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Charge Type Price  
Hospital Charge Code 64904877
Hospital Revenue Code 270
Min. Negotiated Rate $14.88
Max. Negotiated Rate $34.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $23.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $21.25
Rate for Payer: Aetna Government $21.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $34.00
Rate for Payer: Cigna LocalPlus Benefit Plan $28.90
Rate for Payer: Group Health Inc Commercial $21.25
Rate for Payer: Group Health Inc Medicare $14.88
Rate for Payer: Hamaspik Choice Inc Medicaid $21.25
Rate for Payer: Hamaspik Choice Inc Medicare $21.25
Hospital Charge Code 64903497
Hospital Revenue Code 270
Min. Negotiated Rate $59.50
Max. Negotiated Rate $136.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $93.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $85.00
Rate for Payer: Aetna Government $85.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $136.00
Rate for Payer: Cigna LocalPlus Benefit Plan $115.60
Rate for Payer: Group Health Inc Commercial $85.00
Rate for Payer: Group Health Inc Medicare $59.50
Rate for Payer: Hamaspik Choice Inc Medicaid $85.00
Rate for Payer: Hamaspik Choice Inc Medicare $85.00
Service Code HCPCS 92572
Hospital Charge Code 42004507
Hospital Revenue Code 471
Min. Negotiated Rate $52.45
Max. Negotiated Rate $335.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial $230.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $180.64
Rate for Payer: Aetna Government $180.64
Rate for Payer: Cash Price $180.64
Rate for Payer: Cash Price $180.64
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $180.64
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $335.22
Rate for Payer: Cigna LocalPlus Benefit Plan $284.94
Rate for Payer: Elderplan Medicare Advantage $180.64
Rate for Payer: EmblemHealth Commercial $180.64
Rate for Payer: Fidelis CHP/HARP/Medicaid $52.45
Rate for Payer: Fidelis Essential Plan Aliesa $153.54
Rate for Payer: Fidelis Essential Plan QHP $160.77
Rate for Payer: Fidelis Medicare Advantage $180.64
Rate for Payer: Fidelis Qualified Health Plan $160.77
Rate for Payer: Group Health Inc Commercial $180.64
Rate for Payer: Group Health Inc Medicare $180.64
Rate for Payer: Hamaspik Choice Inc Medicaid $209.52
Rate for Payer: Hamaspik Choice Inc Medicare $180.64
Rate for Payer: Healthfirst CHP/FHP/Medicaid $58.28
Rate for Payer: Healthfirst Medicare Advantage $153.54
Rate for Payer: Healthfirst QHP $180.64
Rate for Payer: Senior Whole Health Medicare Advantage $180.64
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $180.64
Rate for Payer: Wellcare CHP/FHP/Medicaid $144.51
Rate for Payer: Wellcare Medicare $171.61
Service Code HCPCS 58960
Hospital Charge Code 40011060
Hospital Revenue Code 360
Min. Negotiated Rate $1,077.19
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,692.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,247.93
Rate for Payer: Aetna Government $1,247.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: EmblemHealth Commercial $1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid $1,113.90
Rate for Payer: Group Health Inc Commercial $1,538.84
Rate for Payer: Group Health Inc Medicare $1,077.19
Rate for Payer: Hamaspik Choice Inc Medicaid $1,538.84
Rate for Payer: Hamaspik Choice Inc Medicare $1,538.84
Rate for Payer: Healthfirst CHP/FHP/Medicaid $1,237.67
Service Code HCPCS C1713
Hospital Charge Code 64902994
Hospital Revenue Code 278
Min. Negotiated Rate $1,681.25
Max. Negotiated Rate $1,681.25
Rate for Payer: Hamaspik Choice Inc Medicaid $1,681.25
Rate for Payer: Hamaspik Choice Inc Medicare $1,681.25
Service Code HCPCS C1713
Hospital Charge Code 64902994
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $3,530.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,849.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $134.20
Rate for Payer: Aetna Government $134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,681.25
Rate for Payer: Cigna LocalPlus Benefit Plan $1,933.44
Rate for Payer: Fidelis Medicare Advantage $3,530.62
Rate for Payer: Group Health Inc Commercial $1,681.25
Rate for Payer: Group Health Inc Medicare $1,176.88
Rate for Payer: Hamaspik Choice Inc Medicaid $1,681.25
Rate for Payer: Hamaspik Choice Inc Medicare $1,681.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,185.62
Hospital Charge Code 40207627
Hospital Revenue Code 270
Min. Negotiated Rate $8.93
Max. Negotiated Rate $20.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial $14.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $12.76
Rate for Payer: Aetna Government $12.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $20.42
Rate for Payer: Cigna LocalPlus Benefit Plan $17.35
Rate for Payer: Group Health Inc Commercial $12.76
Rate for Payer: Group Health Inc Medicare $8.93
