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Charge Type Price  
Hospital Charge Code 64902723
Hospital Revenue Code 270
Min. Negotiated Rate $312.18
Max. Negotiated Rate $713.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial $490.57
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $445.98
Rate for Payer: Aetna Government $445.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $713.56
Rate for Payer: Cigna LocalPlus Benefit Plan $606.53
Rate for Payer: Group Health Inc Commercial $445.98
Rate for Payer: Group Health Inc Medicare $312.18
Rate for Payer: Hamaspik Choice Inc Medicaid $445.98
Rate for Payer: Hamaspik Choice Inc Medicare $445.98
Hospital Charge Code 40200151
Hospital Revenue Code 272
Min. Negotiated Rate $79.38
Max. Negotiated Rate $181.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial $124.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $113.40
Rate for Payer: Aetna Government $113.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $181.44
Rate for Payer: Cigna LocalPlus Benefit Plan $154.22
Rate for Payer: Group Health Inc Commercial $113.40
Rate for Payer: Group Health Inc Medicare $79.38
Rate for Payer: Hamaspik Choice Inc Medicaid $113.40
Rate for Payer: Hamaspik Choice Inc Medicare $113.40
Hospital Charge Code 40200188
Hospital Revenue Code 270
Min. Negotiated Rate $212.10
Max. Negotiated Rate $484.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $333.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $303.00
Rate for Payer: Aetna Government $303.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $484.80
Rate for Payer: Cigna LocalPlus Benefit Plan $412.08
Rate for Payer: Group Health Inc Commercial $303.00
Rate for Payer: Group Health Inc Medicare $212.10
Rate for Payer: Hamaspik Choice Inc Medicaid $303.00
Rate for Payer: Hamaspik Choice Inc Medicare $303.00
Hospital Charge Code 40200325
Hospital Revenue Code 272
Min. Negotiated Rate $211.88
Max. Negotiated Rate $484.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $332.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $302.69
Rate for Payer: Aetna Government $302.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $484.30
Rate for Payer: Cigna LocalPlus Benefit Plan $411.66
Rate for Payer: Group Health Inc Commercial $302.69
Rate for Payer: Group Health Inc Medicare $211.88
Rate for Payer: Hamaspik Choice Inc Medicaid $302.69
Rate for Payer: Hamaspik Choice Inc Medicare $302.69
Hospital Charge Code 40200326
Hospital Revenue Code 272
Min. Negotiated Rate $211.88
Max. Negotiated Rate $484.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $332.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $302.69
Rate for Payer: Aetna Government $302.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $484.30
Rate for Payer: Cigna LocalPlus Benefit Plan $411.66
Rate for Payer: Group Health Inc Commercial $302.69
Rate for Payer: Group Health Inc Medicare $211.88
Rate for Payer: Hamaspik Choice Inc Medicaid $302.69
Rate for Payer: Hamaspik Choice Inc Medicare $302.69
Hospital Charge Code 40200328
Hospital Revenue Code 272
Min. Negotiated Rate $211.88
Max. Negotiated Rate $484.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $332.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $302.69
Rate for Payer: Aetna Government $302.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $484.30
Rate for Payer: Cigna LocalPlus Benefit Plan $411.66
Rate for Payer: Group Health Inc Commercial $302.69
Rate for Payer: Group Health Inc Medicare $211.88
Rate for Payer: Hamaspik Choice Inc Medicaid $302.69
Rate for Payer: Hamaspik Choice Inc Medicare $302.69
Hospital Charge Code 40200327
Hospital Revenue Code 272
Min. Negotiated Rate $211.88
Max. Negotiated Rate $484.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $332.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $302.69
Rate for Payer: Aetna Government $302.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $484.30
Rate for Payer: Cigna LocalPlus Benefit Plan $411.66
Rate for Payer: Group Health Inc Commercial $302.69
Rate for Payer: Group Health Inc Medicare $211.88
Rate for Payer: Hamaspik Choice Inc Medicaid $302.69
Rate for Payer: Hamaspik Choice Inc Medicare $302.69
Service Code HCPCS C1725
Hospital Charge Code 40207000
Hospital Revenue Code 278
Min. Negotiated Rate $265.54
Max. Negotiated Rate $265.54
Rate for Payer: Hamaspik Choice Inc Medicaid $265.54
Rate for Payer: Hamaspik Choice Inc Medicare $265.54
Service Code HCPCS C1725
Hospital Charge Code 40207000
