Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

COLLAGENASE 250U/GM OINT 30 GM

Facility

$759.37

Service Code	NDC 50484001030
Hospital Charge Code	4400688
Hospital Revenue Code	250
Min. Negotiated Rate	$417.65
Max. Negotiated Rate	$493.59
Rate for Payer: Cash Price	$569.53
Rate for Payer: Galaxy Health Commercial	$493.59
Rate for Payer: WellCare Medicare	$417.65

COLLAGENASE 250U/GM OINT 30 GM

Facility

$759.37

Service Code	NDC 50484001030
Hospital Charge Code	4400688
Hospital Revenue Code	250
Min. Negotiated Rate	$258.19
Max. Negotiated Rate	$611.29
Rate for Payer: Aetna of NY Commercial	$531.56
Rate for Payer: Aetna of NY Medicare	$349.31
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$569.53
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$569.53
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$280.97
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$379.68
Rate for Payer: Cash Price	$569.53
Rate for Payer: CDPHP Commercial	$611.29
Rate for Payer: CDPHP Medicare	$280.97
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$607.50
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$607.50
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$607.50
Rate for Payer: EmblemHealth Medicaid	$607.50
Rate for Payer: EmblemHealth Medicare	$258.19
Rate for Payer: EmblemHealth Select Care	$546.75
Rate for Payer: Fidelis Medicare	$289.40
Rate for Payer: Galaxy Health Commercial	$493.59
Rate for Payer: Hamaspik Choice Medicare	$280.97
Rate for Payer: Humana Medicare	$280.97
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$531.56
Rate for Payer: Local 1199SEIU Medicare	$349.31
Rate for Payer: MVP Health Care of NY Commercial	$569.53
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$427.53
Rate for Payer: MVP Health Care of NY Medicare	$295.02
Rate for Payer: United Healthcare Medicare	$280.97
Rate for Payer: WellCare Medicare	$417.65

COLLAR PHILADELPHIA 5 1/4 IN LRG

Facility

$54.00

Hospital Charge Code	4479081
Hospital Revenue Code	270
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$43.47
Rate for Payer: Aetna of NY Commercial	$37.80
Rate for Payer: Aetna of NY Medicare	$24.84
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$40.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$40.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$19.98
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$27.00
Rate for Payer: Cash Price	$40.50
Rate for Payer: CDPHP Commercial	$43.47
Rate for Payer: CDPHP Medicare	$19.98
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$43.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$43.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$43.20
Rate for Payer: EmblemHealth Medicaid	$43.20
Rate for Payer: EmblemHealth Medicare	$18.36
Rate for Payer: EmblemHealth Select Care	$38.88
Rate for Payer: Fidelis Medicare	$20.58
Rate for Payer: Galaxy Health Commercial	$35.10
Rate for Payer: Hamaspik Choice Medicare	$19.98
Rate for Payer: Humana Medicare	$19.98
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$37.80
Rate for Payer: Local 1199SEIU Medicare	$24.84
Rate for Payer: MVP Health Care of NY Commercial	$40.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$30.40
Rate for Payer: MVP Health Care of NY Medicare	$20.98
Rate for Payer: United Healthcare Medicare	$19.98
Rate for Payer: WellCare Medicare	$29.70

COLLAR PHILADELPHIA 5 1/4 IN LRG

Facility

$54.00

Hospital Charge Code	4479081
Hospital Revenue Code	270
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Cash Price	$40.50
Rate for Payer: Galaxy Health Commercial	$35.10