Rate for Payer: Hamaspik Choice Inc Medicaid $12.76
Rate for Payer: Hamaspik Choice Inc Medicare $12.76
Hospital Charge Code 64902836
Hospital Revenue Code 270
Min. Negotiated Rate $364.98
Max. Negotiated Rate $834.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial $573.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $521.40
Rate for Payer: Aetna Government $521.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $834.24
Rate for Payer: Cigna LocalPlus Benefit Plan $709.10
Rate for Payer: Group Health Inc Commercial $521.40
Rate for Payer: Group Health Inc Medicare $364.98
Rate for Payer: Hamaspik Choice Inc Medicaid $521.40
Rate for Payer: Hamaspik Choice Inc Medicare $521.40
Hospital Charge Code 40209780
Hospital Revenue Code 270
Min. Negotiated Rate $133.00
Max. Negotiated Rate $304.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $209.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $190.00
Rate for Payer: Aetna Government $190.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $304.00
Rate for Payer: Cigna LocalPlus Benefit Plan $258.40
Rate for Payer: Group Health Inc Commercial $190.00
Rate for Payer: Group Health Inc Medicare $133.00
Rate for Payer: Hamaspik Choice Inc Medicaid $190.00
Rate for Payer: Hamaspik Choice Inc Medicare $190.00
Service Code HCPCS C1776
Hospital Charge Code 40209933
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $2,382.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,248.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $339.17
Rate for Payer: Aetna Government $339.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,134.75
Rate for Payer: Cigna LocalPlus Benefit Plan $1,304.96
Rate for Payer: Fidelis Medicare Advantage $2,382.98
Rate for Payer: Group Health Inc Commercial $1,134.75
Rate for Payer: Group Health Inc Medicare $794.32
Rate for Payer: Hamaspik Choice Inc Medicaid $1,134.75
Rate for Payer: Hamaspik Choice Inc Medicare $1,134.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,475.18
Service Code HCPCS C1776
Hospital Charge Code 40209933
Hospital Revenue Code 278
Min. Negotiated Rate $1,134.75
Max. Negotiated Rate $1,134.75
Rate for Payer: Hamaspik Choice Inc Medicaid $1,134.75
Rate for Payer: Hamaspik Choice Inc Medicare $1,134.75
Service Code HCPCS C1713
Hospital Charge Code 40006562
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $4,378.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,293.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $134.20
Rate for Payer: Aetna Government $134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,085.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,397.75
Rate for Payer: Fidelis Medicare Advantage $4,378.50
Rate for Payer: Group Health Inc Commercial $2,085.00
Rate for Payer: Group Health Inc Medicare $1,459.50
Rate for Payer: Hamaspik Choice Inc Medicaid $2,085.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,085.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,710.50
Service Code HCPCS C1713
Hospital Charge Code 40006562
Hospital Revenue Code 278
Min. Negotiated Rate $2,085.00
Max. Negotiated Rate $2,085.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,085.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,085.00
Service Code HCPCS C1713
Hospital Charge Code 40202127
Hospital Revenue Code 278
Min. Negotiated Rate $35.00
Max. Negotiated Rate $35.00
Rate for Payer: Hamaspik Choice Inc Medicaid $35.00
Rate for Payer: Hamaspik Choice Inc Medicare $35.00
Service Code HCPCS C1713
Hospital Charge Code 40202127
Hospital Revenue Code 278
Min. Negotiated Rate $24.50
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $38.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $134.20
Rate for Payer: Aetna Government $134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $35.00
Rate for Payer: Cigna LocalPlus Benefit Plan $40.25
Rate for Payer: Fidelis Medicare Advantage $73.50
Rate for Payer: Group Health Inc Commercial $35.00
Rate for Payer: Group Health Inc Medicare $24.50
Rate for Payer: Hamaspik Choice Inc Medicaid $35.00
Rate for Payer: Hamaspik Choice Inc Medicare $35.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $45.50
Service Code HCPCS C1713
Hospital Charge Code 64907344
Hospital Revenue Code 278
Min. Negotiated Rate $1.25
Max. Negotiated Rate $1.25
Rate for Payer: Hamaspik Choice Inc Medicaid $1.25
Rate for Payer: Hamaspik Choice Inc Medicare $1.25
Service Code HCPCS C1713
Hospital Charge Code 64907344
Hospital Revenue Code 278
Min. Negotiated Rate $0.88
Max. Negotiated Rate $134.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $134.20
Rate for Payer: Aetna Government $134.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.25
Rate for Payer: Cigna LocalPlus Benefit Plan $1.44
Rate for Payer: Fidelis Medicare Advantage $2.62
