Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

CEFTRIAXONE SODIUM, PER 250 MG

Facility

$3.49

Service Code	HCPCS J0696
Hospital Charge Code	4400146
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$2.79
Rate for Payer: Aetna of NY Medicare	$1.61
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1.40
Rate for Payer: Cash Price	$2.62
Rate for Payer: Cash Price	$2.62
Rate for Payer: CDPHP Medicare	$1.29
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.43
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2.79
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2.79
Rate for Payer: EmblemHealth Medicaid	$2.79
Rate for Payer: EmblemHealth Medicare	$1.19
Rate for Payer: EmblemHealth Select Care	$0.43
Rate for Payer: Fidelis Medicare	$1.40
Rate for Payer: Galaxy Health Commercial	$2.27
Rate for Payer: Hamaspik Choice Medicare	$1.40
Rate for Payer: Humana Medicare	$1.40
Rate for Payer: Local 1199SEIU Medicare	$1.61
Rate for Payer: MVP Health Care of NY Commercial	$2.62
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1.96
Rate for Payer: MVP Health Care of NY Medicare	$1.47
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$0.94
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$0.52
Rate for Payer: United Healthcare Commercial	$0.94
Rate for Payer: United Healthcare Medicare	$1.40
Rate for Payer: WellCare Medicare	$1.92

CEFTRIAXONE SODIUM, Per 50 ml

Facility

$10.75

Service Code	HCPCS J0696
Hospital Charge Code	4401248
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$8.60
Rate for Payer: Aetna of NY Medicare	$4.95
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$4.30
Rate for Payer: Cash Price	$8.06
Rate for Payer: Cash Price	$8.06
Rate for Payer: CDPHP Medicare	$3.98
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.43
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$8.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$8.60
Rate for Payer: EmblemHealth Medicaid	$8.60
Rate for Payer: EmblemHealth Medicare	$3.65
Rate for Payer: EmblemHealth Select Care	$0.43
Rate for Payer: Fidelis Medicare	$4.30
Rate for Payer: Galaxy Health Commercial	$6.99
Rate for Payer: Hamaspik Choice Medicare	$4.30
Rate for Payer: Humana Medicare	$4.30
Rate for Payer: Local 1199SEIU Medicare	$4.95
Rate for Payer: MVP Health Care of NY Commercial	$8.06
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$6.05
Rate for Payer: MVP Health Care of NY Medicare	$4.51
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$0.94
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.61
Rate for Payer: United Healthcare Commercial	$0.94
Rate for Payer: United Healthcare Medicare	$4.30
Rate for Payer: WellCare Medicare	$5.91

CEFTRIAXONE SODIUM, Per 50 ml

Facility

$10.75

Service Code	HCPCS J0696
Hospital Charge Code	4401248
Hospital Revenue Code	636
Min. Negotiated Rate	$0.43
Max. Negotiated Rate	$6.99
Rate for Payer: Aetna of NY Commercial	$5.91
Rate for Payer: Cash Price	$8.06
Rate for Payer: Cash Price	$8.06
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$0.43
Rate for Payer: EmblemHealth Select Care	$0.43
Rate for Payer: Galaxy Health Commercial	$6.99
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$5.91
Rate for Payer: WellCare Medicare	$5.91

CEFUROXIME 250 MG TABLET

Facility

$12.50

Service Code	NDC 65862069920
Hospital Charge Code	4401292
Hospital Revenue Code	250
Min. Negotiated Rate	$6.88
Max. Negotiated Rate	$8.12
Rate for Payer: Cash Price	$9.38
Rate for Payer: Galaxy Health Commercial	$8.12
Rate for Payer: WellCare Medicare	$6.88

CEFUROXIME 250 MG TABLET

Facility

$12.50

Service Code	NDC 65862069920
Hospital Charge Code	4401292
Hospital Revenue Code	250
Min. Negotiated Rate	$1.88
Max. Negotiated Rate	$10.00
Rate for Payer: Aetna of NY Commercial	$8.75
Rate for Payer: Aetna of NY Medicare	$5.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$5.00
Rate for Payer: Cash Price	$9.38
Rate for Payer: CDPHP Medicare	$4.62
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$10.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$10.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$10.00
Rate for Payer: EmblemHealth Medicaid	$10.00
Rate for Payer: EmblemHealth Medicare	$4.25
Rate for Payer: EmblemHealth Select Care	$9.00
Rate for Payer: Fidelis Medicare	$5.00
Rate for Payer: Galaxy Health Commercial	$8.12
Rate for Payer: Hamaspik Choice Medicare	$5.00
Rate for Payer: Humana Medicare	$5.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$8.75
Rate for Payer: Local 1199SEIU Medicare	$5.75
Rate for Payer: MVP Health Care of NY Commercial	$9.38
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$7.04
Rate for Payer: MVP Health Care of NY Medicare	$5.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.88
Rate for Payer: United Healthcare Medicare	$5.00
Rate for Payer: WellCare Medicare	$6.88

