Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

VENTRALEX HERNIA PATCH LARGE

Facility

$3,027.17

Service Code	HCPCS C1781
Hospital Charge Code	4471008
Hospital Revenue Code	278
Min. Negotiated Rate	$1,362.23
Max. Negotiated Rate	$2,119.02
Rate for Payer: Aetna of NY Commercial	$2,119.02
Rate for Payer: Cash Price	$2,270.38
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,513.59
Rate for Payer: EmblemHealth Select Care	$1,513.59
Rate for Payer: Galaxy Health Commercial	$1,967.66
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$2,119.02
Rate for Payer: Multiplan Commercial	$1,362.23
Rate for Payer: MVP Health Care of NY Commercial	$1,967.66
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,967.66
Rate for Payer: WellCare Medicare	$1,664.94

VENTRALEX HERNIA PATCH LARGE

Facility

$3,027.17

Service Code	HCPCS C1781
Hospital Charge Code	4471008
Hospital Revenue Code	278
Min. Negotiated Rate	$454.08
Max. Negotiated Rate	$2,421.74
Rate for Payer: Aetna of NY Commercial	$2,119.02
Rate for Payer: Aetna of NY Medicare	$1,392.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,210.87
Rate for Payer: Cash Price	$2,270.38
Rate for Payer: CDPHP Medicare	$1,120.05
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,513.59
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,421.74
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,421.74
Rate for Payer: EmblemHealth Medicaid	$2,421.74
Rate for Payer: EmblemHealth Medicare	$1,029.24
Rate for Payer: EmblemHealth Select Care	$1,513.59
Rate for Payer: Fidelis Medicare	$1,210.87
Rate for Payer: Galaxy Health Commercial	$1,967.66
Rate for Payer: Hamaspik Choice Medicare	$1,210.87
Rate for Payer: Humana Medicare	$1,210.87
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$2,119.02
Rate for Payer: Local 1199SEIU Medicare	$1,392.50
Rate for Payer: MVP Health Care of NY Commercial	$1,967.66
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,967.66
Rate for Payer: MVP Health Care of NY Medicare	$1,271.41
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$454.08
Rate for Payer: United Healthcare Medicare	$1,210.87
Rate for Payer: WellCare Medicare	$1,664.94

VENTRALEX HERNIA PATCH MEDIUM

Facility

$2,566.76

Service Code	HCPCS C1781
Hospital Charge Code	4471007
Hospital Revenue Code	278
Min. Negotiated Rate	$385.01
Max. Negotiated Rate	$2,053.41
Rate for Payer: Aetna of NY Commercial	$1,796.73
Rate for Payer: Aetna of NY Medicare	$1,180.71
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,026.70
Rate for Payer: Cash Price	$1,925.07
Rate for Payer: CDPHP Medicare	$949.70
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,283.38
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,053.41
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,053.41
Rate for Payer: EmblemHealth Medicaid	$2,053.41
Rate for Payer: EmblemHealth Medicare	$872.70
Rate for Payer: EmblemHealth Select Care	$1,283.38
Rate for Payer: Fidelis Medicare	$1,026.70
Rate for Payer: Galaxy Health Commercial	$1,668.39
Rate for Payer: Hamaspik Choice Medicare	$1,026.70
Rate for Payer: Humana Medicare	$1,026.70
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,796.73
Rate for Payer: Local 1199SEIU Medicare	$1,180.71
Rate for Payer: MVP Health Care of NY Commercial	$1,668.39
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,668.39
Rate for Payer: MVP Health Care of NY Medicare	$1,078.04
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$385.01
Rate for Payer: United Healthcare Medicare	$1,026.70
Rate for Payer: WellCare Medicare	$1,411.72

VENTRALEX HERNIA PATCH MEDIUM

Facility

$2,566.76

Service Code	HCPCS C1781
Hospital Charge Code	4471007
Hospital Revenue Code	278
Min. Negotiated Rate	$1,155.04
Max. Negotiated Rate	$1,796.73
Rate for Payer: Aetna of NY Commercial	$1,796.73
Rate for Payer: Cash Price	$1,925.07
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,283.38
Rate for Payer: EmblemHealth Select Care	$1,283.38
Rate for Payer: Galaxy Health Commercial	$1,668.39
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,796.73
Rate for Payer: Multiplan Commercial	$1,155.04
Rate for Payer: MVP Health Care of NY Commercial	$1,668.39
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,668.39
Rate for Payer: WellCare Medicare	$1,411.72

