Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

BIOPSY FORCEPS 3.7MM CHANNEL

Facility

$1,256.00

Hospital Charge Code	4471870
Hospital Revenue Code	270
Min. Negotiated Rate	$816.40
Max. Negotiated Rate	$816.40
Rate for Payer: Cash Price	$942.00
Rate for Payer: Galaxy Health Commercial	$816.40

BIOPSY MUSCLE PERCUTANEOUS NEEDLE

Facility

$4,639.00

Service Code	HCPCS 20206
Hospital Charge Code	4853035
Hospital Revenue Code	761
Min. Negotiated Rate	$1,544.75
Max. Negotiated Rate	$3,734.40
Rate for Payer: Aetna of NY Commercial	$3,247.30
Rate for Payer: Aetna of NY Medicare	$2,133.94
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$2,017.33
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$2,521.93
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,716.43
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$2,319.50
Rate for Payer: Cash Price	$3,479.25
Rate for Payer: Cash Price	$3,479.25
Rate for Payer: Cash Price	$3,479.25
Rate for Payer: CDPHP Commercial	$3,734.40
Rate for Payer: CDPHP Medicare	$1,716.43
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$3,711.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$3,711.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$3,711.20
Rate for Payer: EmblemHealth Medicaid	$3,711.20
Rate for Payer: EmblemHealth Medicare	$1,577.26
Rate for Payer: EmblemHealth Select Care	$3,340.08
Rate for Payer: Fidelis Medicare	$1,767.92
Rate for Payer: Galaxy Health Commercial	$3,015.35
Rate for Payer: Hamaspik Choice Medicare	$1,716.43
Rate for Payer: Humana Medicare	$1,716.43
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$3,247.30
Rate for Payer: Local 1199SEIU Medicare	$2,133.94
Rate for Payer: MVP Health Care of NY Commercial	$3,479.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$2,611.76
Rate for Payer: MVP Health Care of NY Medicare	$1,802.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,544.75
Rate for Payer: United Healthcare Medicare	$1,716.43
Rate for Payer: WellCare Medicare	$2,551.45

BIOPSY MUSCLE PERCUTANEOUS NEEDLE

Facility

$4,639.00

Service Code	HCPCS 20206
Hospital Charge Code	4853035
Hospital Revenue Code	761
Min. Negotiated Rate	$3,015.35
Max. Negotiated Rate	$3,015.35
Rate for Payer: Cash Price	$3,479.25
Rate for Payer: Galaxy Health Commercial	$3,015.35

BIOPSY PENIS DEEP STRUCTURES

Facility

$8,130.00

Service Code	HCPCS 54105
Hospital Charge Code	4002044
Hospital Revenue Code	490
Min. Negotiated Rate	$1,266.00
Max. Negotiated Rate	$6,544.65
Rate for Payer: Aetna of NY Commercial	$1,857.00
Rate for Payer: Aetna of NY Medicare	$3,739.80
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$2,017.33
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$2,521.93
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$3,008.10
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$1,266.00
Rate for Payer: Cash Price	$6,097.50
Rate for Payer: Cash Price	$6,097.50
Rate for Payer: Cash Price	$6,097.50
Rate for Payer: CDPHP Commercial	$6,544.65
Rate for Payer: CDPHP Medicare	$3,008.10
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$6,504.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$6,504.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$6,504.00
Rate for Payer: EmblemHealth Medicaid	$6,504.00
Rate for Payer: EmblemHealth Medicare	$2,764.20
Rate for Payer: EmblemHealth Select Care	$5,853.60
Rate for Payer: Fidelis Medicare	$3,098.34
Rate for Payer: Galaxy Health Commercial	$5,284.50
Rate for Payer: Hamaspik Choice Medicare	$3,008.10
Rate for Payer: Humana Medicare	$3,008.10
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,857.00
Rate for Payer: Local 1199SEIU Medicare	$3,739.80
Rate for Payer: Multiplan Commercial	$6,504.00
Rate for Payer: MVP Health Care of NY Commercial	$6,097.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$4,577.19
Rate for Payer: MVP Health Care of NY Medicare	$3,158.50
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,775.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,707.35
Rate for Payer: United Healthcare Commercial	$2,036.00
Rate for Payer: United Healthcare Medicare	$3,008.10
Rate for Payer: WellCare Medicare	$4,471.50

