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Charge Type Setting Price  
Hospital Charge Code 41645396
Hospital Revenue Code 250
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: Brighton Health Commercial $9.75
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $8.45
Hospital Charge Code 41655397
Hospital Revenue Code 250
Min. Negotiated Rate $0.70
Max. Negotiated Rate $1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.00
Rate for Payer: Aetna Government $1.00
Rate for Payer: Brighton Health Commercial $1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.60
Rate for Payer: Cigna LocalPlus Benefit Plan $1.36
Rate for Payer: Group Health Inc Commercial $1.00
Rate for Payer: Group Health Inc Medicare $0.70
Rate for Payer: Hamaspik Choice Inc Medicaid $1.00
Rate for Payer: Hamaspik Choice Inc Medicare $1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.30
Hospital Charge Code 41645397
Hospital Revenue Code 250
Min. Negotiated Rate $0.70
Max. Negotiated Rate $1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.00
Rate for Payer: Aetna Government $1.00
Rate for Payer: Brighton Health Commercial $1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.60
Rate for Payer: Cigna LocalPlus Benefit Plan $1.36
Rate for Payer: Group Health Inc Commercial $1.00
Rate for Payer: Group Health Inc Medicare $0.70
Rate for Payer: Hamaspik Choice Inc Medicaid $1.00
Rate for Payer: Hamaspik Choice Inc Medicare $1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.30
Hospital Charge Code 41645395
Hospital Revenue Code 250
Min. Negotiated Rate $0.52
Max. Negotiated Rate $1.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.75
Rate for Payer: Aetna Government $0.75
Rate for Payer: Brighton Health Commercial $1.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.19
Rate for Payer: Cigna LocalPlus Benefit Plan $1.01
Rate for Payer: Group Health Inc Commercial $0.75
Rate for Payer: Group Health Inc Medicare $0.52
Rate for Payer: Hamaspik Choice Inc Medicaid $0.75
Rate for Payer: Hamaspik Choice Inc Medicare $0.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.97
Hospital Charge Code 41655395
Hospital Revenue Code 250
Min. Negotiated Rate $0.52
Max. Negotiated Rate $1.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.75
Rate for Payer: Aetna Government $0.75
Rate for Payer: Brighton Health Commercial $1.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.19
Rate for Payer: Cigna LocalPlus Benefit Plan $1.01
Rate for Payer: Group Health Inc Commercial $0.75
Rate for Payer: Group Health Inc Medicare $0.52
Rate for Payer: Hamaspik Choice Inc Medicaid $0.75
Rate for Payer: Hamaspik Choice Inc Medicare $0.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.97
Service Code NDC 63323008950
Hospital Charge Code 63323008950
Hospital Revenue Code 278
Min. Negotiated Rate $0.26
Max. Negotiated Rate $0.26
Rate for Payer: Hamaspik Choice Inc Medicaid $0.26
Rate for Payer: Hamaspik Choice Inc Medicare $0.26
Service Code NDC 00409663714
Hospital Charge Code 00409663714
Hospital Revenue Code 278
Min. Negotiated Rate $0.15
Max. Negotiated Rate $0.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.23
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.21
Rate for Payer: Aetna Government $0.21
Rate for Payer: Brighton Health Commercial $0.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.21
Rate for Payer: Cigna LocalPlus Benefit Plan $0.24
Rate for Payer: EmblemHealth Commercial $0.21
Rate for Payer: Fidelis Medicare Advantage $0.44
Rate for Payer: Group Health Inc Commercial $0.21
Rate for Payer: Group Health Inc Medicare $0.15
Rate for Payer: Hamaspik Choice Inc Medicaid $0.21
Rate for Payer: Hamaspik Choice Inc Medicare $0.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.27
Service Code NDC 51754500105
Hospital Charge Code 51754500105
Hospital Revenue Code 278
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.11
Rate for Payer: Aetna Government $0.11
Rate for Payer: Brighton Health Commercial $0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.11
Rate for Payer: Cigna LocalPlus Benefit Plan $0.12
Rate for Payer: EmblemHealth Commercial $0.11
Rate for Payer: Fidelis Medicare Advantage $0.22
Rate for Payer: Group Health Inc Commercial $0.11
Rate for Payer: Group Health Inc Medicare $0.07
Rate for Payer: Hamaspik Choice Inc Medicaid $0.11
Rate for Payer: Hamaspik Choice Inc Medicare $0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.14
Service Code NDC 51754500105
