Ellenville Regional Hospital

All Charges

Charge

Type

Setting

Price

3D RENDER W/INTRP W/POSTPROCES

Facility

$267.00

Service Code	HCPCS 76377
Hospital Charge Code	4230210
Hospital Revenue Code	350
Min. Negotiated Rate	$173.55
Max. Negotiated Rate	$173.55
Rate for Payer: Cash Price	$200.25
Rate for Payer: Galaxy Health Commercial	$173.55

3D RENDER W/INTRP W/POSTPROCES

Facility

$267.00

Service Code	HCPCS 76377
Hospital Charge Code	4230210
Hospital Revenue Code	350
Min. Negotiated Rate	$40.05
Max. Negotiated Rate	$1,076.00
Rate for Payer: Aetna of NY Commercial	$1,076.00
Rate for Payer: Aetna of NY Medicare	$122.82
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$106.80
Rate for Payer: Cash Price	$200.25
Rate for Payer: Cash Price	$200.25
Rate for Payer: Cash Price	$200.25
Rate for Payer: CDPHP Medicare	$98.79
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$186.90
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$213.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$213.60
Rate for Payer: EmblemHealth Medicaid	$213.60
Rate for Payer: EmblemHealth Medicare	$90.78
Rate for Payer: EmblemHealth Select Care	$173.55
Rate for Payer: Fidelis Medicare	$106.80
Rate for Payer: Galaxy Health Commercial	$173.55
Rate for Payer: Hamaspik Choice Medicare	$106.80
Rate for Payer: Humana Medicare	$106.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,076.00
Rate for Payer: Local 1199SEIU Medicare	$122.82
Rate for Payer: MVP Health Care of NY Commercial	$200.25
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$150.32
Rate for Payer: MVP Health Care of NY Medicare	$112.14
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$798.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$40.05
Rate for Payer: United Healthcare Commercial	$798.00
Rate for Payer: United Healthcare Medicare	$106.80
Rate for Payer: WellCare Medicare	$146.85

3D RENDER W/INTRP W/POSTPROCES

Facility

$86.00

Service Code	HCPCS 76376
Hospital Charge Code	4220001
Hospital Revenue Code	351
Min. Negotiated Rate	$55.90
Max. Negotiated Rate	$55.90
Rate for Payer: Cash Price	$64.50
Rate for Payer: Galaxy Health Commercial	$55.90

3D RENDER W/INTRP W/POSTPROCES

Facility

$86.00

Service Code	HCPCS 76376
Hospital Charge Code	4220001
Hospital Revenue Code	351
Min. Negotiated Rate	$12.90
Max. Negotiated Rate	$1,076.00
Rate for Payer: Aetna of NY Commercial	$1,076.00
Rate for Payer: Aetna of NY Medicare	$39.56
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$34.40
Rate for Payer: Cash Price	$64.50
Rate for Payer: Cash Price	$64.50
Rate for Payer: Cash Price	$64.50
Rate for Payer: CDPHP Medicare	$31.82
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$60.20
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$68.80
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$68.80
Rate for Payer: EmblemHealth Medicaid	$68.80
Rate for Payer: EmblemHealth Medicare	$29.24
Rate for Payer: EmblemHealth Select Care	$55.90
Rate for Payer: Fidelis Medicare	$34.40
Rate for Payer: Galaxy Health Commercial	$55.90
Rate for Payer: Hamaspik Choice Medicare	$34.40
Rate for Payer: Humana Medicare	$34.40
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,076.00
Rate for Payer: Local 1199SEIU Medicare	$39.56
Rate for Payer: MVP Health Care of NY Commercial	$64.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$48.42
Rate for Payer: MVP Health Care of NY Medicare	$36.12
Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro	$798.00
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$12.90
Rate for Payer: United Healthcare Commercial	$798.00
Rate for Payer: United Healthcare Medicare	$34.40
Rate for Payer: WellCare Medicare	$47.30

