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Charge Type Price  
Hospital Charge Code 64902201
Hospital Revenue Code 270
Min. Negotiated Rate $2.26
Max. Negotiated Rate $5.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $3.23
Rate for Payer: Aetna Government $3.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $5.17
Rate for Payer: Cigna LocalPlus Benefit Plan $4.39
Rate for Payer: Group Health Inc Commercial $3.23
Rate for Payer: Group Health Inc Medicare $2.26
Rate for Payer: Hamaspik Choice Inc Medicaid $3.23
Rate for Payer: Hamaspik Choice Inc Medicare $3.23
Hospital Charge Code 64902198
Hospital Revenue Code 270
Min. Negotiated Rate $2.93
Max. Negotiated Rate $6.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.19
Rate for Payer: Aetna Government $4.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $6.70
Rate for Payer: Cigna LocalPlus Benefit Plan $5.70
Rate for Payer: Group Health Inc Commercial $4.19
Rate for Payer: Group Health Inc Medicare $2.93
Rate for Payer: Hamaspik Choice Inc Medicaid $4.19
Rate for Payer: Hamaspik Choice Inc Medicare $4.19
Hospital Charge Code 64901717
Hospital Revenue Code 270
Min. Negotiated Rate $4.57
Max. Negotiated Rate $10.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial $7.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $6.52
Rate for Payer: Aetna Government $6.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $10.44
Rate for Payer: Cigna LocalPlus Benefit Plan $8.87
Rate for Payer: Group Health Inc Commercial $6.52
Rate for Payer: Group Health Inc Medicare $4.57
Rate for Payer: Hamaspik Choice Inc Medicaid $6.52
Rate for Payer: Hamaspik Choice Inc Medicare $6.52
Hospital Charge Code 64904190
Hospital Revenue Code 270
Min. Negotiated Rate $49.40
Max. Negotiated Rate $112.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial $77.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $70.56
Rate for Payer: Aetna Government $70.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $112.90
Rate for Payer: Cigna LocalPlus Benefit Plan $95.97
Rate for Payer: Group Health Inc Commercial $70.56
Rate for Payer: Group Health Inc Medicare $49.40
Rate for Payer: Hamaspik Choice Inc Medicaid $70.56
Rate for Payer: Hamaspik Choice Inc Medicare $70.56
Hospital Charge Code 40205982
Hospital Revenue Code 270
Min. Negotiated Rate $35.00
Max. Negotiated Rate $80.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $55.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $50.00
Rate for Payer: Aetna Government $50.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $80.00
Rate for Payer: Cigna LocalPlus Benefit Plan $68.00
Rate for Payer: Group Health Inc Commercial $50.00
Rate for Payer: Group Health Inc Medicare $35.00
Rate for Payer: Hamaspik Choice Inc Medicaid $50.00
Rate for Payer: Hamaspik Choice Inc Medicare $50.00
Hospital Charge Code 64903187
Hospital Revenue Code 270
Min. Negotiated Rate $1.31
Max. Negotiated Rate $3.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.88
Rate for Payer: Aetna Government $1.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $3.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2.55
Rate for Payer: Group Health Inc Commercial $1.88
Rate for Payer: Group Health Inc Medicare $1.31
Rate for Payer: Hamaspik Choice Inc Medicaid $1.88
Rate for Payer: Hamaspik Choice Inc Medicare $1.88
Hospital Charge Code 64902069
Hospital Revenue Code 270
Min. Negotiated Rate $5.27
Max. Negotiated Rate $12.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial $8.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $7.53
Rate for Payer: Aetna Government $7.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $12.05
Rate for Payer: Cigna LocalPlus Benefit Plan $10.24
Rate for Payer: Group Health Inc Commercial $7.53
Rate for Payer: Group Health Inc Medicare $5.27
Rate for Payer: Hamaspik Choice Inc Medicaid $7.53
Rate for Payer: Hamaspik Choice Inc Medicare $7.53
Hospital Charge Code 64901869
Hospital Revenue Code 270
Min. Negotiated Rate $0.02
Max. Negotiated Rate $0.04
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.03
Rate for Payer: Aetna Government $0.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.04
Rate for Payer: Cigna LocalPlus Benefit Plan $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
Hospital Charge Code 41646090
Hospital Revenue Code 250
Min. Negotiated Rate $1.75