CEFUROXIME AXETIL 500MG TABS 60 EA

Facility

$24.72

Service Code	NDC 68180030360
Hospital Charge Code	4400148
Hospital Revenue Code	250
Min. Negotiated Rate	$3.71
Max. Negotiated Rate	$19.78
Rate for Payer: Aetna of NY Commercial	$17.30
Rate for Payer: Aetna of NY Medicare	$11.37
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$9.89
Rate for Payer: Cash Price	$18.54
Rate for Payer: CDPHP Medicare	$9.15
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$19.78
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$19.78
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$19.78
Rate for Payer: EmblemHealth Medicaid	$19.78
Rate for Payer: EmblemHealth Medicare	$8.40
Rate for Payer: EmblemHealth Select Care	$17.80
Rate for Payer: Fidelis Medicare	$9.89
Rate for Payer: Galaxy Health Commercial	$16.07
Rate for Payer: Hamaspik Choice Medicare	$9.89
Rate for Payer: Humana Medicare	$9.89
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$17.30
Rate for Payer: Local 1199SEIU Medicare	$11.37
Rate for Payer: MVP Health Care of NY Commercial	$18.54
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$13.92
Rate for Payer: MVP Health Care of NY Medicare	$10.38
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$3.71
Rate for Payer: United Healthcare Medicare	$9.89
Rate for Payer: WellCare Medicare	$13.60

CEFUROXIME AXETIL 500MG TABS 60 EA

Facility

$24.72

Service Code	NDC 68180030360
Hospital Charge Code	4400148
Hospital Revenue Code	250
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$16.07
Rate for Payer: Cash Price	$18.54
Rate for Payer: Galaxy Health Commercial	$16.07
Rate for Payer: WellCare Medicare	$13.60

CELECOXIB 100MG CAPS 100 EA

Facility

$22.66

Service Code	NDC 904650261
Hospital Charge Code	4400150
Hospital Revenue Code	250
Min. Negotiated Rate	$12.46
Max. Negotiated Rate	$14.73
Rate for Payer: Cash Price	$17.00
Rate for Payer: Galaxy Health Commercial	$14.73
Rate for Payer: WellCare Medicare	$12.46

CELECOXIB 100MG CAPS 100 EA

Facility

$22.66

Service Code	NDC 904650261
Hospital Charge Code	4400150
Hospital Revenue Code	250
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

CELERO HANDPIECES / CELERO-12

Facility

$462.47

Hospital Charge Code	4473013
Hospital Revenue Code	272
Min. Negotiated Rate	$300.61
Max. Negotiated Rate	$300.61
Rate for Payer: Cash Price	$346.85
Rate for Payer: Galaxy Health Commercial	$300.61

CELERO HANDPIECES / CELERO-12

Facility

$462.47

Hospital Charge Code	4473013
Hospital Revenue Code	272
Min. Negotiated Rate	$69.37
Max. Negotiated Rate	$369.98
Rate for Payer: Aetna of NY Commercial	$323.73
Rate for Payer: Aetna of NY Medicare	$212.74
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$184.99
Rate for Payer: Cash Price	$346.85
Rate for Payer: CDPHP Medicare	$171.11
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$369.98
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$369.98
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$369.98
Rate for Payer: EmblemHealth Medicaid	$369.98
Rate for Payer: EmblemHealth Medicare	$157.24
Rate for Payer: EmblemHealth Select Care	$332.98
Rate for Payer: Fidelis Medicare	$184.99
Rate for Payer: Galaxy Health Commercial	$300.61
Rate for Payer: Hamaspik Choice Medicare	$184.99
Rate for Payer: Humana Medicare	$184.99
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$323.73
Rate for Payer: Local 1199SEIU Medicare	$212.74
Rate for Payer: MVP Health Care of NY Commercial	$346.85
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$260.37
Rate for Payer: MVP Health Care of NY Medicare	$194.24
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$69.37
Rate for Payer: United Healthcare Medicare	$184.99
Rate for Payer: WellCare Medicare	$254.36

CELERO INTRO-12 / INTRODUCER

Facility

$43.26

Hospital Charge Code	4473014
Hospital Revenue Code	272
Min. Negotiated Rate	$6.49
Max. Negotiated Rate	$34.61
Rate for Payer: Aetna of NY Commercial	$30.28
Rate for Payer: Aetna of NY Medicare	$19.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$17.30
Rate for Payer: Cash Price	$32.44
Rate for Payer: CDPHP Medicare	$16.01
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$34.61
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$34.61
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$34.61
Rate for Payer: EmblemHealth Medicaid	$34.61
Rate for Payer: EmblemHealth Medicare	$14.71
Rate for Payer: EmblemHealth Select Care	$31.15
Rate for Payer: Fidelis Medicare	$17.30
Rate for Payer: Galaxy Health Commercial	$28.12
Rate for Payer: Hamaspik Choice Medicare	$17.30
Rate for Payer: Humana Medicare	$17.30
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$30.28
Rate for Payer: Local 1199SEIU Medicare	$19.90
Rate for Payer: MVP Health Care of NY Commercial	$32.45
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$24.36
Rate for Payer: MVP Health Care of NY Medicare	$18.17
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$6.49
Rate for Payer: United Healthcare Medicare	$17.30
Rate for Payer: WellCare Medicare	$23.79

