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Charge Type Price  
Hospital Charge Code 40205941
Hospital Revenue Code 270
Min. Negotiated Rate $107.78
Max. Negotiated Rate $246.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial $169.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $153.98
Rate for Payer: Aetna Government $153.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $246.36
Rate for Payer: Cigna LocalPlus Benefit Plan $209.41
Rate for Payer: Group Health Inc Commercial $153.98
Rate for Payer: Group Health Inc Medicare $107.78
Rate for Payer: Hamaspik Choice Inc Medicaid $153.98
Rate for Payer: Hamaspik Choice Inc Medicare $153.98
Hospital Charge Code 40207592
Hospital Revenue Code 270
Min. Negotiated Rate $35.97
Max. Negotiated Rate $82.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial $56.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $51.38
Rate for Payer: Aetna Government $51.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $82.22
Rate for Payer: Cigna LocalPlus Benefit Plan $69.88
Rate for Payer: Group Health Inc Commercial $51.38
Rate for Payer: Group Health Inc Medicare $35.97
Rate for Payer: Hamaspik Choice Inc Medicaid $51.38
Rate for Payer: Hamaspik Choice Inc Medicare $51.38
Hospital Charge Code 40205942
Hospital Revenue Code 272
Min. Negotiated Rate $107.78
Max. Negotiated Rate $246.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial $169.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $153.98
Rate for Payer: Aetna Government $153.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $246.36
Rate for Payer: Cigna LocalPlus Benefit Plan $209.41
Rate for Payer: Group Health Inc Commercial $153.98
Rate for Payer: Group Health Inc Medicare $107.78
Rate for Payer: Hamaspik Choice Inc Medicaid $153.98
Rate for Payer: Hamaspik Choice Inc Medicare $153.98
Hospital Charge Code 41658013
Hospital Revenue Code 250
Min. Negotiated Rate $14.70
Max. Negotiated Rate $33.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $23.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $21.00
Rate for Payer: Aetna Government $21.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $33.60
Rate for Payer: Cigna LocalPlus Benefit Plan $28.56
Rate for Payer: Group Health Inc Commercial $21.00
Rate for Payer: Group Health Inc Medicare $14.70
Rate for Payer: Hamaspik Choice Inc Medicaid $21.00
Rate for Payer: Hamaspik Choice Inc Medicare $21.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $27.30
Hospital Charge Code 41648013
Hospital Revenue Code 250
Min. Negotiated Rate $14.70
Max. Negotiated Rate $33.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $23.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $21.00
Rate for Payer: Aetna Government $21.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $33.60
Rate for Payer: Cigna LocalPlus Benefit Plan $28.56
Rate for Payer: Group Health Inc Commercial $21.00
Rate for Payer: Group Health Inc Medicare $14.70
Rate for Payer: Hamaspik Choice Inc Medicaid $21.00
Rate for Payer: Hamaspik Choice Inc Medicare $21.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $27.30
Hospital Charge Code 40202153
Hospital Revenue Code 270
Min. Negotiated Rate $250.39
Max. Negotiated Rate $572.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial $393.47
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $357.70
Rate for Payer: Aetna Government $357.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $572.32
Rate for Payer: Cigna LocalPlus Benefit Plan $486.47
Rate for Payer: Group Health Inc Commercial $357.70
Rate for Payer: Group Health Inc Medicare $250.39
Rate for Payer: Hamaspik Choice Inc Medicaid $357.70
Rate for Payer: Hamaspik Choice Inc Medicare $357.70
Service Code HCPCS C1776
Hospital Charge Code 40209847
Hospital Revenue Code 278
Min. Negotiated Rate $960.00
Max. Negotiated Rate $960.00
Rate for Payer: Hamaspik Choice Inc Medicaid $960.00
Rate for Payer: Hamaspik Choice Inc Medicare $960.00
Service Code HCPCS C1776
Hospital Charge Code 40209847
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $2,016.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,056.00
