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Charge Type Price  
Hospital Charge Code 41567290
Hospital Revenue Code 270
Min. Negotiated Rate $222.51
Max. Negotiated Rate $508.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $349.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $317.88
Rate for Payer: Aetna Government $317.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $508.60
Rate for Payer: Cigna LocalPlus Benefit Plan $432.31
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
Hospital Charge Code 41567196
Hospital Revenue Code 270
Min. Negotiated Rate $901.46
Max. Negotiated Rate $2,060.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,416.58
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,287.80
Rate for Payer: Aetna Government $1,287.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,060.48
Rate for Payer: Cigna LocalPlus Benefit Plan $1,751.41
Rate for Payer: Group Health Inc Commercial $1,287.80
Rate for Payer: Group Health Inc Medicare $901.46
Rate for Payer: Hamaspik Choice Inc Medicaid $1,287.80
Rate for Payer: Hamaspik Choice Inc Medicare $1,287.80
Hospital Charge Code 41569818
Hospital Revenue Code 270
Min. Negotiated Rate $67.47
Max. Negotiated Rate $154.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial $106.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $96.39
Rate for Payer: Aetna Government $96.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $154.22
Rate for Payer: Cigna LocalPlus Benefit Plan $131.09
Rate for Payer: Group Health Inc Commercial $96.39
Rate for Payer: Group Health Inc Medicare $67.47
Rate for Payer: Hamaspik Choice Inc Medicaid $96.39
Rate for Payer: Hamaspik Choice Inc Medicare $96.39
Hospital Charge Code 41567512
Hospital Revenue Code 270
Min. Negotiated Rate $268.16
Max. Negotiated Rate $612.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial $421.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $383.08
Rate for Payer: Aetna Government $383.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $612.93
Rate for Payer: Cigna LocalPlus Benefit Plan $520.99
Rate for Payer: Group Health Inc Commercial $383.08
Rate for Payer: Group Health Inc Medicare $268.16
Rate for Payer: Hamaspik Choice Inc Medicaid $383.08
Rate for Payer: Hamaspik Choice Inc Medicare $383.08
Service Code HCPCS C1894
Hospital Charge Code 41567016
Hospital Revenue Code 278
Min. Negotiated Rate $0.82
Max. Negotiated Rate $106.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial $55.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.82
Rate for Payer: Aetna Government $0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $50.50
Rate for Payer: Cigna LocalPlus Benefit Plan $58.08
Rate for Payer: Fidelis Medicare Advantage $106.05
Rate for Payer: Group Health Inc Commercial $50.50
Rate for Payer: Group Health Inc Medicare $35.35
Rate for Payer: Hamaspik Choice Inc Medicaid $50.50
Rate for Payer: Hamaspik Choice Inc Medicare $50.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $65.65
Service Code HCPCS C1894
Hospital Charge Code 41567016
Hospital Revenue Code 278
Min. Negotiated Rate $50.50
Max. Negotiated Rate $50.50
Rate for Payer: Hamaspik Choice Inc Medicaid $50.50
Rate for Payer: Hamaspik Choice Inc Medicare $50.50
Service Code HCPCS C1894
Hospital Charge Code 41567018
Hospital Revenue Code 278
Min. Negotiated Rate $0.82
Max. Negotiated Rate $106.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial $55.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.82
Rate for Payer: Aetna Government $0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $50.50
Rate for Payer: Cigna LocalPlus Benefit Plan $58.08
Rate for Payer: Fidelis Medicare Advantage $106.05
Rate for Payer: Group Health Inc Commercial $50.50
Rate for Payer: Group Health Inc Medicare $35.35
Rate for Payer: Hamaspik Choice Inc Medicaid $50.50
Rate for Payer: Hamaspik Choice Inc Medicare $50.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $65.65
Service Code HCPCS C1894
