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Charge Type Price  
Hospital Charge Code 41567353
Hospital Revenue Code 270
Min. Negotiated Rate $1,226.67
Max. Negotiated Rate $2,803.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,927.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,752.38
Rate for Payer: Aetna Government $1,752.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,803.82
Rate for Payer: Cigna LocalPlus Benefit Plan $2,383.24
Rate for Payer: Group Health Inc Commercial $1,752.38
Rate for Payer: Group Health Inc Medicare $1,226.67
Rate for Payer: Hamaspik Choice Inc Medicaid $1,752.38
Rate for Payer: Hamaspik Choice Inc Medicare $1,752.38
Hospital Charge Code 41567356
Hospital Revenue Code 270
Min. Negotiated Rate $1,363.60
Max. Negotiated Rate $3,116.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,142.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,948.00
Rate for Payer: Aetna Government $1,948.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $3,116.80
Rate for Payer: Cigna LocalPlus Benefit Plan $2,649.28
Rate for Payer: Group Health Inc Commercial $1,948.00
Rate for Payer: Group Health Inc Medicare $1,363.60
Rate for Payer: Hamaspik Choice Inc Medicaid $1,948.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,948.00
Hospital Charge Code 41567354
Hospital Revenue Code 270
Min. Negotiated Rate $1,226.67
Max. Negotiated Rate $2,803.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,927.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,752.38
Rate for Payer: Aetna Government $1,752.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,803.82
Rate for Payer: Cigna LocalPlus Benefit Plan $2,383.24
Rate for Payer: Group Health Inc Commercial $1,752.38
Rate for Payer: Group Health Inc Medicare $1,226.67
Rate for Payer: Hamaspik Choice Inc Medicaid $1,752.38
Rate for Payer: Hamaspik Choice Inc Medicare $1,752.38
Hospital Charge Code 41567357
Hospital Revenue Code 270
Min. Negotiated Rate $1,968.38
Max. Negotiated Rate $4,499.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3,093.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2,811.97
Rate for Payer: Aetna Government $2,811.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $4,499.15
Rate for Payer: Cigna LocalPlus Benefit Plan $3,824.28
Rate for Payer: Group Health Inc Commercial $2,811.97
Rate for Payer: Group Health Inc Medicare $1,968.38
Rate for Payer: Hamaspik Choice Inc Medicaid $2,811.97
Rate for Payer: Hamaspik Choice Inc Medicare $2,811.97
Hospital Charge Code 41567358
Hospital Revenue Code 270
Min. Negotiated Rate $1,226.67
Max. Negotiated Rate $2,803.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,927.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,752.38
Rate for Payer: Aetna Government $1,752.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,803.82
Rate for Payer: Cigna LocalPlus Benefit Plan $2,383.24
Rate for Payer: Group Health Inc Commercial $1,752.38
Rate for Payer: Group Health Inc Medicare $1,226.67
Rate for Payer: Hamaspik Choice Inc Medicaid $1,752.38
Rate for Payer: Hamaspik Choice Inc Medicare $1,752.38
Hospital Charge Code 41567359
Hospital Revenue Code 270
Min. Negotiated Rate $1,968.38
Max. Negotiated Rate $4,499.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3,093.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2,811.97
Rate for Payer: Aetna Government $2,811.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $4,499.15
Rate for Payer: Cigna LocalPlus Benefit Plan $3,824.28
Rate for Payer: Group Health Inc Commercial $2,811.97
Rate for Payer: Group Health Inc Medicare $1,968.38
Rate for Payer: Hamaspik Choice Inc Medicaid $2,811.97
Rate for Payer: Hamaspik Choice Inc Medicare $2,811.97
Service Code HCPCS C1725
Hospital Charge Code 41569675
Hospital Revenue Code 278
Min. Negotiated Rate $127.58
Max. Negotiated Rate $127.58
Rate for Payer: Hamaspik Choice Inc Medicaid $127.58
Rate for Payer: Hamaspik Choice Inc Medicare $127.58
Service Code HCPCS C1725
Hospital Charge Code 41569675
Hospital Revenue Code 278
Min. Negotiated Rate $44.85
