Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

CLOSED TX RADIAL HEAD W/MANIP

Facility

$756.00

Service Code	HCPCS 24640
Hospital Charge Code	4600055
Hospital Revenue Code	450
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$1,234.00
Rate for Payer: Aetna of NY Commercial	$1,000.00
Rate for Payer: Aetna of NY Medicare	$347.76
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$302.40
Rate for Payer: Cash Price	$567.00
Rate for Payer: Cash Price	$567.00
Rate for Payer: Cash Price	$567.00
Rate for Payer: CDPHP Medicare	$279.72
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,206.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$604.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$604.80
Rate for Payer: EmblemHealth Medicaid	$604.80
Rate for Payer: EmblemHealth Medicare	$257.04
Rate for Payer: EmblemHealth Select Care	$1,085.00
Rate for Payer: Fidelis Medicare	$302.40
Rate for Payer: Galaxy Health Commercial	$491.40
Rate for Payer: Hamaspik Choice Medicare	$302.40
Rate for Payer: Humana Medicare	$302.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,000.00
Rate for Payer: Local 1199SEIU Medicare	$347.76
Rate for Payer: MVP Health Care of NY Commercial	$1,234.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$925.00
Rate for Payer: MVP Health Care of NY Medicare	$317.52
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,009.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$113.40
Rate for Payer: United Healthcare Commercial	$1,009.00
Rate for Payer: United Healthcare Medicare	$302.40
Rate for Payer: WellCare Medicare	$415.80

CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION

Facility

$4,928.00

Service Code	HCPCS 25505
Hospital Charge Code	4852014
Hospital Revenue Code	761
Min. Negotiated Rate	$739.20
Max. Negotiated Rate	$3,942.40
Rate for Payer: Aetna of NY Commercial	$3,449.60
Rate for Payer: Aetna of NY Medicare	$2,266.88
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,971.20
Rate for Payer: Cash Price	$3,696.00
Rate for Payer: CDPHP Medicare	$1,823.36
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$3,942.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$3,942.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$3,942.40
Rate for Payer: EmblemHealth Medicaid	$3,942.40
Rate for Payer: EmblemHealth Medicare	$1,675.52
Rate for Payer: EmblemHealth Select Care	$3,548.16
Rate for Payer: Fidelis Medicare	$1,971.20
Rate for Payer: Galaxy Health Commercial	$3,203.20
Rate for Payer: Hamaspik Choice Medicare	$1,971.20
Rate for Payer: Humana Medicare	$1,971.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$3,449.60
Rate for Payer: Local 1199SEIU Medicare	$2,266.88
Rate for Payer: MVP Health Care of NY Commercial	$3,696.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$2,774.46
Rate for Payer: MVP Health Care of NY Medicare	$2,069.76
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$739.20
Rate for Payer: United Healthcare Medicare	$1,971.20
Rate for Payer: WellCare Medicare	$2,710.40

CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION

Facility

$4,928.00

Service Code	HCPCS 25505
Hospital Charge Code	4852014
Hospital Revenue Code	761
Min. Negotiated Rate	$3,203.20
Max. Negotiated Rate	$3,203.20
Rate for Payer: Cash Price	$3,696.00
Rate for Payer: Galaxy Health Commercial	$3,203.20

CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ

Facility

$4,928.00

Service Code	HCPCS 25565
Hospital Charge Code	4853039
Hospital Revenue Code	761
Min. Negotiated Rate	$3,203.20
Max. Negotiated Rate	$3,203.20
Rate for Payer: Cash Price	$3,696.00
Rate for Payer: Galaxy Health Commercial	$3,203.20

CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ

Facility

$4,928.00

Service Code	HCPCS 25565
Hospital Charge Code	4853039
Hospital Revenue Code	761
Min. Negotiated Rate	$739.20
Max. Negotiated Rate	$3,942.40
Rate for Payer: Aetna of NY Commercial	$3,449.60
Rate for Payer: Aetna of NY Medicare	$2,266.88
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,971.20
Rate for Payer: Cash Price	$3,696.00
Rate for Payer: CDPHP Medicare	$1,823.36
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$3,942.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$3,942.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$3,942.40
Rate for Payer: EmblemHealth Medicaid	$3,942.40
Rate for Payer: EmblemHealth Medicare	$1,675.52
Rate for Payer: EmblemHealth Select Care	$3,548.16
Rate for Payer: Fidelis Medicare	$1,971.20
Rate for Payer: Galaxy Health Commercial	$3,203.20
Rate for Payer: Hamaspik Choice Medicare	$1,971.20
Rate for Payer: Humana Medicare	$1,971.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$3,449.60
Rate for Payer: Local 1199SEIU Medicare	$2,266.88
Rate for Payer: MVP Health Care of NY Commercial	$3,696.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$2,774.46
Rate for Payer: MVP Health Care of NY Medicare	$2,069.76
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$739.20
Rate for Payer: United Healthcare Medicare	$1,971.20
Rate for Payer: WellCare Medicare	$2,710.40

