Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

CAD BREAST MRI

Facility

$110.21

Service Code	HCPCS C8937
Hospital Charge Code	4230213
Hospital Revenue Code	610
Min. Negotiated Rate	$71.64
Max. Negotiated Rate	$71.64
Rate for Payer: Cash Price	$82.66
Rate for Payer: Galaxy Health Commercial	$71.64

CAD BREAST MRI

Facility

$110.21

Service Code	HCPCS C8937
Hospital Charge Code	4230213
Hospital Revenue Code	610
Min. Negotiated Rate	$16.53
Max. Negotiated Rate	$2,328.00
Rate for Payer: Aetna of NY Commercial	$1,750.00
Rate for Payer: Aetna of NY Medicare	$50.70
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$44.08
Rate for Payer: Cash Price	$82.66
Rate for Payer: Cash Price	$82.66
Rate for Payer: Cash Price	$82.66
Rate for Payer: CDPHP Medicare	$40.78
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$77.15
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$88.17
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$88.17
Rate for Payer: EmblemHealth Medicaid	$88.17
Rate for Payer: EmblemHealth Medicare	$37.47
Rate for Payer: EmblemHealth Select Care	$71.64
Rate for Payer: Fidelis Medicare	$44.08
Rate for Payer: Galaxy Health Commercial	$71.64
Rate for Payer: Hamaspik Choice Medicare	$44.08
Rate for Payer: Humana Medicare	$44.08
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,750.00
Rate for Payer: Local 1199SEIU Medicare	$50.70
Rate for Payer: MVP Health Care of NY Commercial	$1,334.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$964.00
Rate for Payer: MVP Health Care of NY Medicare	$46.29
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$2,328.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$16.53
Rate for Payer: United Healthcare Commercial	$2,328.00
Rate for Payer: United Healthcare Medicare	$44.08
Rate for Payer: WellCare Medicare	$60.62

CALAMINE LOTN 177 ML

Facility

$9.50

Service Code	NDC 904253321
Hospital Charge Code	4400121
Hospital Revenue Code	250
Min. Negotiated Rate	$1.43
Max. Negotiated Rate	$7.60
Rate for Payer: Aetna of NY Commercial	$6.65
Rate for Payer: Aetna of NY Medicare	$4.37
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$3.80
Rate for Payer: Cash Price	$7.12
Rate for Payer: CDPHP Medicare	$3.52
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$7.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$7.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$7.60
Rate for Payer: EmblemHealth Medicaid	$7.60
Rate for Payer: EmblemHealth Medicare	$3.23
Rate for Payer: EmblemHealth Select Care	$6.84
Rate for Payer: Fidelis Medicare	$3.80
Rate for Payer: Galaxy Health Commercial	$6.17
Rate for Payer: Hamaspik Choice Medicare	$3.80
Rate for Payer: Humana Medicare	$3.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$6.65
Rate for Payer: Local 1199SEIU Medicare	$4.37
Rate for Payer: MVP Health Care of NY Commercial	$7.12
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$5.35
Rate for Payer: MVP Health Care of NY Medicare	$3.99
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.43
Rate for Payer: United Healthcare Medicare	$3.80
Rate for Payer: WellCare Medicare	$5.22

CALAMINE LOTN 177 ML

Facility

$9.50

Service Code	NDC 904253321
Hospital Charge Code	4400121
Hospital Revenue Code	250
Min. Negotiated Rate	$5.22
Max. Negotiated Rate	$6.17
Rate for Payer: Cash Price	$7.12
Rate for Payer: Galaxy Health Commercial	$6.17
Rate for Payer: WellCare Medicare	$5.22

CALAMINE/ZINC OXIDE OINT 113 GM

Facility

$13.65

Service Code	NDC 64980032212
Hospital Charge Code	4400126
Hospital Revenue Code	250
Min. Negotiated Rate	$2.05
Max. Negotiated Rate	$10.92
Rate for Payer: Aetna of NY Commercial	$9.55
Rate for Payer: Aetna of NY Medicare	$6.28
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$5.46
Rate for Payer: Cash Price	$10.24
Rate for Payer: CDPHP Medicare	$5.05
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$10.92
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$10.92
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$10.92
Rate for Payer: EmblemHealth Medicaid	$10.92
Rate for Payer: EmblemHealth Medicare	$4.64
Rate for Payer: EmblemHealth Select Care	$9.83
Rate for Payer: Fidelis Medicare	$5.46
Rate for Payer: Galaxy Health Commercial	$8.87
Rate for Payer: Hamaspik Choice Medicare	$5.46
Rate for Payer: Humana Medicare	$5.46
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$9.55
Rate for Payer: Local 1199SEIU Medicare	$6.28
Rate for Payer: MVP Health Care of NY Commercial	$10.24
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$7.68
Rate for Payer: MVP Health Care of NY Medicare	$5.73
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.05
Rate for Payer: United Healthcare Medicare	$5.46
Rate for Payer: WellCare Medicare	$7.51

