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Charge Type Price  
Hospital Charge Code 64901091
Hospital Revenue Code 270
Min. Negotiated Rate $0.28
Max. Negotiated Rate $0.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.40
Rate for Payer: Aetna Government $0.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.63
Rate for Payer: Cigna LocalPlus Benefit Plan $0.54
Rate for Payer: Group Health Inc Commercial $0.40
Rate for Payer: Group Health Inc Medicare $0.28
Rate for Payer: Hamaspik Choice Inc Medicaid $0.40
Rate for Payer: Hamaspik Choice Inc Medicare $0.40
Hospital Charge Code 64901434
Hospital Revenue Code 270
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.08
Rate for Payer: Aetna Government $0.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.13
Rate for Payer: Cigna LocalPlus Benefit Plan $0.11
Rate for Payer: Group Health Inc Commercial $0.08
Rate for Payer: Group Health Inc Medicare $0.06
Rate for Payer: Hamaspik Choice Inc Medicaid $0.08
Rate for Payer: Hamaspik Choice Inc Medicare $0.08
Hospital Charge Code 64901437
Hospital Revenue Code 270
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 $0.38
Rate for Payer: Aetna Government $0.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.60
Rate for Payer: Cigna LocalPlus Benefit Plan $0.51
Rate for Payer: Group Health Inc Commercial $0.38
Rate for Payer: Group Health Inc Medicare $0.26
Rate for Payer: Hamaspik Choice Inc Medicaid $0.38
Rate for Payer: Hamaspik Choice Inc Medicare $0.38
Hospital Charge Code 64901440
Hospital Revenue Code 270
Min. Negotiated Rate $0.15
Max. Negotiated Rate $0.35
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: Cigna HMO/Network Benefit Plan/Open Access $0.35
Rate for Payer: Cigna LocalPlus Benefit Plan $0.30
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
Hospital Charge Code 64901084
Hospital Revenue Code 270
Min. Negotiated Rate $0.23
Max. Negotiated Rate $0.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.33
Rate for Payer: Aetna Government $0.33
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.53
Rate for Payer: Cigna LocalPlus Benefit Plan $0.45
Rate for Payer: Group Health Inc Commercial $0.33
Rate for Payer: Group Health Inc Medicare $0.23
Rate for Payer: Hamaspik Choice Inc Medicaid $0.33
Rate for Payer: Hamaspik Choice Inc Medicare $0.33
Hospital Charge Code 64901009
Hospital Revenue Code 270
Min. Negotiated Rate $0.21
Max. Negotiated Rate $0.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.30
Rate for Payer: Aetna Government $0.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.48
Rate for Payer: Cigna LocalPlus Benefit Plan $0.41
Rate for Payer: Group Health Inc Commercial $0.30
Rate for Payer: Group Health Inc Medicare $0.21
Rate for Payer: Hamaspik Choice Inc Medicaid $0.30
Rate for Payer: Hamaspik Choice Inc Medicare $0.30
Hospital Charge Code 64901477
Hospital Revenue Code 270
Min. Negotiated Rate $0.17
Max. Negotiated Rate $0.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.24
Rate for Payer: Aetna Government $0.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.38
Rate for Payer: Cigna LocalPlus Benefit Plan $0.33
Rate for Payer: Group Health Inc Commercial $0.24
Rate for Payer: Group Health Inc Medicare $0.17
Rate for Payer: Hamaspik Choice Inc Medicaid $0.24
Rate for Payer: Hamaspik Choice Inc Medicare $0.24
Hospital Charge Code 64906817
Hospital Revenue Code 270
Min. Negotiated Rate $66.50
Max. Negotiated Rate $152.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $104.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $95.00
Rate for Payer: Aetna Government $95.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $152.00
Rate for Payer: Cigna LocalPlus Benefit Plan $129.20
Rate for Payer: Group Health Inc Commercial $95.00
Rate for Payer: Group Health Inc Medicare $66.50
Rate for Payer: Hamaspik Choice Inc Medicaid $95.00
Rate for Payer: Hamaspik Choice Inc Medicare $95.00
Hospital Charge Code 64901482
Hospital Revenue Code 270
Min. Negotiated Rate $1.30
Max. Negotiated Rate $2.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.86
Rate for Payer: Aetna Government $1.86
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2.97