VENTRALEX HERNIA PATCH SMALL

Facility

$1,818.98

Service Code	HCPCS C1781
Hospital Charge Code	4471006
Hospital Revenue Code	278
Min. Negotiated Rate	$818.54
Max. Negotiated Rate	$1,273.29
Rate for Payer: Aetna of NY Commercial	$1,273.29
Rate for Payer: Cash Price	$1,364.24
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$909.49
Rate for Payer: EmblemHealth Select Care	$909.49
Rate for Payer: Galaxy Health Commercial	$1,182.34
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,273.29
Rate for Payer: Multiplan Commercial	$818.54
Rate for Payer: MVP Health Care of NY Commercial	$1,182.34
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,182.34
Rate for Payer: WellCare Medicare	$1,000.44

VENTRALEX HERNIA PATCH SMALL

Facility

$1,818.98

Service Code	HCPCS C1781
Hospital Charge Code	4471006
Hospital Revenue Code	278
Min. Negotiated Rate	$272.85
Max. Negotiated Rate	$1,455.18
Rate for Payer: Aetna of NY Commercial	$1,273.29
Rate for Payer: Aetna of NY Medicare	$836.73
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$727.59
Rate for Payer: Cash Price	$1,364.24
Rate for Payer: CDPHP Medicare	$673.02
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$909.49
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,455.18
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,455.18
Rate for Payer: EmblemHealth Medicaid	$1,455.18
Rate for Payer: EmblemHealth Medicare	$618.45
Rate for Payer: EmblemHealth Select Care	$909.49
Rate for Payer: Fidelis Medicare	$727.59
Rate for Payer: Galaxy Health Commercial	$1,182.34
Rate for Payer: Hamaspik Choice Medicare	$727.59
Rate for Payer: Humana Medicare	$727.59
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,273.29
Rate for Payer: Local 1199SEIU Medicare	$836.73
Rate for Payer: MVP Health Care of NY Commercial	$1,182.34
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,182.34
Rate for Payer: MVP Health Care of NY Medicare	$763.97
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$272.85
Rate for Payer: United Healthcare Medicare	$727.59
Rate for Payer: WellCare Medicare	$1,000.44

VENTRICULAR LEAD

Facility

$2,254.67

Hospital Charge Code	4471349
Hospital Revenue Code	270
Min. Negotiated Rate	$1,465.54
Max. Negotiated Rate	$1,465.54
Rate for Payer: Cash Price	$1,691.00
Rate for Payer: Galaxy Health Commercial	$1,465.54

VENTRICULAR LEAD

Facility

$2,254.67

Hospital Charge Code	4471349
Hospital Revenue Code	270
Min. Negotiated Rate	$338.20
Max. Negotiated Rate	$1,803.74
Rate for Payer: Aetna of NY Commercial	$1,578.27
Rate for Payer: Aetna of NY Medicare	$1,037.15
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$901.87
Rate for Payer: Cash Price	$1,691.00
Rate for Payer: CDPHP Medicare	$834.23
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,803.74
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,803.74
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,803.74
Rate for Payer: EmblemHealth Medicaid	$1,803.74
Rate for Payer: EmblemHealth Medicare	$766.59
Rate for Payer: EmblemHealth Select Care	$1,623.36
Rate for Payer: Fidelis Medicare	$901.87
Rate for Payer: Galaxy Health Commercial	$1,465.54
Rate for Payer: Hamaspik Choice Medicare	$901.87
Rate for Payer: Humana Medicare	$901.87
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,578.27
Rate for Payer: Local 1199SEIU Medicare	$1,037.15
Rate for Payer: MVP Health Care of NY Commercial	$1,691.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,269.38
Rate for Payer: MVP Health Care of NY Medicare	$946.96
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$338.20
Rate for Payer: United Healthcare Medicare	$901.87
Rate for Payer: WellCare Medicare	$1,240.07

VERAPAMIL 120 MG

Facility

$7.21

Service Code	NDC 51079089420
Hospital Charge Code	4409067
Hospital Revenue Code	250
Min. Negotiated Rate	$3.97
Max. Negotiated Rate	$4.69
Rate for Payer: Cash Price	$5.41
Rate for Payer: Galaxy Health Commercial	$4.69
Rate for Payer: WellCare Medicare	$3.97