BIOPSY PENIS DEEP STRUCTURES

Facility

$8,130.00

Service Code	HCPCS 54105
Hospital Charge Code	4002044
Hospital Revenue Code	490
Min. Negotiated Rate	$5,284.50
Max. Negotiated Rate	$5,284.50
Rate for Payer: Cash Price	$6,097.50
Rate for Payer: Galaxy Health Commercial	$5,284.50

BIOPSY URETHRA

Facility

$5,828.00

Service Code	HCPCS 53200
Hospital Charge Code	4002033
Hospital Revenue Code	490
Min. Negotiated Rate	$3,788.20
Max. Negotiated Rate	$3,788.20
Rate for Payer: Cash Price	$4,371.00
Rate for Payer: Galaxy Health Commercial	$3,788.20

BIOPSY URETHRA

Facility

$5,828.00

Service Code	HCPCS 53200
Hospital Charge Code	4002033
Hospital Revenue Code	490
Min. Negotiated Rate	$1,266.00
Max. Negotiated Rate	$4,691.54
Rate for Payer: Aetna of NY Commercial	$1,857.00
Rate for Payer: Aetna of NY Medicare	$2,680.88
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$2,017.33
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$2,521.93
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2,156.36
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$1,266.00
Rate for Payer: Cash Price	$4,371.00
Rate for Payer: Cash Price	$4,371.00
Rate for Payer: Cash Price	$4,371.00
Rate for Payer: CDPHP Commercial	$4,691.54
Rate for Payer: CDPHP Medicare	$2,156.36
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$4,662.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$4,662.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$4,662.40
Rate for Payer: EmblemHealth Medicaid	$4,662.40
Rate for Payer: EmblemHealth Medicare	$1,981.52
Rate for Payer: EmblemHealth Select Care	$4,196.16
Rate for Payer: Fidelis Medicare	$2,221.05
Rate for Payer: Galaxy Health Commercial	$3,788.20
Rate for Payer: Hamaspik Choice Medicare	$2,156.36
Rate for Payer: Humana Medicare	$2,156.36
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,857.00
Rate for Payer: Local 1199SEIU Medicare	$2,680.88
Rate for Payer: Multiplan Commercial	$4,662.40
Rate for Payer: MVP Health Care of NY Commercial	$4,371.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$3,281.16
Rate for Payer: MVP Health Care of NY Medicare	$2,264.18
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,775.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,940.66
Rate for Payer: United Healthcare Commercial	$2,036.00
Rate for Payer: United Healthcare Medicare	$2,156.36
Rate for Payer: WellCare Medicare	$3,205.40

BIOSYN 5-0

Facility

$13.00

Hospital Charge Code	4479303
Hospital Revenue Code	270
Min. Negotiated Rate	$4.42
Max. Negotiated Rate	$10.46
Rate for Payer: Aetna of NY Commercial	$9.10
Rate for Payer: Aetna of NY Medicare	$5.98
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$9.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$9.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$4.81
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$6.50
Rate for Payer: Cash Price	$9.75
Rate for Payer: CDPHP Commercial	$10.46
Rate for Payer: CDPHP Medicare	$4.81
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$10.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$10.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$10.40
Rate for Payer: EmblemHealth Medicaid	$10.40
Rate for Payer: EmblemHealth Medicare	$4.42
Rate for Payer: EmblemHealth Select Care	$9.36
Rate for Payer: Fidelis Medicare	$4.95
Rate for Payer: Galaxy Health Commercial	$8.45
Rate for Payer: Hamaspik Choice Medicare	$4.81
Rate for Payer: Humana Medicare	$4.81
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$9.10
Rate for Payer: Local 1199SEIU Medicare	$5.98
Rate for Payer: MVP Health Care of NY Commercial	$9.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$7.32
Rate for Payer: MVP Health Care of NY Medicare	$5.05
Rate for Payer: United Healthcare Medicare	$4.81
Rate for Payer: WellCare Medicare	$7.15

