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Charge Type Price  
Hospital Charge Code 41567536
Hospital Revenue Code 270
Min. Negotiated Rate $69.46
Max. Negotiated Rate $158.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial $109.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $99.22
Rate for Payer: Aetna Government $99.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $158.76
Rate for Payer: Cigna LocalPlus Benefit Plan $134.95
Rate for Payer: Group Health Inc Commercial $99.22
Rate for Payer: Group Health Inc Medicare $69.46
Rate for Payer: Hamaspik Choice Inc Medicaid $99.22
Rate for Payer: Hamaspik Choice Inc Medicare $99.22
Hospital Charge Code 41567534
Hospital Revenue Code 270
Min. Negotiated Rate $10.92
Max. Negotiated Rate $24.95
Rate for Payer: 1199SEIU National Benefit Fund Commercial $17.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $15.60
Rate for Payer: Aetna Government $15.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $24.95
Rate for Payer: Cigna LocalPlus Benefit Plan $21.21
Rate for Payer: Group Health Inc Commercial $15.60
Rate for Payer: Group Health Inc Medicare $10.92
Rate for Payer: Hamaspik Choice Inc Medicaid $15.60
Rate for Payer: Hamaspik Choice Inc Medicare $15.60
Hospital Charge Code 41568744
Hospital Revenue Code 270
Min. Negotiated Rate $1,176.00
Max. Negotiated Rate $2,688.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,848.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,680.00
Rate for Payer: Aetna Government $1,680.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,688.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,284.80
Rate for Payer: Group Health Inc Commercial $1,680.00
Rate for Payer: Group Health Inc Medicare $1,176.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,680.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,680.00
Hospital Charge Code 41567325
Hospital Revenue Code 270
Min. Negotiated Rate $280.31
Max. Negotiated Rate $640.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial $440.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $400.44
Rate for Payer: Aetna Government $400.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $640.71
Rate for Payer: Cigna LocalPlus Benefit Plan $544.61
Rate for Payer: Group Health Inc Commercial $400.44
Rate for Payer: Group Health Inc Medicare $280.31
Rate for Payer: Hamaspik Choice Inc Medicaid $400.44
Rate for Payer: Hamaspik Choice Inc Medicare $400.44
Service Code HCPCS C1769
Hospital Charge Code 41567747
Hospital Revenue Code 278
Min. Negotiated Rate $4.08
Max. Negotiated Rate $289.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial $151.52
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 $137.75
Rate for Payer: Cigna LocalPlus Benefit Plan $158.41
Rate for Payer: Fidelis Medicare Advantage $289.28
Rate for Payer: Group Health Inc Commercial $137.75
Rate for Payer: Group Health Inc Medicare $96.42
Rate for Payer: Hamaspik Choice Inc Medicaid $137.75
Rate for Payer: Hamaspik Choice Inc Medicare $137.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $179.08
Service Code HCPCS C1769
Hospital Charge Code 41567747
Hospital Revenue Code 278
Min. Negotiated Rate $137.75
Max. Negotiated Rate $137.75
Rate for Payer: Hamaspik Choice Inc Medicaid $137.75
Rate for Payer: Hamaspik Choice Inc Medicare $137.75
Hospital Charge Code 41567001
Hospital Revenue Code 270
Min. Negotiated Rate $47.75
Max. Negotiated Rate $109.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial $75.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $68.22
Rate for Payer: Aetna Government $68.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $109.15
Rate for Payer: Cigna LocalPlus Benefit Plan $92.78
Rate for Payer: Group Health Inc Commercial $68.22
Rate for Payer: Group Health Inc Medicare $47.75
Rate for Payer: Hamaspik Choice Inc Medicaid $68.22
Rate for Payer: Hamaspik Choice Inc Medicare $68.22
Hospital Charge Code 41561803
Hospital Revenue Code 270
Min. Negotiated Rate $116.76
Max. Negotiated Rate $266.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial $183.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $166.80
Rate for Payer: Aetna Government $166.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $266.88
Rate for Payer: Cigna LocalPlus Benefit Plan $226.85
Rate for Payer: Group Health Inc Commercial $166.80
Rate for Payer: Group Health Inc Medicare $116.76
Rate for Payer: Hamaspik Choice Inc Medicaid $166.80
Rate for Payer: Hamaspik Choice Inc Medicare $166.80
Hospital Charge Code 41567305
Hospital Revenue Code 270
Min. Negotiated Rate $25.55
Max. Negotiated Rate $58.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial $40.16
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $36.50
