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Charge Type Setting Price  
Service Code NDC 0121119030
Hospital Charge Code 0121119030
Hospital Revenue Code 250
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.09
Rate for Payer: Hamaspik Choice Inc Medicaid $0.09
Service Code NDC 0409329906
Hospital Charge Code 0409329906
Hospital Revenue Code 258
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.04
Rate for Payer: Aetna Government $0.04
Rate for Payer: Brighton Health Commercial $0.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.06
Rate for Payer: Cigna LocalPlus Benefit Plan $0.05
Rate for Payer: EmblemHealth Commercial $0.04
Rate for Payer: Group Health Inc Commercial $0.04
Rate for Payer: Group Health Inc Medicare $0.03
Rate for Payer: Hamaspik Choice Inc Medicaid $0.04
Rate for Payer: Hamaspik Choice Inc Medicare $0.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.05
Service Code NDC 0409729983
Hospital Charge Code 0409729983
Hospital Revenue Code 258
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.10
Rate for Payer: Aetna Government $0.10
Rate for Payer: Brighton Health Commercial $0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.15
Rate for Payer: Cigna LocalPlus Benefit Plan $0.13
Rate for Payer: EmblemHealth Commercial $0.10
Rate for Payer: Group Health Inc Commercial $0.10
Rate for Payer: Group Health Inc Medicare $0.07
Rate for Payer: Hamaspik Choice Inc Medicaid $0.10
Rate for Payer: Hamaspik Choice Inc Medicare $0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.12
Service Code NDC 0641626101
Hospital Charge Code 0641626101
Hospital Revenue Code 258
Min. Negotiated Rate $0.37
Max. Negotiated Rate $0.37
Rate for Payer: Hamaspik Choice Inc Medicaid $0.37
Service Code NDC 0641626101
Hospital Charge Code 0641626101
Hospital Revenue Code 258
Min. Negotiated Rate $0.26
Max. Negotiated Rate $0.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.37
Rate for Payer: Aetna Government $0.37
Rate for Payer: Brighton Health Commercial $0.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.60
Rate for Payer: Cigna LocalPlus Benefit Plan $0.51
Rate for Payer: EmblemHealth Commercial $0.37
Rate for Payer: Group Health Inc Commercial $0.37
Rate for Payer: Group Health Inc Medicare $0.26
Rate for Payer: Hamaspik Choice Inc Medicaid $0.37
Rate for Payer: Hamaspik Choice Inc Medicare $0.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.49
Service Code NDC 0409729983
Hospital Charge Code 0409729983
Hospital Revenue Code 258
Min. Negotiated Rate $0.10
Max. Negotiated Rate $0.10
Rate for Payer: Hamaspik Choice Inc Medicaid $0.10
Service Code NDC 0409329906
Hospital Charge Code 0409329906
Hospital Revenue Code 258
Min. Negotiated Rate $0.04
Max. Negotiated Rate $0.04
Rate for Payer: Hamaspik Choice Inc Medicaid $0.04
Service Code NDC 0409729973
Hospital Charge Code 0409729973
Hospital Revenue Code 258
Min. Negotiated Rate $0.10
Max. Negotiated Rate $0.10
Rate for Payer: Hamaspik Choice Inc Medicaid $0.10
Service Code NDC 0409729973
Hospital Charge Code 0409729973
Hospital Revenue Code 258
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.10
Rate for Payer: Aetna Government $0.10
Rate for Payer: Brighton Health Commercial $0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.15
Rate for Payer: Cigna LocalPlus Benefit Plan $0.13
Rate for Payer: EmblemHealth Commercial $0.10
Rate for Payer: Group Health Inc Commercial $0.10
Rate for Payer: Group Health Inc Medicare $0.07
Rate for Payer: Hamaspik Choice Inc Medicaid $0.10
Rate for Payer: Hamaspik Choice Inc Medicare $0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.12