BIOSYN 5-0

Facility

$13.00

Hospital Charge Code	4479303
Hospital Revenue Code	270
Min. Negotiated Rate	$8.45
Max. Negotiated Rate	$8.45
Rate for Payer: Cash Price	$9.75
Rate for Payer: Galaxy Health Commercial	$8.45

BIOSYN 6-0

Facility

$15.00

Hospital Charge Code	4479305
Hospital Revenue Code	270
Min. Negotiated Rate	$9.75
Max. Negotiated Rate	$9.75
Rate for Payer: Cash Price	$11.25
Rate for Payer: Galaxy Health Commercial	$9.75

BIOSYN 6-0

Facility

$15.00

Hospital Charge Code	4479305
Hospital Revenue Code	270
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$12.08
Rate for Payer: Aetna of NY Commercial	$10.50
Rate for Payer: Aetna of NY Medicare	$6.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$11.25
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$11.25
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$5.55
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$7.50
Rate for Payer: Cash Price	$11.25
Rate for Payer: CDPHP Commercial	$12.08
Rate for Payer: CDPHP Medicare	$5.55
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$12.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$12.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$12.00
Rate for Payer: EmblemHealth Medicaid	$12.00
Rate for Payer: EmblemHealth Medicare	$5.10
Rate for Payer: EmblemHealth Select Care	$10.80
Rate for Payer: Fidelis Medicare	$5.72
Rate for Payer: Galaxy Health Commercial	$9.75
Rate for Payer: Hamaspik Choice Medicare	$5.55
Rate for Payer: Humana Medicare	$5.55
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$10.50
Rate for Payer: Local 1199SEIU Medicare	$6.90
Rate for Payer: MVP Health Care of NY Commercial	$11.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$8.44
Rate for Payer: MVP Health Care of NY Medicare	$5.83
Rate for Payer: United Healthcare Medicare	$5.55
Rate for Payer: WellCare Medicare	$8.25

BIPOLAR PROBE 10FR.

Facility

$523.00

Hospital Charge Code	4471734
Hospital Revenue Code	270
Min. Negotiated Rate	$177.82
Max. Negotiated Rate	$421.02
Rate for Payer: Aetna of NY Commercial	$366.10
Rate for Payer: Aetna of NY Medicare	$240.58
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$392.25
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$392.25
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$193.51
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$261.50
Rate for Payer: Cash Price	$392.25
Rate for Payer: CDPHP Commercial	$421.02
Rate for Payer: CDPHP Medicare	$193.51
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$418.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$418.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$418.40
Rate for Payer: EmblemHealth Medicaid	$418.40
Rate for Payer: EmblemHealth Medicare	$177.82
Rate for Payer: EmblemHealth Select Care	$376.56
Rate for Payer: Fidelis Medicare	$199.32
Rate for Payer: Galaxy Health Commercial	$339.95
Rate for Payer: Hamaspik Choice Medicare	$193.51
Rate for Payer: Humana Medicare	$193.51
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$366.10
Rate for Payer: Local 1199SEIU Medicare	$240.58
Rate for Payer: MVP Health Care of NY Commercial	$392.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$294.45
Rate for Payer: MVP Health Care of NY Medicare	$203.19
Rate for Payer: United Healthcare Medicare	$193.51
Rate for Payer: WellCare Medicare	$287.65

BIPOLAR PROBE 10FR.

Facility

$523.00

Hospital Charge Code	4471734
Hospital Revenue Code	270
Min. Negotiated Rate	$339.95
Max. Negotiated Rate	$339.95
Rate for Payer: Cash Price	$392.25
Rate for Payer: Galaxy Health Commercial	$339.95

BIPOLAR PROBE 7FR.

Facility

$578.00

Hospital Charge Code	4471735
Hospital Revenue Code	270
Min. Negotiated Rate	$375.70
Max. Negotiated Rate	$375.70
Rate for Payer: Cash Price	$433.50
Rate for Payer: Galaxy Health Commercial	$375.70

BIPOLAR PROBE 7FR.