Hospital Charge Code 51754500105
Hospital Revenue Code 278
Min. Negotiated Rate $0.11
Max. Negotiated Rate $0.11
Rate for Payer: Hamaspik Choice Inc Medicaid $0.11
Rate for Payer: Hamaspik Choice Inc Medicare $0.11
Service Code NDC 51754500104
Hospital Charge Code 51754500104
Hospital Revenue Code 278
Min. Negotiated Rate $0.07
Max. Negotiated Rate $0.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.12
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.11
Rate for Payer: Aetna Government $0.11
Rate for Payer: Brighton Health Commercial $0.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.11
Rate for Payer: Cigna LocalPlus Benefit Plan $0.12
Rate for Payer: EmblemHealth Commercial $0.11
Rate for Payer: Fidelis Medicare Advantage $0.22
Rate for Payer: Group Health Inc Commercial $0.11
Rate for Payer: Group Health Inc Medicare $0.07
Rate for Payer: Hamaspik Choice Inc Medicaid $0.11
Rate for Payer: Hamaspik Choice Inc Medicare $0.11
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.14
Service Code NDC 00409662514
Hospital Charge Code 00409662514
Hospital Revenue Code 278
Min. Negotiated Rate $0.12
Max. Negotiated Rate $0.12
Rate for Payer: Hamaspik Choice Inc Medicaid $0.12
Rate for Payer: Hamaspik Choice Inc Medicare $0.12
Service Code NDC 51754501101
Hospital Charge Code 51754501101
Hospital Revenue Code 278
Min. Negotiated Rate $0.55
Max. Negotiated Rate $0.55
Rate for Payer: Hamaspik Choice Inc Medicaid $0.55
Rate for Payer: Hamaspik Choice Inc Medicare $0.55
Service Code NDC 76329335201
Hospital Charge Code 76329335201
Hospital Revenue Code 278
Min. Negotiated Rate $0.15
Max. Negotiated Rate $0.45
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.22
Rate for Payer: Aetna Government $0.22
Rate for Payer: Brighton Health Commercial $0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.22
Rate for Payer: Cigna LocalPlus Benefit Plan $0.25
Rate for Payer: EmblemHealth Commercial $0.22
Rate for Payer: Fidelis Medicare Advantage $0.45
Rate for Payer: Group Health Inc Commercial $0.22
Rate for Payer: Group Health Inc Medicare $0.15
Rate for Payer: Hamaspik Choice Inc Medicaid $0.22
Rate for Payer: Hamaspik Choice Inc Medicare $0.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.28
Service Code NDC 00409663714
Hospital Charge Code 00409663714
Hospital Revenue Code 278
Min. Negotiated Rate $0.21
Max. Negotiated Rate $0.21
Rate for Payer: Hamaspik Choice Inc Medicaid $0.21
Rate for Payer: Hamaspik Choice Inc Medicare $0.21
Service Code NDC 51754500104
Hospital Charge Code 51754500104
Hospital Revenue Code 278
Min. Negotiated Rate $0.11
Max. Negotiated Rate $0.11
Rate for Payer: Hamaspik Choice Inc Medicaid $0.11
Rate for Payer: Hamaspik Choice Inc Medicare $0.11
Service Code NDC 00409662514
Hospital Charge Code 00409662514
Hospital Revenue Code 278
Min. Negotiated Rate $0.08
Max. Negotiated Rate $0.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.12
Rate for Payer: Aetna Government $0.12
Rate for Payer: Brighton Health Commercial $0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.12
Rate for Payer: Cigna LocalPlus Benefit Plan $0.14
Rate for Payer: EmblemHealth Commercial $0.12
Rate for Payer: Fidelis Medicare Advantage $0.25
Rate for Payer: Group Health Inc Commercial $0.12
Rate for Payer: Group Health Inc Medicare $0.08
Rate for Payer: Hamaspik Choice Inc Medicaid $0.12
Rate for Payer: Hamaspik Choice Inc Medicare $0.12
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.15
Service Code NDC 51754501101
Hospital Charge Code 51754501101
Hospital Revenue Code 278
Min. Negotiated Rate $0.39
Max. Negotiated Rate $1.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.61
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.55
Rate for Payer: Aetna Government $0.55
Rate for Payer: Brighton Health Commercial $0.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.55
Rate for Payer: Cigna LocalPlus Benefit Plan $0.63
Rate for Payer: EmblemHealth Commercial $0.55
Rate for Payer: Fidelis Medicare Advantage $1.16
Rate for Payer: Group Health Inc Commercial $0.55
Rate for Payer: Group Health Inc Medicare $0.39
Rate for Payer: Hamaspik Choice Inc Medicaid $0.55
Rate for Payer: Hamaspik Choice Inc Medicare $0.55
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.72
Service Code NDC 76329335201
Hospital Charge Code 76329335201
Hospital Revenue Code 278
Min. Negotiated Rate $0.22
Max. Negotiated Rate $0.22
Rate for Payer: Hamaspik Choice Inc Medicaid $0.22
Rate for Payer: Hamaspik Choice Inc Medicare $0.22