CLOSED TX RAD/ULN SHAF W/MANI

Facility

$4,928.00

Service Code	HCPCS 25565
Hospital Charge Code	4600065
Hospital Revenue Code	450
Min. Negotiated Rate	$3,203.20
Max. Negotiated Rate	$3,203.20
Rate for Payer: Cash Price	$3,696.00
Rate for Payer: Galaxy Health Commercial	$3,203.20

CLOSED TX RAD/ULN SHAF W/MANI

Facility

$4,928.00

Service Code	HCPCS 25565
Hospital Charge Code	4600065
Hospital Revenue Code	450
Min. Negotiated Rate	$739.20
Max. Negotiated Rate	$3,942.40
Rate for Payer: Aetna of NY Commercial	$1,000.00
Rate for Payer: Aetna of NY Medicare	$2,266.88
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,971.20
Rate for Payer: Cash Price	$3,696.00
Rate for Payer: Cash Price	$3,696.00
Rate for Payer: Cash Price	$3,696.00
Rate for Payer: CDPHP Medicare	$1,823.36
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,206.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$3,942.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$3,942.40
Rate for Payer: EmblemHealth Medicaid	$3,942.40
Rate for Payer: EmblemHealth Medicare	$1,675.52
Rate for Payer: EmblemHealth Select Care	$1,085.00
Rate for Payer: Fidelis Medicare	$1,971.20
Rate for Payer: Galaxy Health Commercial	$3,203.20
Rate for Payer: Hamaspik Choice Medicare	$1,971.20
Rate for Payer: Humana Medicare	$1,971.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,000.00
Rate for Payer: Local 1199SEIU Medicare	$2,266.88
Rate for Payer: MVP Health Care of NY Commercial	$1,234.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$925.00
Rate for Payer: MVP Health Care of NY Medicare	$2,069.76
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,009.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$739.20
Rate for Payer: United Healthcare Commercial	$1,009.00
Rate for Payer: United Healthcare Medicare	$1,971.20
Rate for Payer: WellCare Medicare	$2,710.40

CLOSED TX SHOULDER DISLOCATION

Facility

$756.00

Service Code	HCPCS 23650
Hospital Charge Code	4600060
Hospital Revenue Code	450
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$1,234.00
Rate for Payer: Aetna of NY Commercial	$1,000.00
Rate for Payer: Aetna of NY Medicare	$347.76
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$302.40
Rate for Payer: Cash Price	$567.00
Rate for Payer: Cash Price	$567.00
Rate for Payer: Cash Price	$567.00
Rate for Payer: CDPHP Medicare	$279.72
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,206.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$604.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$604.80
Rate for Payer: EmblemHealth Medicaid	$604.80
Rate for Payer: EmblemHealth Medicare	$257.04
Rate for Payer: EmblemHealth Select Care	$1,085.00
Rate for Payer: Fidelis Medicare	$302.40
Rate for Payer: Galaxy Health Commercial	$491.40
Rate for Payer: Hamaspik Choice Medicare	$302.40
Rate for Payer: Humana Medicare	$302.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,000.00
Rate for Payer: Local 1199SEIU Medicare	$347.76
Rate for Payer: MVP Health Care of NY Commercial	$1,234.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$925.00
Rate for Payer: MVP Health Care of NY Medicare	$317.52
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,009.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$113.40
Rate for Payer: United Healthcare Commercial	$1,009.00
Rate for Payer: United Healthcare Medicare	$302.40
Rate for Payer: WellCare Medicare	$415.80

CLOSED TX SHOULDER DISLOCATION

Facility

$756.00

Service Code	HCPCS 23650
Hospital Charge Code	4600060
Hospital Revenue Code	450
Min. Negotiated Rate	$491.40
Max. Negotiated Rate	$491.40
Rate for Payer: Cash Price	$567.00
Rate for Payer: Galaxy Health Commercial	$491.40

