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Charge Type Price  
Hospital Charge Code 41567246
Hospital Revenue Code 270
Min. Negotiated Rate $18.85
Max. Negotiated Rate $43.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $29.63
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $26.94
Rate for Payer: Aetna Government $26.94
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $43.10
Rate for Payer: Cigna LocalPlus Benefit Plan $36.63
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
Hospital Charge Code 41569002
Hospital Revenue Code 270
Min. Negotiated Rate $1.52
Max. Negotiated Rate $3.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.17
Rate for Payer: Aetna Government $2.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $3.47
Rate for Payer: Cigna LocalPlus Benefit Plan $2.95
Rate for Payer: Group Health Inc Commercial $2.17
Rate for Payer: Group Health Inc Medicare $1.52
Rate for Payer: Hamaspik Choice Inc Medicaid $2.17
Rate for Payer: Hamaspik Choice Inc Medicare $2.17
Hospital Charge Code 41569003
Hospital Revenue Code 270
Min. Negotiated Rate $1.52
Max. Negotiated Rate $3.47
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.17
Rate for Payer: Aetna Government $2.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $3.47
Rate for Payer: Cigna LocalPlus Benefit Plan $2.95
Rate for Payer: Group Health Inc Commercial $2.17
Rate for Payer: Group Health Inc Medicare $1.52
Rate for Payer: Hamaspik Choice Inc Medicaid $2.17
Rate for Payer: Hamaspik Choice Inc Medicare $2.17
Service Code HCPCS C1726
Hospital Charge Code 41567757
Hospital Revenue Code 278
Min. Negotiated Rate $17.43
Max. Negotiated Rate $58.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial $30.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $17.43
Rate for Payer: Aetna Government $17.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $27.94
Rate for Payer: Cigna LocalPlus Benefit Plan $32.13
Rate for Payer: Fidelis Medicare Advantage $58.67
Rate for Payer: Group Health Inc Commercial $27.94
Rate for Payer: Group Health Inc Medicare $19.56
Rate for Payer: Hamaspik Choice Inc Medicaid $27.94
Rate for Payer: Hamaspik Choice Inc Medicare $27.94
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $36.32
Service Code HCPCS C1726
Hospital Charge Code 41567757
Hospital Revenue Code 278
Min. Negotiated Rate $27.94
Max. Negotiated Rate $27.94
Rate for Payer: Hamaspik Choice Inc Medicaid $27.94
Rate for Payer: Hamaspik Choice Inc Medicare $27.94
Hospital Charge Code 41567242
Hospital Revenue Code 270
Min. Negotiated Rate $55.94
Max. Negotiated Rate $127.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial $87.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $79.91
Rate for Payer: Aetna Government $79.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $127.86
Rate for Payer: Cigna LocalPlus Benefit Plan $108.68
Rate for Payer: Group Health Inc Commercial $79.91
Rate for Payer: Group Health Inc Medicare $55.94
Rate for Payer: Hamaspik Choice Inc Medicaid $79.91
Rate for Payer: Hamaspik Choice Inc Medicare $79.91
Hospital Charge Code 41567239
Hospital Revenue Code 270
Min. Negotiated Rate $55.94
Max. Negotiated Rate $127.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial $87.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $79.91
Rate for Payer: Aetna Government $79.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $127.86
Rate for Payer: Cigna LocalPlus Benefit Plan $108.68
Rate for Payer: Group Health Inc Commercial $79.91
Rate for Payer: Group Health Inc Medicare $55.94
Rate for Payer: Hamaspik Choice Inc Medicaid $79.91
Rate for Payer: Hamaspik Choice Inc Medicare $79.91
Service Code HCPCS C1725
Hospital Charge Code 41567240
Hospital Revenue Code 278
Min. Negotiated Rate $79.91
Max. Negotiated Rate $79.91
Rate for Payer: Hamaspik Choice Inc Medicaid $79.91
Rate for Payer: Hamaspik Choice Inc Medicare $79.91
Service Code HCPCS C1725
Hospital Charge Code 41567240
Hospital Revenue Code 278
Min. Negotiated Rate $44.85
Max. Negotiated Rate $167.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial $87.90
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 $79.91
Rate for Payer: Cigna LocalPlus Benefit Plan $91.90
Rate for Payer: Fidelis Medicare Advantage $167.81
Rate for Payer: Group Health Inc Commercial $79.91
Rate for Payer: Group Health Inc Medicare $55.94
Rate for Payer: Hamaspik Choice Inc Medicaid $79.91
Rate for Payer: Hamaspik Choice Inc Medicare $79.91
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $103.88
Hospital Charge Code 41567241
Hospital Revenue Code 270
Min. Negotiated Rate $55.94
Max. Negotiated Rate $127.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial $87.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $79.91
Rate for Payer: Aetna Government $79.91
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $127.86
Rate for Payer: Cigna LocalPlus Benefit Plan $108.68
Rate for Payer: Group Health Inc Commercial $79.91
Rate for Payer: Group Health Inc Medicare $55.94
Rate for Payer: Hamaspik Choice Inc Medicaid $79.91
Rate for Payer: Hamaspik Choice Inc Medicare $79.91
Hospital Charge Code 41561895
Hospital Revenue Code 270
Min. Negotiated Rate $17.71
Max. Negotiated Rate $40.48
Rate for Payer: 1199SEIU National Benefit Fund Commercial $27.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $25.30
Rate for Payer: Aetna Government $25.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $40.48
Rate for Payer: Cigna LocalPlus Benefit Plan $34.41
Rate for Payer: Group Health Inc Commercial $25.30
Rate for Payer: Group Health Inc Medicare $17.71
Rate for Payer: Hamaspik Choice Inc Medicaid $25.30
Rate for Payer: Hamaspik Choice Inc Medicare $25.30