VERAPAMIL 120 MG

Facility

$7.21

Service Code	NDC 51079089420
Hospital Charge Code	4409067
Hospital Revenue Code	250
Min. Negotiated Rate	$1.08
Max. Negotiated Rate	$5.77
Rate for Payer: Aetna of NY Commercial	$5.05
Rate for Payer: Aetna of NY Medicare	$3.32
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2.88
Rate for Payer: Cash Price	$5.41
Rate for Payer: CDPHP Medicare	$2.67
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$5.77
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$5.77
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$5.77
Rate for Payer: EmblemHealth Medicaid	$5.77
Rate for Payer: EmblemHealth Medicare	$2.45
Rate for Payer: EmblemHealth Select Care	$5.19
Rate for Payer: Fidelis Medicare	$2.88
Rate for Payer: Galaxy Health Commercial	$4.69
Rate for Payer: Hamaspik Choice Medicare	$2.88
Rate for Payer: Humana Medicare	$2.88
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$5.05
Rate for Payer: Local 1199SEIU Medicare	$3.32
Rate for Payer: MVP Health Care of NY Commercial	$5.41
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$4.06
Rate for Payer: MVP Health Care of NY Medicare	$3.03
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.08
Rate for Payer: United Healthcare Medicare	$2.88
Rate for Payer: WellCare Medicare	$3.97

VERAPAMIL ER 180 MG TABLET 180 mg, 100 eaches

Facility

$6.00

Service Code	NDC 68462029301
Hospital Charge Code	4401397
Hospital Revenue Code	250
Min. Negotiated Rate	$0.90
Max. Negotiated Rate	$4.80
Rate for Payer: Aetna of NY Commercial	$4.20
Rate for Payer: Aetna of NY Medicare	$2.76
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2.40
Rate for Payer: Cash Price	$4.50
Rate for Payer: CDPHP Medicare	$2.22
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$4.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$4.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$4.80
Rate for Payer: EmblemHealth Medicaid	$4.80
Rate for Payer: EmblemHealth Medicare	$2.04
Rate for Payer: EmblemHealth Select Care	$4.32
Rate for Payer: Fidelis Medicare	$2.40
Rate for Payer: Galaxy Health Commercial	$3.90
Rate for Payer: Hamaspik Choice Medicare	$2.40
Rate for Payer: Humana Medicare	$2.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$4.20
Rate for Payer: Local 1199SEIU Medicare	$2.76
Rate for Payer: MVP Health Care of NY Commercial	$4.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$3.38
Rate for Payer: MVP Health Care of NY Medicare	$2.52
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.90
Rate for Payer: United Healthcare Medicare	$2.40
Rate for Payer: WellCare Medicare	$3.30

VERAPAMIL ER 180 MG TABLET 180 mg, 100 eaches

Facility

$6.00

Service Code	NDC 68462029301
Hospital Charge Code	4401397
Hospital Revenue Code	250
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$3.90
Rate for Payer: Cash Price	$4.50
Rate for Payer: Galaxy Health Commercial	$3.90
Rate for Payer: WellCare Medicare	$3.30

VERAPAMIL HCL 120MG TABS 100 EA

Facility

$6.18

Service Code	NDC 904292461
Hospital Charge Code	4400796
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

VERAPAMIL HCL 120MG TABS 100 EA

Facility

$6.18

Service Code	NDC 904292461
Hospital Charge Code	4400796
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

VERAPAMIL HCL 2.5MG/ML SDV 25X2ML

Facility

$117.94

Service Code	NDC 409114405
Hospital Charge Code	4400797
Hospital Revenue Code	250
Min. Negotiated Rate	$17.69
Max. Negotiated Rate	$94.35
Rate for Payer: Aetna of NY Commercial	$82.56
Rate for Payer: Aetna of NY Medicare	$54.25
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$47.18
Rate for Payer: Cash Price	$88.46
Rate for Payer: CDPHP Medicare	$43.64
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$94.35
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$94.35
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$94.35
Rate for Payer: EmblemHealth Medicaid	$94.35
Rate for Payer: EmblemHealth Medicare	$40.10
Rate for Payer: EmblemHealth Select Care	$84.92
Rate for Payer: Fidelis Medicare	$47.18
Rate for Payer: Galaxy Health Commercial	$76.66
Rate for Payer: Hamaspik Choice Medicare	$47.18
Rate for Payer: Humana Medicare	$47.18
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$82.56
Rate for Payer: Local 1199SEIU Medicare	$54.25
Rate for Payer: MVP Health Care of NY Commercial	$88.45
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$66.40
Rate for Payer: MVP Health Care of NY Medicare	$49.53
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$17.69
Rate for Payer: United Healthcare Medicare	$47.18
Rate for Payer: WellCare Medicare	$64.87