CLOSED TX TEMPMAND DISLOCATION

Facility

$756.00

Service Code	HCPCS 21480
Hospital Charge Code	4600061
Hospital Revenue Code	450
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$1,234.00
Rate for Payer: Aetna of NY Commercial	$1,000.00
Rate for Payer: Aetna of NY Medicare	$347.76
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$302.40
Rate for Payer: Cash Price	$567.00
Rate for Payer: Cash Price	$567.00
Rate for Payer: Cash Price	$567.00
Rate for Payer: CDPHP Medicare	$279.72
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,206.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$604.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$604.80
Rate for Payer: EmblemHealth Medicaid	$604.80
Rate for Payer: EmblemHealth Medicare	$257.04
Rate for Payer: EmblemHealth Select Care	$1,085.00
Rate for Payer: Fidelis Medicare	$302.40
Rate for Payer: Galaxy Health Commercial	$491.40
Rate for Payer: Hamaspik Choice Medicare	$302.40
Rate for Payer: Humana Medicare	$302.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,000.00
Rate for Payer: Local 1199SEIU Medicare	$347.76
Rate for Payer: MVP Health Care of NY Commercial	$1,234.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$925.00
Rate for Payer: MVP Health Care of NY Medicare	$317.52
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,009.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$113.40
Rate for Payer: United Healthcare Commercial	$1,009.00
Rate for Payer: United Healthcare Medicare	$302.40
Rate for Payer: WellCare Medicare	$415.80

CLOSED TX TEMPMAND DISLOCATION

Facility

$756.00

Service Code	HCPCS 21480
Hospital Charge Code	4600061
Hospital Revenue Code	450
Min. Negotiated Rate	$491.40
Max. Negotiated Rate	$491.40
Rate for Payer: Cash Price	$567.00
Rate for Payer: Galaxy Health Commercial	$491.40

CLOSED TX THUMB DISLOCATION

Facility

$756.00

Service Code	HCPCS 26641
Hospital Charge Code	4600062
Hospital Revenue Code	450
Min. Negotiated Rate	$491.40
Max. Negotiated Rate	$491.40
Rate for Payer: Cash Price	$567.00
Rate for Payer: Galaxy Health Commercial	$491.40

CLOSED TX THUMB DISLOCATION

Facility

$756.00

Service Code	HCPCS 26641
Hospital Charge Code	4600062
Hospital Revenue Code	450
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$1,234.00
Rate for Payer: Aetna of NY Commercial	$1,000.00
Rate for Payer: Aetna of NY Medicare	$347.76
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$302.40
Rate for Payer: Cash Price	$567.00
Rate for Payer: Cash Price	$567.00
Rate for Payer: Cash Price	$567.00
Rate for Payer: CDPHP Medicare	$279.72
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,206.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$604.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$604.80
Rate for Payer: EmblemHealth Medicaid	$604.80
Rate for Payer: EmblemHealth Medicare	$257.04
Rate for Payer: EmblemHealth Select Care	$1,085.00
Rate for Payer: Fidelis Medicare	$302.40
Rate for Payer: Galaxy Health Commercial	$491.40
Rate for Payer: Hamaspik Choice Medicare	$302.40
Rate for Payer: Humana Medicare	$302.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,000.00
Rate for Payer: Local 1199SEIU Medicare	$347.76
Rate for Payer: MVP Health Care of NY Commercial	$1,234.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$925.00
Rate for Payer: MVP Health Care of NY Medicare	$317.52
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,009.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$113.40
Rate for Payer: United Healthcare Commercial	$1,009.00
Rate for Payer: United Healthcare Medicare	$302.40
Rate for Payer: WellCare Medicare	$415.80

CLOTRIMAZOLE 0.01 CRM 15 GM

Facility

$17.25

Service Code	NDC 904782236
Hospital Charge Code	4400177
Hospital Revenue Code	250
Min. Negotiated Rate	$9.49
Max. Negotiated Rate	$11.21
Rate for Payer: Cash Price	$12.94
Rate for Payer: Galaxy Health Commercial	$11.21
Rate for Payer: WellCare Medicare	$9.49

