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Charge Type Price  
Hospital Charge Code 40207739
Hospital Revenue Code 270
Min. Negotiated Rate $1,091.30
Max. Negotiated Rate $2,494.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,714.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,559.00
Rate for Payer: Aetna Government $1,559.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,494.40
Rate for Payer: Cigna LocalPlus Benefit Plan $2,120.24
Rate for Payer: Group Health Inc Commercial $1,559.00
Rate for Payer: Group Health Inc Medicare $1,091.30
Rate for Payer: Hamaspik Choice Inc Medicaid $1,559.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,559.00
Hospital Charge Code 41567740
Hospital Revenue Code 270
Min. Negotiated Rate $1,091.30
Max. Negotiated Rate $2,494.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,714.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,559.00
Rate for Payer: Aetna Government $1,559.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,494.40
Rate for Payer: Cigna LocalPlus Benefit Plan $2,120.24
Rate for Payer: Group Health Inc Commercial $1,559.00
Rate for Payer: Group Health Inc Medicare $1,091.30
Rate for Payer: Hamaspik Choice Inc Medicaid $1,559.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,559.00
Service Code HCPCS C1880
Hospital Charge Code 41569802
Hospital Revenue Code 278
Min. Negotiated Rate $1,562.08
Max. Negotiated Rate $1,562.08
Rate for Payer: Hamaspik Choice Inc Medicaid $1,562.08
Rate for Payer: Hamaspik Choice Inc Medicare $1,562.08
Service Code HCPCS C1880
Hospital Charge Code 41569802
Hospital Revenue Code 278
Min. Negotiated Rate $57.08
Max. Negotiated Rate $3,280.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,718.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $57.08
Rate for Payer: Aetna Government $57.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,562.08
Rate for Payer: Cigna LocalPlus Benefit Plan $1,796.40
Rate for Payer: Fidelis Medicare Advantage $3,280.38
Rate for Payer: Group Health Inc Commercial $1,562.08
Rate for Payer: Group Health Inc Medicare $1,093.46
Rate for Payer: Hamaspik Choice Inc Medicaid $1,562.08
Rate for Payer: Hamaspik Choice Inc Medicare $1,562.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,030.71
Service Code HCPCS C1880
Hospital Charge Code 41569803
Hospital Revenue Code 278
Min. Negotiated Rate $57.08
Max. Negotiated Rate $3,280.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,718.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $57.08
Rate for Payer: Aetna Government $57.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,562.08
Rate for Payer: Cigna LocalPlus Benefit Plan $1,796.40
Rate for Payer: Fidelis Medicare Advantage $3,280.38
Rate for Payer: Group Health Inc Commercial $1,562.08
Rate for Payer: Group Health Inc Medicare $1,093.46
Rate for Payer: Hamaspik Choice Inc Medicaid $1,562.08
Rate for Payer: Hamaspik Choice Inc Medicare $1,562.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,030.71
Service Code HCPCS C1880
Hospital Charge Code 41569803
Hospital Revenue Code 278
Min. Negotiated Rate $1,562.08
Max. Negotiated Rate $1,562.08
Rate for Payer: Hamaspik Choice Inc Medicaid $1,562.08
Rate for Payer: Hamaspik Choice Inc Medicare $1,562.08
Hospital Charge Code 41569035
Hospital Revenue Code 270
Min. Negotiated Rate $34.38
Max. Negotiated Rate $78.59
Rate for Payer: 1199SEIU National Benefit Fund Commercial $54.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $49.12
Rate for Payer: Aetna Government $49.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $78.59
Rate for Payer: Cigna LocalPlus Benefit Plan $66.80
Rate for Payer: Group Health Inc Commercial $49.12
Rate for Payer: Group Health Inc Medicare $34.38
Rate for Payer: Hamaspik Choice Inc Medicaid $49.12
Rate for Payer: Hamaspik Choice Inc Medicare $49.12
Hospital Charge Code 41569536
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 41569535
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
Hospital Charge Code 41569537
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 41567231
Hospital Revenue Code 270
Min. Negotiated Rate $90.17
Max. Negotiated Rate $206.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $141.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $128.82