Rate for Payer: Cigna LocalPlus Benefit Plan $2.52
Rate for Payer: Group Health Inc Commercial $1.86
Rate for Payer: Group Health Inc Medicare $1.30
Rate for Payer: Hamaspik Choice Inc Medicaid $1.86
Rate for Payer: Hamaspik Choice Inc Medicare $1.86
Hospital Charge Code 64901480
Hospital Revenue Code 270
Min. Negotiated Rate $0.33
Max. Negotiated Rate $0.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.47
Rate for Payer: Aetna Government $0.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.74
Rate for Payer: Cigna LocalPlus Benefit Plan $0.63
Rate for Payer: Group Health Inc Commercial $0.47
Rate for Payer: Group Health Inc Medicare $0.33
Rate for Payer: Hamaspik Choice Inc Medicaid $0.47
Rate for Payer: Hamaspik Choice Inc Medicare $0.47
Hospital Charge Code 64901990
Hospital Revenue Code 270
Min. Negotiated Rate $0.49
Max. Negotiated Rate $1.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.77
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.70
Rate for Payer: Aetna Government $0.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.12
Rate for Payer: Cigna LocalPlus Benefit Plan $0.95
Rate for Payer: Group Health Inc Commercial $0.70
Rate for Payer: Group Health Inc Medicare $0.49
Rate for Payer: Hamaspik Choice Inc Medicaid $0.70
Rate for Payer: Hamaspik Choice Inc Medicare $0.70
Hospital Charge Code 64902798
Hospital Revenue Code 270
Min. Negotiated Rate $1.42
Max. Negotiated Rate $3.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.04
Rate for Payer: Aetna Government $2.04
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $3.26
Rate for Payer: Cigna LocalPlus Benefit Plan $2.77
Rate for Payer: Group Health Inc Commercial $2.04
Rate for Payer: Group Health Inc Medicare $1.42
Rate for Payer: Hamaspik Choice Inc Medicaid $2.04
Rate for Payer: Hamaspik Choice Inc Medicare $2.04
Hospital Charge Code 64901086
Hospital Revenue Code 270
Min. Negotiated Rate $0.28
Max. Negotiated Rate $0.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.40
Rate for Payer: Aetna Government $0.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.63
Rate for Payer: Cigna LocalPlus Benefit Plan $0.54
Rate for Payer: Group Health Inc Commercial $0.40
Rate for Payer: Group Health Inc Medicare $0.28
Rate for Payer: Hamaspik Choice Inc Medicaid $0.40
Rate for Payer: Hamaspik Choice Inc Medicare $0.40
Hospital Charge Code 64902568
Hospital Revenue Code 270
Min. Negotiated Rate $0.33
Max. Negotiated Rate $0.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.47
Rate for Payer: Aetna Government $0.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.74
Rate for Payer: Cigna LocalPlus Benefit Plan $0.63
Rate for Payer: Group Health Inc Commercial $0.47
Rate for Payer: Group Health Inc Medicare $0.33
Rate for Payer: Hamaspik Choice Inc Medicaid $0.47
Rate for Payer: Hamaspik Choice Inc Medicare $0.47
Hospital Charge Code 64902570
Hospital Revenue Code 270
Min. Negotiated Rate $0.33
Max. Negotiated Rate $0.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.47
Rate for Payer: Aetna Government $0.47
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.74
Rate for Payer: Cigna LocalPlus Benefit Plan $0.63
Rate for Payer: Group Health Inc Commercial $0.47
Rate for Payer: Group Health Inc Medicare $0.33
Rate for Payer: Hamaspik Choice Inc Medicaid $0.47
Rate for Payer: Hamaspik Choice Inc Medicare $0.47
Hospital Charge Code 64901088
Hospital Revenue Code 270
Min. Negotiated Rate $0.28
Max. Negotiated Rate $0.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.40
Rate for Payer: Aetna Government $0.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.63
Rate for Payer: Cigna LocalPlus Benefit Plan $0.54
Rate for Payer: Group Health Inc Commercial $0.40
Rate for Payer: Group Health Inc Medicare $0.28
Rate for Payer: Hamaspik Choice Inc Medicaid $0.40
Rate for Payer: Hamaspik Choice Inc Medicare $0.40
Hospital Charge Code 40200269
Hospital Revenue Code 270
Min. Negotiated Rate $29.26
Max. Negotiated Rate $66.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial $45.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $41.80
Rate for Payer: Aetna Government $41.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $66.88
