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Service Code HCPCS 11954
Hospital Charge Code 42201700
Hospital Revenue Code 361
Rate for Payer: Cash Price $726.29
Service Code HCPCS 92609
Hospital Charge Code 41905003
Hospital Revenue Code 440
Min. Negotiated Rate $55.00
Max. Negotiated Rate $13,928.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $173.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $95.24
Rate for Payer: Aetna Government $95.24
Rate for Payer: Amida Care Medicaid $139.28
Rate for Payer: Brighton Health Commercial $182.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $147.00
Rate for Payer: Cigna LocalPlus Benefit Plan $124.95
Rate for Payer: Fidelis CHP/HARP/Medicaid $13,928.00
Rate for Payer: Fidelis Essential Plan Aliesa $139.28
Rate for Payer: Fidelis Essential Plan QHP $139.28
Rate for Payer: Fidelis Qualified Health Plan $146.24
Rate for Payer: Group Health Inc Commercial $157.99
Rate for Payer: Group Health Inc Medicare $120.00
Rate for Payer: Hamaspik Choice Inc Medicaid $139.28
Rate for Payer: Hamaspik Choice Inc Medicare $157.99
Rate for Payer: Healthfirst CHP/FHP/Medicaid $139.28
Rate for Payer: Healthfirst Essential Plan $313.38
Rate for Payer: Healthfirst QHP $139.28
Rate for Payer: SOMOS CHP/HARP/Medicaid $139.28
Rate for Payer: SOMOS Essential $313.38
Rate for Payer: Wellcare CHP/FHP/Medicaid $139.28
Rate for Payer: Wellcare Medicare $55.00
Service Code HCPCS Q4121
Hospital Charge Code 30305417
Hospital Revenue Code 636
Min. Negotiated Rate $22.30
Max. Negotiated Rate $22.30
Rate for Payer: Hamaspik Choice Inc Medicaid $22.30
Rate for Payer: Hamaspik Choice Inc Medicare $22.30
Service Code HCPCS Q4121
Hospital Charge Code 30305417
Hospital Revenue Code 636
Min. Negotiated Rate $15.61
Max. Negotiated Rate $48.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial $24.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $43.84
Rate for Payer: Aetna Government $43.84
Rate for Payer: Brighton Health Commercial $26.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $22.30
Rate for Payer: Cigna LocalPlus Benefit Plan $25.64
Rate for Payer: Group Health Inc Commercial $22.30
Rate for Payer: Group Health Inc Medicare $15.61
Rate for Payer: Hamaspik Choice Inc Medicaid $22.30
Rate for Payer: Hamaspik Choice Inc Medicare $22.30
Rate for Payer: SOMOS CHP/HARP/Medicaid $48.90
Rate for Payer: SOMOS Essential $48.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $28.99
Service Code HCPCS Q4121
Hospital Charge Code 42501058
Hospital Revenue Code 636
Min. Negotiated Rate $267.50
Max. Negotiated Rate $267.50
Rate for Payer: Hamaspik Choice Inc Medicaid $267.50
Rate for Payer: Hamaspik Choice Inc Medicare $267.50
Service Code HCPCS Q4121
Hospital Charge Code 42501058
Hospital Revenue Code 636
Min. Negotiated Rate $43.84
Max. Negotiated Rate $347.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial $294.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $43.84
Rate for Payer: Aetna Government $43.84
Rate for Payer: Brighton Health Commercial $321.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $267.50
Rate for Payer: Cigna LocalPlus Benefit Plan $307.62
Rate for Payer: Group Health Inc Commercial $267.50
Rate for Payer: Group Health Inc Medicare $187.25
Rate for Payer: Hamaspik Choice Inc Medicaid $267.50
Rate for Payer: Hamaspik Choice Inc Medicare $267.50
Rate for Payer: SOMOS CHP/HARP/Medicaid $48.90
Rate for Payer: SOMOS Essential $48.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $347.75
Service Code HCPCS 96368
Hospital Charge Code 30305934
Hospital Revenue Code 260
Min. Negotiated Rate $18.06
Max. Negotiated Rate $57.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial $39.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $18.06
Rate for Payer: Aetna Government $18.06
Rate for Payer: Brighton Health Commercial $53.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $57.16
Rate for Payer: Cigna LocalPlus Benefit Plan $48.59