Rate for Payer: Aetna Government $128.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $206.10
Rate for Payer: Cigna LocalPlus Benefit Plan $175.19
Rate for Payer: Group Health Inc Commercial $128.82
Rate for Payer: Group Health Inc Medicare $90.17
Rate for Payer: Hamaspik Choice Inc Medicaid $128.82
Rate for Payer: Hamaspik Choice Inc Medicare $128.82
Hospital Charge Code 41567232
Hospital Revenue Code 270
Min. Negotiated Rate $90.17
Max. Negotiated Rate $206.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $141.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $128.82
Rate for Payer: Aetna Government $128.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $206.10
Rate for Payer: Cigna LocalPlus Benefit Plan $175.19
Rate for Payer: Group Health Inc Commercial $128.82
Rate for Payer: Group Health Inc Medicare $90.17
Rate for Payer: Hamaspik Choice Inc Medicaid $128.82
Rate for Payer: Hamaspik Choice Inc Medicare $128.82
Hospital Charge Code 41567105
Hospital Revenue Code 270
Min. Negotiated Rate $13.27
Max. Negotiated Rate $30.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial $20.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $18.96
Rate for Payer: Aetna Government $18.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $30.34
Rate for Payer: Cigna LocalPlus Benefit Plan $25.79
Rate for Payer: Group Health Inc Commercial $18.96
Rate for Payer: Group Health Inc Medicare $13.27
Rate for Payer: Hamaspik Choice Inc Medicaid $18.96
Rate for Payer: Hamaspik Choice Inc Medicare $18.96
Hospital Charge Code 41567104
Hospital Revenue Code 270
Min. Negotiated Rate $13.27
Max. Negotiated Rate $30.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial $20.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $18.96
Rate for Payer: Aetna Government $18.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $30.34
Rate for Payer: Cigna LocalPlus Benefit Plan $25.79
Rate for Payer: Group Health Inc Commercial $18.96
Rate for Payer: Group Health Inc Medicare $13.27
Rate for Payer: Hamaspik Choice Inc Medicaid $18.96
Rate for Payer: Hamaspik Choice Inc Medicare $18.96
Hospital Charge Code 41567106
Hospital Revenue Code 270
Min. Negotiated Rate $13.27
Max. Negotiated Rate $30.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial $20.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $18.96
Rate for Payer: Aetna Government $18.96
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $30.34
Rate for Payer: Cigna LocalPlus Benefit Plan $25.79
Rate for Payer: Group Health Inc Commercial $18.96
Rate for Payer: Group Health Inc Medicare $13.27
Rate for Payer: Hamaspik Choice Inc Medicaid $18.96
Rate for Payer: Hamaspik Choice Inc Medicare $18.96
Hospital Charge Code 41567103
Hospital Revenue Code 270
Min. Negotiated Rate $10.79
Max. Negotiated Rate $24.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial $16.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $15.42
Rate for Payer: Aetna Government $15.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $24.66
Rate for Payer: Cigna LocalPlus Benefit Plan $20.96
Rate for Payer: Group Health Inc Commercial $15.42
Rate for Payer: Group Health Inc Medicare $10.79
Rate for Payer: Hamaspik Choice Inc Medicaid $15.42
Rate for Payer: Hamaspik Choice Inc Medicare $15.42
Hospital Charge Code 41567255
Hospital Revenue Code 270
Min. Negotiated Rate $26.30
Max. Negotiated Rate $60.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $41.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $37.56
Rate for Payer: Aetna Government $37.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $60.10
Rate for Payer: Cigna LocalPlus Benefit Plan $51.09
Rate for Payer: Group Health Inc Commercial $37.56
Rate for Payer: Group Health Inc Medicare $26.30
Rate for Payer: Hamaspik Choice Inc Medicaid $37.56
Rate for Payer: Hamaspik Choice Inc Medicare $37.56
Hospital Charge Code 41567252
Hospital Revenue Code 270
Min. Negotiated Rate $199.69
Max. Negotiated Rate $456.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial $313.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $285.28
Rate for Payer: Aetna Government $285.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $456.44
Rate for Payer: Cigna LocalPlus Benefit Plan $387.97
Rate for Payer: Group Health Inc Commercial $285.28