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 $960.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,104.00
Rate for Payer: Fidelis Medicare Advantage $2,016.00
Rate for Payer: Group Health Inc Commercial $960.00
Rate for Payer: Group Health Inc Medicare $672.00
Rate for Payer: Hamaspik Choice Inc Medicaid $960.00
Rate for Payer: Hamaspik Choice Inc Medicare $960.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,248.00
Service Code HCPCS C1776
Hospital Charge Code 40209846
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $2,965.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,553.20
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 $1,412.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,623.80
Rate for Payer: Fidelis Medicare Advantage $2,965.20
Rate for Payer: Group Health Inc Commercial $1,412.00
Rate for Payer: Group Health Inc Medicare $988.40
Rate for Payer: Hamaspik Choice Inc Medicaid $1,412.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,412.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,835.60
Service Code HCPCS C1776
Hospital Charge Code 40209846
Hospital Revenue Code 278
Min. Negotiated Rate $1,412.00
Max. Negotiated Rate $1,412.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,412.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,412.00
Service Code HCPCS C1776
Hospital Charge Code 40209848
Hospital Revenue Code 278
Min. Negotiated Rate $920.50
Max. Negotiated Rate $920.50
Rate for Payer: Hamaspik Choice Inc Medicaid $920.50
Rate for Payer: Hamaspik Choice Inc Medicare $920.50
Service Code HCPCS C1776
Hospital Charge Code 40209848
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $1,933.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,012.55
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 $920.50
Rate for Payer: Cigna LocalPlus Benefit Plan $1,058.58
Rate for Payer: Fidelis Medicare Advantage $1,933.05
Rate for Payer: Group Health Inc Commercial $920.50
Rate for Payer: Group Health Inc Medicare $644.35
Rate for Payer: Hamaspik Choice Inc Medicaid $920.50
Rate for Payer: Hamaspik Choice Inc Medicare $920.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,196.65
Service Code HCPCS C1776
Hospital Charge Code 40209849
Hospital Revenue Code 278
Min. Negotiated Rate $920.70
Max. Negotiated Rate $920.70
Rate for Payer: Hamaspik Choice Inc Medicaid $920.70
Rate for Payer: Hamaspik Choice Inc Medicare $920.70
Service Code HCPCS C1776
Hospital Charge Code 40209849
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $1,933.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,012.77
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 $920.70
Rate for Payer: Cigna LocalPlus Benefit Plan $1,058.80
Rate for Payer: Fidelis Medicare Advantage $1,933.47
Rate for Payer: Group Health Inc Commercial $920.70
Rate for Payer: Group Health Inc Medicare $644.49
Rate for Payer: Hamaspik Choice Inc Medicaid $920.70
Rate for Payer: Hamaspik Choice Inc Medicare $920.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,196.91
Hospital Charge Code 64901599
Hospital Revenue Code 270
Min. Negotiated Rate $21.28
Max. Negotiated Rate $48.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial $33.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $30.40
Rate for Payer: Aetna Government $30.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $48.63
Rate for Payer: Cigna LocalPlus Benefit Plan $41.34
Rate for Payer: Group Health Inc Commercial $30.40
Rate for Payer: Group Health Inc Medicare $21.28
Rate for Payer: Hamaspik Choice Inc Medicaid $30.40
Rate for Payer: Hamaspik Choice Inc Medicare $30.40
Hospital Charge Code 64904217
Hospital Revenue Code 270
Min. Negotiated Rate $616.88
Max. Negotiated Rate $1,410.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $969.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $881.25
Rate for Payer: Aetna Government $881.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,410.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,198.50
Rate for Payer: Group Health Inc Commercial $881.25
Rate for Payer: Group Health Inc Medicare $616.88
Rate for Payer: Hamaspik Choice Inc Medicaid $881.25
Rate for Payer: Hamaspik Choice Inc Medicare $881.25
Hospital Charge Code 64904219