Rate for Payer: Cigna LocalPlus Benefit Plan $56.85
Rate for Payer: Group Health Inc Commercial $41.80
Rate for Payer: Group Health Inc Medicare $29.26
Rate for Payer: Hamaspik Choice Inc Medicaid $41.80
Rate for Payer: Hamaspik Choice Inc Medicare $41.80
Service Code HCPCS C1713
Hospital Charge Code 40205755
Hospital Revenue Code 278
Min. Negotiated Rate $130.20
Max. Negotiated Rate $130.20
Rate for Payer: Hamaspik Choice Inc Medicaid $130.20
Rate for Payer: Hamaspik Choice Inc Medicare $130.20
Service Code HCPCS C1713
Hospital Charge Code 40205755
Hospital Revenue Code 278
Min. Negotiated Rate $91.14
Max. Negotiated Rate $273.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial $143.22
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 $130.20
Rate for Payer: Cigna LocalPlus Benefit Plan $149.73
Rate for Payer: Fidelis Medicare Advantage $273.42
Rate for Payer: Group Health Inc Commercial $130.20
Rate for Payer: Group Health Inc Medicare $91.14
Rate for Payer: Hamaspik Choice Inc Medicaid $130.20
Rate for Payer: Hamaspik Choice Inc Medicare $130.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $169.26
Service Code HCPCS G8752
Hospital Charge Code 30307852
Hospital Revenue Code 510
Min. Negotiated Rate $0.01
Max. Negotiated Rate $250.00
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 $233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $204.58
Rate for Payer: Cigna LocalPlus Benefit Plan $173.89
Rate for Payer: Group Health Inc Commercial $250.00
Rate for Payer: Group Health Inc Medicare $250.00
Rate for Payer: Hamaspik Choice Inc Medicaid $0.01
Rate for Payer: Hamaspik Choice Inc Medicare $0.01
Service Code HCPCS G8753
Hospital Charge Code 30307853
Hospital Revenue Code 510
Min. Negotiated Rate $0.01
Max. Negotiated Rate $250.00
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 $233.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $204.58
Rate for Payer: Cigna LocalPlus Benefit Plan $173.89
Rate for Payer: Group Health Inc Commercial $250.00
Rate for Payer: Group Health Inc Medicare $250.00
Rate for Payer: Hamaspik Choice Inc Medicaid $0.01
Rate for Payer: Hamaspik Choice Inc Medicare $0.01
Hospital Charge Code 64905877
Hospital Revenue Code 270
Min. Negotiated Rate $40.18
Max. Negotiated Rate $91.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial $63.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $57.40
Rate for Payer: Aetna Government $57.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $91.84
Rate for Payer: Cigna LocalPlus Benefit Plan $78.06
Rate for Payer: Group Health Inc Commercial $57.40
Rate for Payer: Group Health Inc Medicare $40.18
Rate for Payer: Hamaspik Choice Inc Medicaid $57.40
Rate for Payer: Hamaspik Choice Inc Medicare $57.40
Service Code HCPCS C1713
Hospital Charge Code 40200367
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $787.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $412.50
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 $375.00
Rate for Payer: Cigna LocalPlus Benefit Plan $431.25
Rate for Payer: Fidelis Medicare Advantage $787.50
Rate for Payer: Group Health Inc Commercial $375.00
Rate for Payer: Group Health Inc Medicare $262.50
Rate for Payer: Hamaspik Choice Inc Medicaid $375.00
Rate for Payer: Hamaspik Choice Inc Medicare $375.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $487.50
Service Code HCPCS C1713
Hospital Charge Code 40200367
Hospital Revenue Code 278
Min. Negotiated Rate $375.00
Max. Negotiated Rate $375.00
Rate for Payer: Hamaspik Choice Inc Medicaid $375.00
Rate for Payer: Hamaspik Choice Inc Medicare $375.00
Hospital Charge Code 64903308
Hospital Revenue Code 270
Min. Negotiated Rate $1,402.00
Max. Negotiated Rate $3,204.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,203.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2,002.85
Rate for Payer: Aetna Government $2,002.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $3,204.56
Rate for Payer: Cigna LocalPlus Benefit Plan $2,723.88
Rate for Payer: Group Health Inc Commercial $2,002.85
Rate for Payer: Group Health Inc Medicare $1,402.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,002.85
Rate for Payer: Hamaspik Choice Inc Medicare $2,002.85