VERAPAMIL HCL 2.5MG/ML SDV 25X2ML

Facility

$117.94

Service Code	NDC 409114405
Hospital Charge Code	4400797
Hospital Revenue Code	250
Min. Negotiated Rate	$64.87
Max. Negotiated Rate	$76.66
Rate for Payer: Cash Price	$88.46
Rate for Payer: Galaxy Health Commercial	$76.66
Rate for Payer: WellCare Medicare	$64.87

VERAPAMIL HCL 40MG TABS 100 EA

Facility

$6.18

Service Code	NDC 23155005901
Hospital Charge Code	4400798
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

VERAPAMIL HCL 40MG TABS 100 EA

Facility

$6.18

Service Code	NDC 23155005901
Hospital Charge Code	4400798
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

VERTIFLEX KIT

Facility

$31,765.20

Service Code	HCPCS C1821
Hospital Charge Code	4473023
Hospital Revenue Code	278
Min. Negotiated Rate	$4,764.78
Max. Negotiated Rate	$25,412.16
Rate for Payer: Aetna of NY Commercial	$22,235.64
Rate for Payer: Aetna of NY Medicare	$14,611.99
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$12,706.08
Rate for Payer: Cash Price	$23,823.90
Rate for Payer: CDPHP Medicare	$11,753.12
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$15,882.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$25,412.16
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$25,412.16
Rate for Payer: EmblemHealth Medicaid	$25,412.16
Rate for Payer: EmblemHealth Medicare	$10,800.17
Rate for Payer: EmblemHealth Select Care	$15,882.60
Rate for Payer: Fidelis Medicare	$12,706.08
Rate for Payer: Galaxy Health Commercial	$20,647.38
Rate for Payer: Hamaspik Choice Medicare	$12,706.08
Rate for Payer: Humana Medicare	$12,706.08
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$22,235.64
Rate for Payer: Local 1199SEIU Medicare	$14,611.99
Rate for Payer: MVP Health Care of NY Commercial	$20,647.38
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$20,647.38
Rate for Payer: MVP Health Care of NY Medicare	$13,341.38
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4,764.78
Rate for Payer: United Healthcare Medicare	$12,706.08
Rate for Payer: WellCare Medicare	$17,470.86

VERTIFLEX KIT

Facility

$31,765.20

Service Code	HCPCS C1821
Hospital Charge Code	4473023
Hospital Revenue Code	278
Min. Negotiated Rate	$14,294.34
Max. Negotiated Rate	$22,235.64
Rate for Payer: Aetna of NY Commercial	$22,235.64
Rate for Payer: Cash Price	$23,823.90
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$15,882.60
Rate for Payer: EmblemHealth Select Care	$15,882.60
Rate for Payer: Galaxy Health Commercial	$20,647.38
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$22,235.64
Rate for Payer: Multiplan Commercial	$14,294.34
Rate for Payer: MVP Health Care of NY Commercial	$20,647.38
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$20,647.38
Rate for Payer: WellCare Medicare	$17,470.86

VERTIFLEX SPACER KIT

Facility

$33,353.46

Service Code	HCPCS C1821
Hospital Charge Code	4473022
Hospital Revenue Code	278
Min. Negotiated Rate	$15,009.06
Max. Negotiated Rate	$23,347.42
Rate for Payer: Aetna of NY Commercial	$23,347.42
Rate for Payer: Cash Price	$25,015.10
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$16,676.73
Rate for Payer: EmblemHealth Select Care	$16,676.73
Rate for Payer: Galaxy Health Commercial	$21,679.75
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$23,347.42
Rate for Payer: Multiplan Commercial	$15,009.06
Rate for Payer: MVP Health Care of NY Commercial	$21,679.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$21,679.75
Rate for Payer: WellCare Medicare	$18,344.40