CALAMINE/ZINC OXIDE OINT 113 GM

Facility

$13.65

Service Code	NDC 64980032212
Hospital Charge Code	4400126
Hospital Revenue Code	250
Min. Negotiated Rate	$7.51
Max. Negotiated Rate	$8.87
Rate for Payer: Cash Price	$10.24
Rate for Payer: Galaxy Health Commercial	$8.87
Rate for Payer: WellCare Medicare	$7.51

CALCITONIN

Facility

$80.00

Service Code	HCPCS 82308
Hospital Charge Code	4301152
Hospital Revenue Code	300
Min. Negotiated Rate	$52.00
Max. Negotiated Rate	$52.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Galaxy Health Commercial	$52.00

CALCITONIN

Facility

$80.00

Service Code	HCPCS 82308
Hospital Charge Code	4301152
Hospital Revenue Code	300
Min. Negotiated Rate	$12.00
Max. Negotiated Rate	$64.00
Rate for Payer: Aetna of NY Commercial	$52.00
Rate for Payer: Aetna of NY Medicare	$36.80
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$32.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: CDPHP Medicare	$29.60
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$48.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$64.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$64.00
Rate for Payer: EmblemHealth Medicaid	$64.00
Rate for Payer: EmblemHealth Medicare	$27.20
Rate for Payer: EmblemHealth Select Care	$48.00
Rate for Payer: Fidelis Medicare	$32.00
Rate for Payer: Galaxy Health Commercial	$52.00
Rate for Payer: Hamaspik Choice Medicare	$32.00
Rate for Payer: Humana Medicare	$32.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$52.00
Rate for Payer: Local 1199SEIU Medicare	$36.80
Rate for Payer: MVP Health Care of NY Commercial	$60.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$45.04
Rate for Payer: MVP Health Care of NY Medicare	$33.60
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$60.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$12.00
Rate for Payer: United Healthcare Commercial	$60.00
Rate for Payer: United Healthcare Medicare	$32.00
Rate for Payer: WellCare Medicare	$44.00

CALCITRATE ORAL

Facility

$6.18

Service Code	NDC 904527260
Hospital Charge Code	4409233
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

CALCITRATE ORAL

Facility

$6.18

Service Code	NDC 904527260
Hospital Charge Code	4409233
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

CALCITRIOL CAPSULE 0.25 MCG

Facility

$6.18

Service Code	NDC 54000713
Hospital Charge Code	4409138
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

CALCITRIOL CAPSULE 0.25 MCG

Facility

$6.18

Service Code	NDC 54000713
Hospital Charge Code	4409138
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

CALCIUM ACETATE 667 MG TABLET

Facility

$6.18

Service Code	NDC 71321080320
Hospital Charge Code	4409182
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

CALCIUM ACETATE 667 MG TABLET

Facility

$6.18

Service Code	NDC 71321080320
Hospital Charge Code	4409182
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

CALCIUM CARBONATE 500MG CHEW 150 EA

Facility

$6.18

Service Code	NDC 37205021047
Hospital Charge Code	4400122
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

CALCIUM CARBONATE 500MG CHEW 150 EA

Facility

$6.18

Service Code	NDC 37205021047
Hospital Charge Code	4400122
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

CALCIUM CHLORIDE 100MG/ML ANSY 10X10ML

Facility

$33.48

Service Code	NDC 76329330401
Hospital Charge Code	4400123
Hospital Revenue Code	250
Min. Negotiated Rate	$5.02
Max. Negotiated Rate	$26.78
Rate for Payer: Aetna of NY Commercial	$23.44
Rate for Payer: Aetna of NY Medicare	$15.40
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$13.39
Rate for Payer: Cash Price	$25.11
Rate for Payer: CDPHP Medicare	$12.39
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$26.78
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$26.78
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$26.78
Rate for Payer: EmblemHealth Medicaid	$26.78
Rate for Payer: EmblemHealth Medicare	$11.38
Rate for Payer: EmblemHealth Select Care	$24.11
Rate for Payer: Fidelis Medicare	$13.39
Rate for Payer: Galaxy Health Commercial	$21.76
Rate for Payer: Hamaspik Choice Medicare	$13.39
Rate for Payer: Humana Medicare	$13.39
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$23.44
Rate for Payer: Local 1199SEIU Medicare	$15.40
Rate for Payer: MVP Health Care of NY Commercial	$25.11
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$18.85
Rate for Payer: MVP Health Care of NY Medicare	$14.06
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.02
Rate for Payer: United Healthcare Medicare	$13.39
Rate for Payer: WellCare Medicare	$18.41

CALCIUM CHLORIDE 100MG/ML ANSY 10X10ML

Facility

$33.48

Service Code	NDC 76329330401
Hospital Charge Code	4400123
Hospital Revenue Code	250
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$21.76
Rate for Payer: Cash Price	$25.11
Rate for Payer: Galaxy Health Commercial	$21.76
Rate for Payer: WellCare Medicare	$18.41