Max. Negotiated Rate $267.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial $140.33
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 $127.58
Rate for Payer: Cigna LocalPlus Benefit Plan $146.71
Rate for Payer: Fidelis Medicare Advantage $267.91
Rate for Payer: Group Health Inc Commercial $127.58
Rate for Payer: Group Health Inc Medicare $89.30
Rate for Payer: Hamaspik Choice Inc Medicaid $127.58
Rate for Payer: Hamaspik Choice Inc Medicare $127.58
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $165.85
Hospital Charge Code 41569186
Hospital Revenue Code 270
Min. Negotiated Rate $27.07
Max. Negotiated Rate $61.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial $42.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $38.68
Rate for Payer: Aetna Government $38.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $61.88
Rate for Payer: Cigna LocalPlus Benefit Plan $52.60
Rate for Payer: Group Health Inc Commercial $38.68
Rate for Payer: Group Health Inc Medicare $27.07
Rate for Payer: Hamaspik Choice Inc Medicaid $38.68
Rate for Payer: Hamaspik Choice Inc Medicare $38.68
Hospital Charge Code 41569187
Hospital Revenue Code 270
Min. Negotiated Rate $31.82
Max. Negotiated Rate $72.73
Rate for Payer: 1199SEIU National Benefit Fund Commercial $50.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $45.46
Rate for Payer: Aetna Government $45.46
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $72.73
Rate for Payer: Cigna LocalPlus Benefit Plan $61.82
Rate for Payer: Group Health Inc Commercial $45.46
Rate for Payer: Group Health Inc Medicare $31.82
Rate for Payer: Hamaspik Choice Inc Medicaid $45.46
Rate for Payer: Hamaspik Choice Inc Medicare $45.46
Hospital Charge Code 41561938
Hospital Revenue Code 270
Min. Negotiated Rate $136.50
Max. Negotiated Rate $312.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $214.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $195.00
Rate for Payer: Aetna Government $195.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $312.00
Rate for Payer: Cigna LocalPlus Benefit Plan $265.20
Rate for Payer: Group Health Inc Commercial $195.00
Rate for Payer: Group Health Inc Medicare $136.50
Rate for Payer: Hamaspik Choice Inc Medicaid $195.00
Rate for Payer: Hamaspik Choice Inc Medicare $195.00
Hospital Charge Code 41561934
Hospital Revenue Code 270
Min. Negotiated Rate $238.00
Max. Negotiated Rate $544.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $374.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $340.00
Rate for Payer: Aetna Government $340.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $544.00
Rate for Payer: Cigna LocalPlus Benefit Plan $462.40
Rate for Payer: Group Health Inc Commercial $340.00
Rate for Payer: Group Health Inc Medicare $238.00
Rate for Payer: Hamaspik Choice Inc Medicaid $340.00
Rate for Payer: Hamaspik Choice Inc Medicare $340.00
Hospital Charge Code 41561935
Hospital Revenue Code 270
Min. Negotiated Rate $238.00
Max. Negotiated Rate $544.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $374.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $340.00
Rate for Payer: Aetna Government $340.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $544.00
Rate for Payer: Cigna LocalPlus Benefit Plan $462.40
Rate for Payer: Group Health Inc Commercial $340.00
Rate for Payer: Group Health Inc Medicare $238.00
Rate for Payer: Hamaspik Choice Inc Medicaid $340.00
Rate for Payer: Hamaspik Choice Inc Medicare $340.00
Hospital Charge Code 41561936
Hospital Revenue Code 270
Min. Negotiated Rate $560.00
Max. Negotiated Rate $1,280.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $880.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $800.00
Rate for Payer: Aetna Government $800.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,280.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,088.00
Rate for Payer: Group Health Inc Commercial $800.00
Rate for Payer: Group Health Inc Medicare $560.00
Rate for Payer: Hamaspik Choice Inc Medicaid $800.00
Rate for Payer: Hamaspik Choice Inc Medicare $800.00
Hospital Charge Code 41561937
Hospital Revenue Code 270
