285.10
Rate for Payer: EmblemHealth Medicare	$121.17
Rate for Payer: EmblemHealth Select Care	$256.59
Rate for Payer: Fidelis Medicare	$142.55
Rate for Payer: Galaxy Health Commercial	$231.65
Rate for Payer: Hamaspik Choice Medicare	$142.55
Rate for Payer: Humana Medicare	$142.55
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$249.47
Rate for Payer: Local 1199SEIU Medicare	$163.93
Rate for Payer: MVP Health Care of NY Commercial	$267.29
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$200.64
Rate for Payer: MVP Health Care of NY Medicare	$149.68
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$53.46
Rate for Payer: United Healthcare Medicare	$142.55
Rate for Payer: WellCare Medicare	$196.01

TROCAR ENDO BLUNT 12MM THREA

Facility

$790.01

Hospital Charge Code	4471761
Hospital Revenue Code	272
Min. Negotiated Rate	$513.51
Max. Negotiated Rate	$513.51
Rate for Payer: Cash Price	$592.51
Rate for Payer: Galaxy Health Commercial	$513.51

TROCAR ENDO BLUNT 12MM THREA

Facility

$790.01

Hospital Charge Code	4471761
Hospital Revenue Code	272
Min. Negotiated Rate	$118.50
Max. Negotiated Rate	$632.01
Rate for Payer: Aetna of NY Commercial	$553.01
Rate for Payer: Aetna of NY Medicare	$363.40
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$316.00
Rate for Payer: Cash Price	$592.51
Rate for Payer: CDPHP Medicare	$292.30
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$632.01
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$632.01
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$632.01
Rate for Payer: EmblemHealth Medicaid	$632.01
Rate for Payer: EmblemHealth Medicare	$268.60
Rate for Payer: EmblemHealth Select Care	$568.81
Rate for Payer: Fidelis Medicare	$316.00
Rate for Payer: Galaxy Health Commercial	$513.51
Rate for Payer: Hamaspik Choice Medicare	$316.00
Rate for Payer: Humana Medicare	$316.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$553.01
Rate for Payer: Local 1199SEIU Medicare	$363.40
Rate for Payer: MVP Health Care of NY Commercial	$592.51
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$444.78
Rate for Payer: MVP Health Care of NY Medicare	$331.80
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$118.50
Rate for Payer: United Healthcare Medicare	$316.00
Rate for Payer: WellCare Medicare	$434.51

TROPONIN QUAN

Facility

$121.00

Service Code	HCPCS 84484
Hospital Charge Code	4300798
Hospital Revenue Code	301
Min. Negotiated Rate	$18.15
Max. Negotiated Rate	$96.80
Rate for Payer: Aetna of NY Commercial	$78.65
Rate for Payer: Aetna of NY Medicare	$55.66
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$48.40
Rate for Payer: Cash Price	$90.75
Rate for Payer: CDPHP Medicare	$44.77
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$72.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$96.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$96.80
Rate for Payer: EmblemHealth Medicaid	$96.80
Rate for Payer: EmblemHealth Medicare	$41.14
Rate for Payer: EmblemHealth Select Care	$72.60
Rate for Payer: Fidelis Medicare	$48.40
Rate for Payer: Galaxy Health Commercial	$78.65
Rate for Payer: Hamaspik Choice Medicare	$48.40
Rate for Payer: Humana Medicare	$48.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$78.65
Rate for Payer: Local 1199SEIU Medicare	$55.66
Rate for Payer: MVP Health Care of NY Commercial	$90.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$68.12
Rate for Payer: MVP Health Care of NY Medicare	$50.82
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$90.75
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$18.15
Rate for Payer: United Healthcare Commercial	$90.75
Rate for Payer: United Healthcare Medicare	$48.40
Rate for Payer: WellCare Medicare	$66.55

TROPONIN QUAN

Facility

$121.00

Service Code	HCPCS 84484
Hospital Charge Code	4300798
Hospital Revenue Code	301
Min. Negotiated Rate	$78.65
Max. Negotiated Rate	$78.65
Rate for Payer: Cash Price	$90.75
Rate for Payer: Galaxy Health Commercial	$78.65

TRULICITY 1.5 MG/0.5 ML PEN 0.5 ML, 0.5 ML

Facility

$739.54

Hospital Charge Code	4404330
Hospital Revenue Code	250
Min. Negotiated Rate	$110.93
Max. Negotiated Rate	$591.63
Rate for Payer: Aetna of NY Commercial	$517.68
Rate for Payer: Aetna of NY Medicare	$340.19
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$295.82
Rate for Payer: Cash Price	$554.66
Rate for Payer: CDPHP Medicare	$273.63
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$591.63
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$591.63
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$591.63
Rate for Payer: EmblemHealth Medicaid	$591.63
Rate for Payer: EmblemHealth Medicare	$251.44
Rate for Payer: EmblemHealth Select Care	$532.47
Rate for Payer: Fidelis Medicare	$295.82
Rate for Payer: Galaxy Health Commercial	$480.70
Rate for Payer: Hamaspik Choice Medicare	$295.82
Rate for Payer: Humana Medicare	$295.82
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$517.68
Rate for Payer: Local 1199SEIU Medicare	$340.19
Rate for Payer: MVP Health Care of NY Commercial	$554.65
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$416.36
Rate for Payer: MVP Health Care of NY Medicare	$310.61
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$110.93
Rate for Payer: United Healthcare Medicare	$295.82
Rate for Payer: WellCare Medicare	$406.75

Know your out-of-pocket cost for care.

All Charges