Max. Negotiated Rate $4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.50
Rate for Payer: Aetna Government $2.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $4.00
Rate for Payer: Cigna LocalPlus Benefit Plan $3.40
Rate for Payer: Group Health Inc Commercial $2.50
Rate for Payer: Group Health Inc Medicare $1.75
Rate for Payer: Hamaspik Choice Inc Medicaid $2.50
Rate for Payer: Hamaspik Choice Inc Medicare $2.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3.25
Hospital Charge Code 41656090
Hospital Revenue Code 250
Min. Negotiated Rate $1.75
Max. Negotiated Rate $4.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.50
Rate for Payer: Aetna Government $2.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $4.00
Rate for Payer: Cigna LocalPlus Benefit Plan $3.40
Rate for Payer: Group Health Inc Commercial $2.50
Rate for Payer: Group Health Inc Medicare $1.75
Rate for Payer: Hamaspik Choice Inc Medicaid $2.50
Rate for Payer: Hamaspik Choice Inc Medicare $2.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3.25
Hospital Charge Code 41656088
Hospital Revenue Code 250
Min. Negotiated Rate $1.68
Max. Negotiated Rate $3.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.40
Rate for Payer: Aetna Government $2.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $3.84
Rate for Payer: Cigna LocalPlus Benefit Plan $3.26
Rate for Payer: Group Health Inc Commercial $2.40
Rate for Payer: Group Health Inc Medicare $1.68
Rate for Payer: Hamaspik Choice Inc Medicaid $2.40
Rate for Payer: Hamaspik Choice Inc Medicare $2.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3.12
Hospital Charge Code 41646088
Hospital Revenue Code 250
Min. Negotiated Rate $1.68
Max. Negotiated Rate $3.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.40
Rate for Payer: Aetna Government $2.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $3.84
Rate for Payer: Cigna LocalPlus Benefit Plan $3.26
Rate for Payer: Group Health Inc Commercial $2.40
Rate for Payer: Group Health Inc Medicare $1.68
Rate for Payer: Hamaspik Choice Inc Medicaid $2.40
Rate for Payer: Hamaspik Choice Inc Medicare $2.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3.12
Hospital Charge Code 40209453
Hospital Revenue Code 270
Min. Negotiated Rate $0.29
Max. Negotiated Rate $0.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.42
Rate for Payer: Aetna Government $0.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.67
Rate for Payer: Cigna LocalPlus Benefit Plan $0.57
Rate for Payer: Group Health Inc Commercial $0.42
Rate for Payer: Group Health Inc Medicare $0.29
Rate for Payer: Hamaspik Choice Inc Medicaid $0.42
Rate for Payer: Hamaspik Choice Inc Medicare $0.42
Hospital Charge Code 64901715
Hospital Revenue Code 270
Min. Negotiated Rate $0.23
Max. Negotiated Rate $0.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.34
Rate for Payer: Aetna Government $0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.54
Rate for Payer: Cigna LocalPlus Benefit Plan $0.46
Rate for Payer: Group Health Inc Commercial $0.34
Rate for Payer: Group Health Inc Medicare $0.23
Rate for Payer: Hamaspik Choice Inc Medicaid $0.34
Rate for Payer: Hamaspik Choice Inc Medicare $0.34
Hospital Charge Code 64901712
Hospital Revenue Code 270
Min. Negotiated Rate $0.47
Max. Negotiated Rate $1.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.67
Rate for Payer: Aetna Government $0.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.07
Rate for Payer: Cigna LocalPlus Benefit Plan $0.91
Rate for Payer: Group Health Inc Commercial $0.67
Rate for Payer: Group Health Inc Medicare $0.47
Rate for Payer: Hamaspik Choice Inc Medicaid $0.67
Rate for Payer: Hamaspik Choice Inc Medicare $0.67
Hospital Charge Code 64901709
Hospital Revenue Code 270
Min. Negotiated Rate $0.71
Max. Negotiated Rate $1.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.02
Rate for Payer: Aetna Government $1.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.63
Rate for Payer: Cigna LocalPlus Benefit Plan $1.39
Rate for Payer: Group Health Inc Commercial $1.02
Rate for Payer: Group Health Inc Medicare $0.71
Rate for Payer: Hamaspik Choice Inc Medicaid $1.02
Rate for Payer: Hamaspik Choice Inc Medicare $1.02
Hospital Charge Code 64901937
Hospital Revenue Code 270
Min. Negotiated Rate $0.23
Max. Negotiated Rate $0.52
