Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

BURR OVAL 10 FLUTE 3.5MM (AR-9350OBT)

Facility

$210.12

Hospital Charge Code	4473030
Hospital Revenue Code	272
Min. Negotiated Rate	$31.52
Max. Negotiated Rate	$168.10
Rate for Payer: Aetna of NY Commercial	$147.08
Rate for Payer: Aetna of NY Medicare	$96.66
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$84.05
Rate for Payer: Cash Price	$157.59
Rate for Payer: CDPHP Medicare	$77.74
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$168.10
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$168.10
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$168.10
Rate for Payer: EmblemHealth Medicaid	$168.10
Rate for Payer: EmblemHealth Medicare	$71.44
Rate for Payer: EmblemHealth Select Care	$151.29
Rate for Payer: Fidelis Medicare	$84.05
Rate for Payer: Galaxy Health Commercial	$136.58
Rate for Payer: Hamaspik Choice Medicare	$84.05
Rate for Payer: Humana Medicare	$84.05
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$147.08
Rate for Payer: Local 1199SEIU Medicare	$96.66
Rate for Payer: MVP Health Care of NY Commercial	$157.59
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$118.30
Rate for Payer: MVP Health Care of NY Medicare	$88.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$31.52
Rate for Payer: United Healthcare Medicare	$84.05
Rate for Payer: WellCare Medicare	$115.57

BURR OVAL 10 FLUTE 3.5MM (AR-9350OBT)

Facility

$210.12

Hospital Charge Code	4473030
Hospital Revenue Code	272
Min. Negotiated Rate	$136.58
Max. Negotiated Rate	$136.58
Rate for Payer: Cash Price	$157.59
Rate for Payer: Galaxy Health Commercial	$136.58

BURR ROUND 10 FLUTE 3.0MM (AR-9300RBT)

Facility

$210.12

Hospital Charge Code	4473031
Hospital Revenue Code	272
Min. Negotiated Rate	$31.52
Max. Negotiated Rate	$168.10
Rate for Payer: Aetna of NY Commercial	$147.08
Rate for Payer: Aetna of NY Medicare	$96.66
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$84.05
Rate for Payer: Cash Price	$157.59
Rate for Payer: CDPHP Medicare	$77.74
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$168.10
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$168.10
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$168.10
Rate for Payer: EmblemHealth Medicaid	$168.10
Rate for Payer: EmblemHealth Medicare	$71.44
Rate for Payer: EmblemHealth Select Care	$151.29
Rate for Payer: Fidelis Medicare	$84.05
Rate for Payer: Galaxy Health Commercial	$136.58
Rate for Payer: Hamaspik Choice Medicare	$84.05
Rate for Payer: Humana Medicare	$84.05
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$147.08
Rate for Payer: Local 1199SEIU Medicare	$96.66
Rate for Payer: MVP Health Care of NY Commercial	$157.59
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$118.30
Rate for Payer: MVP Health Care of NY Medicare	$88.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$31.52
Rate for Payer: United Healthcare Medicare	$84.05
Rate for Payer: WellCare Medicare	$115.57

BURR ROUND 10 FLUTE 3.0MM (AR-9300RBT)

Facility

$210.12

Hospital Charge Code	4473031
Hospital Revenue Code	272
Min. Negotiated Rate	$136.58
Max. Negotiated Rate	$136.58
Rate for Payer: Cash Price	$157.59
Rate for Payer: Galaxy Health Commercial	$136.58

BUSPIRONE 15 MG

Facility

$6.18

Service Code	NDC 51079096020
Hospital Charge Code	4409077
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

BUSPIRONE 15 MG

Facility

$6.18

Service Code	NDC 51079096020
Hospital Charge Code	4409077
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

busPIRone HCL 5 MG TABLET 5 mg, 100 eaches

Facility

$6.00

Service Code	NDC 904712261
Hospital Charge Code	4401520
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

busPIRone HCL 5 MG TABLET 5 mg, 100 eaches

Facility

$6.00

Service Code	NDC 904712261
Hospital Charge Code	4401520
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

BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID

Facility

$5,062.00

Service Code	HCPCS 19083
Hospital Charge Code	4201073
Hospital Revenue Code	402
Min. Negotiated Rate	$3,290.30
Max. Negotiated Rate	$3,290.30
Rate for Payer: Cash Price	$3,796.50
Rate for Payer: Galaxy Health Commercial	$3,290.30

BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID

Facility

$473.00

Service Code	HCPCS 19083 26
Hospital Charge Code	5201073
Hospital Revenue Code	960
Min. Negotiated Rate	$70.95
Max. Negotiated Rate	$378.40
Rate for Payer: Aetna of NY Commercial	$331.10
Rate for Payer: Aetna of NY Medicare	$217.58
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$189.20
Rate for Payer: Cash Price	$354.75
Rate for Payer: CDPHP Medicare	$175.01
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$378.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$378.40
Rate for Payer: EmblemHealth Medicaid	$378.40
Rate for Payer: EmblemHealth Medicare	$160.82
Rate for Payer: Fidelis Medicare	$189.20
Rate for Payer: Galaxy Health Commercial	$307.45
Rate for Payer: Hamaspik Choice Medicare	$189.20
Rate for Payer: Humana Medicare	$189.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$331.10
Rate for Payer: Local 1199SEIU Medicare	$217.58
Rate for Payer: MVP Health Care of NY Commercial	$354.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$266.30
Rate for Payer: MVP Health Care of NY Medicare	$198.66
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$70.95
Rate for Payer: United Healthcare Medicare	$189.20
Rate for Payer: WellCare Medicare	$260.15

BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID

Facility

$5,062.00

Service Code	HCPCS 19083
Hospital Charge Code	4201073
Hospital Revenue Code	402
Min. Negotiated Rate	$489.00
Max. Negotiated Rate	$4,049.60
Rate for Payer: Aetna of NY Commercial	$3,543.40
Rate for Payer: Aetna of NY Medicare	$2,328.52
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2,024.80
Rate for Payer: Cash Price	$3,796.50
Rate for Payer: Cash Price	$3,796.50
Rate for Payer: CDPHP Medicare	$1,872.94
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$3,543.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$4,049.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$4,049.60
Rate for Payer: EmblemHealth Medicaid	$4,049.60
Rate for Payer: EmblemHealth Medicare	$1,721.08
Rate for Payer: EmblemHealth Select Care	$3,290.30
Rate for Payer: Fidelis Medicare	$2,024.80
Rate for Payer: Galaxy Health Commercial	$3,290.30
Rate for Payer: Hamaspik Choice Medicare	$2,024.80
Rate for Payer: Humana Medicare	$2,024.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$3,543.40
Rate for Payer: Local 1199SEIU Medicare	$2,328.52
Rate for Payer: MVP Health Care of NY Commercial	$3,796.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$2,849.91
Rate for Payer: MVP Health Care of NY Medicare	$2,126.04
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$489.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$759.30
Rate for Payer: United Healthcare Commercial	$489.00
Rate for Payer: United Healthcare Medicare	$2,024.80
Rate for Payer: WellCare Medicare	$2,784.10

BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID

Facility

$473.00

Service Code	HCPCS 19083 26
Hospital Charge Code	5201073
Hospital Revenue Code	960
Min. Negotiated Rate	$307.45
Max. Negotiated Rate	$307.45
Rate for Payer: Cash Price	$354.75
Rate for Payer: Galaxy Health Commercial	$307.45

BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID, BILATERAL

Facility

$473.00

Service Code	HCPCS 19083 26,50
Hospital Charge Code	5201072
Hospital Revenue Code	960
Min. Negotiated Rate	$70.95
Max. Negotiated Rate	$378.40
Rate for Payer: Aetna of NY Commercial	$331.10
Rate for Payer: Aetna of NY Medicare	$217.58
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$189.20
Rate for Payer: Cash Price	$354.75
Rate for Payer: CDPHP Medicare	$175.01
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$378.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$378.40
Rate for Payer: EmblemHealth Medicaid	$378.40
Rate for Payer: EmblemHealth Medicare	$160.82
Rate for Payer: Fidelis Medicare	$189.20
Rate for Payer: Galaxy Health Commercial	$307.45
Rate for Payer: Hamaspik Choice Medicare	$189.20
Rate for Payer: Humana Medicare	$189.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$331.10
Rate for Payer: Local 1199SEIU Medicare	$217.58
Rate for Payer: MVP Health Care of NY Commercial	$354.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$266.30
Rate for Payer: MVP Health Care of NY Medicare	$198.66
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$70.95
Rate for Payer: United Healthcare Medicare	$189.20
Rate for Payer: WellCare Medicare	$260.15

BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID, BILATERAL

Facility

$473.00

Service Code	HCPCS 19083 26,50
Hospital Charge Code	5201072
Hospital Revenue Code	960
Min. Negotiated Rate	$307.45
Max. Negotiated Rate	$307.45
Rate for Payer: Cash Price	$354.75
Rate for Payer: Galaxy Health Commercial	$307.45

BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID, BILTERAL

Facility

$5,062.00

Service Code	HCPCS 19083 50
Hospital Charge Code	4201072
Hospital Revenue Code	402
Min. Negotiated Rate	$3,290.30
Max. Negotiated Rate	$3,290.30
Rate for Payer: Cash Price	$3,796.50
Rate for Payer: Galaxy Health Commercial	$3,290.30

BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID, BILTERAL

Facility

$5,062.00

Service Code	HCPCS 19083 50
Hospital Charge Code	4201072
Hospital Revenue Code	402
Min. Negotiated Rate	$489.00
Max. Negotiated Rate	$4,049.60
Rate for Payer: Aetna of NY Commercial	$3,543.40
Rate for Payer: Aetna of NY Medicare	$2,328.52
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2,024.80
Rate for Payer: Cash Price	$3,796.50
Rate for Payer: Cash Price	$3,796.50
Rate for Payer: CDPHP Medicare	$1,872.94
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$3,543.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$4,049.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$4,049.60
Rate for Payer: EmblemHealth Medicaid	$4,049.60
Rate for Payer: EmblemHealth Medicare	$1,721.08
Rate for Payer: EmblemHealth Select Care	$3,290.30
Rate for Payer: Fidelis Medicare	$2,024.80
Rate for Payer: Galaxy Health Commercial	$3,290.30
Rate for Payer: Hamaspik Choice Medicare	$2,024.80
Rate for Payer: Humana Medicare	$2,024.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$3,543.40
Rate for Payer: Local 1199SEIU Medicare	$2,328.52
Rate for Payer: MVP Health Care of NY Commercial	$3,796.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$2,849.91
Rate for Payer: MVP Health Care of NY Medicare	$2,126.04
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$489.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$759.30
Rate for Payer: United Healthcare Commercial	$489.00
Rate for Payer: United Healthcare Medicare	$2,024.80
Rate for Payer: WellCare Medicare	$2,784.10

BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUIDE, LEFT

Facility

$473.00

Service Code	HCPCS 19083 26,LT
Hospital Charge Code	5201071
Hospital Revenue Code	960
Min. Negotiated Rate	$307.45
Max. Negotiated Rate	$307.45
Rate for Payer: Cash Price	$354.75
Rate for Payer: Galaxy Health Commercial	$307.45

BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUIDE, LEFT

Facility

$473.00

Service Code	HCPCS 19083 26,LT
Hospital Charge Code	5201071
Hospital Revenue Code	960
Min. Negotiated Rate	$70.95
Max. Negotiated Rate	$378.40
Rate for Payer: Aetna of NY Commercial	$331.10
Rate for Payer: Aetna of NY Medicare	$217.58
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$189.20
Rate for Payer: Cash Price	$354.75
Rate for Payer: CDPHP Medicare	$175.01
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$378.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$378.40
Rate for Payer: EmblemHealth Medicaid	$378.40
Rate for Payer: EmblemHealth Medicare	$160.82
Rate for Payer: Fidelis Medicare	$189.20
Rate for Payer: Galaxy Health Commercial	$307.45
Rate for Payer: Hamaspik Choice Medicare	$189.20
Rate for Payer: Humana Medicare	$189.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$331.10
Rate for Payer: Local 1199SEIU Medicare	$217.58
Rate for Payer: MVP Health Care of NY Commercial	$354.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$266.30
Rate for Payer: MVP Health Care of NY Medicare	$198.66
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$70.95
Rate for Payer: United Healthcare Medicare	$189.20
Rate for Payer: WellCare Medicare	$260.15

BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID, LEFT SIDE

Facility

$5,062.00

Service Code	HCPCS 19083 LT
Hospital Charge Code	4201071
Hospital Revenue Code	402
Min. Negotiated Rate	$489.00
Max. Negotiated Rate	$4,049.60
Rate for Payer: Aetna of NY Commercial	$3,543.40
Rate for Payer: Aetna of NY Medicare	$2,328.52
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2,024.80
Rate for Payer: Cash Price	$3,796.50
Rate for Payer: Cash Price	$3,796.50
Rate for Payer: CDPHP Medicare	$1,872.94
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$3,543.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$4,049.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$4,049.60
Rate for Payer: EmblemHealth Medicaid	$4,049.60
Rate for Payer: EmblemHealth Medicare	$1,721.08
Rate for Payer: EmblemHealth Select Care	$3,290.30
Rate for Payer: Fidelis Medicare	$2,024.80
Rate for Payer: Galaxy Health Commercial	$3,290.30
Rate for Payer: Hamaspik Choice Medicare	$2,024.80
Rate for Payer: Humana Medicare	$2,024.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$3,543.40
Rate for Payer: Local 1199SEIU Medicare	$2,328.52
Rate for Payer: MVP Health Care of NY Commercial	$3,796.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$2,849.91
Rate for Payer: MVP Health Care of NY Medicare	$2,126.04
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$489.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$759.30
Rate for Payer: United Healthcare Commercial	$489.00
Rate for Payer: United Healthcare Medicare	$2,024.80
Rate for Payer: WellCare Medicare	$2,784.10

BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID, LEFT SIDE

Facility

$5,062.00

Service Code	HCPCS 19083 LT
Hospital Charge Code	4201071
Hospital Revenue Code	402
Min. Negotiated Rate	$3,290.30
Max. Negotiated Rate	$3,290.30
Rate for Payer: Cash Price	$3,796.50
Rate for Payer: Galaxy Health Commercial	$3,290.30

BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID, RIGHT

Facility

$473.00

Service Code	HCPCS 19083 26,RT
Hospital Charge Code	5201068
Hospital Revenue Code	960
Min. Negotiated Rate	$307.45
Max. Negotiated Rate	$307.45
Rate for Payer: Cash Price	$354.75
Rate for Payer: Galaxy Health Commercial	$307.45

BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID, RIGHT

Facility

$473.00

Service Code	HCPCS 19083 26,RT
Hospital Charge Code	5201068
Hospital Revenue Code	960
Min. Negotiated Rate	$70.95
Max. Negotiated Rate	$378.40
Rate for Payer: Aetna of NY Commercial	$331.10
Rate for Payer: Aetna of NY Medicare	$217.58
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$189.20
Rate for Payer: Cash Price	$354.75
Rate for Payer: CDPHP Medicare	$175.01
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$378.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$378.40
Rate for Payer: EmblemHealth Medicaid	$378.40
Rate for Payer: EmblemHealth Medicare	$160.82
Rate for Payer: Fidelis Medicare	$189.20
Rate for Payer: Galaxy Health Commercial	$307.45
Rate for Payer: Hamaspik Choice Medicare	$189.20
Rate for Payer: Humana Medicare	$189.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$331.10
Rate for Payer: Local 1199SEIU Medicare	$217.58
Rate for Payer: MVP Health Care of NY Commercial	$354.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$266.30
Rate for Payer: MVP Health Care of NY Medicare	$198.66
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$70.95
Rate for Payer: United Healthcare Medicare	$189.20
Rate for Payer: WellCare Medicare	$260.15

BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID, RIGHT SIDE

Facility

$5,062.00

Service Code	HCPCS 19083 RT
Hospital Charge Code	4201068
Hospital Revenue Code	402
Min. Negotiated Rate	$3,290.30
Max. Negotiated Rate	$3,290.30
Rate for Payer: Cash Price	$3,796.50
Rate for Payer: Galaxy Health Commercial	$3,290.30

BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID, RIGHT SIDE

Facility

$5,062.00

Service Code	HCPCS 19083 RT
Hospital Charge Code	4201068
Hospital Revenue Code	402
Min. Negotiated Rate	$489.00
Max. Negotiated Rate	$4,049.60
Rate for Payer: Aetna of NY Commercial	$3,543.40
Rate for Payer: Aetna of NY Medicare	$2,328.52
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$2,024.80
Rate for Payer: Cash Price	$3,796.50
Rate for Payer: Cash Price	$3,796.50
Rate for Payer: CDPHP Medicare	$1,872.94
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$3,543.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$4,049.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$4,049.60
Rate for Payer: EmblemHealth Medicaid	$4,049.60
Rate for Payer: EmblemHealth Medicare	$1,721.08
Rate for Payer: EmblemHealth Select Care	$3,290.30
Rate for Payer: Fidelis Medicare	$2,024.80
Rate for Payer: Galaxy Health Commercial	$3,290.30
Rate for Payer: Hamaspik Choice Medicare	$2,024.80
Rate for Payer: Humana Medicare	$2,024.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$3,543.40
Rate for Payer: Local 1199SEIU Medicare	$2,328.52
Rate for Payer: MVP Health Care of NY Commercial	$3,796.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$2,849.91
Rate for Payer: MVP Health Care of NY Medicare	$2,126.04
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$489.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$759.30
Rate for Payer: United Healthcare Commercial	$489.00
Rate for Payer: United Healthcare Medicare	$2,024.80
Rate for Payer: WellCare Medicare	$2,784.10

BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID

Facility

$239.00

Service Code	HCPCS 19084 26
Hospital Charge Code	5201069
Hospital Revenue Code	960
Min. Negotiated Rate	$35.85
Max. Negotiated Rate	$191.20
Rate for Payer: Aetna of NY Commercial	$167.30
Rate for Payer: Aetna of NY Medicare	$109.94
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$95.60
Rate for Payer: Cash Price	$179.25
Rate for Payer: CDPHP Medicare	$88.43
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$191.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$191.20
Rate for Payer: EmblemHealth Medicaid	$191.20
Rate for Payer: EmblemHealth Medicare	$81.26
Rate for Payer: Fidelis Medicare	$95.60
Rate for Payer: Galaxy Health Commercial	$155.35
Rate for Payer: Hamaspik Choice Medicare	$95.60
Rate for Payer: Humana Medicare	$95.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$167.30
Rate for Payer: Local 1199SEIU Medicare	$109.94
Rate for Payer: MVP Health Care of NY Commercial	$179.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$134.56
Rate for Payer: MVP Health Care of NY Medicare	$100.38
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$35.85
Rate for Payer: United Healthcare Medicare	$95.60
Rate for Payer: WellCare Medicare	$131.45

Know your out-of-pocket cost for care.

All Charges