Rate for Payer: Group Health Inc Medicare $199.69
Rate for Payer: Hamaspik Choice Inc Medicaid $285.28
Rate for Payer: Hamaspik Choice Inc Medicare $285.28
Hospital Charge Code 41567253
Hospital Revenue Code 270
Min. Negotiated Rate $199.69
Max. Negotiated Rate $456.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial $313.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $285.28
Rate for Payer: Aetna Government $285.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $456.44
Rate for Payer: Cigna LocalPlus Benefit Plan $387.97
Rate for Payer: Group Health Inc Commercial $285.28
Rate for Payer: Group Health Inc Medicare $199.69
Rate for Payer: Hamaspik Choice Inc Medicaid $285.28
Rate for Payer: Hamaspik Choice Inc Medicare $285.28
Hospital Charge Code 41567254
Hospital Revenue Code 270
Min. Negotiated Rate $199.69
Max. Negotiated Rate $456.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial $313.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $285.28
Rate for Payer: Aetna Government $285.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $456.44
Rate for Payer: Cigna LocalPlus Benefit Plan $387.97
Rate for Payer: Group Health Inc Commercial $285.28
Rate for Payer: Group Health Inc Medicare $199.69
Rate for Payer: Hamaspik Choice Inc Medicaid $285.28
Rate for Payer: Hamaspik Choice Inc Medicare $285.28
Hospital Charge Code 41561900
Hospital Revenue Code 270
Min. Negotiated Rate $23.20
Max. Negotiated Rate $53.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial $36.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $33.14
Rate for Payer: Aetna Government $33.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $53.02
Rate for Payer: Cigna LocalPlus Benefit Plan $45.07
Rate for Payer: Group Health Inc Commercial $33.14
Rate for Payer: Group Health Inc Medicare $23.20
Rate for Payer: Hamaspik Choice Inc Medicaid $33.14
Rate for Payer: Hamaspik Choice Inc Medicare $33.14
Hospital Charge Code 30301900
Hospital Revenue Code 270
Min. Negotiated Rate $23.20
Max. Negotiated Rate $53.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial $36.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $33.14
Rate for Payer: Aetna Government $33.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $53.02
Rate for Payer: Cigna LocalPlus Benefit Plan $45.07
Rate for Payer: Group Health Inc Commercial $33.14
Rate for Payer: Group Health Inc Medicare $23.20
Rate for Payer: Hamaspik Choice Inc Medicaid $33.14
Rate for Payer: Hamaspik Choice Inc Medicare $33.14
Hospital Charge Code 41561901
Hospital Revenue Code 270
Min. Negotiated Rate $23.20
Max. Negotiated Rate $53.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial $36.45
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $33.14
Rate for Payer: Aetna Government $33.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $53.02
Rate for Payer: Cigna LocalPlus Benefit Plan $45.07
Rate for Payer: Group Health Inc Commercial $33.14
Rate for Payer: Group Health Inc Medicare $23.20
Rate for Payer: Hamaspik Choice Inc Medicaid $33.14
Rate for Payer: Hamaspik Choice Inc Medicare $33.14
Hospital Charge Code 41568091
Hospital Revenue Code 270
Min. Negotiated Rate $65.62
Max. Negotiated Rate $150.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $103.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $93.75
Rate for Payer: Aetna Government $93.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $150.00
Rate for Payer: Cigna LocalPlus Benefit Plan $127.50
Rate for Payer: Group Health Inc Commercial $93.75
Rate for Payer: Group Health Inc Medicare $65.62
Rate for Payer: Hamaspik Choice Inc Medicaid $93.75
Rate for Payer: Hamaspik Choice Inc Medicare $93.75
Hospital Charge Code 41568092
Hospital Revenue Code 270
Min. Negotiated Rate $139.12
Max. Negotiated Rate $318.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $218.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $198.75
Rate for Payer: Aetna Government $198.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $318.00
Rate for Payer: Cigna LocalPlus Benefit Plan $270.30
Rate for Payer: Group Health Inc Commercial $198.75
Rate for Payer: Group Health Inc Medicare $139.12
Rate for Payer: Hamaspik Choice Inc Medicaid $198.75
Rate for Payer: Hamaspik Choice Inc Medicare $198.75