Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

2.0MM DRILL

Facility

$645.81

Hospital Charge Code	4471841
Hospital Revenue Code	270
Min. Negotiated Rate	$419.78
Max. Negotiated Rate	$419.78
Rate for Payer: Cash Price	$484.36
Rate for Payer: Galaxy Health Commercial	$419.78

2.0MM DRILL

Facility

$645.81

Hospital Charge Code	4471841
Hospital Revenue Code	270
Min. Negotiated Rate	$96.87
Max. Negotiated Rate	$516.65
Rate for Payer: Aetna of NY Commercial	$452.07
Rate for Payer: Aetna of NY Medicare	$297.07
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$258.32
Rate for Payer: Cash Price	$484.36
Rate for Payer: CDPHP Medicare	$238.95
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$516.65
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$516.65
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$516.65
Rate for Payer: EmblemHealth Medicaid	$516.65
Rate for Payer: EmblemHealth Medicare	$219.58
Rate for Payer: EmblemHealth Select Care	$464.98
Rate for Payer: Fidelis Medicare	$258.32
Rate for Payer: Galaxy Health Commercial	$419.78
Rate for Payer: Hamaspik Choice Medicare	$258.32
Rate for Payer: Humana Medicare	$258.32
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$452.07
Rate for Payer: Local 1199SEIU Medicare	$297.07
Rate for Payer: MVP Health Care of NY Commercial	$484.36
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$363.59
Rate for Payer: MVP Health Care of NY Medicare	$271.24
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$96.87
Rate for Payer: United Healthcare Medicare	$258.32
Rate for Payer: WellCare Medicare	$355.20

22GA 6" SPINAL NEEDLE

Facility

$9.27

Hospital Charge Code	4472101
Hospital Revenue Code	270
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$6.03
Rate for Payer: Cash Price	$6.95
Rate for Payer: Galaxy Health Commercial	$6.03

22GA 6" SPINAL NEEDLE

Facility

$9.27

Hospital Charge Code	4472101
Hospital Revenue Code	270
Min. Negotiated Rate	$1.39
Max. Negotiated Rate	$7.42
Rate for Payer: Aetna of NY Commercial	$6.49
Rate for Payer: Aetna of NY Medicare	$4.26
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$3.71
Rate for Payer: Cash Price	$6.95
Rate for Payer: CDPHP Medicare	$3.43
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$7.42
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$7.42
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$7.42
Rate for Payer: EmblemHealth Medicaid	$7.42
Rate for Payer: EmblemHealth Medicare	$3.15
Rate for Payer: EmblemHealth Select Care	$6.67
Rate for Payer: Fidelis Medicare	$3.71
Rate for Payer: Galaxy Health Commercial	$6.03
Rate for Payer: Hamaspik Choice Medicare	$3.71
Rate for Payer: Humana Medicare	$3.71
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$6.49
Rate for Payer: Local 1199SEIU Medicare	$4.26
Rate for Payer: MVP Health Care of NY Commercial	$6.95
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$5.22
Rate for Payer: MVP Health Care of NY Medicare	$3.89
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.39
Rate for Payer: United Healthcare Medicare	$3.71
Rate for Payer: WellCare Medicare	$5.10

22GA 8" SPINAL NEEDLE

Facility

$10.30

Hospital Charge Code	4472103
Hospital Revenue Code	270
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$8.24
Rate for Payer: Aetna of NY Commercial	$7.21
Rate for Payer: Aetna of NY Medicare	$4.74
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$4.12
Rate for Payer: Cash Price	$7.72
Rate for Payer: CDPHP Medicare	$3.81
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$8.24
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$8.24
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$8.24
Rate for Payer: EmblemHealth Medicaid	$8.24
Rate for Payer: EmblemHealth Medicare	$3.50
Rate for Payer: EmblemHealth Select Care	$7.42
Rate for Payer: Fidelis Medicare	$4.12
Rate for Payer: Galaxy Health Commercial	$6.70
Rate for Payer: Hamaspik Choice Medicare	$4.12
Rate for Payer: Humana Medicare	$4.12
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$7.21
Rate for Payer: Local 1199SEIU Medicare	$4.74
Rate for Payer: MVP Health Care of NY Commercial	$7.72
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$5.80
Rate for Payer: MVP Health Care of NY Medicare	$4.33
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.54
Rate for Payer: United Healthcare Medicare	$4.12
Rate for Payer: WellCare Medicare	$5.67