Rate for Payer: Group Health Inc Commercial $1.25
Rate for Payer: Group Health Inc Medicare $0.88
Rate for Payer: Hamaspik Choice Inc Medicaid $1.25
Rate for Payer: Hamaspik Choice Inc Medicare $1.25
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.62
Service Code HCPCS C1889
Hospital Charge Code 64907484
Hospital Revenue Code 278
Min. Negotiated Rate $3,127.50
Max. Negotiated Rate $3,127.50
Rate for Payer: Hamaspik Choice Inc Medicaid $3,127.50
Rate for Payer: Hamaspik Choice Inc Medicare $3,127.50
Service Code HCPCS C1889
Hospital Charge Code 64907484
Hospital Revenue Code 278
Min. Negotiated Rate $2,189.25
Max. Negotiated Rate $6,567.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3,440.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $3,127.50
Rate for Payer: Aetna Government $3,127.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $3,127.50
Rate for Payer: Cigna LocalPlus Benefit Plan $3,596.62
Rate for Payer: Fidelis Medicare Advantage $6,567.75
Rate for Payer: Group Health Inc Commercial $3,127.50
Rate for Payer: Group Health Inc Medicare $2,189.25
Rate for Payer: Hamaspik Choice Inc Medicaid $3,127.50
Rate for Payer: Hamaspik Choice Inc Medicare $3,127.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $4,065.75
Hospital Charge Code 64905134
Hospital Revenue Code 270
Min. Negotiated Rate $280.71
Max. Negotiated Rate $641.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial $441.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $401.02
Rate for Payer: Aetna Government $401.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $641.62
Rate for Payer: Cigna LocalPlus Benefit Plan $545.38
Rate for Payer: Group Health Inc Commercial $401.02
Rate for Payer: Group Health Inc Medicare $280.71
Rate for Payer: Hamaspik Choice Inc Medicaid $401.02
Rate for Payer: Hamaspik Choice Inc Medicare $401.02
Hospital Charge Code 64905450
Hospital Revenue Code 270
Min. Negotiated Rate $393.62
Max. Negotiated Rate $899.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial $618.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $562.32
Rate for Payer: Aetna Government $562.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $899.70
Rate for Payer: Cigna LocalPlus Benefit Plan $764.75
Rate for Payer: Group Health Inc Commercial $562.32
Rate for Payer: Group Health Inc Medicare $393.62
Rate for Payer: Hamaspik Choice Inc Medicaid $562.32
Rate for Payer: Hamaspik Choice Inc Medicare $562.32
Hospital Charge Code 64907040
Hospital Revenue Code 270
Min. Negotiated Rate $120.96
Max. Negotiated Rate $276.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial $190.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $172.80
Rate for Payer: Aetna Government $172.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $276.48
Rate for Payer: Cigna LocalPlus Benefit Plan $235.01
Rate for Payer: Group Health Inc Commercial $172.80
Rate for Payer: Group Health Inc Medicare $120.96
Rate for Payer: Hamaspik Choice Inc Medicaid $172.80
Rate for Payer: Hamaspik Choice Inc Medicare $172.80
Hospital Charge Code 64904648
Hospital Revenue Code 270
Min. Negotiated Rate $313.74
Max. Negotiated Rate $717.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial $493.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $448.20
Rate for Payer: Aetna Government $448.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $717.13
Rate for Payer: Cigna LocalPlus Benefit Plan $609.56
Rate for Payer: Group Health Inc Commercial $448.20
Rate for Payer: Group Health Inc Medicare $313.74
Rate for Payer: Hamaspik Choice Inc Medicaid $448.20
Rate for Payer: Hamaspik Choice Inc Medicare $448.20
Hospital Charge Code 40205111
Hospital Revenue Code 270
Min. Negotiated Rate $681.34
Max. Negotiated Rate $1,557.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,070.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $973.35
Rate for Payer: Aetna Government $973.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,557.36
Rate for Payer: Cigna LocalPlus Benefit Plan $1,323.76
Rate for Payer: Group Health Inc Commercial $973.35
Rate for Payer: Group Health Inc Medicare $681.34
Rate for Payer: Hamaspik Choice Inc Medicaid $973.35
Rate for Payer: Hamaspik Choice Inc Medicare $973.35
Hospital Charge Code 64906557
Hospital Revenue Code 279
Min. Negotiated Rate $391.85
Max. Negotiated Rate $895.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial $615.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $559.79
Rate for Payer: Aetna Government $559.79
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $895.66
Rate for Payer: Cigna LocalPlus Benefit Plan $761.31
Rate for Payer: Group Health Inc Commercial $559.79
Rate for Payer: Group Health Inc Medicare $391.85
Rate for Payer: Hamaspik Choice Inc Medicaid $559.79
Rate for Payer: Hamaspik Choice Inc Medicare $559.79