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Charge Type Price  
Hospital Charge Code 41569016
Hospital Revenue Code 270
Min. Negotiated Rate $2.08
Max. Negotiated Rate $4.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.98
Rate for Payer: Aetna Government $2.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $4.76
Rate for Payer: Cigna LocalPlus Benefit Plan $4.05
Rate for Payer: Group Health Inc Commercial $2.98
Rate for Payer: Group Health Inc Medicare $2.08
Rate for Payer: Hamaspik Choice Inc Medicaid $2.98
Rate for Payer: Hamaspik Choice Inc Medicare $2.98
Hospital Charge Code 41569533
Hospital Revenue Code 270
Min. Negotiated Rate $19.84
Max. Negotiated Rate $45.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial $31.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $28.35
Rate for Payer: Aetna Government $28.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $45.36
Rate for Payer: Cigna LocalPlus Benefit Plan $38.56
Rate for Payer: Group Health Inc Commercial $28.35
Rate for Payer: Group Health Inc Medicare $19.84
Rate for Payer: Hamaspik Choice Inc Medicaid $28.35
Rate for Payer: Hamaspik Choice Inc Medicare $28.35
Hospital Charge Code 41561896
Hospital Revenue Code 270
Min. Negotiated Rate $276.50
Max. Negotiated Rate $632.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $434.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $395.00
Rate for Payer: Aetna Government $395.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $632.00
Rate for Payer: Cigna LocalPlus Benefit Plan $537.20
Rate for Payer: Group Health Inc Commercial $395.00
Rate for Payer: Group Health Inc Medicare $276.50
Rate for Payer: Hamaspik Choice Inc Medicaid $395.00
Rate for Payer: Hamaspik Choice Inc Medicare $395.00
Hospital Charge Code 41569532
Hospital Revenue Code 270
Min. Negotiated Rate $223.26
Max. Negotiated Rate $510.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $350.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $318.94
Rate for Payer: Aetna Government $318.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $510.30
Rate for Payer: Cigna LocalPlus Benefit Plan $433.76
Rate for Payer: Group Health Inc Commercial $318.94
Rate for Payer: Group Health Inc Medicare $223.26
Rate for Payer: Hamaspik Choice Inc Medicaid $318.94
Rate for Payer: Hamaspik Choice Inc Medicare $318.94
Service Code HCPCS C1725
Hospital Charge Code 41569534
Hospital Revenue Code 278
Min. Negotiated Rate $19.84
Max. Negotiated Rate $59.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial $31.18
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 $28.35
Rate for Payer: Cigna LocalPlus Benefit Plan $32.60
Rate for Payer: Fidelis Medicare Advantage $59.54
Rate for Payer: Group Health Inc Commercial $28.35
Rate for Payer: Group Health Inc Medicare $19.84
Rate for Payer: Hamaspik Choice Inc Medicaid $28.35
Rate for Payer: Hamaspik Choice Inc Medicare $28.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $36.86
Service Code HCPCS C1725
Hospital Charge Code 41569534
Hospital Revenue Code 278
Min. Negotiated Rate $28.35
Max. Negotiated Rate $28.35
Rate for Payer: Hamaspik Choice Inc Medicaid $28.35
Rate for Payer: Hamaspik Choice Inc Medicare $28.35
Service Code HCPCS C1725
Hospital Charge Code 41567245
Hospital Revenue Code 278
Min. Negotiated Rate $26.94
Max. Negotiated Rate $26.94
Rate for Payer: Hamaspik Choice Inc Medicaid $26.94
Rate for Payer: Hamaspik Choice Inc Medicare $26.94
Service Code HCPCS C1725
Hospital Charge Code 41567245
Hospital Revenue Code 278
Min. Negotiated Rate $18.85
Max. Negotiated Rate $56.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial $29.63
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 $26.94
Rate for Payer: Cigna LocalPlus Benefit Plan $30.98
Rate for Payer: Fidelis Medicare Advantage $56.56
Rate for Payer: Group Health Inc Commercial $26.94
Rate for Payer: Group Health Inc Medicare $18.85
Rate for Payer: Hamaspik Choice Inc Medicaid $26.94
Rate for Payer: Hamaspik Choice Inc Medicare $26.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $35.02