22GA 8" SPINAL NEEDLE

Facility

$10.30

Hospital Charge Code	4472103
Hospital Revenue Code	270
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$6.70
Rate for Payer: Cash Price	$7.72
Rate for Payer: Galaxy Health Commercial	$6.70

22" QUICK-FIT BASIC KNEE SPLIN

Facility

$57.68

Hospital Charge Code	4471600
Hospital Revenue Code	270
Min. Negotiated Rate	$37.49
Max. Negotiated Rate	$37.49
Rate for Payer: Cash Price	$43.26
Rate for Payer: Galaxy Health Commercial	$37.49

22" QUICK-FIT BASIC KNEE SPLIN

Facility

$57.68

Hospital Charge Code	4471600
Hospital Revenue Code	270
Min. Negotiated Rate	$8.65
Max. Negotiated Rate	$46.14
Rate for Payer: Aetna of NY Commercial	$40.38
Rate for Payer: Aetna of NY Medicare	$26.53
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$23.07
Rate for Payer: Cash Price	$43.26
Rate for Payer: CDPHP Medicare	$21.34
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$46.14
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$46.14
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$46.14
Rate for Payer: EmblemHealth Medicaid	$46.14
Rate for Payer: EmblemHealth Medicare	$19.61
Rate for Payer: EmblemHealth Select Care	$41.53
Rate for Payer: Fidelis Medicare	$23.07
Rate for Payer: Galaxy Health Commercial	$37.49
Rate for Payer: Hamaspik Choice Medicare	$23.07
Rate for Payer: Humana Medicare	$23.07
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$40.38
Rate for Payer: Local 1199SEIU Medicare	$26.53
Rate for Payer: MVP Health Care of NY Commercial	$43.26
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$32.47
Rate for Payer: MVP Health Care of NY Medicare	$24.23
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$8.65
Rate for Payer: United Healthcare Medicare	$23.07
Rate for Payer: WellCare Medicare	$31.72

24FR 5CC FOLEY

Facility

$14.42

Hospital Charge Code	4478210
Hospital Revenue Code	270
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$11.54
Rate for Payer: Aetna of NY Commercial	$10.09
Rate for Payer: Aetna of NY Medicare	$6.63
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$5.77
Rate for Payer: Cash Price	$10.82
Rate for Payer: CDPHP Medicare	$5.34
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$11.54
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$11.54
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$11.54
Rate for Payer: EmblemHealth Medicaid	$11.54
Rate for Payer: EmblemHealth Medicare	$4.90
Rate for Payer: EmblemHealth Select Care	$10.38
Rate for Payer: Fidelis Medicare	$5.77
Rate for Payer: Galaxy Health Commercial	$9.37
Rate for Payer: Hamaspik Choice Medicare	$5.77
Rate for Payer: Humana Medicare	$5.77
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$10.09
Rate for Payer: Local 1199SEIU Medicare	$6.63
Rate for Payer: MVP Health Care of NY Commercial	$10.81
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$8.12
Rate for Payer: MVP Health Care of NY Medicare	$6.06
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.16
Rate for Payer: United Healthcare Medicare	$5.77
Rate for Payer: WellCare Medicare	$7.93

24FR 5CC FOLEY

Facility

$14.42

Hospital Charge Code	4478210
Hospital Revenue Code	270
Min. Negotiated Rate	$9.37
Max. Negotiated Rate	$9.37
Rate for Payer: Cash Price	$10.82
Rate for Payer: Galaxy Health Commercial	$9.37

