Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

COOLED INTRODUCER (GENERIC) BOX OF 2

Facility

$209.09

Hospital Charge Code	4479220
Hospital Revenue Code	270
Min. Negotiated Rate	$135.91
Max. Negotiated Rate	$135.91
Rate for Payer: Cash Price	$156.82
Rate for Payer: Galaxy Health Commercial	$135.91

COOLED LUMBAR PROBE LUP-17-100-4

Facility

$2,190.81

Hospital Charge Code	4479193
Hospital Revenue Code	270
Min. Negotiated Rate	$328.62
Max. Negotiated Rate	$1,752.65
Rate for Payer: Aetna of NY Commercial	$1,533.57
Rate for Payer: Aetna of NY Medicare	$1,007.77
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$876.32
Rate for Payer: Cash Price	$1,643.11
Rate for Payer: CDPHP Medicare	$810.60
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,752.65
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,752.65
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,752.65
Rate for Payer: EmblemHealth Medicaid	$1,752.65
Rate for Payer: EmblemHealth Medicare	$744.88
Rate for Payer: EmblemHealth Select Care	$1,577.38
Rate for Payer: Fidelis Medicare	$876.32
Rate for Payer: Galaxy Health Commercial	$1,424.03
Rate for Payer: Hamaspik Choice Medicare	$876.32
Rate for Payer: Humana Medicare	$876.32
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,533.57
Rate for Payer: Local 1199SEIU Medicare	$1,007.77
Rate for Payer: MVP Health Care of NY Commercial	$1,643.11
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,233.43
Rate for Payer: MVP Health Care of NY Medicare	$920.14
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$328.62
Rate for Payer: United Healthcare Medicare	$876.32
Rate for Payer: WellCare Medicare	$1,204.95

COOLED LUMBAR PROBE LUP-17-100-4

Facility

$2,190.81

Hospital Charge Code	4479193
Hospital Revenue Code	270
Min. Negotiated Rate	$1,424.03
Max. Negotiated Rate	$1,424.03
Rate for Payer: Cash Price	$1,643.11
Rate for Payer: Galaxy Health Commercial	$1,424.03

COOLIEF RADIOFREQUENCY KIT 75MM

Facility

$2,382.39

Hospital Charge Code	4473036
Hospital Revenue Code	272
Min. Negotiated Rate	$357.36
Max. Negotiated Rate	$1,905.91
Rate for Payer: Aetna of NY Commercial	$1,667.67
Rate for Payer: Aetna of NY Medicare	$1,095.90
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$952.96
Rate for Payer: Cash Price	$1,786.79
Rate for Payer: CDPHP Medicare	$881.48
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$1,905.91
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$1,905.91
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$1,905.91
Rate for Payer: EmblemHealth Medicaid	$1,905.91
Rate for Payer: EmblemHealth Medicare	$810.01
Rate for Payer: EmblemHealth Select Care	$1,715.32
Rate for Payer: Fidelis Medicare	$952.96
Rate for Payer: Galaxy Health Commercial	$1,548.55
Rate for Payer: Hamaspik Choice Medicare	$952.96
Rate for Payer: Humana Medicare	$952.96
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,667.67
Rate for Payer: Local 1199SEIU Medicare	$1,095.90
Rate for Payer: MVP Health Care of NY Commercial	$1,786.79
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$1,341.29
Rate for Payer: MVP Health Care of NY Medicare	$1,000.60
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$357.36
Rate for Payer: United Healthcare Medicare	$952.96
Rate for Payer: WellCare Medicare	$1,310.31

COOLIEF RADIOFREQUENCY KIT 75MM

Facility

$2,382.39

Hospital Charge Code	4473036
Hospital Revenue Code	272
Min. Negotiated Rate	$1,548.55
Max. Negotiated Rate	$1,548.55
Rate for Payer: Cash Price	$1,786.79
Rate for Payer: Galaxy Health Commercial	$1,548.55