COLLAR PHILADELPHIA 5 1/4 IN MED

Facility

$54.00

Hospital Charge Code	4479080
Hospital Revenue Code	270
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$43.47
Rate for Payer: Aetna of NY Commercial	$37.80
Rate for Payer: Aetna of NY Medicare	$24.84
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$40.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$40.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$19.98
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$27.00
Rate for Payer: Cash Price	$40.50
Rate for Payer: CDPHP Commercial	$43.47
Rate for Payer: CDPHP Medicare	$19.98
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$43.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$43.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$43.20
Rate for Payer: EmblemHealth Medicaid	$43.20
Rate for Payer: EmblemHealth Medicare	$18.36
Rate for Payer: EmblemHealth Select Care	$38.88
Rate for Payer: Fidelis Medicare	$20.58
Rate for Payer: Galaxy Health Commercial	$35.10
Rate for Payer: Hamaspik Choice Medicare	$19.98
Rate for Payer: Humana Medicare	$19.98
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$37.80
Rate for Payer: Local 1199SEIU Medicare	$24.84
Rate for Payer: MVP Health Care of NY Commercial	$40.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$30.40
Rate for Payer: MVP Health Care of NY Medicare	$20.98
Rate for Payer: United Healthcare Medicare	$19.98
Rate for Payer: WellCare Medicare	$29.70

COLLAR PHILADELPHIA 5 1/4 IN MED

Facility

$54.00

Hospital Charge Code	4479080
Hospital Revenue Code	270
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Cash Price	$40.50
Rate for Payer: Galaxy Health Commercial	$35.10

COLLAR PHILADELPHIA 5 1/4 IN SM

Facility

$54.00

Hospital Charge Code	4479079
Hospital Revenue Code	270
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$43.47
Rate for Payer: Aetna of NY Commercial	$37.80
Rate for Payer: Aetna of NY Medicare	$24.84
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$40.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$40.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$19.98
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$27.00
Rate for Payer: Cash Price	$40.50
Rate for Payer: CDPHP Commercial	$43.47
Rate for Payer: CDPHP Medicare	$19.98
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$43.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$43.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$43.20
Rate for Payer: EmblemHealth Medicaid	$43.20
Rate for Payer: EmblemHealth Medicare	$18.36
Rate for Payer: EmblemHealth Select Care	$38.88
Rate for Payer: Fidelis Medicare	$20.58
Rate for Payer: Galaxy Health Commercial	$35.10
Rate for Payer: Hamaspik Choice Medicare	$19.98
Rate for Payer: Humana Medicare	$19.98
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$37.80
Rate for Payer: Local 1199SEIU Medicare	$24.84
Rate for Payer: MVP Health Care of NY Commercial	$40.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$30.40
Rate for Payer: MVP Health Care of NY Medicare	$20.98
Rate for Payer: United Healthcare Medicare	$19.98
Rate for Payer: WellCare Medicare	$29.70

COLLAR PHILADELPHIA 5 1/4 IN SM

Facility

$54.00

Hospital Charge Code	4479079
Hospital Revenue Code	270
Min. Negotiated Rate	$35.10
Max. Negotiated Rate	$35.10
Rate for Payer: Cash Price	$40.50
Rate for Payer: Galaxy Health Commercial	$35.10

COLLECT BLOOD FROM PICC

Facility

$366.00

Service Code	HCPCS 36592
Hospital Charge Code	4451252
Hospital Revenue Code	300
Min. Negotiated Rate	$121.71
Max. Negotiated Rate	$294.63
Rate for Payer: Aetna of NY Commercial	$256.20
Rate for Payer: Aetna of NY Medicare	$168.36
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$274.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$274.50
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$135.42
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$183.00
Rate for Payer: Cash Price	$274.50
Rate for Payer: Cash Price	$274.50
Rate for Payer: CDPHP Commercial	$294.63
Rate for Payer: CDPHP Medicare	$135.42
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$219.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$292.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$292.80
Rate for Payer: EmblemHealth Medicaid	$292.80
Rate for Payer: EmblemHealth Medicare	$124.44
Rate for Payer: EmblemHealth Select Care	$219.60
Rate for Payer: Fidelis Medicare	$139.48
Rate for Payer: Galaxy Health Commercial	$237.90
Rate for Payer: Hamaspik Choice Medicare	$135.42
Rate for Payer: Humana Medicare	$135.42
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$256.20
Rate for Payer: Local 1199SEIU Medicare	$168.36
Rate for Payer: MVP Health Care of NY Commercial	$274.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$206.06
Rate for Payer: MVP Health Care of NY Medicare	$142.19
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$274.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$121.71
Rate for Payer: United Healthcare Commercial	$274.50
Rate for Payer: United Healthcare Medicare	$135.42
Rate for Payer: WellCare Medicare	$201.30