CLOTRIMAZOLE 0.01 CRM 15 GM

Facility

$17.25

Service Code	NDC 904782236
Hospital Charge Code	4400177
Hospital Revenue Code	250
Min. Negotiated Rate	$2.59
Max. Negotiated Rate	$13.80
Rate for Payer: Aetna of NY Commercial	$12.07
Rate for Payer: Aetna of NY Medicare	$7.93
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$6.90
Rate for Payer: Cash Price	$12.94
Rate for Payer: CDPHP Medicare	$6.38
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$13.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$13.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$13.80
Rate for Payer: EmblemHealth Medicaid	$13.80
Rate for Payer: EmblemHealth Medicare	$5.87
Rate for Payer: EmblemHealth Select Care	$12.42
Rate for Payer: Fidelis Medicare	$6.90
Rate for Payer: Galaxy Health Commercial	$11.21
Rate for Payer: Hamaspik Choice Medicare	$6.90
Rate for Payer: Humana Medicare	$6.90
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$12.07
Rate for Payer: Local 1199SEIU Medicare	$7.93
Rate for Payer: MVP Health Care of NY Commercial	$12.94
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$9.71
Rate for Payer: MVP Health Care of NY Medicare	$7.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.59
Rate for Payer: United Healthcare Medicare	$6.90
Rate for Payer: WellCare Medicare	$9.49

CLOTRIMAZOLE 10MG LOZG 70 EA

Facility

$6.18

Service Code	NDC 574010777
Hospital Charge Code	4400180
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

CLOTRIMAZOLE 10MG LOZG 70 EA

Facility

$6.18

Service Code	NDC 574010777
Hospital Charge Code	4400180
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

CLOTRIMAZOLE/BETAMETH DIP 1-0.05% CRM 15

Facility

$105.58

Service Code	NDC 168025815
Hospital Charge Code	4400181
Hospital Revenue Code	250
Min. Negotiated Rate	$58.07
Max. Negotiated Rate	$68.63
Rate for Payer: Cash Price	$79.18
Rate for Payer: Galaxy Health Commercial	$68.63
Rate for Payer: WellCare Medicare	$58.07

CLOTRIMAZOLE/BETAMETH DIP 1-0.05% CRM 15

Facility

$105.58

Service Code	NDC 168025815
Hospital Charge Code	4400181
Hospital Revenue Code	250
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$84.46
Rate for Payer: Aetna of NY Commercial	$73.91
Rate for Payer: Aetna of NY Medicare	$48.57
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$42.23
Rate for Payer: Cash Price	$79.18
Rate for Payer: CDPHP Medicare	$39.06
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$84.46
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$84.46
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$84.46
Rate for Payer: EmblemHealth Medicaid	$84.46
Rate for Payer: EmblemHealth Medicare	$35.90
Rate for Payer: EmblemHealth Select Care	$76.02
Rate for Payer: Fidelis Medicare	$42.23
Rate for Payer: Galaxy Health Commercial	$68.63
Rate for Payer: Hamaspik Choice Medicare	$42.23
Rate for Payer: Humana Medicare	$42.23
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$73.91
Rate for Payer: Local 1199SEIU Medicare	$48.57
Rate for Payer: MVP Health Care of NY Commercial	$79.19
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$59.44
Rate for Payer: MVP Health Care of NY Medicare	$44.34
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$15.84
Rate for Payer: United Healthcare Medicare	$42.23
Rate for Payer: WellCare Medicare	$58.07

CLOTTING: FACTOR VIII VW FACTOR AG

Facility

$69.00

Service Code	HCPCS 85246
Hospital Charge Code	4301043
Hospital Revenue Code	300
Min. Negotiated Rate	$10.35
Max. Negotiated Rate	$55.20
Rate for Payer: Aetna of NY Commercial	$44.85
Rate for Payer: Aetna of NY Medicare	$31.74
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$27.60
Rate for Payer: Cash Price	$51.75
Rate for Payer: CDPHP Medicare	$25.53
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$41.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$55.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$55.20
Rate for Payer: EmblemHealth Medicaid	$55.20
Rate for Payer: EmblemHealth Medicare	$23.46
Rate for Payer: EmblemHealth Select Care	$41.40
Rate for Payer: Fidelis Medicare	$27.60
Rate for Payer: Galaxy Health Commercial	$44.85
Rate for Payer: Hamaspik Choice Medicare	$27.60
Rate for Payer: Humana Medicare	$27.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$44.85
Rate for Payer: Local 1199SEIU Medicare	$31.74
Rate for Payer: MVP Health Care of NY Commercial	$51.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$38.85
Rate for Payer: MVP Health Care of NY Medicare	$28.98
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$51.75
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$10.35
Rate for Payer: United Healthcare Commercial	$51.75
Rate for Payer: United Healthcare Medicare	$27.60
Rate for Payer: WellCare Medicare	$37.95