Rate for Payer: Aetna Government $36.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $58.41
Rate for Payer: Cigna LocalPlus Benefit Plan $49.65
Rate for Payer: Group Health Inc Commercial $36.50
Rate for Payer: Group Health Inc Medicare $25.55
Rate for Payer: Hamaspik Choice Inc Medicaid $36.50
Rate for Payer: Hamaspik Choice Inc Medicare $36.50
Hospital Charge Code 41569638
Hospital Revenue Code 270
Min. Negotiated Rate $3.97
Max. Negotiated Rate $9.07
Rate for Payer: 1199SEIU National Benefit Fund Commercial $6.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $5.67
Rate for Payer: Aetna Government $5.67
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $9.07
Rate for Payer: Cigna LocalPlus Benefit Plan $7.71
Rate for Payer: Group Health Inc Commercial $5.67
Rate for Payer: Group Health Inc Medicare $3.97
Rate for Payer: Hamaspik Choice Inc Medicaid $5.67
Rate for Payer: Hamaspik Choice Inc Medicare $5.67
Hospital Charge Code 41567571
Hospital Revenue Code 270
Min. Negotiated Rate $51.58
Max. Negotiated Rate $117.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial $81.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $73.69
Rate for Payer: Aetna Government $73.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $117.90
Rate for Payer: Cigna LocalPlus Benefit Plan $100.22
Rate for Payer: Group Health Inc Commercial $73.69
Rate for Payer: Group Health Inc Medicare $51.58
Rate for Payer: Hamaspik Choice Inc Medicaid $73.69
Rate for Payer: Hamaspik Choice Inc Medicare $73.69
Hospital Charge Code 41569958
Hospital Revenue Code 279
Min. Negotiated Rate $8.40
Max. Negotiated Rate $19.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $13.20
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $12.00
Rate for Payer: Aetna Government $12.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $19.20
Rate for Payer: Cigna LocalPlus Benefit Plan $16.32
Rate for Payer: Group Health Inc Commercial $12.00
Rate for Payer: Group Health Inc Medicare $8.40
Rate for Payer: Hamaspik Choice Inc Medicaid $12.00
Rate for Payer: Hamaspik Choice Inc Medicare $12.00
Hospital Charge Code 41568856
Hospital Revenue Code 270
Min. Negotiated Rate $52.50
Max. Negotiated Rate $120.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $82.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $75.00
Rate for Payer: Aetna Government $75.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $120.00
Rate for Payer: Cigna LocalPlus Benefit Plan $102.00
Rate for Payer: Group Health Inc Commercial $75.00
Rate for Payer: Group Health Inc Medicare $52.50
Rate for Payer: Hamaspik Choice Inc Medicaid $75.00
Rate for Payer: Hamaspik Choice Inc Medicare $75.00
Hospital Charge Code 41568853
Hospital Revenue Code 272
Min. Negotiated Rate $4.55
Max. Negotiated Rate $10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $6.50
Rate for Payer: Aetna Government $6.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $10.40
Rate for Payer: Cigna LocalPlus Benefit Plan $8.84
Rate for Payer: Group Health Inc Commercial $6.50
Rate for Payer: Group Health Inc Medicare $4.55
Rate for Payer: Hamaspik Choice Inc Medicaid $6.50
Rate for Payer: Hamaspik Choice Inc Medicare $6.50
Hospital Charge Code 41568806
Hospital Revenue Code 270
Min. Negotiated Rate $140.00
Max. Negotiated Rate $320.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $220.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $200.00
Rate for Payer: Aetna Government $200.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $320.00
Rate for Payer: Cigna LocalPlus Benefit Plan $272.00
Rate for Payer: Group Health Inc Commercial $200.00
Rate for Payer: Group Health Inc Medicare $140.00
Rate for Payer: Hamaspik Choice Inc Medicaid $200.00
Rate for Payer: Hamaspik Choice Inc Medicare $200.00
Hospital Charge Code 41568854
Hospital Revenue Code 270
Min. Negotiated Rate $4.55
Max. Negotiated Rate $10.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $7.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $6.50
Rate for Payer: Aetna Government $6.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $10.40
Rate for Payer: Cigna LocalPlus Benefit Plan $8.84
Rate for Payer: Group Health Inc Commercial $6.50
Rate for Payer: Group Health Inc Medicare $4.55
Rate for Payer: Hamaspik Choice Inc Medicaid $6.50
Rate for Payer: Hamaspik Choice Inc Medicare $6.50
Hospital Charge Code 41568807
Hospital Revenue Code 270
Min. Negotiated Rate $140.00
Max. Negotiated Rate $320.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $220.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $200.00
Rate for Payer: Aetna Government $200.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $320.00
Rate for Payer: Cigna LocalPlus Benefit Plan $272.00
Rate for Payer: Group Health Inc Commercial $200.00
Rate for Payer: Group Health Inc Medicare $140.00