CELERO INTRO-12 / INTRODUCER

Facility

$43.26

Hospital Charge Code	4473014
Hospital Revenue Code	272
Min. Negotiated Rate	$28.12
Max. Negotiated Rate	$28.12
Rate for Payer: Cash Price	$32.44
Rate for Payer: Galaxy Health Commercial	$28.12

CELERO SECURMARK

Facility

$230.72

Hospital Charge Code	4473016
Hospital Revenue Code	270
Min. Negotiated Rate	$34.61
Max. Negotiated Rate	$184.58
Rate for Payer: Aetna of NY Commercial	$161.50
Rate for Payer: Aetna of NY Medicare	$106.13
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$92.29
Rate for Payer: Cash Price	$173.04
Rate for Payer: CDPHP Medicare	$85.37
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$184.58
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$184.58
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$184.58
Rate for Payer: EmblemHealth Medicaid	$184.58
Rate for Payer: EmblemHealth Medicare	$78.44
Rate for Payer: EmblemHealth Select Care	$166.12
Rate for Payer: Fidelis Medicare	$92.29
Rate for Payer: Galaxy Health Commercial	$149.97
Rate for Payer: Hamaspik Choice Medicare	$92.29
Rate for Payer: Humana Medicare	$92.29
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$161.50
Rate for Payer: Local 1199SEIU Medicare	$106.13
Rate for Payer: MVP Health Care of NY Commercial	$173.04
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$129.90
Rate for Payer: MVP Health Care of NY Medicare	$96.90
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$34.61
Rate for Payer: United Healthcare Medicare	$92.29
Rate for Payer: WellCare Medicare	$126.90

CELERO SECURMARK

Facility

$230.72

Hospital Charge Code	4473016
Hospital Revenue Code	270
Min. Negotiated Rate	$149.97
Max. Negotiated Rate	$149.97
Rate for Payer: Cash Price	$173.04
Rate for Payer: Galaxy Health Commercial	$149.97

CEPACOL 3 MG

Facility

$6.18

Hospital Charge Code	4401235
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

CEPACOL 3 MG

Facility

$6.18

Hospital Charge Code	4401235
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

CEPHALEXIN MONOHYDRATE 250MG/5ML POSR 10

Facility

$6.18

Service Code	NDC 93417773
Hospital Charge Code	4400154
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

CEPHALEXIN MONOHYDRATE 250MG/5ML POSR 10

Facility

$6.18

Service Code	NDC 93417773
Hospital Charge Code	4400154
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

CEPHALEXIN MONOHYDRATE 250MG CAPS 100 EA

Facility

$6.18

Service Code	NDC 93314501
Hospital Charge Code	4400153
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

CEPHALEXIN MONOHYDRATE 250MG CAPS 100 EA

Facility

$6.18

Service Code	NDC 93314501
Hospital Charge Code	4400153
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

CEPHALEXIN MONOHYDRATE 500MG CAPS 100 EA

Facility

$6.18

Service Code	NDC 50268015215
Hospital Charge Code	4400155
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

CEPHALEXIN MONOHYDRATE 500MG CAPS 100 EA

Facility

$6.18

Service Code	NDC 50268015215
Hospital Charge Code	4400155
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

CERVICOLL KIT CEK-17-50-2

Facility

$3,131.20

Hospital Charge Code	4479256
Hospital Revenue Code	270
Min. Negotiated Rate	$469.68
Max. Negotiated Rate	$2,504.96
Rate for Payer: Aetna of NY Commercial	$2,191.84
Rate for Payer: Aetna of NY Medicare	$1,440.35
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,252.48
Rate for Payer: Cash Price	$2,348.40
Rate for Payer: CDPHP Medicare	$1,158.54
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$2,504.96
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,504.96
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,504.96
Rate for Payer: EmblemHealth Medicaid	$2,504.96
Rate for Payer: EmblemHealth Medicare	$1,064.61
Rate for Payer: EmblemHealth Select Care	$2,254.46
Rate for Payer: Fidelis Medicare	$1,252.48
Rate for Payer: Galaxy Health Commercial	$2,035.28
Rate for Payer: Hamaspik Choice Medicare	$1,252.48
Rate for Payer: Humana Medicare	$1,252.48
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$2,191.84
Rate for Payer: Local 1199SEIU Medicare	$1,440.35
Rate for Payer: MVP Health Care of NY Commercial	$2,348.40
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,762.87
Rate for Payer: MVP Health Care of NY Medicare	$1,315.10
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$469.68
Rate for Payer: United Healthcare Medicare	$1,252.48
Rate for Payer: WellCare Medicare	$1,722.16

CERVICOLL KIT CEK-17-50-2

Facility

$3,131.20

Hospital Charge Code	4479256
Hospital Revenue Code	270
Min. Negotiated Rate	$2,035.28
Max. Negotiated Rate	$2,035.28
Rate for Payer: Cash Price	$2,348.40
Rate for Payer: Galaxy Health Commercial	$2,035.28

Know your out-of-pocket cost for care.

All Charges