COOMBS DIRECT

Facility

$181.00

Service Code	HCPCS 86880
Hospital Charge Code	4300207
Hospital Revenue Code	300
Min. Negotiated Rate	$27.15
Max. Negotiated Rate	$144.80
Rate for Payer: Aetna of NY Commercial	$117.65
Rate for Payer: Aetna of NY Medicare	$83.26
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$72.40
Rate for Payer: Cash Price	$135.75
Rate for Payer: CDPHP Medicare	$66.97
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$108.60
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$144.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$144.80
Rate for Payer: EmblemHealth Medicaid	$144.80
Rate for Payer: EmblemHealth Medicare	$61.54
Rate for Payer: EmblemHealth Select Care	$108.60
Rate for Payer: Fidelis Medicare	$72.40
Rate for Payer: Galaxy Health Commercial	$117.65
Rate for Payer: Hamaspik Choice Medicare	$72.40
Rate for Payer: Humana Medicare	$72.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$117.65
Rate for Payer: Local 1199SEIU Medicare	$83.26
Rate for Payer: MVP Health Care of NY Commercial	$135.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$101.90
Rate for Payer: MVP Health Care of NY Medicare	$76.02
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$135.75
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$27.15
Rate for Payer: United Healthcare Commercial	$135.75
Rate for Payer: United Healthcare Medicare	$72.40
Rate for Payer: WellCare Medicare	$99.55

COOMBS DIRECT

Facility

$181.00

Service Code	HCPCS 86880
Hospital Charge Code	4300207
Hospital Revenue Code	300
Min. Negotiated Rate	$117.65
Max. Negotiated Rate	$117.65
Rate for Payer: Cash Price	$135.75
Rate for Payer: Galaxy Health Commercial	$117.65

CORRECTION OF HALLUX VALGUS

Facility

$10,029.00

Service Code	HCPCS 28292
Hospital Charge Code	4853008
Hospital Revenue Code	761
Min. Negotiated Rate	$6,518.85
Max. Negotiated Rate	$6,518.85
Rate for Payer: Cash Price	$7,521.75
Rate for Payer: Galaxy Health Commercial	$6,518.85

CORRECTION OF HALLUX VALGUS

Facility

$10,029.00

Service Code	HCPCS 28292
Hospital Charge Code	4853008
Hospital Revenue Code	761
Min. Negotiated Rate	$1,504.35
Max. Negotiated Rate	$8,023.20
Rate for Payer: Aetna of NY Commercial	$7,020.30
Rate for Payer: Aetna of NY Medicare	$4,613.34
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$4,011.60
Rate for Payer: Cash Price	$7,521.75
Rate for Payer: CDPHP Medicare	$3,710.73
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$8,023.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$8,023.20
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$8,023.20
Rate for Payer: EmblemHealth Medicaid	$8,023.20
Rate for Payer: EmblemHealth Medicare	$3,409.86
Rate for Payer: EmblemHealth Select Care	$7,220.88
Rate for Payer: Fidelis Medicare	$4,011.60
Rate for Payer: Galaxy Health Commercial	$6,518.85
Rate for Payer: Hamaspik Choice Medicare	$4,011.60
Rate for Payer: Humana Medicare	$4,011.60
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$7,020.30
Rate for Payer: Local 1199SEIU Medicare	$4,613.34
Rate for Payer: MVP Health Care of NY Commercial	$7,521.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$5,646.33
Rate for Payer: MVP Health Care of NY Medicare	$4,212.18
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1,504.35
Rate for Payer: United Healthcare Medicare	$4,011.60
Rate for Payer: WellCare Medicare	$5,515.95

CORTISOL SERUM-PLASMA

Facility

$63.00

Service Code	HCPCS 82533
Hospital Charge Code	4300209
Hospital Revenue Code	301
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$50.40
Rate for Payer: Aetna of NY Commercial	$40.95
Rate for Payer: Aetna of NY Medicare	$28.98
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$25.20
Rate for Payer: Cash Price	$47.25
Rate for Payer: CDPHP Medicare	$23.31
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$37.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$50.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$50.40
Rate for Payer: EmblemHealth Medicaid	$50.40
Rate for Payer: EmblemHealth Medicare	$21.42
Rate for Payer: EmblemHealth Select Care	$37.80
Rate for Payer: Fidelis Medicare	$25.20
Rate for Payer: Galaxy Health Commercial	$40.95
Rate for Payer: Hamaspik Choice Medicare	$25.20
Rate for Payer: Humana Medicare	$25.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$40.95
Rate for Payer: Local 1199SEIU Medicare	$28.98
Rate for Payer: MVP Health Care of NY Commercial	$47.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$35.47
Rate for Payer: MVP Health Care of NY Medicare	$26.46
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$47.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$9.45
Rate for Payer: United Healthcare Commercial	$47.25
Rate for Payer: United Healthcare Medicare	$25.20
Rate for Payer: WellCare Medicare	$34.65