Hospital Charge Code 41567015
Hospital Revenue Code 270
Min. Negotiated Rate $83.35
Max. Negotiated Rate $190.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial $130.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $119.07
Rate for Payer: Aetna Government $119.07
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $190.51
Rate for Payer: Cigna LocalPlus Benefit Plan $161.94
Rate for Payer: Group Health Inc Commercial $119.07
Rate for Payer: Group Health Inc Medicare $83.35
Rate for Payer: Hamaspik Choice Inc Medicaid $119.07
Rate for Payer: Hamaspik Choice Inc Medicare $119.07
Hospital Charge Code 41563213
Hospital Revenue Code 272
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 41561334
Hospital Revenue Code 272
Min. Negotiated Rate $735.00
Max. Negotiated Rate $1,680.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,155.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,050.00
Rate for Payer: Aetna Government $1,050.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,680.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,428.00
Rate for Payer: Group Health Inc Commercial $1,050.00
Rate for Payer: Group Health Inc Medicare $735.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,050.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,050.00
Hospital Charge Code 41569564
Hospital Revenue Code 270
Min. Negotiated Rate $38.77
Max. Negotiated Rate $88.62
Rate for Payer: 1199SEIU National Benefit Fund Commercial $60.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $55.39
Rate for Payer: Aetna Government $55.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $88.62
Rate for Payer: Cigna LocalPlus Benefit Plan $75.33
Rate for Payer: Group Health Inc Commercial $55.39
Rate for Payer: Group Health Inc Medicare $38.77
Rate for Payer: Hamaspik Choice Inc Medicaid $55.39
Rate for Payer: Hamaspik Choice Inc Medicare $55.39
Service Code HCPCS C1725
Hospital Charge Code 41567198
Hospital Revenue Code 278
Min. Negotiated Rate $44.85
Max. Negotiated Rate $236.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial $123.77
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 $112.52
Rate for Payer: Cigna LocalPlus Benefit Plan $129.39
Rate for Payer: Fidelis Medicare Advantage $236.28
Rate for Payer: Group Health Inc Commercial $112.52
Rate for Payer: Group Health Inc Medicare $78.76
Rate for Payer: Hamaspik Choice Inc Medicaid $112.52
Rate for Payer: Hamaspik Choice Inc Medicare $112.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $146.27
Service Code HCPCS C1725
Hospital Charge Code 41567198
Hospital Revenue Code 278
Min. Negotiated Rate $112.52
Max. Negotiated Rate $112.52
Rate for Payer: Hamaspik Choice Inc Medicaid $112.52
Rate for Payer: Hamaspik Choice Inc Medicare $112.52
Hospital Charge Code 41563133
Hospital Revenue Code 272
Min. Negotiated Rate $770.00
Max. Negotiated Rate $1,760.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,100.00
Rate for Payer: Aetna Government $1,100.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,760.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,496.00
Rate for Payer: Group Health Inc Commercial $1,100.00
Rate for Payer: Group Health Inc Medicare $770.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Service Code HCPCS C1769
Hospital Charge Code 41567121
Hospital Revenue Code 278
Min. Negotiated Rate $4.08
Max. Negotiated Rate $85.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial $44.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.08
Rate for Payer: Aetna Government $4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $40.76
Rate for Payer: Cigna LocalPlus Benefit Plan $46.87
Rate for Payer: Fidelis Medicare Advantage $85.59
Rate for Payer: Group Health Inc Commercial $40.76
Rate for Payer: Group Health Inc Medicare $28.53
Rate for Payer: Hamaspik Choice Inc Medicaid $40.76
Rate for Payer: Hamaspik Choice Inc Medicare $40.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $52.98
Service Code HCPCS C1769
Hospital Charge Code 41567121