Service Code NDC 63323008950
Hospital Charge Code 63323008950
Hospital Revenue Code 278
Min. Negotiated Rate $0.18
Max. Negotiated Rate $0.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.26
Rate for Payer: Aetna Government $0.26
Rate for Payer: Brighton Health Commercial $0.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.26
Rate for Payer: Cigna LocalPlus Benefit Plan $0.30
Rate for Payer: EmblemHealth Commercial $0.26
Rate for Payer: Fidelis Medicare Advantage $0.55
Rate for Payer: Group Health Inc Commercial $0.26
Rate for Payer: Group Health Inc Medicare $0.18
Rate for Payer: Hamaspik Choice Inc Medicaid $0.26
Rate for Payer: Hamaspik Choice Inc Medicare $0.26
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.34
Hospital Charge Code 41657071
Hospital Revenue Code 250
Min. Negotiated Rate $0.70
Max. Negotiated Rate $1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.00
Rate for Payer: Aetna Government $1.00
Rate for Payer: Brighton Health Commercial $1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.60
Rate for Payer: Cigna LocalPlus Benefit Plan $1.36
Rate for Payer: Group Health Inc Commercial $1.00
Rate for Payer: Group Health Inc Medicare $0.70
Rate for Payer: Hamaspik Choice Inc Medicaid $1.00
Rate for Payer: Hamaspik Choice Inc Medicare $1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.30
Hospital Charge Code 41647071
Hospital Revenue Code 250
Min. Negotiated Rate $0.70
Max. Negotiated Rate $1.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.00
Rate for Payer: Aetna Government $1.00
Rate for Payer: Brighton Health Commercial $1.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.60
Rate for Payer: Cigna LocalPlus Benefit Plan $1.36
Rate for Payer: Group Health Inc Commercial $1.00
Rate for Payer: Group Health Inc Medicare $0.70
Rate for Payer: Hamaspik Choice Inc Medicaid $1.00
Rate for Payer: Hamaspik Choice Inc Medicare $1.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.30
Hospital Charge Code 64902540
Hospital Revenue Code 270
Min. Negotiated Rate $4.49
Max. Negotiated Rate $10.26
Rate for Payer: 1199SEIU National Benefit Fund Commercial $7.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $6.41
Rate for Payer: Aetna Government $6.41
Rate for Payer: Brighton Health Commercial $9.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $10.26
Rate for Payer: Cigna LocalPlus Benefit Plan $8.72
Rate for Payer: Group Health Inc Commercial $6.41
Rate for Payer: Group Health Inc Medicare $4.49
Rate for Payer: Hamaspik Choice Inc Medicaid $6.41
Rate for Payer: Hamaspik Choice Inc Medicare $6.41
Hospital Charge Code 41641454
Hospital Revenue Code 250
Min. Negotiated Rate $2.45
Max. Negotiated Rate $5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $3.50
Rate for Payer: Aetna Government $3.50
Rate for Payer: Brighton Health Commercial $5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $5.60
Rate for Payer: Cigna LocalPlus Benefit Plan $4.76
Rate for Payer: Group Health Inc Commercial $3.50
Rate for Payer: Group Health Inc Medicare $2.45
Rate for Payer: Hamaspik Choice Inc Medicaid $3.50
Rate for Payer: Hamaspik Choice Inc Medicare $3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $4.55
Hospital Charge Code 41651454
Hospital Revenue Code 250
Min. Negotiated Rate $2.45
Max. Negotiated Rate $5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $3.50
Rate for Payer: Aetna Government $3.50
Rate for Payer: Brighton Health Commercial $5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $5.60
Rate for Payer: Cigna LocalPlus Benefit Plan $4.76
Rate for Payer: Group Health Inc Commercial $3.50
Rate for Payer: Group Health Inc Medicare $2.45
Rate for Payer: Hamaspik Choice Inc Medicaid $3.50
Rate for Payer: Hamaspik Choice Inc Medicare $3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $4.55
Hospital Charge Code 41645601
Hospital Revenue Code 250
Min. Negotiated Rate $3.85
Max. Negotiated Rate $8.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $6.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $5.50
Rate for Payer: Aetna Government $5.50
Rate for Payer: Brighton Health Commercial $8.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $8.80
Rate for Payer: Cigna LocalPlus Benefit Plan $7.48
Rate for Payer: Group Health Inc Commercial $5.50
Rate for Payer: Group Health Inc Medicare $3.85
Rate for Payer: Hamaspik Choice Inc Medicaid $5.50
Rate for Payer: Hamaspik Choice Inc Medicare $5.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $7.15