Rate for Payer: Hamaspik Choice Inc Medicaid $200.00
Rate for Payer: Hamaspik Choice Inc Medicare $200.00
Hospital Charge Code 41568857
Hospital Revenue Code 270
Min. Negotiated Rate $52.50
Max. Negotiated Rate $120.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $82.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $75.00
Rate for Payer: Aetna Government $75.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $120.00
Rate for Payer: Cigna LocalPlus Benefit Plan $102.00
Rate for Payer: Group Health Inc Commercial $75.00
Rate for Payer: Group Health Inc Medicare $52.50
Rate for Payer: Hamaspik Choice Inc Medicaid $75.00
Rate for Payer: Hamaspik Choice Inc Medicare $75.00
Hospital Charge Code 41568859
Hospital Revenue Code 270
Min. Negotiated Rate $52.50
Max. Negotiated Rate $120.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $82.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $75.00
Rate for Payer: Aetna Government $75.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $120.00
Rate for Payer: Cigna LocalPlus Benefit Plan $102.00
Rate for Payer: Group Health Inc Commercial $75.00
Rate for Payer: Group Health Inc Medicare $52.50
Rate for Payer: Hamaspik Choice Inc Medicaid $75.00
Rate for Payer: Hamaspik Choice Inc Medicare $75.00
Hospital Charge Code 41568858
Hospital Revenue Code 270
Min. Negotiated Rate $52.50
Max. Negotiated Rate $120.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $82.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $75.00
Rate for Payer: Aetna Government $75.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $120.00
Rate for Payer: Cigna LocalPlus Benefit Plan $102.00
Rate for Payer: Group Health Inc Commercial $75.00
Rate for Payer: Group Health Inc Medicare $52.50
Rate for Payer: Hamaspik Choice Inc Medicaid $75.00
Rate for Payer: Hamaspik Choice Inc Medicare $75.00
Hospital Charge Code 41568860
Hospital Revenue Code 270
Min. Negotiated Rate $332.50
Max. Negotiated Rate $760.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $522.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $475.00
Rate for Payer: Aetna Government $475.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $760.00
Rate for Payer: Cigna LocalPlus Benefit Plan $646.00
Rate for Payer: Group Health Inc Commercial $475.00
Rate for Payer: Group Health Inc Medicare $332.50
Rate for Payer: Hamaspik Choice Inc Medicaid $475.00
Rate for Payer: Hamaspik Choice Inc Medicare $475.00
Hospital Charge Code 41568862
Hospital Revenue Code 270
Min. Negotiated Rate $59.50
Max. Negotiated Rate $136.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $93.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $85.00
Rate for Payer: Aetna Government $85.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $136.00
Rate for Payer: Cigna LocalPlus Benefit Plan $115.60
Rate for Payer: Group Health Inc Commercial $85.00
Rate for Payer: Group Health Inc Medicare $59.50
Rate for Payer: Hamaspik Choice Inc Medicaid $85.00
Rate for Payer: Hamaspik Choice Inc Medicare $85.00
Hospital Charge Code 41568861
Hospital Revenue Code 270
Min. Negotiated Rate $332.50
Max. Negotiated Rate $760.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $522.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $475.00
Rate for Payer: Aetna Government $475.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $760.00
Rate for Payer: Cigna LocalPlus Benefit Plan $646.00
Rate for Payer: Group Health Inc Commercial $475.00
Rate for Payer: Group Health Inc Medicare $332.50
Rate for Payer: Hamaspik Choice Inc Medicaid $475.00
Rate for Payer: Hamaspik Choice Inc Medicare $475.00
Hospital Charge Code 41568863
Hospital Revenue Code 270
Min. Negotiated Rate $59.50
Max. Negotiated Rate $136.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $93.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $85.00
Rate for Payer: Aetna Government $85.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $136.00
Rate for Payer: Cigna LocalPlus Benefit Plan $115.60
Rate for Payer: Group Health Inc Commercial $85.00
Rate for Payer: Group Health Inc Medicare $59.50
Rate for Payer: Hamaspik Choice Inc Medicaid $85.00
Rate for Payer: Hamaspik Choice Inc Medicare $85.00
Hospital Charge Code 41568855
Hospital Revenue Code 270
Min. Negotiated Rate $8.68
Max. Negotiated Rate $19.84
Rate for Payer: 1199SEIU National Benefit Fund Commercial $13.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $12.40
Rate for Payer: Aetna Government $12.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $19.84
Rate for Payer: Cigna LocalPlus Benefit Plan $16.86
Rate for Payer: Group Health Inc Commercial $12.40
Rate for Payer: Group Health Inc Medicare $8.68
Rate for Payer: Hamaspik Choice Inc Medicaid $12.40
Rate for Payer: Hamaspik Choice Inc Medicare $12.40