Hospital Revenue Code 278
Min. Negotiated Rate $40.76
Max. Negotiated Rate $40.76
Rate for Payer: Hamaspik Choice Inc Medicaid $40.76
Rate for Payer: Hamaspik Choice Inc Medicare $40.76
Service Code HCPCS C1769
Hospital Charge Code 41567279
Hospital Revenue Code 278
Min. Negotiated Rate $774.31
Max. Negotiated Rate $774.31
Rate for Payer: Hamaspik Choice Inc Medicaid $774.31
Rate for Payer: Hamaspik Choice Inc Medicare $774.31
Service Code HCPCS C1769
Hospital Charge Code 41567279
Hospital Revenue Code 278
Min. Negotiated Rate $4.08
Max. Negotiated Rate $1,626.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial $851.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.08
Rate for Payer: Aetna Government $4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $774.31
Rate for Payer: Cigna LocalPlus Benefit Plan $890.46
Rate for Payer: Fidelis Medicare Advantage $1,626.05
Rate for Payer: Group Health Inc Commercial $774.31
Rate for Payer: Group Health Inc Medicare $542.02
Rate for Payer: Hamaspik Choice Inc Medicaid $774.31
Rate for Payer: Hamaspik Choice Inc Medicare $774.31
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,006.60
Service Code HCPCS C1769
Hospital Charge Code 41567278
Hospital Revenue Code 278
Min. Negotiated Rate $4.08
Max. Negotiated Rate $667.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial $349.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.08
Rate for Payer: Aetna Government $4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $317.88
Rate for Payer: Cigna LocalPlus Benefit Plan $365.56
Rate for Payer: Fidelis Medicare Advantage $667.54
Rate for Payer: Group Health Inc Commercial $317.88
Rate for Payer: Group Health Inc Medicare $222.51
Rate for Payer: Hamaspik Choice Inc Medicaid $317.88
Rate for Payer: Hamaspik Choice Inc Medicare $317.88
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $413.24
Service Code HCPCS C1769
Hospital Charge Code 41567278
Hospital Revenue Code 278
Min. Negotiated Rate $317.88
Max. Negotiated Rate $317.88
Rate for Payer: Hamaspik Choice Inc Medicaid $317.88
Rate for Payer: Hamaspik Choice Inc Medicare $317.88
Service Code HCPCS C1769
Hospital Charge Code 41567122
Hospital Revenue Code 278
Min. Negotiated Rate $40.76
Max. Negotiated Rate $40.76
Rate for Payer: Hamaspik Choice Inc Medicaid $40.76
Rate for Payer: Hamaspik Choice Inc Medicare $40.76
Service Code HCPCS C1769
Hospital Charge Code 41567122
Hospital Revenue Code 278
Min. Negotiated Rate $4.08
Max. Negotiated Rate $85.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial $44.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.08
Rate for Payer: Aetna Government $4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $40.76
Rate for Payer: Cigna LocalPlus Benefit Plan $46.87
Rate for Payer: Fidelis Medicare Advantage $85.59
Rate for Payer: Group Health Inc Commercial $40.76
Rate for Payer: Group Health Inc Medicare $28.53
Rate for Payer: Hamaspik Choice Inc Medicaid $40.76
Rate for Payer: Hamaspik Choice Inc Medicare $40.76
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $52.98
Service Code HCPCS C1769
Hospital Charge Code 41567123
Hospital Revenue Code 278
Min. Negotiated Rate $4.08
Max. Negotiated Rate $140.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial $73.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.08
Rate for Payer: Aetna Government $4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $66.80
Rate for Payer: Cigna LocalPlus Benefit Plan $76.82
Rate for Payer: Fidelis Medicare Advantage $140.28
Rate for Payer: Group Health Inc Commercial $66.80
Rate for Payer: Group Health Inc Medicare $46.76
Rate for Payer: Hamaspik Choice Inc Medicaid $66.80
Rate for Payer: Hamaspik Choice Inc Medicare $66.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $86.84
Service Code HCPCS C1769
Hospital Charge Code 41567123
Hospital Revenue Code 278
Min. Negotiated Rate $66.80
Max. Negotiated Rate $66.80
Rate for Payer: Hamaspik Choice Inc Medicaid $66.80
Rate for Payer: Hamaspik Choice Inc Medicare $66.80