CORTISOL SERUM-PLASMA

Facility

$63.00

Service Code	HCPCS 82533
Hospital Charge Code	4300209
Hospital Revenue Code	301
Min. Negotiated Rate	$40.95
Max. Negotiated Rate	$40.95
Rate for Payer: Cash Price	$47.25
Rate for Payer: Galaxy Health Commercial	$40.95

COTTON STOCKINET 3""

Facility

$39.14

Hospital Charge Code	4471785
Hospital Revenue Code	270
Min. Negotiated Rate	$5.87
Max. Negotiated Rate	$31.31
Rate for Payer: Aetna of NY Commercial	$27.40
Rate for Payer: Aetna of NY Medicare	$18.00
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$15.66
Rate for Payer: Cash Price	$29.36
Rate for Payer: CDPHP Medicare	$14.48
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$31.31
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$31.31
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$31.31
Rate for Payer: EmblemHealth Medicaid	$31.31
Rate for Payer: EmblemHealth Medicare	$13.31
Rate for Payer: EmblemHealth Select Care	$28.18
Rate for Payer: Fidelis Medicare	$15.66
Rate for Payer: Galaxy Health Commercial	$25.44
Rate for Payer: Hamaspik Choice Medicare	$15.66
Rate for Payer: Humana Medicare	$15.66
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$27.40
Rate for Payer: Local 1199SEIU Medicare	$18.00
Rate for Payer: MVP Health Care of NY Commercial	$29.36
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$22.04
Rate for Payer: MVP Health Care of NY Medicare	$16.44
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.87
Rate for Payer: United Healthcare Medicare	$15.66
Rate for Payer: WellCare Medicare	$21.53

COTTON STOCKINET 3""

Facility

$39.14

Hospital Charge Code	4471785
Hospital Revenue Code	270
Min. Negotiated Rate	$25.44
Max. Negotiated Rate	$25.44
Rate for Payer: Cash Price	$29.36
Rate for Payer: Galaxy Health Commercial	$25.44

COTTON STOCKINET 4""

Facility

$13.39

Hospital Charge Code	4471786
Hospital Revenue Code	270
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$10.71
Rate for Payer: Aetna of NY Commercial	$9.37
Rate for Payer: Aetna of NY Medicare	$6.16
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$5.36
Rate for Payer: Cash Price	$10.04
Rate for Payer: CDPHP Medicare	$4.95
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$10.71
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$10.71
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$10.71
Rate for Payer: EmblemHealth Medicaid	$10.71
Rate for Payer: EmblemHealth Medicare	$4.55
Rate for Payer: EmblemHealth Select Care	$9.64
Rate for Payer: Fidelis Medicare	$5.36
Rate for Payer: Galaxy Health Commercial	$8.70
Rate for Payer: Hamaspik Choice Medicare	$5.36
Rate for Payer: Humana Medicare	$5.36
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$9.37
Rate for Payer: Local 1199SEIU Medicare	$6.16
Rate for Payer: MVP Health Care of NY Commercial	$10.04
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$7.54
Rate for Payer: MVP Health Care of NY Medicare	$5.62
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.01
Rate for Payer: United Healthcare Medicare	$5.36
Rate for Payer: WellCare Medicare	$7.36

COTTON STOCKINET 4""

Facility

$13.39

Hospital Charge Code	4471786
Hospital Revenue Code	270
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$8.70
Rate for Payer: Cash Price	$10.04
Rate for Payer: Galaxy Health Commercial	$8.70

COTTON STOCKINET 6""