3D RENDER W/ INTRP W/ POSTPROCESS

Facility

$117.00

Service Code	HCPCS 76377 26
Hospital Charge Code	5230210
Hospital Revenue Code	960
Min. Negotiated Rate	$17.55
Max. Negotiated Rate	$1,076.00
Rate for Payer: Aetna of NY Commercial	$1,076.00
Rate for Payer: Aetna of NY Medicare	$53.82
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$46.80
Rate for Payer: Cash Price	$87.75
Rate for Payer: Cash Price	$87.75
Rate for Payer: CDPHP Medicare	$43.29
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$93.60
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$93.60
Rate for Payer: EmblemHealth Medicaid	$93.60
Rate for Payer: EmblemHealth Medicare	$39.78
Rate for Payer: Fidelis Medicare	$46.80
Rate for Payer: Galaxy Health Commercial	$76.05
Rate for Payer: Hamaspik Choice Medicare	$46.80
Rate for Payer: Humana Medicare	$46.80
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,076.00
Rate for Payer: Local 1199SEIU Medicare	$53.82
Rate for Payer: MVP Health Care of NY Commercial	$87.75
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$65.87
Rate for Payer: MVP Health Care of NY Medicare	$49.14
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$17.55
Rate for Payer: United Healthcare Medicare	$46.80
Rate for Payer: WellCare Medicare	$64.35

3D RENDER W/ INTRP W/ POSTPROCESS

Facility

$117.00

Service Code	HCPCS 76377 26
Hospital Charge Code	5230210
Hospital Revenue Code	960
Min. Negotiated Rate	$76.05
Max. Negotiated Rate	$76.05
Rate for Payer: Cash Price	$87.75
Rate for Payer: Galaxy Health Commercial	$76.05

3D RENDER W/INTRP W/POSTPROCESS

Facility

$30.00

Service Code	HCPCS 76376 26
Hospital Charge Code	5220001
Hospital Revenue Code	960
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$1,076.00
Rate for Payer: Aetna of NY Commercial	$1,076.00
Rate for Payer: Aetna of NY Medicare	$13.80
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$12.00
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: CDPHP Medicare	$11.10
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$24.00
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$24.00
Rate for Payer: EmblemHealth Medicaid	$24.00
Rate for Payer: EmblemHealth Medicare	$10.20
Rate for Payer: Fidelis Medicare	$12.00
Rate for Payer: Galaxy Health Commercial	$19.50
Rate for Payer: Hamaspik Choice Medicare	$12.00
Rate for Payer: Humana Medicare	$12.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$1,076.00
Rate for Payer: Local 1199SEIU Medicare	$13.80
Rate for Payer: MVP Health Care of NY Commercial	$22.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$16.89
Rate for Payer: MVP Health Care of NY Medicare	$12.60
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$4.50
Rate for Payer: United Healthcare Medicare	$12.00
Rate for Payer: WellCare Medicare	$16.50

3D RENDER W/INTRP W/POSTPROCESS

Facility

$30.00

Service Code	HCPCS 76376 26
Hospital Charge Code	5220001
Hospital Revenue Code	960
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$19.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Galaxy Health Commercial	$19.50

3" ECONOMY COTTON STOCKINETTE

Facility

$13.39

Hospital Charge Code	4472038
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

3" ECONOMY COTTON STOCKINETTE

Facility

$13.39

Hospital Charge Code	4472038
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

3M COBAN 3"X5YD

Facility

$17.51

Hospital Charge Code	4471986
Hospital Revenue Code	270
Min. Negotiated Rate	$11.38
Max. Negotiated Rate	$11.38
Rate for Payer: Cash Price	$13.13
Rate for Payer: Galaxy Health Commercial	$11.38

3M COBAN 3"X5YD

Facility

$17.51

Hospital Charge Code	4471986
Hospital Revenue Code	270
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$14.01
Rate for Payer: Aetna of NY Commercial	$12.26
Rate for Payer: Aetna of NY Medicare	$8.05
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$7.00
Rate for Payer: Cash Price	$13.13
Rate for Payer: CDPHP Medicare	$6.48
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$14.01
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$14.01
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$14.01
Rate for Payer: EmblemHealth Medicaid	$14.01
Rate for Payer: EmblemHealth Medicare	$5.95
Rate for Payer: EmblemHealth Select Care	$12.61
Rate for Payer: Fidelis Medicare	$7.00
Rate for Payer: Galaxy Health Commercial	$11.38
Rate for Payer: Hamaspik Choice Medicare	$7.00
Rate for Payer: Humana Medicare	$7.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$12.26
Rate for Payer: Local 1199SEIU Medicare	$8.05
Rate for Payer: MVP Health Care of NY Commercial	$13.13
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$9.86
Rate for Payer: MVP Health Care of NY Medicare	$7.35
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.63
Rate for Payer: United Healthcare Medicare	$7.00
Rate for Payer: WellCare Medicare	$9.63