Hospital Charge Code 41567018
Hospital Revenue Code 278
Min. Negotiated Rate $50.50
Max. Negotiated Rate $50.50
Rate for Payer: Hamaspik Choice Inc Medicaid $50.50
Rate for Payer: Hamaspik Choice Inc Medicare $50.50
Service Code HCPCS C1894
Hospital Charge Code 41567019
Hospital Revenue Code 278
Min. Negotiated Rate $50.50
Max. Negotiated Rate $50.50
Rate for Payer: Hamaspik Choice Inc Medicaid $50.50
Rate for Payer: Hamaspik Choice Inc Medicare $50.50
Service Code HCPCS C1894
Hospital Charge Code 41567019
Hospital Revenue Code 278
Min. Negotiated Rate $0.82
Max. Negotiated Rate $106.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial $55.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.82
Rate for Payer: Aetna Government $0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $50.50
Rate for Payer: Cigna LocalPlus Benefit Plan $58.08
Rate for Payer: Fidelis Medicare Advantage $106.05
Rate for Payer: Group Health Inc Commercial $50.50
Rate for Payer: Group Health Inc Medicare $35.35
Rate for Payer: Hamaspik Choice Inc Medicaid $50.50
Rate for Payer: Hamaspik Choice Inc Medicare $50.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $65.65
Service Code HCPCS C1894
Hospital Charge Code 41567017
Hospital Revenue Code 278
Min. Negotiated Rate $50.50
Max. Negotiated Rate $50.50
Rate for Payer: Hamaspik Choice Inc Medicaid $50.50
Rate for Payer: Hamaspik Choice Inc Medicare $50.50
Service Code HCPCS C1894
Hospital Charge Code 41567017
Hospital Revenue Code 278
Min. Negotiated Rate $0.82
Max. Negotiated Rate $106.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial $55.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.82
Rate for Payer: Aetna Government $0.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $50.50
Rate for Payer: Cigna LocalPlus Benefit Plan $58.08
Rate for Payer: Fidelis Medicare Advantage $106.05
Rate for Payer: Group Health Inc Commercial $50.50
Rate for Payer: Group Health Inc Medicare $35.35
Rate for Payer: Hamaspik Choice Inc Medicaid $50.50
Rate for Payer: Hamaspik Choice Inc Medicare $50.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $65.65
Service Code HCPCS C1725
Hospital Charge Code 41567755
Hospital Revenue Code 278
Min. Negotiated Rate $185.00
Max. Negotiated Rate $185.00
Rate for Payer: Hamaspik Choice Inc Medicaid $185.00
Rate for Payer: Hamaspik Choice Inc Medicare $185.00
Service Code HCPCS C1725
Hospital Charge Code 41567755
Hospital Revenue Code 278
Min. Negotiated Rate $44.85
Max. Negotiated Rate $388.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $203.50
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 $185.00
Rate for Payer: Cigna LocalPlus Benefit Plan $212.75
Rate for Payer: Fidelis Medicare Advantage $388.50
Rate for Payer: Group Health Inc Commercial $185.00
Rate for Payer: Group Health Inc Medicare $129.50
Rate for Payer: Hamaspik Choice Inc Medicaid $185.00
Rate for Payer: Hamaspik Choice Inc Medicare $185.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $240.50
Hospital Charge Code 41569133
Hospital Revenue Code 270
Min. Negotiated Rate $189.77
Max. Negotiated Rate $433.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial $298.21
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $271.10
Rate for Payer: Aetna Government $271.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $433.76
Rate for Payer: Cigna LocalPlus Benefit Plan $368.70
Rate for Payer: Group Health Inc Commercial $271.10
Rate for Payer: Group Health Inc Medicare $189.77
Rate for Payer: Hamaspik Choice Inc Medicaid $271.10
Rate for Payer: Hamaspik Choice Inc Medicare $271.10
Service Code HCPCS C1725
Hospital Charge Code 41569134
Hospital Revenue Code 278
Min. Negotiated Rate $44.85
Max. Negotiated Rate $569.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial $298.21
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 $271.10
Rate for Payer: Cigna LocalPlus Benefit Plan $311.76
Rate for Payer: Fidelis Medicare Advantage $569.31
Rate for Payer: Group Health Inc Commercial $271.10