VERTIFLEX SPACER KIT

Facility

$33,353.46

Service Code	HCPCS C1821
Hospital Charge Code	4473022
Hospital Revenue Code	278
Min. Negotiated Rate	$5,003.02
Max. Negotiated Rate	$26,682.77
Rate for Payer: Aetna of NY Commercial	$23,347.42
Rate for Payer: Aetna of NY Medicare	$15,342.59
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$13,341.38
Rate for Payer: Cash Price	$25,015.10
Rate for Payer: CDPHP Medicare	$12,340.78
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$16,676.73
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$26,682.77
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$26,682.77
Rate for Payer: EmblemHealth Medicaid	$26,682.77
Rate for Payer: EmblemHealth Medicare	$11,340.18
Rate for Payer: EmblemHealth Select Care	$16,676.73
Rate for Payer: Fidelis Medicare	$13,341.38
Rate for Payer: Galaxy Health Commercial	$21,679.75
Rate for Payer: Hamaspik Choice Medicare	$13,341.38
Rate for Payer: Humana Medicare	$13,341.38
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$23,347.42
Rate for Payer: Local 1199SEIU Medicare	$15,342.59
Rate for Payer: MVP Health Care of NY Commercial	$21,679.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$21,679.75
Rate for Payer: MVP Health Care of NY Medicare	$14,008.45
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5,003.02
Rate for Payer: United Healthcare Medicare	$13,341.38
Rate for Payer: WellCare Medicare	$18,344.40

VICRYL P-3

Facility

$35.02

Hospital Charge Code	4478154
Hospital Revenue Code	270
Min. Negotiated Rate	$22.76
Max. Negotiated Rate	$22.76
Rate for Payer: Cash Price	$26.26
Rate for Payer: Galaxy Health Commercial	$22.76

VICRYL P-3

Facility

$35.02

Hospital Charge Code	4478154
Hospital Revenue Code	270
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$28.02
Rate for Payer: Aetna of NY Commercial	$24.51
Rate for Payer: Aetna of NY Medicare	$16.11
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$14.01
Rate for Payer: Cash Price	$26.26
Rate for Payer: CDPHP Medicare	$12.96
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$28.02
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$28.02
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$28.02
Rate for Payer: EmblemHealth Medicaid	$28.02
Rate for Payer: EmblemHealth Medicare	$11.91
Rate for Payer: EmblemHealth Select Care	$25.21
Rate for Payer: Fidelis Medicare	$14.01
Rate for Payer: Galaxy Health Commercial	$22.76
Rate for Payer: Hamaspik Choice Medicare	$14.01
Rate for Payer: Humana Medicare	$14.01
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$24.51
Rate for Payer: Local 1199SEIU Medicare	$16.11
Rate for Payer: MVP Health Care of NY Commercial	$26.27
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$19.72
Rate for Payer: MVP Health Care of NY Medicare	$14.71
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.25
Rate for Payer: United Healthcare Medicare	$14.01
Rate for Payer: WellCare Medicare	$19.26

VICTOZA 3-PAK 18 MG/3 ML PEN 1 ea, 3 mL

Facility

$1,162.00

Service Code	NDC 169406013
Hospital Charge Code	4401414
Hospital Revenue Code	250
Min. Negotiated Rate	$174.30
Max. Negotiated Rate	$929.60
Rate for Payer: Aetna of NY Commercial	$813.40
Rate for Payer: Aetna of NY Medicare	$534.52
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$464.80
Rate for Payer: Cash Price	$871.50
Rate for Payer: CDPHP Medicare	$429.94
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$929.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$929.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$929.60
Rate for Payer: EmblemHealth Medicaid	$929.60
Rate for Payer: EmblemHealth Medicare	$395.08
Rate for Payer: EmblemHealth Select Care	$836.64
Rate for Payer: Fidelis Medicare	$464.80
Rate for Payer: Galaxy Health Commercial	$755.30
Rate for Payer: Hamaspik Choice Medicare	$464.80
Rate for Payer: Humana Medicare	$464.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$813.40
Rate for Payer: Local 1199SEIU Medicare	$534.52
Rate for Payer: MVP Health Care of NY Commercial	$871.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$654.21
Rate for Payer: MVP Health Care of NY Medicare	$488.04
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$174.30
Rate for Payer: United Healthcare Medicare	$464.80
Rate for Payer: WellCare Medicare	$639.10

Know your out-of-pocket cost for care.

All Charges