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 $0.52
Rate for Payer: Cigna LocalPlus Benefit Plan $0.44
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 40200044
Hospital Revenue Code 279
Min. Negotiated Rate $592.20
Max. Negotiated Rate $1,353.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $930.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $846.00
Rate for Payer: Aetna Government $846.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,353.60
Rate for Payer: Cigna LocalPlus Benefit Plan $1,150.56
Rate for Payer: Group Health Inc Commercial $846.00
Rate for Payer: Group Health Inc Medicare $592.20
Rate for Payer: Hamaspik Choice Inc Medicaid $846.00
Rate for Payer: Hamaspik Choice Inc Medicare $846.00
Hospital Charge Code 40209454
Hospital Revenue Code 270
Min. Negotiated Rate $0.37
Max. Negotiated Rate $0.85
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.53
Rate for Payer: Aetna Government $0.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.85
Rate for Payer: Cigna LocalPlus Benefit Plan $0.72
Rate for Payer: Group Health Inc Commercial $0.53
Rate for Payer: Group Health Inc Medicare $0.37
Rate for Payer: Hamaspik Choice Inc Medicaid $0.53
Rate for Payer: Hamaspik Choice Inc Medicare $0.53
Hospital Charge Code 64901232
Hospital Revenue Code 270
Min. Negotiated Rate $0.41
Max. Negotiated Rate $0.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.58
Rate for Payer: Aetna Government $0.58
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.93
Rate for Payer: Cigna LocalPlus Benefit Plan $0.79
Rate for Payer: Group Health Inc Commercial $0.58
Rate for Payer: Group Health Inc Medicare $0.41
Rate for Payer: Hamaspik Choice Inc Medicaid $0.58
Rate for Payer: Hamaspik Choice Inc Medicare $0.58
Hospital Charge Code 64901032
Hospital Revenue Code 270
Min. Negotiated Rate $1.28
Max. Negotiated Rate $2.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.83
Rate for Payer: Aetna Government $1.83
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2.93
Rate for Payer: Cigna LocalPlus Benefit Plan $2.49
Rate for Payer: Group Health Inc Commercial $1.83
Rate for Payer: Group Health Inc Medicare $1.28
Rate for Payer: Hamaspik Choice Inc Medicaid $1.83
Rate for Payer: Hamaspik Choice Inc Medicare $1.83
Hospital Charge Code 64902051
Hospital Revenue Code 270
Min. Negotiated Rate $0.44
Max. Negotiated Rate $1.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.63
Rate for Payer: Aetna Government $0.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.01
Rate for Payer: Cigna LocalPlus Benefit Plan $0.86
Rate for Payer: Group Health Inc Commercial $0.63
Rate for Payer: Group Health Inc Medicare $0.44
Rate for Payer: Hamaspik Choice Inc Medicaid $0.63
Rate for Payer: Hamaspik Choice Inc Medicare $0.63
Hospital Charge Code 64906795
Hospital Revenue Code 270
Min. Negotiated Rate $2.04
Max. Negotiated Rate $4.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.91
Rate for Payer: Aetna Government $2.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $4.66
Rate for Payer: Cigna LocalPlus Benefit Plan $3.96
Rate for Payer: Group Health Inc Commercial $2.91
Rate for Payer: Group Health Inc Medicare $2.04
Rate for Payer: Hamaspik Choice Inc Medicaid $2.91
Rate for Payer: Hamaspik Choice Inc Medicare $2.91
Hospital Charge Code 64905577
Hospital Revenue Code 270
Min. Negotiated Rate $5.31
Max. Negotiated Rate $12.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial $8.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $7.59
Rate for Payer: Aetna Government $7.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $12.14
Rate for Payer: Cigna LocalPlus Benefit Plan $10.32
Rate for Payer: Group Health Inc Commercial $7.59
Rate for Payer: Group Health Inc Medicare $5.31
Rate for Payer: Hamaspik Choice Inc Medicaid $7.59
Rate for Payer: Hamaspik Choice Inc Medicare $7.59
Hospital Charge Code 64907101
Hospital Revenue Code 270
Min. Negotiated Rate $1.67
Max. Negotiated Rate $3.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.39
Rate for Payer: Aetna Government $2.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $3.82
Rate for Payer: Cigna LocalPlus Benefit Plan $3.25
Rate for Payer: Group Health Inc Commercial $2.39
Rate for Payer: Group Health Inc Medicare $1.67
Rate for Payer: Hamaspik Choice Inc Medicaid $2.39
Rate for Payer: Hamaspik Choice Inc Medicare $2.39