Service Code HCPCS C1725
Hospital Charge Code 41567247
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 41567247
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 41569515
Hospital Revenue Code 270
Min. Negotiated Rate $51.72
Max. Negotiated Rate $118.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial $81.28
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $73.89
Rate for Payer: Aetna Government $73.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $118.22
Rate for Payer: Cigna LocalPlus Benefit Plan $100.49
Rate for Payer: Group Health Inc Commercial $73.89
Rate for Payer: Group Health Inc Medicare $51.72
Rate for Payer: Hamaspik Choice Inc Medicaid $73.89
Rate for Payer: Hamaspik Choice Inc Medicare $73.89
Hospital Charge Code 41567500
Hospital Revenue Code 270
Min. Negotiated Rate $45.64
Max. Negotiated Rate $104.33
Rate for Payer: 1199SEIU National Benefit Fund Commercial $71.73
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $65.20
Rate for Payer: Aetna Government $65.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $104.33
Rate for Payer: Cigna LocalPlus Benefit Plan $88.68
Rate for Payer: Group Health Inc Commercial $65.20
Rate for Payer: Group Health Inc Medicare $45.64
Rate for Payer: Hamaspik Choice Inc Medicaid $65.20
Rate for Payer: Hamaspik Choice Inc Medicare $65.20
Service Code HCPCS C1725
Hospital Charge Code 41569517
Hospital Revenue Code 278
Min. Negotiated Rate $313.62
Max. Negotiated Rate $313.62
Rate for Payer: Hamaspik Choice Inc Medicaid $313.62
Rate for Payer: Hamaspik Choice Inc Medicare $313.62
Service Code HCPCS C1725
Hospital Charge Code 41569517
Hospital Revenue Code 278
Min. Negotiated Rate $44.85
Max. Negotiated Rate $658.61
Rate for Payer: 1199SEIU National Benefit Fund Commercial $344.99
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 $313.62
Rate for Payer: Cigna LocalPlus Benefit Plan $360.67
Rate for Payer: Fidelis Medicare Advantage $658.61
Rate for Payer: Group Health Inc Commercial $313.62
Rate for Payer: Group Health Inc Medicare $219.54
Rate for Payer: Hamaspik Choice Inc Medicaid $313.62
Rate for Payer: Hamaspik Choice Inc Medicare $313.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $407.71
Hospital Charge Code 41569962
Hospital Revenue Code 279
Min. Negotiated Rate $277.90
Max. Negotiated Rate $635.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $436.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $397.00
Rate for Payer: Aetna Government $397.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $635.20
Rate for Payer: Cigna LocalPlus Benefit Plan $539.92
Rate for Payer: Group Health Inc Commercial $397.00
Rate for Payer: Group Health Inc Medicare $277.90
Rate for Payer: Hamaspik Choice Inc Medicaid $397.00
Rate for Payer: Hamaspik Choice Inc Medicare $397.00
Service Code HCPCS C1876
Hospital Charge Code 41560055
Hospital Revenue Code 278
Min. Negotiated Rate $1,701.00
Max. Negotiated Rate $1,701.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,701.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,701.00
Service Code HCPCS C1876
Hospital Charge Code 41560055
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $3,572.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,871.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,701.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,956.15
Rate for Payer: Fidelis Medicare Advantage $3,572.10
Rate for Payer: Group Health Inc Commercial $1,701.00
Rate for Payer: Group Health Inc Medicare $1,190.70
Rate for Payer: Hamaspik Choice Inc Medicaid $1,701.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,701.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,211.30
Service Code HCPCS C1876
Hospital Charge Code 41569660
Hospital Revenue Code 278
Min. Negotiated Rate $1,701.00
Max. Negotiated Rate $1,701.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,701.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,701.00
Service Code HCPCS C1876
Hospital Charge Code 41569660
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $3,572.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,871.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,701.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,956.15
Rate for Payer: Fidelis Medicare Advantage $3,572.10
Rate for Payer: Group Health Inc Commercial $1,701.00
Rate for Payer: Group Health Inc Medicare $1,190.70
Rate for Payer: Hamaspik Choice Inc Medicaid $1,701.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,701.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,211.30
Service Code HCPCS C1876
Hospital Charge Code 41569658
Hospital Revenue Code 278
Min. Negotiated Rate $1,701.00
Max. Negotiated Rate $1,701.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,701.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,701.00
Service Code HCPCS C1876
Hospital Charge Code 41569658
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $3,572.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,871.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,701.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,956.15
Rate for Payer: Fidelis Medicare Advantage $3,572.10
Rate for Payer: Group Health Inc Commercial $1,701.00
Rate for Payer: Group Health Inc Medicare $1,190.70
Rate for Payer: Hamaspik Choice Inc Medicaid $1,701.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,701.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,211.30
Service Code HCPCS C1876
Hospital Charge Code 41569661
Hospital Revenue Code 278
Min. Negotiated Rate $1,701.00
Max. Negotiated Rate $1,701.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,701.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,701.00