CLOTTING: FACTOR VIII VW FACTOR AG

Facility

$69.00

Service Code	HCPCS 85246
Hospital Charge Code	4301043
Hospital Revenue Code	300
Min. Negotiated Rate	$44.85
Max. Negotiated Rate	$44.85
Rate for Payer: Cash Price	$51.75
Rate for Payer: Galaxy Health Commercial	$44.85

CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES

Facility

$756.00

Service Code	HCPCS 23650
Hospital Charge Code	4853037
Hospital Revenue Code	761
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$604.80
Rate for Payer: Aetna of NY Commercial	$529.20
Rate for Payer: Aetna of NY Medicare	$347.76
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$302.40
Rate for Payer: Cash Price	$567.00
Rate for Payer: CDPHP Medicare	$279.72
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$604.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$604.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$604.80
Rate for Payer: EmblemHealth Medicaid	$604.80
Rate for Payer: EmblemHealth Medicare	$257.04
Rate for Payer: EmblemHealth Select Care	$544.32
Rate for Payer: Fidelis Medicare	$302.40
Rate for Payer: Galaxy Health Commercial	$491.40
Rate for Payer: Hamaspik Choice Medicare	$302.40
Rate for Payer: Humana Medicare	$302.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$529.20
Rate for Payer: Local 1199SEIU Medicare	$347.76
Rate for Payer: MVP Health Care of NY Commercial	$567.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$425.63
Rate for Payer: MVP Health Care of NY Medicare	$317.52
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$113.40
Rate for Payer: United Healthcare Medicare	$302.40
Rate for Payer: WellCare Medicare	$415.80

CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES

Facility

$756.00

Service Code	HCPCS 23650
Hospital Charge Code	4853037
Hospital Revenue Code	761
Min. Negotiated Rate	$491.40
Max. Negotiated Rate	$491.40
Rate for Payer: Cash Price	$567.00
Rate for Payer: Galaxy Health Commercial	$491.40

CLTX BIMALLEOLAR ANKLE FRACT W MNP

Facility

$4,928.00

Service Code	HCPCS 27810
Hospital Charge Code	4609648
Hospital Revenue Code	450
Min. Negotiated Rate	$739.20
Max. Negotiated Rate	$3,942.40
Rate for Payer: Aetna of NY Commercial	$1,000.00
Rate for Payer: Aetna of NY Medicare	$2,266.88
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,971.20
Rate for Payer: Cash Price	$3,696.00
Rate for Payer: Cash Price	$3,696.00
Rate for Payer: Cash Price	$3,696.00
Rate for Payer: CDPHP Medicare	$1,823.36
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,206.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$3,942.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$3,942.40
Rate for Payer: EmblemHealth Medicaid	$3,942.40
Rate for Payer: EmblemHealth Medicare	$1,675.52
Rate for Payer: EmblemHealth Select Care	$1,085.00
Rate for Payer: Fidelis Medicare	$1,971.20
Rate for Payer: Galaxy Health Commercial	$3,203.20
Rate for Payer: Hamaspik Choice Medicare	$1,971.20
Rate for Payer: Humana Medicare	$1,971.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,000.00
Rate for Payer: Local 1199SEIU Medicare	$2,266.88
Rate for Payer: MVP Health Care of NY Commercial	$1,234.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$925.00
Rate for Payer: MVP Health Care of NY Medicare	$2,069.76
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,009.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$739.20
Rate for Payer: United Healthcare Commercial	$1,009.00
Rate for Payer: United Healthcare Medicare	$1,971.20
Rate for Payer: WellCare Medicare	$2,710.40

CLTX BIMALLEOLAR ANKLE FRACT W MNP

Facility

$4,928.00

Service Code	HCPCS 27810
Hospital Charge Code	4609648
Hospital Revenue Code	450
Min. Negotiated Rate	$3,203.20
Max. Negotiated Rate	$3,203.20
Rate for Payer: Cash Price	$3,696.00
Rate for Payer: Galaxy Health Commercial	$3,203.20

Know your out-of-pocket cost for care.

All Charges