Hospital Revenue Code 278
Min. Negotiated Rate $44.85
Max. Negotiated Rate $557.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial $292.09
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $44.85
Rate for Payer: Aetna Government $44.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $265.54
Rate for Payer: Cigna LocalPlus Benefit Plan $305.37
Rate for Payer: Fidelis Medicare Advantage $557.63
Rate for Payer: Group Health Inc Commercial $265.54
Rate for Payer: Group Health Inc Medicare $185.88
Rate for Payer: Hamaspik Choice Inc Medicaid $265.54
Rate for Payer: Hamaspik Choice Inc Medicare $265.54
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $345.20
Hospital Charge Code 64907081
Hospital Revenue Code 270
Min. Negotiated Rate $14.24
Max. Negotiated Rate $32.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial $22.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $20.35
Rate for Payer: Aetna Government $20.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $32.56
Rate for Payer: Cigna LocalPlus Benefit Plan $27.68
Rate for Payer: Group Health Inc Commercial $20.35
Rate for Payer: Group Health Inc Medicare $14.24
Rate for Payer: Hamaspik Choice Inc Medicaid $20.35
Rate for Payer: Hamaspik Choice Inc Medicare $20.35
Hospital Charge Code 64904369
Hospital Revenue Code 270
Min. Negotiated Rate $39.97
Max. Negotiated Rate $91.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial $62.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $57.10
Rate for Payer: Aetna Government $57.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $91.36
Rate for Payer: Cigna LocalPlus Benefit Plan $77.66
Rate for Payer: Group Health Inc Commercial $57.10
Rate for Payer: Group Health Inc Medicare $39.97
Rate for Payer: Hamaspik Choice Inc Medicaid $57.10
Rate for Payer: Hamaspik Choice Inc Medicare $57.10
Hospital Charge Code 64906043
Hospital Revenue Code 270
Min. Negotiated Rate $20.17
Max. Negotiated Rate $46.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $31.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $28.82
Rate for Payer: Aetna Government $28.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $46.10
Rate for Payer: Cigna LocalPlus Benefit Plan $39.19
Rate for Payer: Group Health Inc Commercial $28.82
Rate for Payer: Group Health Inc Medicare $20.17
Rate for Payer: Hamaspik Choice Inc Medicaid $28.82
Rate for Payer: Hamaspik Choice Inc Medicare $28.82
Hospital Charge Code 64906044
Hospital Revenue Code 270
Min. Negotiated Rate $131.25
Max. Negotiated Rate $300.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $206.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $187.50
Rate for Payer: Aetna Government $187.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $300.00
Rate for Payer: Cigna LocalPlus Benefit Plan $255.00
Rate for Payer: Group Health Inc Commercial $187.50
Rate for Payer: Group Health Inc Medicare $131.25
Rate for Payer: Hamaspik Choice Inc Medicaid $187.50
Rate for Payer: Hamaspik Choice Inc Medicare $187.50
Hospital Charge Code 64906046
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
Hospital Charge Code 64905430
Hospital Revenue Code 270
Min. Negotiated Rate $149.42
Max. Negotiated Rate $341.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial $234.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $213.45
Rate for Payer: Aetna Government $213.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $341.52
Rate for Payer: Cigna LocalPlus Benefit Plan $290.29
Rate for Payer: Group Health Inc Commercial $213.45
Rate for Payer: Group Health Inc Medicare $149.42
Rate for Payer: Hamaspik Choice Inc Medicaid $213.45
Rate for Payer: Hamaspik Choice Inc Medicare $213.45
Hospital Charge Code 64905811
Hospital Revenue Code 270
Min. Negotiated Rate $4.37
Max. Negotiated Rate $9.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial $6.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $6.24
Rate for Payer: Aetna Government $6.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $9.98
Rate for Payer: Cigna LocalPlus Benefit Plan $8.49
Rate for Payer: Group Health Inc Commercial $6.24
Rate for Payer: Group Health Inc Medicare $4.37
Rate for Payer: Hamaspik Choice Inc Medicaid $6.24
Rate for Payer: Hamaspik Choice Inc Medicare $6.24
Hospital Charge Code 40206037
Hospital Revenue Code 270
Min. Negotiated Rate $43.40
Max. Negotiated Rate $99.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $68.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $62.00