Service Code NDC 0409555502
Hospital Charge Code 0409555502
Hospital Revenue Code 258
Min. Negotiated Rate $0.93
Max. Negotiated Rate $0.93
Rate for Payer: Hamaspik Choice Inc Medicaid $0.93
Service Code NDC 0409553414
Hospital Charge Code 0409553414
Hospital Revenue Code 258
Min. Negotiated Rate $0.77
Max. Negotiated Rate $1.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.10
Rate for Payer: Aetna Government $1.10
Rate for Payer: Brighton Health Commercial $1.65
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.76
Rate for Payer: Cigna LocalPlus Benefit Plan $1.49
Rate for Payer: EmblemHealth Commercial $1.10
Rate for Payer: Group Health Inc Commercial $1.10
Rate for Payer: Group Health Inc Medicare $0.77
Rate for Payer: Hamaspik Choice Inc Medicaid $1.10
Rate for Payer: Hamaspik Choice Inc Medicare $1.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.43
Service Code NDC 0409553414
Hospital Charge Code 0409553414
Hospital Revenue Code 258
Min. Negotiated Rate $1.10
Max. Negotiated Rate $1.10
Rate for Payer: Hamaspik Choice Inc Medicaid $1.10
Service Code NDC 0409555502
Hospital Charge Code 0409555502
Hospital Revenue Code 258
Min. Negotiated Rate $0.65
Max. Negotiated Rate $1.49
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.93
Rate for Payer: Aetna Government $0.93
Rate for Payer: Brighton Health Commercial $1.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.49
Rate for Payer: Cigna LocalPlus Benefit Plan $1.26
Rate for Payer: EmblemHealth Commercial $0.93
Rate for Payer: Group Health Inc Commercial $0.93
Rate for Payer: Group Health Inc Medicare $0.65
Rate for Payer: Hamaspik Choice Inc Medicaid $0.93
Rate for Payer: Hamaspik Choice Inc Medicare $0.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.21
Service Code NDC 6655300801
Hospital Charge Code 6655300801
Hospital Revenue Code 250
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.06
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.03
Rate for Payer: Aetna Government $0.03
Rate for Payer: Brighton Health Commercial $0.05
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.06
Rate for Payer: Cigna LocalPlus Benefit Plan $0.05
Rate for Payer: EmblemHealth Commercial $0.03
Rate for Payer: Group Health Inc Commercial $0.03
Rate for Payer: Group Health Inc Medicare $0.02
Rate for Payer: Hamaspik Choice Inc Medicaid $0.03
Rate for Payer: Hamaspik Choice Inc Medicare $0.03
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.04
Service Code NDC 0904726161
Hospital Charge Code 0904726161
Hospital Revenue Code 250
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.09
Rate for Payer: Aetna Government $0.09
Rate for Payer: Brighton Health Commercial $0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.15
Rate for Payer: Cigna LocalPlus Benefit Plan $0.12
Rate for Payer: EmblemHealth Commercial $0.09
Rate for Payer: Group Health Inc Commercial $0.09
Rate for Payer: Group Health Inc Medicare $0.06
Rate for Payer: Hamaspik Choice Inc Medicaid $0.09
Rate for Payer: Hamaspik Choice Inc Medicare $0.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.12
Service Code NDC 0536104710
Hospital Charge Code 0536104710
Hospital Revenue Code 250
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.01
Rate for Payer: Aetna Government $0.01
Rate for Payer: Brighton Health Commercial $0.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.02
Rate for Payer: Cigna LocalPlus Benefit Plan $0.01
Rate for Payer: EmblemHealth Commercial $0.01
Rate for Payer: Group Health Inc Commercial $0.01
Rate for Payer: Group Health Inc Medicare $0.01
Rate for Payer: Hamaspik Choice Inc Medicaid $0.01