Facility

$578.00

Hospital Charge Code	4471735
Hospital Revenue Code	270
Min. Negotiated Rate	$196.52
Max. Negotiated Rate	$465.29
Rate for Payer: Aetna of NY Commercial	$404.60
Rate for Payer: Aetna of NY Medicare	$265.88
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$433.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$433.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$213.86
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$289.00
Rate for Payer: Cash Price	$433.50
Rate for Payer: CDPHP Commercial	$465.29
Rate for Payer: CDPHP Medicare	$213.86
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$462.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$462.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$462.40
Rate for Payer: EmblemHealth Medicaid	$462.40
Rate for Payer: EmblemHealth Medicare	$196.52
Rate for Payer: EmblemHealth Select Care	$416.16
Rate for Payer: Fidelis Medicare	$220.28
Rate for Payer: Galaxy Health Commercial	$375.70
Rate for Payer: Hamaspik Choice Medicare	$213.86
Rate for Payer: Humana Medicare	$213.86
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$404.60
Rate for Payer: Local 1199SEIU Medicare	$265.88
Rate for Payer: MVP Health Care of NY Commercial	$433.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$325.41
Rate for Payer: MVP Health Care of NY Medicare	$224.55
Rate for Payer: United Healthcare Medicare	$213.86
Rate for Payer: WellCare Medicare	$317.90

BISACODYL 10MG SUPP 12 EA

Facility

$6.18

Service Code	NDC 00574705050
Hospital Charge Code	4400105
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

BISACODYL 10MG SUPP 12 EA

Facility

$6.18

Service Code	NDC 00574705050
Hospital Charge Code	4400105
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.97
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) Blue Access/Small Group	$4.64
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$4.64
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2.29
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$3.09
Rate for Payer: Cash Price	$4.64
Rate for Payer: CDPHP Commercial	$4.97
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	$2.36
Rate for Payer: Galaxy Health Commercial	$4.02
Rate for Payer: Hamaspik Choice Medicare	$2.29
Rate for Payer: Humana Medicare	$2.29
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	$4.64
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$3.48
Rate for Payer: MVP Health Care of NY Medicare	$2.40
Rate for Payer: United Healthcare Medicare	$2.29
Rate for Payer: WellCare Medicare	$3.40

BISACODYL 5MG TABS 100 EA

Facility

$6.18

Service Code	NDC 00904640761
Hospital Charge Code	4400106
Hospital Revenue Code	250
Min. Negotiated Rate	$2.10
Max. Negotiated Rate	$4.97
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) Blue Access/Small Group	$4.64
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$4.64
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2.29
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$3.09
Rate for Payer: Cash Price	$4.64
Rate for Payer: CDPHP Commercial	$4.97
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	$2.36
Rate for Payer: Galaxy Health Commercial	$4.02
Rate for Payer: Hamaspik Choice Medicare	$2.29
Rate for Payer: Humana Medicare	$2.29
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	$4.64
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$3.48
Rate for Payer: MVP Health Care of NY Medicare	$2.40
Rate for Payer: United Healthcare Medicare	$2.29
Rate for Payer: WellCare Medicare	$3.40

BISACODYL 5MG TABS 100 EA

Facility

$6.18

Service Code	NDC 00904640761
Hospital Charge Code	4400106
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

BITE BLOCKS

Facility

$49.00

Hospital Charge Code	4479157
Hospital Revenue Code	270
Min. Negotiated Rate	$31.85
Max. Negotiated Rate	$31.85
Rate for Payer: Cash Price	$36.75
Rate for Payer: Galaxy Health Commercial	$31.85