Facility

$13.39

Hospital Charge Code	4471818
Hospital Revenue Code	270
Min. Negotiated Rate	$2.01
Max. Negotiated Rate	$10.71
Rate for Payer: Aetna of NY Commercial	$9.37
Rate for Payer: Aetna of NY Medicare	$6.16
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$5.36
Rate for Payer: Cash Price	$10.04
Rate for Payer: CDPHP Medicare	$4.95
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$10.71
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$10.71
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$10.71
Rate for Payer: EmblemHealth Medicaid	$10.71
Rate for Payer: EmblemHealth Medicare	$4.55
Rate for Payer: EmblemHealth Select Care	$9.64
Rate for Payer: Fidelis Medicare	$5.36
Rate for Payer: Galaxy Health Commercial	$8.70
Rate for Payer: Hamaspik Choice Medicare	$5.36
Rate for Payer: Humana Medicare	$5.36
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$9.37
Rate for Payer: Local 1199SEIU Medicare	$6.16
Rate for Payer: MVP Health Care of NY Commercial	$10.04
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$7.54
Rate for Payer: MVP Health Care of NY Medicare	$5.62
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.01
Rate for Payer: United Healthcare Medicare	$5.36
Rate for Payer: WellCare Medicare	$7.36

COTTON STOCKINET 6""

Facility

$13.39

Hospital Charge Code	4471818
Hospital Revenue Code	270
Min. Negotiated Rate	$8.70
Max. Negotiated Rate	$8.70
Rate for Payer: Cash Price	$10.04
Rate for Payer: Galaxy Health Commercial	$8.70

COUDE BLUNT NERVE BLOCK NEEDLE 20 GA

Facility

$67.98

Hospital Charge Code	4479275
Hospital Revenue Code	270
Min. Negotiated Rate	$44.19
Max. Negotiated Rate	$44.19
Rate for Payer: Cash Price	$50.98
Rate for Payer: Galaxy Health Commercial	$44.19

COUDE BLUNT NERVE BLOCK NEEDLE 20 GA

Facility

$67.98

Hospital Charge Code	4479275
Hospital Revenue Code	270
Min. Negotiated Rate	$10.20
Max. Negotiated Rate	$54.38
Rate for Payer: Aetna of NY Commercial	$47.59
Rate for Payer: Aetna of NY Medicare	$31.27
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$27.19
Rate for Payer: Cash Price	$50.98
Rate for Payer: CDPHP Medicare	$25.15
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$54.38
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$54.38
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$54.38
Rate for Payer: EmblemHealth Medicaid	$54.38
Rate for Payer: EmblemHealth Medicare	$23.11
Rate for Payer: EmblemHealth Select Care	$48.95
Rate for Payer: Fidelis Medicare	$27.19
Rate for Payer: Galaxy Health Commercial	$44.19
Rate for Payer: Hamaspik Choice Medicare	$27.19
Rate for Payer: Humana Medicare	$27.19
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$47.59
Rate for Payer: Local 1199SEIU Medicare	$31.27
Rate for Payer: MVP Health Care of NY Commercial	$50.98
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$38.27
Rate for Payer: MVP Health Care of NY Medicare	$28.55
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$10.20
Rate for Payer: United Healthcare Medicare	$27.19
Rate for Payer: WellCare Medicare	$37.39

CPAP

Facility

$671.00

Service Code	HCPCS 94660
Hospital Charge Code	4530012
Hospital Revenue Code	410
Min. Negotiated Rate	$100.65
Max. Negotiated Rate	$536.80
Rate for Payer: Aetna of NY Commercial	$469.70
Rate for Payer: Aetna of NY Medicare	$308.66
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$268.40
Rate for Payer: Cash Price	$503.25
Rate for Payer: CDPHP Medicare	$248.27
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$536.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$536.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$536.80
Rate for Payer: EmblemHealth Medicaid	$536.80
Rate for Payer: EmblemHealth Medicare	$228.14
Rate for Payer: EmblemHealth Select Care	$483.12
Rate for Payer: Fidelis Medicare	$268.40
Rate for Payer: Galaxy Health Commercial	$436.15
Rate for Payer: Hamaspik Choice Medicare	$268.40
Rate for Payer: Humana Medicare	$268.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$469.70
Rate for Payer: Local 1199SEIU Medicare	$308.66
Rate for Payer: MVP Health Care of NY Commercial	$503.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$377.77
Rate for Payer: MVP Health Care of NY Medicare	$281.82
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$100.65
Rate for Payer: United Healthcare Medicare	$268.40
Rate for Payer: WellCare Medicare	$369.05