Rate for Payer: Hamaspik Choice Inc Medicare $0.01
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.01
Service Code NDC 6655300801
Hospital Charge Code 6655300801
Hospital Revenue Code 250
Min. Negotiated Rate $0.03
Max. Negotiated Rate $0.03
Rate for Payer: Hamaspik Choice Inc Medicaid $0.03
Service Code NDC 7733383110
Hospital Charge Code 7733383110
Hospital Revenue Code 250
Min. Negotiated Rate $0.10
Max. Negotiated Rate $0.10
Rate for Payer: Hamaspik Choice Inc Medicaid $0.10
Service Code NDC 0904726161
Hospital Charge Code 0904726161
Hospital Revenue Code 250
Min. Negotiated Rate $0.09
Max. Negotiated Rate $0.09
Rate for Payer: Hamaspik Choice Inc Medicaid $0.09
Service Code NDC 0536104710
Hospital Charge Code 0536104710
Hospital Revenue Code 250
Min. Negotiated Rate $0.01
Max. Negotiated Rate $0.01
Rate for Payer: Hamaspik Choice Inc Medicaid $0.01
Service Code NDC 7733383110
Hospital Charge Code 7733383110
Hospital Revenue Code 250
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.10
Rate for Payer: Aetna Government $0.10
Rate for Payer: Brighton Health Commercial $0.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.16
Rate for Payer: Cigna LocalPlus Benefit Plan $0.14
Rate for Payer: EmblemHealth Commercial $0.10
Rate for Payer: Group Health Inc Commercial $0.10
Rate for Payer: Group Health Inc Medicare $0.07
Rate for Payer: Hamaspik Choice Inc Medicaid $0.10
Rate for Payer: Hamaspik Choice Inc Medicare $0.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.13
Service Code NDC 5175450015
Hospital Charge Code 5175450015
Hospital Revenue Code 258
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.11
Rate for Payer: Aetna Government $0.11
Rate for Payer: Brighton Health Commercial $0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.17
Rate for Payer: Cigna LocalPlus Benefit Plan $0.14
Rate for Payer: EmblemHealth Commercial $0.11
Rate for Payer: Group Health Inc Commercial $0.11
Rate for Payer: Group Health Inc Medicare $0.07
Rate for Payer: Hamaspik Choice Inc Medicaid $0.11
Rate for Payer: Hamaspik Choice Inc Medicare $0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.14
Service Code NDC 5175450015
Hospital Charge Code 5175450015
Hospital Revenue Code 258
Min. Negotiated Rate $0.11
Max. Negotiated Rate $0.11
Rate for Payer: Hamaspik Choice Inc Medicaid $0.11
Service Code NDC 5175450014
Hospital Charge Code 5175450014
Hospital Revenue Code 258
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.11
Rate for Payer: Aetna Government $0.11
Rate for Payer: Brighton Health Commercial $0.16
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.17
Rate for Payer: Cigna LocalPlus Benefit Plan $0.14
Rate for Payer: EmblemHealth Commercial $0.11
Rate for Payer: Group Health Inc Commercial $0.11
Rate for Payer: Group Health Inc Medicare $0.07
Rate for Payer: Hamaspik Choice Inc Medicaid $0.11
Rate for Payer: Hamaspik Choice Inc Medicare $0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.14
Service Code NDC 7632933521
Hospital Charge Code 7632933521
Hospital Revenue Code 258
Min. Negotiated Rate $0.15
Max. Negotiated Rate $0.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.22
Rate for Payer: Aetna Government $0.22
Rate for Payer: Brighton Health Commercial $0.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.34
Rate for Payer: Cigna LocalPlus Benefit Plan $0.29
Rate for Payer: EmblemHealth Commercial $0.22
Rate for Payer: Group Health Inc Commercial $0.22
Rate for Payer: Group Health Inc Medicare $0.15
Rate for Payer: Hamaspik Choice Inc Medicaid $0.22
Rate for Payer: Hamaspik Choice Inc Medicare $0.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.28