Rate for Payer: Aetna Government $62.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $99.20
Rate for Payer: Cigna LocalPlus Benefit Plan $84.32
Rate for Payer: Group Health Inc Commercial $62.00
Rate for Payer: Group Health Inc Medicare $43.40
Rate for Payer: Hamaspik Choice Inc Medicaid $62.00
Rate for Payer: Hamaspik Choice Inc Medicare $62.00
Hospital Charge Code 64904167
Hospital Revenue Code 270
Min. Negotiated Rate $63.00
Max. Negotiated Rate $144.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $99.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $90.00
Rate for Payer: Aetna Government $90.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $144.00
Rate for Payer: Cigna LocalPlus Benefit Plan $122.40
Rate for Payer: Group Health Inc Commercial $90.00
Rate for Payer: Group Health Inc Medicare $63.00
Rate for Payer: Hamaspik Choice Inc Medicaid $90.00
Rate for Payer: Hamaspik Choice Inc Medicare $90.00
Hospital Charge Code 64905433
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
Hospital Charge Code 64906072
Hospital Revenue Code 270
Min. Negotiated Rate $296.62
Max. Negotiated Rate $678.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $466.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $423.75
Rate for Payer: Aetna Government $423.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $678.00
Rate for Payer: Cigna LocalPlus Benefit Plan $576.30
Rate for Payer: Group Health Inc Commercial $423.75
Rate for Payer: Group Health Inc Medicare $296.62
Rate for Payer: Hamaspik Choice Inc Medicaid $423.75
Rate for Payer: Hamaspik Choice Inc Medicare $423.75
Hospital Charge Code 64904627
Hospital Revenue Code 270
Min. Negotiated Rate $46.36
Max. Negotiated Rate $105.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial $72.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $66.22
Rate for Payer: Aetna Government $66.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $105.96
Rate for Payer: Cigna LocalPlus Benefit Plan $90.07
Rate for Payer: Group Health Inc Commercial $66.22
Rate for Payer: Group Health Inc Medicare $46.36
Rate for Payer: Hamaspik Choice Inc Medicaid $66.22
Rate for Payer: Hamaspik Choice Inc Medicare $66.22
Hospital Charge Code 40206056
Hospital Revenue Code 270
Min. Negotiated Rate $106.48
Max. Negotiated Rate $243.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial $167.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $152.11
Rate for Payer: Aetna Government $152.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $243.38
Rate for Payer: Cigna LocalPlus Benefit Plan $206.87
Rate for Payer: Group Health Inc Commercial $152.11
Rate for Payer: Group Health Inc Medicare $106.48
Rate for Payer: Hamaspik Choice Inc Medicaid $152.11
Rate for Payer: Hamaspik Choice Inc Medicare $152.11
Hospital Charge Code 64904365
Hospital Revenue Code 270
Min. Negotiated Rate $38.78
Max. Negotiated Rate $88.65
Rate for Payer: 1199SEIU National Benefit Fund Commercial $60.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $55.40
Rate for Payer: Aetna Government $55.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $88.65
Rate for Payer: Cigna LocalPlus Benefit Plan $75.35
Rate for Payer: Group Health Inc Commercial $55.40
Rate for Payer: Group Health Inc Medicare $38.78
Rate for Payer: Hamaspik Choice Inc Medicaid $55.40
Rate for Payer: Hamaspik Choice Inc Medicare $55.40
Hospital Charge Code 40206049
Hospital Revenue Code 270
Min. Negotiated Rate $105.00
Max. Negotiated Rate $240.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $165.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $150.00
Rate for Payer: Aetna Government $150.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $240.00
Rate for Payer: Cigna LocalPlus Benefit Plan $204.00
Rate for Payer: Group Health Inc Commercial $150.00
Rate for Payer: Group Health Inc Medicare $105.00
Rate for Payer: Hamaspik Choice Inc Medicaid $150.00
Rate for Payer: Hamaspik Choice Inc Medicare $150.00
Hospital Charge Code 64907102
Hospital Revenue Code 270
Min. Negotiated Rate $12.46
Max. Negotiated Rate $28.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial $19.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $17.80
Rate for Payer: Aetna Government $17.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $28.48
Rate for Payer: Cigna LocalPlus Benefit Plan $24.21
Rate for Payer: Group Health Inc Commercial $17.80
Rate for Payer: Group Health Inc Medicare $12.46
Rate for Payer: Hamaspik Choice Inc Medicaid $17.80
Rate for Payer: Hamaspik Choice Inc Medicare $17.80