CALCIUM GLUCONATE, PER 10 ML

Facility

$20.09

Service Code	HCPCS J0612
Hospital Charge Code	4408957
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$13.06
Rate for Payer: Aetna of NY Commercial	$11.05
Rate for Payer: Cash Price	$15.07
Rate for Payer: Cash Price	$15.07
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.03
Rate for Payer: EmblemHealth Select Care	$0.03
Rate for Payer: Galaxy Health Commercial	$13.06
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$11.05
Rate for Payer: WellCare Medicare	$11.05

CALCIUM GLUCONATE, PER 10 ML

Facility

$20.09

Service Code	HCPCS J0612
Hospital Charge Code	4408957
Hospital Revenue Code	636
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$16.07
Rate for Payer: Aetna of NY Medicare	$9.24
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$8.04
Rate for Payer: Cash Price	$15.07
Rate for Payer: Cash Price	$15.07
Rate for Payer: CDPHP Medicare	$7.43
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.03
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$16.07
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$16.07
Rate for Payer: EmblemHealth Medicaid	$16.07
Rate for Payer: EmblemHealth Medicare	$6.83
Rate for Payer: EmblemHealth Select Care	$0.03
Rate for Payer: Fidelis Medicare	$8.04
Rate for Payer: Galaxy Health Commercial	$13.06
Rate for Payer: Hamaspik Choice Medicare	$8.04
Rate for Payer: Humana Medicare	$8.04
Rate for Payer: Local 1199SEIU Medicare	$9.24
Rate for Payer: MVP Health Care of NY Commercial	$15.07
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$11.31
Rate for Payer: MVP Health Care of NY Medicare	$8.44
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$0.10
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3.01
Rate for Payer: United Healthcare Commercial	$0.10
Rate for Payer: United Healthcare Medicare	$8.04
Rate for Payer: WellCare Medicare	$11.05

CALCIUM SERUM

Facility

$15.00

Service Code	HCPCS 82310
Hospital Charge Code	4300141
Hospital Revenue Code	301
Min. Negotiated Rate	$2.25
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna of NY Commercial	$9.75
Rate for Payer: Aetna of NY Medicare	$6.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$6.00
Rate for Payer: Cash Price	$11.25
Rate for Payer: CDPHP Medicare	$5.55
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$9.00
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	$9.00
Rate for Payer: Fidelis Medicare	$6.00
Rate for Payer: Galaxy Health Commercial	$9.75
Rate for Payer: Hamaspik Choice Medicare	$6.00
Rate for Payer: Humana Medicare	$6.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$9.75
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	$8.45
Rate for Payer: MVP Health Care of NY Medicare	$6.30
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$11.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.25
Rate for Payer: United Healthcare Commercial	$11.25
Rate for Payer: United Healthcare Medicare	$6.00
Rate for Payer: WellCare Medicare	$8.25

CALCIUM SERUM

Facility

$15.00

Service Code	HCPCS 82310
Hospital Charge Code	4300141
Hospital Revenue Code	301
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

CALCULUS INFRARED SPECTROSCOPY

Facility

$39.00

Service Code	HCPCS 82365
Hospital Charge Code	4302025
Hospital Revenue Code	300
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$25.35
Rate for Payer: Cash Price	$29.25
Rate for Payer: Galaxy Health Commercial	$25.35

CALCULUS INFRARED SPECTROSCOPY

Facility

$39.00

Service Code	HCPCS 82365
Hospital Charge Code	4302025
Hospital Revenue Code	300
Min. Negotiated Rate	$5.85
Max. Negotiated Rate	$31.20
Rate for Payer: Aetna of NY Commercial	$25.35
Rate for Payer: Aetna of NY Medicare	$17.94
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$15.60
Rate for Payer: Cash Price	$29.25
Rate for Payer: CDPHP Medicare	$14.43
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$23.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$31.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$31.20
Rate for Payer: EmblemHealth Medicaid	$31.20
Rate for Payer: EmblemHealth Medicare	$13.26
Rate for Payer: EmblemHealth Select Care	$23.40
Rate for Payer: Fidelis Medicare	$15.60
Rate for Payer: Galaxy Health Commercial	$25.35
Rate for Payer: Hamaspik Choice Medicare	$15.60
Rate for Payer: Humana Medicare	$15.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$25.35
Rate for Payer: Local 1199SEIU Medicare	$17.94
Rate for Payer: MVP Health Care of NY Commercial	$29.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$21.96
Rate for Payer: MVP Health Care of NY Medicare	$16.38
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$29.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.85
Rate for Payer: United Healthcare Commercial	$29.25
Rate for Payer: United Healthcare Medicare	$15.60
Rate for Payer: WellCare Medicare	$21.45

CALDOLOR 800 MG/200 ML BAG 1 ea, 200 mL

Facility

$74.00

Service Code	NDC 66220028411
Hospital Charge Code	4401437
Hospital Revenue Code	250
Min. Negotiated Rate	$40.70
Max. Negotiated Rate	$48.10
Rate for Payer: Cash Price	$55.50
Rate for Payer: Galaxy Health Commercial	$48.10
Rate for Payer: WellCare Medicare	$40.70

Know your out-of-pocket cost for care.

All Charges