3M COBAN 4"X5YD

Facility

$8.24

Hospital Charge Code	4471987
Hospital Revenue Code	270
Min. Negotiated Rate	$5.36
Max. Negotiated Rate	$5.36
Rate for Payer: Cash Price	$6.18
Rate for Payer: Galaxy Health Commercial	$5.36

3M COBAN 4"X5YD

Facility

$8.24

Hospital Charge Code	4471987
Hospital Revenue Code	270
Min. Negotiated Rate	$1.24
Max. Negotiated Rate	$6.59
Rate for Payer: Aetna of NY Commercial	$5.77
Rate for Payer: Aetna of NY Medicare	$3.79
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$3.30
Rate for Payer: Cash Price	$6.18
Rate for Payer: CDPHP Medicare	$3.05
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$6.59
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$6.59
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$6.59
Rate for Payer: EmblemHealth Medicaid	$6.59
Rate for Payer: EmblemHealth Medicare	$2.80
Rate for Payer: EmblemHealth Select Care	$5.93
Rate for Payer: Fidelis Medicare	$3.30
Rate for Payer: Galaxy Health Commercial	$5.36
Rate for Payer: Hamaspik Choice Medicare	$3.30
Rate for Payer: Humana Medicare	$3.30
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$5.77
Rate for Payer: Local 1199SEIU Medicare	$3.79
Rate for Payer: MVP Health Care of NY Commercial	$6.18
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$4.64
Rate for Payer: MVP Health Care of NY Medicare	$3.46
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.24
Rate for Payer: United Healthcare Medicare	$3.30
Rate for Payer: WellCare Medicare	$4.53

3M COBAN 6"X5YD

Facility

$17.51

Hospital Charge Code	4471988
Hospital Revenue Code	270
Min. Negotiated Rate	$11.38
Max. Negotiated Rate	$11.38
Rate for Payer: Cash Price	$13.13
Rate for Payer: Galaxy Health Commercial	$11.38

3M COBAN 6"X5YD

Facility

$17.51

Hospital Charge Code	4471988
Hospital Revenue Code	270
Min. Negotiated Rate	$2.63
Max. Negotiated Rate	$14.01
Rate for Payer: Aetna of NY Commercial	$12.26
Rate for Payer: Aetna of NY Medicare	$8.05
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$7.00
Rate for Payer: Cash Price	$13.13
Rate for Payer: CDPHP Medicare	$6.48
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$14.01
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$14.01
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$14.01
Rate for Payer: EmblemHealth Medicaid	$14.01
Rate for Payer: EmblemHealth Medicare	$5.95
Rate for Payer: EmblemHealth Select Care	$12.61
Rate for Payer: Fidelis Medicare	$7.00
Rate for Payer: Galaxy Health Commercial	$11.38
Rate for Payer: Hamaspik Choice Medicare	$7.00
Rate for Payer: Humana Medicare	$7.00
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$12.26
Rate for Payer: Local 1199SEIU Medicare	$8.05
Rate for Payer: MVP Health Care of NY Commercial	$13.13
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$9.86
Rate for Payer: MVP Health Care of NY Medicare	$7.35
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$2.63
Rate for Payer: United Healthcare Medicare	$7.00
Rate for Payer: WellCare Medicare	$9.63

3" SCOTCH PLUS CAST TAPE

Facility

$11.33

Hospital Charge Code	4472152
Hospital Revenue Code	270
Min. Negotiated Rate	$7.36
Max. Negotiated Rate	$7.36
Rate for Payer: Cash Price	$8.50
Rate for Payer: Galaxy Health Commercial	$7.36

3" SCOTCH PLUS CAST TAPE

Facility

$11.33

Hospital Charge Code	4472152
Hospital Revenue Code	270
Min. Negotiated Rate	$1.70
Max. Negotiated Rate	$9.06
Rate for Payer: Aetna of NY Commercial	$7.93
Rate for Payer: Aetna of NY Medicare	$5.21
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$4.53
Rate for Payer: Cash Price	$8.50
Rate for Payer: CDPHP Medicare	$4.19
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$9.06
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$9.06
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$9.06
Rate for Payer: EmblemHealth Medicaid	$9.06
Rate for Payer: EmblemHealth Medicare	$3.85
Rate for Payer: EmblemHealth Select Care	$8.16
Rate for Payer: Fidelis Medicare	$4.53
Rate for Payer: Galaxy Health Commercial	$7.36
Rate for Payer: Hamaspik Choice Medicare	$4.53
Rate for Payer: Humana Medicare	$4.53
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$7.93
Rate for Payer: Local 1199SEIU Medicare	$5.21
Rate for Payer: MVP Health Care of NY Commercial	$8.50
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$6.38
Rate for Payer: MVP Health Care of NY Medicare	$4.76
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$1.70
Rate for Payer: United Healthcare Medicare	$4.53
Rate for Payer: WellCare Medicare	$6.23