COLLECT BLOOD FROM PICC

Facility

$366.00

Service Code	HCPCS 36592
Hospital Charge Code	4451252
Hospital Revenue Code	300
Min. Negotiated Rate	$237.90
Max. Negotiated Rate	$237.90
Rate for Payer: Cash Price	$274.50
Rate for Payer: Galaxy Health Commercial	$237.90

COLLES(COCK UP) SPLINT

Facility

$20.00

Hospital Charge Code	4472168
Hospital Revenue Code	270
Min. Negotiated Rate	$13.00
Max. Negotiated Rate	$13.00
Rate for Payer: Cash Price	$15.00
Rate for Payer: Galaxy Health Commercial	$13.00

COLLES(COCK UP) SPLINT

Facility

$20.00

Hospital Charge Code	4472168
Hospital Revenue Code	270
Min. Negotiated Rate	$6.80
Max. Negotiated Rate	$16.10
Rate for Payer: Aetna of NY Commercial	$14.00
Rate for Payer: Aetna of NY Medicare	$9.20
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$15.00
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$15.00
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$7.40
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$10.00
Rate for Payer: Cash Price	$15.00
Rate for Payer: CDPHP Commercial	$16.10
Rate for Payer: CDPHP Medicare	$7.40
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$16.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$16.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$16.00
Rate for Payer: EmblemHealth Medicaid	$16.00
Rate for Payer: EmblemHealth Medicare	$6.80
Rate for Payer: EmblemHealth Select Care	$14.40
Rate for Payer: Fidelis Medicare	$7.62
Rate for Payer: Galaxy Health Commercial	$13.00
Rate for Payer: Hamaspik Choice Medicare	$7.40
Rate for Payer: Humana Medicare	$7.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$14.00
Rate for Payer: Local 1199SEIU Medicare	$9.20
Rate for Payer: MVP Health Care of NY Commercial	$15.00
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$11.26
Rate for Payer: MVP Health Care of NY Medicare	$7.77
Rate for Payer: United Healthcare Medicare	$7.40
Rate for Payer: WellCare Medicare	$11.00

COLONOSCOPY FLEX ; DX

Facility

$2,615.00

Service Code	HCPCS 45378
Hospital Charge Code	4851916
Hospital Revenue Code	761
Min. Negotiated Rate	$1,699.75
Max. Negotiated Rate	$1,699.75
Rate for Payer: Cash Price	$1,961.25
Rate for Payer: Galaxy Health Commercial	$1,699.75

COLONOSCOPY FLEX ; DX

Facility

$2,615.00

Service Code	HCPCS 45378
Hospital Charge Code	4851916
Hospital Revenue Code	761
Min. Negotiated Rate	$870.81
Max. Negotiated Rate	$2,521.93
Rate for Payer: Aetna of NY Commercial	$1,830.50
Rate for Payer: Aetna of NY Medicare	$1,202.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$2,017.33
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$2,521.93
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$967.55
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$1,307.50
Rate for Payer: Cash Price	$1,961.25
Rate for Payer: Cash Price	$1,961.25
Rate for Payer: Cash Price	$1,961.25
Rate for Payer: CDPHP Commercial	$2,105.08
Rate for Payer: CDPHP Medicare	$967.55
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$2,092.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,092.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,092.00
Rate for Payer: EmblemHealth Medicaid	$2,092.00
Rate for Payer: EmblemHealth Medicare	$889.10
Rate for Payer: EmblemHealth Select Care	$1,882.80
Rate for Payer: Fidelis Medicare	$996.58
Rate for Payer: Galaxy Health Commercial	$1,699.75
Rate for Payer: Hamaspik Choice Medicare	$967.55
Rate for Payer: Humana Medicare	$967.55
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,830.50
Rate for Payer: Local 1199SEIU Medicare	$1,202.90
Rate for Payer: MVP Health Care of NY Commercial	$1,961.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,472.24
Rate for Payer: MVP Health Care of NY Medicare	$1,015.93
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$870.81
Rate for Payer: United Healthcare Medicare	$967.55
Rate for Payer: WellCare Medicare	$1,438.25

COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)