CPAP

Facility

$671.00

Service Code	HCPCS 94660
Hospital Charge Code	4530012
Hospital Revenue Code	410
Min. Negotiated Rate	$436.15
Max. Negotiated Rate	$436.15
Rate for Payer: Cash Price	$503.25
Rate for Payer: Galaxy Health Commercial	$436.15

CP CONCENTR TECH SMEAR

Facility

$118.00

Service Code	HCPCS 88108
Hospital Charge Code	4305528
Hospital Revenue Code	310
Min. Negotiated Rate	$76.70
Max. Negotiated Rate	$76.70
Rate for Payer: Cash Price	$88.50
Rate for Payer: Galaxy Health Commercial	$76.70

CP CONCENTR TECH SMEAR

Facility

$118.00

Service Code	HCPCS 88108
Hospital Charge Code	4305528
Hospital Revenue Code	310
Min. Negotiated Rate	$17.70
Max. Negotiated Rate	$94.40
Rate for Payer: Aetna of NY Commercial	$76.70
Rate for Payer: Aetna of NY Medicare	$54.28
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$47.20
Rate for Payer: Cash Price	$88.50
Rate for Payer: CDPHP Medicare	$43.66
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$70.80
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$94.40
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$94.40
Rate for Payer: EmblemHealth Medicaid	$94.40
Rate for Payer: EmblemHealth Medicare	$40.12
Rate for Payer: EmblemHealth Select Care	$70.80
Rate for Payer: Fidelis Medicare	$47.20
Rate for Payer: Galaxy Health Commercial	$76.70
Rate for Payer: Hamaspik Choice Medicare	$47.20
Rate for Payer: Humana Medicare	$47.20
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$76.70
Rate for Payer: Local 1199SEIU Medicare	$54.28
Rate for Payer: MVP Health Care of NY Commercial	$88.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$66.43
Rate for Payer: MVP Health Care of NY Medicare	$49.56
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$88.50
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$17.70
Rate for Payer: United Healthcare Commercial	$88.50
Rate for Payer: United Healthcare Medicare	$47.20
Rate for Payer: WellCare Medicare	$64.90

CPK-MB SCREEN

Facility

$35.00

Service Code	HCPCS 82553
Hospital Charge Code	4300216
Hospital Revenue Code	301
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna of NY Commercial	$22.75
Rate for Payer: Aetna of NY Medicare	$16.10
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$14.00
Rate for Payer: Cash Price	$26.25
Rate for Payer: CDPHP Medicare	$12.95
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$21.00
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$28.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$28.00
Rate for Payer: EmblemHealth Medicaid	$28.00
Rate for Payer: EmblemHealth Medicare	$11.90
Rate for Payer: EmblemHealth Select Care	$21.00
Rate for Payer: Fidelis Medicare	$14.00
Rate for Payer: Galaxy Health Commercial	$22.75
Rate for Payer: Hamaspik Choice Medicare	$14.00
Rate for Payer: Humana Medicare	$14.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$22.75
Rate for Payer: Local 1199SEIU Medicare	$16.10
Rate for Payer: MVP Health Care of NY Commercial	$26.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$19.70
Rate for Payer: MVP Health Care of NY Medicare	$14.70
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$26.25
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.25
Rate for Payer: United Healthcare Commercial	$26.25
Rate for Payer: United Healthcare Medicare	$14.00
Rate for Payer: WellCare Medicare	$19.25

CPK-MB SCREEN

Facility

$35.00

Service Code	HCPCS 82553
Hospital Charge Code	4300216
Hospital Revenue Code	301
Min. Negotiated Rate	$22.75
Max. Negotiated Rate	$22.75
Rate for Payer: Cash Price	$26.25
Rate for Payer: Galaxy Health Commercial	$22.75

Know your out-of-pocket cost for care.

All Charges