Rate for Payer: Group Health Inc Medicare $189.77
Rate for Payer: Hamaspik Choice Inc Medicaid $271.10
Rate for Payer: Hamaspik Choice Inc Medicare $271.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $352.43
Service Code HCPCS C1725
Hospital Charge Code 41569134
Hospital Revenue Code 278
Min. Negotiated Rate $271.10
Max. Negotiated Rate $271.10
Rate for Payer: Hamaspik Choice Inc Medicaid $271.10
Rate for Payer: Hamaspik Choice Inc Medicare $271.10
Service Code HCPCS C1725
Hospital Charge Code 41569135
Hospital Revenue Code 278
Min. Negotiated Rate $271.10
Max. Negotiated Rate $271.10
Rate for Payer: Hamaspik Choice Inc Medicaid $271.10
Rate for Payer: Hamaspik Choice Inc Medicare $271.10
Service Code HCPCS C1725
Hospital Charge Code 41569135
Hospital Revenue Code 278
Min. Negotiated Rate $44.85
Max. Negotiated Rate $569.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial $298.21
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 $271.10
Rate for Payer: Cigna LocalPlus Benefit Plan $311.76
Rate for Payer: Fidelis Medicare Advantage $569.31
Rate for Payer: Group Health Inc Commercial $271.10
Rate for Payer: Group Health Inc Medicare $189.77
Rate for Payer: Hamaspik Choice Inc Medicaid $271.10
Rate for Payer: Hamaspik Choice Inc Medicare $271.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $352.43
Service Code HCPCS C1725
Hospital Charge Code 41569136
Hospital Revenue Code 278
Min. Negotiated Rate $44.85
Max. Negotiated Rate $569.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial $298.21
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 $271.10
Rate for Payer: Cigna LocalPlus Benefit Plan $311.76
Rate for Payer: Fidelis Medicare Advantage $569.31
Rate for Payer: Group Health Inc Commercial $271.10
Rate for Payer: Group Health Inc Medicare $189.77
Rate for Payer: Hamaspik Choice Inc Medicaid $271.10
Rate for Payer: Hamaspik Choice Inc Medicare $271.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $352.43
Service Code HCPCS C1725
Hospital Charge Code 41569136
Hospital Revenue Code 278
Min. Negotiated Rate $271.10
Max. Negotiated Rate $271.10
Rate for Payer: Hamaspik Choice Inc Medicaid $271.10
Rate for Payer: Hamaspik Choice Inc Medicare $271.10
Service Code HCPCS C1725
Hospital Charge Code 41569137
Hospital Revenue Code 278
Min. Negotiated Rate $44.85
Max. Negotiated Rate $569.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial $298.21
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 $271.10
Rate for Payer: Cigna LocalPlus Benefit Plan $311.76
Rate for Payer: Fidelis Medicare Advantage $569.31
Rate for Payer: Group Health Inc Commercial $271.10
Rate for Payer: Group Health Inc Medicare $189.77
Rate for Payer: Hamaspik Choice Inc Medicaid $271.10
Rate for Payer: Hamaspik Choice Inc Medicare $271.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $352.43
Service Code HCPCS C1725
Hospital Charge Code 41569137
Hospital Revenue Code 278
Min. Negotiated Rate $271.10
Max. Negotiated Rate $271.10
Rate for Payer: Hamaspik Choice Inc Medicaid $271.10
Rate for Payer: Hamaspik Choice Inc Medicare $271.10
Service Code HCPCS C1725
Hospital Charge Code 41569138
Hospital Revenue Code 278
Min. Negotiated Rate $44.85
Max. Negotiated Rate $578.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial $302.88
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 $275.35
Rate for Payer: Cigna LocalPlus Benefit Plan $316.65
Rate for Payer: Fidelis Medicare Advantage $578.24
Rate for Payer: Group Health Inc Commercial $275.35
Rate for Payer: Group Health Inc Medicare $192.74
Rate for Payer: Hamaspik Choice Inc Medicaid $275.35
Rate for Payer: Hamaspik Choice Inc Medicare $275.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $357.96
Service Code HCPCS C1725
Hospital Charge Code 41569138
Hospital Revenue Code 278
Min. Negotiated Rate $275.35
Max. Negotiated Rate $275.35
Rate for Payer: Hamaspik Choice Inc Medicaid $275.35
Rate for Payer: Hamaspik Choice Inc Medicare $275.35