Rate for Payer: Group Health Inc Commercial $35.72
Rate for Payer: Group Health Inc Medicare $25.01
Rate for Payer: Hamaspik Choice Inc Medicaid $35.72
Rate for Payer: Hamaspik Choice Inc Medicare $35.72
Service Code HCPCS 96368
Hospital Charge Code 30105934
Hospital Revenue Code 260
Min. Negotiated Rate $18.06
Max. Negotiated Rate $57.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial $39.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $18.06
Rate for Payer: Aetna Government $18.06
Rate for Payer: Brighton Health Commercial $53.59
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $57.16
Rate for Payer: Cigna LocalPlus Benefit Plan $48.59
Rate for Payer: Group Health Inc Commercial $35.72
Rate for Payer: Group Health Inc Medicare $25.01
Rate for Payer: Hamaspik Choice Inc Medicaid $35.72
Rate for Payer: Hamaspik Choice Inc Medicare $35.72
Service Code HCPCS 30930
Hospital Charge Code 40109383
Hospital Revenue Code 360
Rate for Payer: Cash Price $3,723.23
Service Code HCPCS 30930
Hospital Charge Code 40109383
Hospital Revenue Code 360
Min. Negotiated Rate $1,505.00
Max. Negotiated Rate $5,949.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2,485.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $3,723.23
Rate for Payer: Aetna Government $3,723.23
Rate for Payer: Brighton Health Commercial $5,949.88
Rate for Payer: Cash Price $3,723.23
Rate for Payer: Cash Price $3,723.23
Rate for Payer: Cash Price $3,723.23
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $3,723.23
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $3,723.23
Rate for Payer: EmblemHealth Commercial $1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa $3,164.75
Rate for Payer: Fidelis Essential Plan QHP $3,313.67
Rate for Payer: Fidelis Medicare Advantage $3,723.23
Rate for Payer: Fidelis Qualified Health Plan $3,313.67
Rate for Payer: Group Health Inc Commercial $3,723.23
Rate for Payer: Group Health Inc Medicare $3,723.23
Rate for Payer: Hamaspik Choice Inc Medicaid $3,966.59
Rate for Payer: Hamaspik Choice Inc Medicare $3,723.23
Rate for Payer: Healthfirst Medicare Advantage $3,164.75
Rate for Payer: Healthfirst QHP $3,723.23
Rate for Payer: Senior Whole Health Medicare Advantage $3,723.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,723.23
Rate for Payer: Wellcare CHP/FHP/Medicaid $2,978.58
Rate for Payer: Wellcare Medicare $3,537.07
Service Code HCPCS C1713
Hospital Charge Code 40205441
Hospital Revenue Code 278
Min. Negotiated Rate $250.00
Max. Negotiated Rate $250.00
Rate for Payer: Hamaspik Choice Inc Medicaid $250.00
Rate for Payer: Hamaspik Choice Inc Medicare $250.00
Service Code HCPCS C1713
Hospital Charge Code 40205441
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $525.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $134.20
Rate for Payer: Aetna Government $134.20
Rate for Payer: Brighton Health Commercial $300.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $250.00
Rate for Payer: Cigna LocalPlus Benefit Plan $287.50
Rate for Payer: EmblemHealth Commercial $250.00
Rate for Payer: Fidelis Medicare Advantage $525.00
Rate for Payer: Group Health Inc Commercial $250.00
Rate for Payer: Group Health Inc Medicare $175.00
Rate for Payer: Hamaspik Choice Inc Medicaid $250.00
Rate for Payer: Hamaspik Choice Inc Medicare $250.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $325.00
Service Code HCPCS C1713
Hospital Charge Code 40202062
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $1,680.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $880.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $134.20
Rate for Payer: Aetna Government $134.20
Rate for Payer: Brighton Health Commercial $960.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $800.00
Rate for Payer: Cigna LocalPlus Benefit Plan $920.00
Rate for Payer: EmblemHealth Commercial $800.00
Rate for Payer: Fidelis Medicare Advantage $1,680.00
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