Hospital Revenue Code 270
Min. Negotiated Rate $83.12
Max. Negotiated Rate $190.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $130.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $118.75
Rate for Payer: Aetna Government $118.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $190.00
Rate for Payer: Cigna LocalPlus Benefit Plan $161.50
Rate for Payer: Group Health Inc Commercial $118.75
Rate for Payer: Group Health Inc Medicare $83.12
Rate for Payer: Hamaspik Choice Inc Medicaid $118.75
Rate for Payer: Hamaspik Choice Inc Medicare $118.75
Service Code HCPCS C1776
Hospital Charge Code 40206078
Hospital Revenue Code 278
Min. Negotiated Rate $1,407.85
Max. Negotiated Rate $1,407.85
Rate for Payer: Hamaspik Choice Inc Medicaid $1,407.85
Rate for Payer: Hamaspik Choice Inc Medicare $1,407.85
Service Code HCPCS C1776
Hospital Charge Code 40206078
Hospital Revenue Code 278
Min. Negotiated Rate $339.17
Max. Negotiated Rate $2,956.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,548.64
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 $1,407.85
Rate for Payer: Cigna LocalPlus Benefit Plan $1,619.03
Rate for Payer: Fidelis Medicare Advantage $2,956.48
Rate for Payer: Group Health Inc Commercial $1,407.85
Rate for Payer: Group Health Inc Medicare $985.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,407.85
Rate for Payer: Hamaspik Choice Inc Medicare $1,407.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,830.20
Service Code HCPCS C1776
Hospital Charge Code 40206079
Hospital Revenue Code 278
Min. Negotiated Rate $153.09
Max. Negotiated Rate $459.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial $240.57
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 $218.70
Rate for Payer: Cigna LocalPlus Benefit Plan $251.50
Rate for Payer: Fidelis Medicare Advantage $459.27
Rate for Payer: Group Health Inc Commercial $218.70
Rate for Payer: Group Health Inc Medicare $153.09
Rate for Payer: Hamaspik Choice Inc Medicaid $218.70
Rate for Payer: Hamaspik Choice Inc Medicare $218.70
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $284.31
Service Code HCPCS C1776
Hospital Charge Code 40206079
Hospital Revenue Code 278
Min. Negotiated Rate $218.70
Max. Negotiated Rate $218.70
Rate for Payer: Hamaspik Choice Inc Medicaid $218.70
Rate for Payer: Hamaspik Choice Inc Medicare $218.70
Hospital Charge Code 64902719
Hospital Revenue Code 270
Min. Negotiated Rate $232.12
Max. Negotiated Rate $530.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial $364.76
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $331.60
Rate for Payer: Aetna Government $331.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $530.56
Rate for Payer: Cigna LocalPlus Benefit Plan $450.98
Rate for Payer: Group Health Inc Commercial $331.60
Rate for Payer: Group Health Inc Medicare $232.12
Rate for Payer: Hamaspik Choice Inc Medicaid $331.60
Rate for Payer: Hamaspik Choice Inc Medicare $331.60
Service Code HCPCS C2626
Hospital Charge Code 40202340
Hospital Revenue Code 278
Min. Negotiated Rate $468.08
Max. Negotiated Rate $23,520.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $12,320.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $468.08
Rate for Payer: Aetna Government $468.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $11,200.00
Rate for Payer: Cigna LocalPlus Benefit Plan $12,880.00
Rate for Payer: Fidelis Medicare Advantage $23,520.00
Rate for Payer: Group Health Inc Commercial $11,200.00
Rate for Payer: Group Health Inc Medicare $7,840.00
Rate for Payer: Hamaspik Choice Inc Medicaid $11,200.00
Rate for Payer: Hamaspik Choice Inc Medicare $11,200.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $14,560.00
Service Code HCPCS C2626
Hospital Charge Code 40202340
Hospital Revenue Code 278
Min. Negotiated Rate $11,200.00
Max. Negotiated Rate $11,200.00
Rate for Payer: Hamaspik Choice Inc Medicaid $11,200.00
Rate for Payer: Hamaspik Choice Inc Medicare $11,200.00
Service Code HCPCS C2626
Hospital Charge Code 40206085
Hospital Revenue Code 278
Min. Negotiated Rate $5,600.00
Max. Negotiated Rate $5,600.00
Rate for Payer: Hamaspik Choice Inc Medicaid $5,600.00
Rate for Payer: Hamaspik Choice Inc Medicare $5,600.00