2.5CM X 3.0CM GAMMA GRAFT

Facility

$1,166.99

Service Code	HCPCS C1763
Hospital Charge Code	4471881
Hospital Revenue Code	278
Min. Negotiated Rate	$175.05
Max. Negotiated Rate	$933.59
Rate for Payer: Aetna of NY Commercial	$816.89
Rate for Payer: Aetna of NY Medicare	$536.82
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$466.80
Rate for Payer: Cash Price	$875.24
Rate for Payer: CDPHP Medicare	$431.79
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$583.50
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$933.59
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$933.59
Rate for Payer: EmblemHealth Medicaid	$933.59
Rate for Payer: EmblemHealth Medicare	$396.78
Rate for Payer: EmblemHealth Select Care	$583.50
Rate for Payer: Fidelis Medicare	$466.80
Rate for Payer: Galaxy Health Commercial	$758.54
Rate for Payer: Hamaspik Choice Medicare	$466.80
Rate for Payer: Humana Medicare	$466.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$816.89
Rate for Payer: Local 1199SEIU Medicare	$536.82
Rate for Payer: MVP Health Care of NY Commercial	$758.54
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$758.54
Rate for Payer: MVP Health Care of NY Medicare	$490.14
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$175.05
Rate for Payer: United Healthcare Medicare	$466.80
Rate for Payer: WellCare Medicare	$641.84

2.5CM X 3.0CM GAMMA GRAFT

Facility

$1,166.99

Service Code	HCPCS C1763
Hospital Charge Code	4471881
Hospital Revenue Code	278
Min. Negotiated Rate	$525.15
Max. Negotiated Rate	$816.89
Rate for Payer: Aetna of NY Commercial	$816.89
Rate for Payer: Cash Price	$875.24
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$583.50
Rate for Payer: EmblemHealth Select Care	$583.50
Rate for Payer: Galaxy Health Commercial	$758.54
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$816.89
Rate for Payer: Multiplan Commercial	$525.15
Rate for Payer: MVP Health Care of NY Commercial	$758.54
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$758.54
Rate for Payer: WellCare Medicare	$641.84

25GA 3CC SYRINGE & NEEDLE

Facility

$22.66

Hospital Charge Code	4472098
Hospital Revenue Code	270
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$18.13
Rate for Payer: Aetna of NY Commercial	$15.86
Rate for Payer: Aetna of NY Medicare	$10.42
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$9.06
Rate for Payer: Cash Price	$17.00
Rate for Payer: CDPHP Medicare	$8.38
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$18.13
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$18.13
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$18.13
Rate for Payer: EmblemHealth Medicaid	$18.13
Rate for Payer: EmblemHealth Medicare	$7.70
Rate for Payer: EmblemHealth Select Care	$16.32
Rate for Payer: Fidelis Medicare	$9.06
Rate for Payer: Galaxy Health Commercial	$14.73
Rate for Payer: Hamaspik Choice Medicare	$9.06
Rate for Payer: Humana Medicare	$9.06
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$15.86
Rate for Payer: Local 1199SEIU Medicare	$10.42
Rate for Payer: MVP Health Care of NY Commercial	$17.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$12.76
Rate for Payer: MVP Health Care of NY Medicare	$9.52
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3.40
Rate for Payer: United Healthcare Medicare	$9.06
Rate for Payer: WellCare Medicare	$12.46

25GA 3CC SYRINGE & NEEDLE

Facility

$22.66

Hospital Charge Code	4472098
Hospital Revenue Code	270
Min. Negotiated Rate	$14.73
Max. Negotiated Rate	$14.73
Rate for Payer: Cash Price	$17.00
Rate for Payer: Galaxy Health Commercial	$14.73