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,040.00
Service Code HCPCS C1713
Hospital Charge Code 40202062
Hospital Revenue Code 278
Min. Negotiated Rate $800.00
Max. Negotiated Rate $800.00
Rate for Payer: Hamaspik Choice Inc Medicaid $800.00
Rate for Payer: Hamaspik Choice Inc Medicare $800.00
Service Code HCPCS 20526
Hospital Charge Code 40009447
Hospital Revenue Code 360
Min. Negotiated Rate $274.01
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $342.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $342.51
Rate for Payer: Aetna Government $342.51
Rate for Payer: Brighton Health Commercial $594.62
Rate for Payer: Cash Price $342.51
Rate for Payer: Cash Price $342.51
Rate for Payer: Cash Price $342.51
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $342.51
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $342.51
Rate for Payer: EmblemHealth Commercial $1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa $291.13
Rate for Payer: Fidelis Essential Plan QHP $304.83
Rate for Payer: Fidelis Medicare Advantage $342.51
Rate for Payer: Fidelis Qualified Health Plan $304.83
Rate for Payer: Group Health Inc Commercial $342.51
Rate for Payer: Group Health Inc Medicare $342.51
Rate for Payer: Hamaspik Choice Inc Medicaid $396.42
Rate for Payer: Hamaspik Choice Inc Medicare $342.51
Rate for Payer: Healthfirst Medicare Advantage $291.13
Rate for Payer: Healthfirst QHP $342.51
Rate for Payer: Senior Whole Health Medicare Advantage $342.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $342.51
Rate for Payer: Wellcare CHP/FHP/Medicaid $274.01
Rate for Payer: Wellcare Medicare $325.38
Service Code HCPCS 20526
Hospital Charge Code 40009447
Hospital Revenue Code 360
Rate for Payer: Cash Price $342.51
Hospital Charge Code 64902875
Hospital Revenue Code 270
Min. Negotiated Rate $182.78
Max. Negotiated Rate $417.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial $287.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $261.11
Rate for Payer: Aetna Government $261.11
Rate for Payer: Brighton Health Commercial $391.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $417.78
Rate for Payer: Cigna LocalPlus Benefit Plan $355.11
Rate for Payer: Group Health Inc Commercial $261.11
Rate for Payer: Group Health Inc Medicare $182.78
Rate for Payer: Hamaspik Choice Inc Medicaid $261.11
Rate for Payer: Hamaspik Choice Inc Medicare $261.11
Hospital Charge Code 64901108
Hospital Revenue Code 270
Min. Negotiated Rate $0.06
Max. Negotiated Rate $0.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.09
Rate for Payer: Aetna Government $0.09
Rate for Payer: Brighton Health Commercial $0.14
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.14
Rate for Payer: Cigna LocalPlus Benefit Plan $0.12
Rate for Payer: Group Health Inc Commercial $0.09
Rate for Payer: Group Health Inc Medicare $0.06
Rate for Payer: Hamaspik Choice Inc Medicaid $0.09
Rate for Payer: Hamaspik Choice Inc Medicare $0.09
Hospital Charge Code 64901110
Hospital Revenue Code 270
Min. Negotiated Rate $0.12
Max. Negotiated Rate $0.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.17
Rate for Payer: Aetna Government $0.17
Rate for Payer: Brighton Health Commercial $0.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.27
Rate for Payer: Cigna LocalPlus Benefit Plan $0.23
Rate for Payer: Group Health Inc Commercial $0.17
Rate for Payer: Group Health Inc Medicare $0.12
Rate for Payer: Hamaspik Choice Inc Medicaid $0.17
Rate for Payer: Hamaspik Choice Inc Medicare $0.17
Service Code HCPCS 96373
Hospital Charge Code 30303090
Hospital Revenue Code 510
Rate for Payer: Cash Price $247.87
Service Code HCPCS 96373
Hospital Charge Code 30303090
Hospital Revenue Code 510
Min. Negotiated Rate $173.89
Max. Negotiated Rate $306.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial $306.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $247.87
Rate for Payer: Aetna Government $247.87
Rate for Payer: Brighton Health Commercial $233.00