BITE BLOCKS

Facility

$49.00

Hospital Charge Code	4479157
Hospital Revenue Code	270
Min. Negotiated Rate	$16.66
Max. Negotiated Rate	$39.44
Rate for Payer: Aetna of NY Commercial	$34.30
Rate for Payer: Aetna of NY Medicare	$22.54
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$36.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$36.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$18.13
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$24.50
Rate for Payer: Cash Price	$36.75
Rate for Payer: CDPHP Commercial	$39.44
Rate for Payer: CDPHP Medicare	$18.13
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$39.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$39.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$39.20
Rate for Payer: EmblemHealth Medicaid	$39.20
Rate for Payer: EmblemHealth Medicare	$16.66
Rate for Payer: EmblemHealth Select Care	$35.28
Rate for Payer: Fidelis Medicare	$18.67
Rate for Payer: Galaxy Health Commercial	$31.85
Rate for Payer: Hamaspik Choice Medicare	$18.13
Rate for Payer: Humana Medicare	$18.13
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$34.30
Rate for Payer: Local 1199SEIU Medicare	$22.54
Rate for Payer: MVP Health Care of NY Commercial	$36.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$27.59
Rate for Payer: MVP Health Care of NY Medicare	$19.04
Rate for Payer: United Healthcare Medicare	$18.13
Rate for Payer: WellCare Medicare	$26.95

BLADE SURGICAL SZ 10

Facility

$34.00

Hospital Charge Code	4471117
Hospital Revenue Code	270
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$22.10
Rate for Payer: Cash Price	$25.50
Rate for Payer: Galaxy Health Commercial	$22.10

BLADE SURGICAL SZ 10

Facility

$34.00

Hospital Charge Code	4471117
Hospital Revenue Code	270
Min. Negotiated Rate	$11.56
Max. Negotiated Rate	$27.37
Rate for Payer: Aetna of NY Commercial	$23.80
Rate for Payer: Aetna of NY Medicare	$15.64
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$25.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$25.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$12.58
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$17.00
Rate for Payer: Cash Price	$25.50
Rate for Payer: CDPHP Commercial	$27.37
Rate for Payer: CDPHP Medicare	$12.58
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$27.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$27.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$27.20
Rate for Payer: EmblemHealth Medicaid	$27.20
Rate for Payer: EmblemHealth Medicare	$11.56
Rate for Payer: EmblemHealth Select Care	$24.48
Rate for Payer: Fidelis Medicare	$12.96
Rate for Payer: Galaxy Health Commercial	$22.10
Rate for Payer: Hamaspik Choice Medicare	$12.58
Rate for Payer: Humana Medicare	$12.58
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$23.80
Rate for Payer: Local 1199SEIU Medicare	$15.64
Rate for Payer: MVP Health Care of NY Commercial	$25.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$19.14
Rate for Payer: MVP Health Care of NY Medicare	$13.21
Rate for Payer: United Healthcare Medicare	$12.58
Rate for Payer: WellCare Medicare	$18.70

BLANKET

Facility

$28.00

Hospital Charge Code	4478239
Hospital Revenue Code	270
Min. Negotiated Rate	$9.52
Max. Negotiated Rate	$22.54
Rate for Payer: Aetna of NY Commercial	$19.60
Rate for Payer: Aetna of NY Medicare	$12.88
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$21.00
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$21.00
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$10.36
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$14.00
Rate for Payer: Cash Price	$21.00
Rate for Payer: CDPHP Commercial	$22.54
Rate for Payer: CDPHP Medicare	$10.36
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$22.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$22.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$22.40
Rate for Payer: EmblemHealth Medicaid	$22.40
Rate for Payer: EmblemHealth Medicare	$9.52
Rate for Payer: EmblemHealth Select Care	$20.16
Rate for Payer: Fidelis Medicare	$10.67
Rate for Payer: Galaxy Health Commercial	$18.20
Rate for Payer: Hamaspik Choice Medicare	$10.36
Rate for Payer: Humana Medicare	$10.36
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$19.60
Rate for Payer: Local 1199SEIU Medicare	$12.88
Rate for Payer: MVP Health Care of NY Commercial	$21.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$15.76
Rate for Payer: MVP Health Care of NY Medicare	$10.88
Rate for Payer: United Healthcare Medicare	$10.36
Rate for Payer: WellCare Medicare	$15.40

BLANKET

Facility

$28.00

Hospital Charge Code	4478239
Hospital Revenue Code	270
Min. Negotiated Rate	$18.20
Max. Negotiated Rate	$18.20
Rate for Payer: Cash Price	$21.00
Rate for Payer: Galaxy Health Commercial	$18.20

Know your out-of-pocket cost for care.

All Charges