3 STAGE BALLOON DILA 18-19-20

Facility

$73.13

Hospital Charge Code	4471893
Hospital Revenue Code	272
Min. Negotiated Rate	$10.97
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna of NY Commercial	$51.19
Rate for Payer: Aetna of NY Medicare	$33.64
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$29.25
Rate for Payer: Cash Price	$54.85
Rate for Payer: CDPHP Medicare	$27.06
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$58.50
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$58.50
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$58.50
Rate for Payer: EmblemHealth Medicaid	$58.50
Rate for Payer: EmblemHealth Medicare	$24.86
Rate for Payer: EmblemHealth Select Care	$52.65
Rate for Payer: Fidelis Medicare	$29.25
Rate for Payer: Galaxy Health Commercial	$47.53
Rate for Payer: Hamaspik Choice Medicare	$29.25
Rate for Payer: Humana Medicare	$29.25
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$51.19
Rate for Payer: Local 1199SEIU Medicare	$33.64
Rate for Payer: MVP Health Care of NY Commercial	$54.85
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$41.17
Rate for Payer: MVP Health Care of NY Medicare	$30.71
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$10.97
Rate for Payer: United Healthcare Medicare	$29.25
Rate for Payer: WellCare Medicare	$40.22

3 STAGE BALLOON DILA 18-19-20

Facility

$73.13

Hospital Charge Code	4471893
Hospital Revenue Code	272
Min. Negotiated Rate	$47.53
Max. Negotiated Rate	$47.53
Rate for Payer: Cash Price	$54.85
Rate for Payer: Galaxy Health Commercial	$47.53

3" X 22" CERVICAL COLLAR

Facility

$10.30

Hospital Charge Code	4471886
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

3" X 22" CERVICAL COLLAR

Facility

$10.30

Hospital Charge Code	4471886
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

3X3YD SPECIALIST EXTRA-FAST PL

Facility

$35.02

Hospital Charge Code	4471915
Hospital Revenue Code	270
Min. Negotiated Rate	$22.76
Max. Negotiated Rate	$22.76
Rate for Payer: Cash Price	$26.26
Rate for Payer: Galaxy Health Commercial	$22.76

3X3YD SPECIALIST EXTRA-FAST PL

Facility

$35.02

Hospital Charge Code	4471915
Hospital Revenue Code	270
Min. Negotiated Rate	$5.25
Max. Negotiated Rate	$28.02
Rate for Payer: Aetna of NY Commercial	$24.51
Rate for Payer: Aetna of NY Medicare	$16.11
Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare	$14.01
Rate for Payer: Cash Price	$26.26
Rate for Payer: CDPHP Medicare	$12.96
Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access	$28.02
Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2	$28.02
Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4	$28.02
Rate for Payer: EmblemHealth Medicaid	$28.02
Rate for Payer: EmblemHealth Medicare	$11.91
Rate for Payer: EmblemHealth Select Care	$25.21
Rate for Payer: Fidelis Medicare	$14.01
Rate for Payer: Galaxy Health Commercial	$22.76
Rate for Payer: Hamaspik Choice Medicare	$14.01
Rate for Payer: Humana Medicare	$14.01
Rate for Payer: Local 1199SEIU Aetna Signature Administrators	$24.51
Rate for Payer: Local 1199SEIU Medicare	$16.11
Rate for Payer: MVP Health Care of NY Commercial	$26.27
Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan	$19.72
Rate for Payer: MVP Health Care of NY Medicare	$14.71
Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid	$5.25
Rate for Payer: United Healthcare Medicare	$14.01
Rate for Payer: WellCare Medicare	$19.26

4-0 ETHILON 18" PS-4 CUTTING

Facility

$37.08

Hospital Charge Code	4471171
Hospital Revenue Code	270
Min. Negotiated Rate	$24.10
Max. Negotiated Rate	$24.10
Rate for Payer: Cash Price	$27.81
Rate for Payer: Galaxy Health Commercial	$24.10

Know your out-of-pocket cost for care.

All Charges