Facility

$2,521.93

Service Code	CPT 45378
Hospital Revenue Code	490
Min. Negotiated Rate	$870.81
Max. Negotiated Rate	$2,521.93
Rate for Payer: Aetna of NY Commercial	$1,857.00
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$2,017.33
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$2,521.93
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$897.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,857.00
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,775.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$870.81
Rate for Payer: United Healthcare Commercial	$1,775.00

COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE

Facility

$2,521.93

Service Code	CPT 45380
Hospital Revenue Code	490
Min. Negotiated Rate	$897.00
Max. Negotiated Rate	$2,521.93
Rate for Payer: Aetna of NY Commercial	$1,857.00
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$2,017.33
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$2,521.93
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$897.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,857.00
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,775.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,124.36
Rate for Payer: United Healthcare Commercial	$1,775.00

COLONOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE

Facility

$2,521.93

Service Code	CPT 45381
Hospital Revenue Code	490
Min. Negotiated Rate	$897.00
Max. Negotiated Rate	$2,521.93
Rate for Payer: Aetna of NY Commercial	$1,857.00
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$2,017.33
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$2,521.93
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$897.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,857.00
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,775.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,124.36
Rate for Payer: United Healthcare Commercial	$1,775.00

COLONOSCOPY, FLEXIBLE; WITH ENDOSCOPIC MUCOSAL RESECTION

Facility

$2,675.24

Service Code	CPT 45390
Hospital Revenue Code	490
Min. Negotiated Rate	$897.00
Max. Negotiated Rate	$2,675.24
Rate for Payer: Aetna of NY Commercial	$1,857.00
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$2,017.33
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$2,521.93
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$897.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,857.00
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,775.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2,675.24
Rate for Payer: United Healthcare Commercial	$1,775.00

COLONOSCOPY FLEX W REM LESION BY SNARE

Facility

$3,377.00

Service Code	HCPCS 45385
Hospital Charge Code	4000359
Hospital Revenue Code	490
Min. Negotiated Rate	$2,195.05
Max. Negotiated Rate	$2,195.05
Rate for Payer: Cash Price	$2,532.75
Rate for Payer: Galaxy Health Commercial	$2,195.05

COLONOSCOPY FLEX W REM LESION BY SNARE

Facility

$3,377.00

Service Code	HCPCS 45385
Hospital Charge Code	4000359
Hospital Revenue Code	490
Min. Negotiated Rate	$897.00
Max. Negotiated Rate	$2,718.48
Rate for Payer: Aetna of NY Commercial	$1,857.00
Rate for Payer: Aetna of NY Medicare	$1,553.42
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$2,017.33
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$2,521.93
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$1,249.49
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$897.00
Rate for Payer: Cash Price	$2,532.75
Rate for Payer: Cash Price	$2,532.75
Rate for Payer: Cash Price	$2,532.75
Rate for Payer: CDPHP Commercial	$2,718.48
Rate for Payer: CDPHP Medicare	$1,249.49
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$2,701.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$2,701.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$2,701.60
Rate for Payer: EmblemHealth Medicaid	$2,701.60
Rate for Payer: EmblemHealth Medicare	$1,148.18
Rate for Payer: EmblemHealth Select Care	$2,431.44
Rate for Payer: Fidelis Medicare	$1,286.97
Rate for Payer: Galaxy Health Commercial	$2,195.05
Rate for Payer: Hamaspik Choice Medicare	$1,249.49
Rate for Payer: Humana Medicare	$1,249.49
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,857.00
Rate for Payer: Local 1199SEIU Medicare	$1,553.42
Rate for Payer: Multiplan Commercial	$2,701.60
Rate for Payer: MVP Health Care of NY Commercial	$2,532.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,901.25
Rate for Payer: MVP Health Care of NY Medicare	$1,311.96
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$1,775.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,124.36
Rate for Payer: United Healthcare Commercial	$1,775.00
Rate for Payer: United Healthcare Medicare	$1,249.49
Rate for Payer: WellCare Medicare	$1,857.35