25GA 6" SPINAL NEEDLE

Facility

$10.30

Hospital Charge Code	4472009
Hospital Revenue Code	270
Min. Negotiated Rate	$1.54
Max. Negotiated Rate	$8.24
Rate for Payer: Aetna of NY Commercial	$7.21
Rate for Payer: Aetna of NY Medicare	$4.74
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$4.12
Rate for Payer: Cash Price	$7.72
Rate for Payer: CDPHP Medicare	$3.81
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$8.24
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$8.24
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$8.24
Rate for Payer: EmblemHealth Medicaid	$8.24
Rate for Payer: EmblemHealth Medicare	$3.50
Rate for Payer: EmblemHealth Select Care	$7.42
Rate for Payer: Fidelis Medicare	$4.12
Rate for Payer: Galaxy Health Commercial	$6.70
Rate for Payer: Hamaspik Choice Medicare	$4.12
Rate for Payer: Humana Medicare	$4.12
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$7.21
Rate for Payer: Local 1199SEIU Medicare	$4.74
Rate for Payer: MVP Health Care of NY Commercial	$7.72
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$5.80
Rate for Payer: MVP Health Care of NY Medicare	$4.33
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.54
Rate for Payer: United Healthcare Medicare	$4.12
Rate for Payer: WellCare Medicare	$5.67

25GA 6" SPINAL NEEDLE

Facility

$10.30

Hospital Charge Code	4472009
Hospital Revenue Code	270
Min. Negotiated Rate	$6.70
Max. Negotiated Rate	$6.70
Rate for Payer: Cash Price	$7.72
Rate for Payer: Galaxy Health Commercial	$6.70

2.5MM SMALL-JOINT FULL RADIUS

Facility

$186.43

Hospital Charge Code	4471045
Hospital Revenue Code	270
Min. Negotiated Rate	$27.96
Max. Negotiated Rate	$149.14
Rate for Payer: Aetna of NY Commercial	$130.50
Rate for Payer: Aetna of NY Medicare	$85.76
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$74.57
Rate for Payer: Cash Price	$139.82
Rate for Payer: CDPHP Medicare	$68.98
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$149.14
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$149.14
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$149.14
Rate for Payer: EmblemHealth Medicaid	$149.14
Rate for Payer: EmblemHealth Medicare	$63.39
Rate for Payer: EmblemHealth Select Care	$134.23
Rate for Payer: Fidelis Medicare	$74.57
Rate for Payer: Galaxy Health Commercial	$121.18
Rate for Payer: Hamaspik Choice Medicare	$74.57
Rate for Payer: Humana Medicare	$74.57
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$130.50
Rate for Payer: Local 1199SEIU Medicare	$85.76
Rate for Payer: MVP Health Care of NY Commercial	$139.82
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$104.96
Rate for Payer: MVP Health Care of NY Medicare	$78.30
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$27.96
Rate for Payer: United Healthcare Medicare	$74.57
Rate for Payer: WellCare Medicare	$102.54

2.5MM SMALL-JOINT FULL RADIUS

Facility

$186.43

Hospital Charge Code	4471045
Hospital Revenue Code	270
Min. Negotiated Rate	$121.18
Max. Negotiated Rate	$121.18
Rate for Payer: Cash Price	$139.82
Rate for Payer: Galaxy Health Commercial	$121.18

26FR 5CC FOLEY

Facility

$14.42

Hospital Charge Code	4478209
Hospital Revenue Code	270
Min. Negotiated Rate	$2.16
Max. Negotiated Rate	$11.54
Rate for Payer: Aetna of NY Commercial	$10.09
Rate for Payer: Aetna of NY Medicare	$6.63
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$5.77
Rate for Payer: Cash Price	$10.82
Rate for Payer: CDPHP Medicare	$5.34
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$11.54
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$11.54
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$11.54
Rate for Payer: EmblemHealth Medicaid	$11.54
Rate for Payer: EmblemHealth Medicare	$4.90
Rate for Payer: EmblemHealth Select Care	$10.38
Rate for Payer: Fidelis Medicare	$5.77
Rate for Payer: Galaxy Health Commercial	$9.37
Rate for Payer: Hamaspik Choice Medicare	$5.77
Rate for Payer: Humana Medicare	$5.77
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$10.09
Rate for Payer: Local 1199SEIU Medicare	$6.63
Rate for Payer: MVP Health Care of NY Commercial	$10.81
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$8.12
Rate for Payer: MVP Health Care of NY Medicare	$6.06
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.16
Rate for Payer: United Healthcare Medicare	$5.77
Rate for Payer: WellCare Medicare	$7.93