Rate for Payer: Cash Price $247.87
Rate for Payer: Cash Price $247.87
Rate for Payer: Cash Price $247.87
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $247.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $204.58
Rate for Payer: Cigna LocalPlus Benefit Plan $173.89
Rate for Payer: Elderplan Medicare Advantage $247.87
Rate for Payer: Fidelis Essential Plan Aliesa $210.69
Rate for Payer: Fidelis Essential Plan QHP $220.60
Rate for Payer: Fidelis Medicare Advantage $247.87
Rate for Payer: Fidelis Qualified Health Plan $220.60
Rate for Payer: Group Health Inc Commercial $250.00
Rate for Payer: Group Health Inc Medicare $250.00
Rate for Payer: Hamaspik Choice Inc Medicaid $278.25
Rate for Payer: Hamaspik Choice Inc Medicare $247.87
Rate for Payer: Healthfirst Medicare Advantage $210.69
Rate for Payer: Healthfirst QHP $247.87
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage $247.87
Rate for Payer: Senior Whole Health Medicare Advantage $247.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $247.87
Rate for Payer: Wellcare CHP/FHP/Medicaid $198.30
Rate for Payer: Wellcare Medicare $235.48
Service Code HCPCS 96365
Hospital Charge Code 30103083
Hospital Revenue Code 260
Min. Negotiated Rate $198.30
Max. Negotiated Rate $445.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial $306.08
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $247.87
Rate for Payer: Aetna Government $247.87
Rate for Payer: Brighton Health Commercial $417.38
Rate for Payer: Cash Price $247.87
Rate for Payer: Cash Price $247.87
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $247.87
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $445.20
Rate for Payer: Cigna LocalPlus Benefit Plan $378.42
Rate for Payer: Elderplan Medicare Advantage $247.87
Rate for Payer: EmblemHealth Commercial $247.87
Rate for Payer: Fidelis Essential Plan Aliesa $210.69
Rate for Payer: Fidelis Essential Plan QHP $220.60
Rate for Payer: Fidelis Medicare Advantage $247.87
Rate for Payer: Fidelis Qualified Health Plan $220.60
Rate for Payer: Group Health Inc Commercial $247.87
Rate for Payer: Group Health Inc Medicare $247.87
Rate for Payer: Hamaspik Choice Inc Medicaid $278.25
Rate for Payer: Hamaspik Choice Inc Medicare $247.87
Rate for Payer: Healthfirst Medicare Advantage $210.69
Rate for Payer: Healthfirst QHP $247.87
Rate for Payer: Senior Whole Health Medicare Advantage $247.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $247.87
Rate for Payer: Wellcare CHP/FHP/Medicaid $198.30
Rate for Payer: Wellcare Medicare $235.48
Service Code HCPCS 96365
Hospital Charge Code 30103083
Hospital Revenue Code 260
Rate for Payer: Cash Price $247.87
Hospital Charge Code 41651522
Hospital Revenue Code 250
Min. Negotiated Rate $1.05
Max. Negotiated Rate $2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.50
Rate for Payer: Aetna Government $1.50
Rate for Payer: Brighton Health Commercial $2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2.40
Rate for Payer: Cigna LocalPlus Benefit Plan $2.04
Rate for Payer: Group Health Inc Commercial $1.50
Rate for Payer: Group Health Inc Medicare $1.05
Rate for Payer: Hamaspik Choice Inc Medicaid $1.50
Rate for Payer: Hamaspik Choice Inc Medicare $1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.95
Hospital Charge Code 41641522
Hospital Revenue Code 250
Min. Negotiated Rate $1.05
Max. Negotiated Rate $2.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.65
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.50
Rate for Payer: Aetna Government $1.50
Rate for Payer: Brighton Health Commercial $2.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2.40
Rate for Payer: Cigna LocalPlus Benefit Plan $2.04
Rate for Payer: Group Health Inc Commercial $1.50
Rate for Payer: Group Health Inc Medicare $1.05
Rate for Payer: Hamaspik Choice Inc Medicaid $1.50
Rate for Payer: Hamaspik Choice Inc Medicare $1.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.95