COMBIVENT RESPIMAT INHALER (MD

Facility

$1,184.24

Service Code	NDC 00597002402
Hospital Charge Code	4409134
Hospital Revenue Code	250
Min. Negotiated Rate	$402.64
Max. Negotiated Rate	$953.31
Rate for Payer: Aetna of NY Commercial	$828.97
Rate for Payer: Aetna of NY Medicare	$544.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$888.18
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$888.18
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$438.17
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$592.12
Rate for Payer: Cash Price	$888.18
Rate for Payer: CDPHP Commercial	$953.31
Rate for Payer: CDPHP Medicare	$438.17
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$947.39
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$947.39
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$947.39
Rate for Payer: EmblemHealth Medicaid	$947.39
Rate for Payer: EmblemHealth Medicare	$402.64
Rate for Payer: EmblemHealth Select Care	$852.65
Rate for Payer: Fidelis Medicare	$451.31
Rate for Payer: Galaxy Health Commercial	$769.76
Rate for Payer: Hamaspik Choice Medicare	$438.17
Rate for Payer: Humana Medicare	$438.17
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$828.97
Rate for Payer: Local 1199SEIU Medicare	$544.75
Rate for Payer: MVP Health Care of NY Commercial	$888.18
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$666.73
Rate for Payer: MVP Health Care of NY Medicare	$460.08
Rate for Payer: United Healthcare Medicare	$438.17
Rate for Payer: WellCare Medicare	$651.33

COMBIVENT RESPIMAT INHALER (MD

Facility

$1,184.24

Service Code	NDC 00597002402
Hospital Charge Code	4409134
Hospital Revenue Code	250
Min. Negotiated Rate	$651.33
Max. Negotiated Rate	$769.76
Rate for Payer: Cash Price	$888.18
Rate for Payer: Galaxy Health Commercial	$769.76
Rate for Payer: WellCare Medicare	$651.33

COMPATIBILITY TEST EACH UNIT

Facility

$489.00

Service Code	HCPCS 86920
Hospital Charge Code	4300200
Hospital Revenue Code	300
Min. Negotiated Rate	$317.85
Max. Negotiated Rate	$317.85
Rate for Payer: Cash Price	$366.75
Rate for Payer: Galaxy Health Commercial	$317.85

COMPATIBILITY TEST EACH UNIT

Facility

$489.00

Service Code	HCPCS 86920
Hospital Charge Code	4300200
Hospital Revenue Code	300
Min. Negotiated Rate	$162.74
Max. Negotiated Rate	$393.64
Rate for Payer: Aetna of NY Commercial	$317.85
Rate for Payer: Aetna of NY Medicare	$224.94
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group	$366.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO	$366.75
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$180.93
Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp	$244.50
Rate for Payer: Cash Price	$366.75
Rate for Payer: Cash Price	$366.75
Rate for Payer: CDPHP Commercial	$393.64
Rate for Payer: CDPHP Medicare	$180.93
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$293.40
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$391.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$391.20
Rate for Payer: EmblemHealth Medicaid	$391.20
Rate for Payer: EmblemHealth Medicare	$166.26
Rate for Payer: EmblemHealth Select Care	$293.40
Rate for Payer: Fidelis Medicare	$186.36
Rate for Payer: Galaxy Health Commercial	$317.85
Rate for Payer: Hamaspik Choice Medicare	$180.93
Rate for Payer: Humana Medicare	$180.93
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$317.85
Rate for Payer: Local 1199SEIU Medicare	$224.94
Rate for Payer: MVP Health Care of NY Commercial	$366.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$275.31
Rate for Payer: MVP Health Care of NY Medicare	$189.98
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$366.75
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$162.74
Rate for Payer: United Healthcare Commercial	$366.75
Rate for Payer: United Healthcare Medicare	$180.93
Rate for Payer: WellCare Medicare	$268.95

COMPL AUTOM CBC W PLT

Facility

$33.00

Service Code	HCPCS 85027
Hospital Charge Code	4300160
Hospital Revenue Code	305
Min. Negotiated Rate	$21.45
Max. Negotiated Rate	$21.45
Rate for Payer: Cash Price	$24.75
Rate for Payer: Galaxy Health Commercial	$21.45

Know your out-of-pocket cost for care.

All Charges