Min. Negotiated Rate $73.50
Max. Negotiated Rate $168.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $115.50
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $105.00
Rate for Payer: Aetna Government $105.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $168.00
Rate for Payer: Cigna LocalPlus Benefit Plan $142.80
Rate for Payer: Group Health Inc Commercial $105.00
Rate for Payer: Group Health Inc Medicare $73.50
Rate for Payer: Hamaspik Choice Inc Medicaid $105.00
Rate for Payer: Hamaspik Choice Inc Medicare $105.00
Service Code HCPCS C1769
Hospital Charge Code 41569774
Hospital Revenue Code 278
Min. Negotiated Rate $1,423.52
Max. Negotiated Rate $1,423.52
Rate for Payer: Hamaspik Choice Inc Medicaid $1,423.52
Rate for Payer: Hamaspik Choice Inc Medicare $1,423.52
Service Code HCPCS C1769
Hospital Charge Code 41569774
Hospital Revenue Code 278
Min. Negotiated Rate $4.08
Max. Negotiated Rate $2,989.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,565.88
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 $1,423.52
Rate for Payer: Cigna LocalPlus Benefit Plan $1,637.05
Rate for Payer: Fidelis Medicare Advantage $2,989.40
Rate for Payer: Group Health Inc Commercial $1,423.52
Rate for Payer: Group Health Inc Medicare $996.47
Rate for Payer: Hamaspik Choice Inc Medicaid $1,423.52
Rate for Payer: Hamaspik Choice Inc Medicare $1,423.52
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,850.58
Service Code HCPCS C1769
Hospital Charge Code 41569775
Hospital Revenue Code 278
Min. Negotiated Rate $4.08
Max. Negotiated Rate $2,983.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,562.76
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 $1,420.69
Rate for Payer: Cigna LocalPlus Benefit Plan $1,633.79
Rate for Payer: Fidelis Medicare Advantage $2,983.45
Rate for Payer: Group Health Inc Commercial $1,420.69
Rate for Payer: Group Health Inc Medicare $994.48
Rate for Payer: Hamaspik Choice Inc Medicaid $1,420.69
Rate for Payer: Hamaspik Choice Inc Medicare $1,420.69
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,846.90
Service Code HCPCS C1769
Hospital Charge Code 41569775
Hospital Revenue Code 278
Min. Negotiated Rate $1,420.69
Max. Negotiated Rate $1,420.69
Rate for Payer: Hamaspik Choice Inc Medicaid $1,420.69
Rate for Payer: Hamaspik Choice Inc Medicare $1,420.69
Service Code HCPCS C1725
Hospital Charge Code 41567276
Hospital Revenue Code 278
Min. Negotiated Rate $44.85
Max. Negotiated Rate $1,009.87
Rate for Payer: 1199SEIU National Benefit Fund Commercial $528.98
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 $480.89
Rate for Payer: Cigna LocalPlus Benefit Plan $553.02
Rate for Payer: Fidelis Medicare Advantage $1,009.87
Rate for Payer: Group Health Inc Commercial $480.89
Rate for Payer: Group Health Inc Medicare $336.62
Rate for Payer: Hamaspik Choice Inc Medicaid $480.89
Rate for Payer: Hamaspik Choice Inc Medicare $480.89
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $625.16
Service Code HCPCS C1725
Hospital Charge Code 41567276
Hospital Revenue Code 278
Min. Negotiated Rate $480.89
Max. Negotiated Rate $480.89
Rate for Payer: Hamaspik Choice Inc Medicaid $480.89
Rate for Payer: Hamaspik Choice Inc Medicare $480.89
Service Code HCPCS C1725
Hospital Charge Code 41567277
Hospital Revenue Code 278
Min. Negotiated Rate $44.85
Max. Negotiated Rate $1,112.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial $582.77
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 $529.80
Rate for Payer: Cigna LocalPlus Benefit Plan $609.26
Rate for Payer: Fidelis Medicare Advantage $1,112.57
Rate for Payer: Group Health Inc Commercial $529.80
Rate for Payer: Group Health Inc Medicare $370.86
Rate for Payer: Hamaspik Choice Inc Medicaid $529.80
Rate for Payer: Hamaspik Choice Inc Medicare $529.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $688.73
Service Code HCPCS C1725
Hospital Charge Code 41567277
Hospital Revenue Code 278
Min. Negotiated Rate $529.80
Max. Negotiated Rate $529.80
Rate for Payer: Hamaspik Choice Inc Medicaid $529.80
Rate for Payer: Hamaspik Choice Inc Medicare $529.80