26FR 5CC FOLEY

Facility

$14.42

Hospital Charge Code	4478209
Hospital Revenue Code	270
Min. Negotiated Rate	$9.37
Max. Negotiated Rate	$9.37
Rate for Payer: Cash Price	$10.82
Rate for Payer: Galaxy Health Commercial	$9.37

26ML CHLORAPREP

Facility

$27.81

Hospital Charge Code	4471237
Hospital Revenue Code	270
Min. Negotiated Rate	$4.17
Max. Negotiated Rate	$22.25
Rate for Payer: Aetna of NY Commercial	$19.47
Rate for Payer: Aetna of NY Medicare	$12.79
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$11.12
Rate for Payer: Cash Price	$20.86
Rate for Payer: CDPHP Medicare	$10.29
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$22.25
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$22.25
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$22.25
Rate for Payer: EmblemHealth Medicaid	$22.25
Rate for Payer: EmblemHealth Medicare	$9.46
Rate for Payer: EmblemHealth Select Care	$20.02
Rate for Payer: Fidelis Medicare	$11.12
Rate for Payer: Galaxy Health Commercial	$18.08
Rate for Payer: Hamaspik Choice Medicare	$11.12
Rate for Payer: Humana Medicare	$11.12
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$19.47
Rate for Payer: Local 1199SEIU Medicare	$12.79
Rate for Payer: MVP Health Care of NY Commercial	$20.86
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$15.66
Rate for Payer: MVP Health Care of NY Medicare	$11.68
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4.17
Rate for Payer: United Healthcare Medicare	$11.12
Rate for Payer: WellCare Medicare	$15.30

26ML CHLORAPREP

Facility

$27.81

Hospital Charge Code	4471237
Hospital Revenue Code	270
Min. Negotiated Rate	$18.08
Max. Negotiated Rate	$18.08
Rate for Payer: Cash Price	$20.86
Rate for Payer: Galaxy Health Commercial	$18.08

26ML CHLORAPREP WITH TINT#1238

Facility

$33.99

Hospital Charge Code	4479281
Hospital Revenue Code	270
Min. Negotiated Rate	$5.10
Max. Negotiated Rate	$27.19
Rate for Payer: Aetna of NY Commercial	$23.79
Rate for Payer: Aetna of NY Medicare	$15.64
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$13.60
Rate for Payer: Cash Price	$25.49
Rate for Payer: CDPHP Medicare	$12.58
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$27.19
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$27.19
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$27.19
Rate for Payer: EmblemHealth Medicaid	$27.19
Rate for Payer: EmblemHealth Medicare	$11.56
Rate for Payer: EmblemHealth Select Care	$24.47
Rate for Payer: Fidelis Medicare	$13.60
Rate for Payer: Galaxy Health Commercial	$22.09
Rate for Payer: Hamaspik Choice Medicare	$13.60
Rate for Payer: Humana Medicare	$13.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$23.79
Rate for Payer: Local 1199SEIU Medicare	$15.64
Rate for Payer: MVP Health Care of NY Commercial	$25.49
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$19.14
Rate for Payer: MVP Health Care of NY Medicare	$14.28
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.10
Rate for Payer: United Healthcare Medicare	$13.60
Rate for Payer: WellCare Medicare	$18.69

26ML CHLORAPREP WITH TINT#1238

Facility

$33.99

Hospital Charge Code	4479281
Hospital Revenue Code	270
Min. Negotiated Rate	$22.09
Max. Negotiated Rate	$22.09
Rate for Payer: Cash Price	$25.49
Rate for Payer: Galaxy Health Commercial	$22.09

26" QUICK-FIT BASIC KNEE SPLIN

Facility

$71.07

Hospital Charge Code	4471601
Hospital Revenue Code	270
Min. Negotiated Rate	$46.20
Max. Negotiated Rate	$46.20
Rate for Payer: Cash Price	$53.30
Rate for Payer: Galaxy Health Commercial	$46.20

Know your out-of-pocket cost for care.

All Charges