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Charge Type Setting Price  
Service Code NDC 7248567035
Hospital Charge Code 7248567035
Hospital Revenue Code 250
Min. Negotiated Rate $4.14
Max. Negotiated Rate $4.14
Rate for Payer: Hamaspik Choice Inc Medicaid $4.14
Service Code NDC 0574402450
Hospital Charge Code 0574402450
Hospital Revenue Code 250
Min. Negotiated Rate $3.04
Max. Negotiated Rate $6.96
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4.78
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.35
Rate for Payer: Aetna Government $4.35
Rate for Payer: Brighton Health Commercial $6.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $6.96
Rate for Payer: Cigna LocalPlus Benefit Plan $5.91
Rate for Payer: EmblemHealth Commercial $4.35
Rate for Payer: Group Health Inc Commercial $4.35
Rate for Payer: Group Health Inc Medicare $3.04
Rate for Payer: Hamaspik Choice Inc Medicaid $4.35
Rate for Payer: Hamaspik Choice Inc Medicare $4.35
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $5.65
Service Code NDC 0574402435
Hospital Charge Code 0574402435
Hospital Revenue Code 250
Min. Negotiated Rate $2.57
Max. Negotiated Rate $2.57
Rate for Payer: Hamaspik Choice Inc Medicaid $2.57
Service Code NDC 7248567031
Hospital Charge Code 7248567031
Hospital Revenue Code 250
Min. Negotiated Rate $10.02
Max. Negotiated Rate $10.02
Rate for Payer: Hamaspik Choice Inc Medicaid $10.02
Service Code NDC 0574402435
Hospital Charge Code 0574402435
Hospital Revenue Code 250
Min. Negotiated Rate $1.80
Max. Negotiated Rate $4.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2.82
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.57
Rate for Payer: Aetna Government $2.57
Rate for Payer: Brighton Health Commercial $3.85
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $4.10
Rate for Payer: Cigna LocalPlus Benefit Plan $3.49
Rate for Payer: EmblemHealth Commercial $2.57
Rate for Payer: Group Health Inc Commercial $2.57
Rate for Payer: Group Health Inc Medicare $1.80
Rate for Payer: Hamaspik Choice Inc Medicaid $2.57
Rate for Payer: Hamaspik Choice Inc Medicare $2.57
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3.34
Service Code NDC 0574402450
Hospital Charge Code 0574402450
Hospital Revenue Code 250
Min. Negotiated Rate $4.35
Max. Negotiated Rate $4.35
Rate for Payer: Hamaspik Choice Inc Medicaid $4.35
Service Code NDC 2420891019
Hospital Charge Code 2420891019
Hospital Revenue Code 250
Min. Negotiated Rate $4.35
Max. Negotiated Rate $9.93
Rate for Payer: 1199SEIU National Benefit Fund Commercial $6.83
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $6.21
Rate for Payer: Aetna Government $6.21
Rate for Payer: Brighton Health Commercial $9.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $9.93
Rate for Payer: Cigna LocalPlus Benefit Plan $8.44
Rate for Payer: EmblemHealth Commercial $6.21
Rate for Payer: Group Health Inc Commercial $6.21
Rate for Payer: Group Health Inc Medicare $4.35
Rate for Payer: Hamaspik Choice Inc Medicaid $6.21
Rate for Payer: Hamaspik Choice Inc Medicare $6.21
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $8.07
Service Code NDC 3326179501
Hospital Charge Code 3326179501
Hospital Revenue Code 250
Min. Negotiated Rate $4.25
Max. Negotiated Rate $9.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial $6.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $6.07
Rate for Payer: Aetna Government $6.07
Rate for Payer: Brighton Health Commercial $9.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $9.71
Rate for Payer: Cigna LocalPlus Benefit Plan $8.26
Rate for Payer: EmblemHealth Commercial $6.07
Rate for Payer: Group Health Inc Commercial $6.07
Rate for Payer: Group Health Inc Medicare $4.25
Rate for Payer: Hamaspik Choice Inc Medicaid $6.07
Rate for Payer: Hamaspik Choice Inc Medicare $6.07
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $7.89
Service Code NDC 7248567031
Hospital Charge Code 7248567031
Hospital Revenue Code 250
Min. Negotiated Rate $7.01
Max. Negotiated Rate $16.03
Rate for Payer: 1199SEIU National Benefit Fund Commercial $11.02
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $10.02
Rate for Payer: Aetna Government $10.02
Rate for Payer: Brighton Health Commercial $15.03
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $16.03
Rate for Payer: Cigna LocalPlus Benefit Plan $13.62
Rate for Payer: EmblemHealth Commercial $10.02
Rate for Payer: Group Health Inc Commercial $10.02
Rate for Payer: Group Health Inc Medicare $7.01
Rate for Payer: Hamaspik Choice Inc Medicaid $10.02
Rate for Payer: Hamaspik Choice Inc Medicare $10.02
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $13.02
Service Code NDC 7590707601
Hospital Charge Code 7590707601
Hospital Revenue Code 250
Min. Negotiated Rate $4.60
Max. Negotiated Rate $4.60
Rate for Payer: Hamaspik Choice Inc Medicaid $4.60
Service Code NDC 7590707601
Hospital Charge Code 7590707601
Hospital Revenue Code 250
Min. Negotiated Rate $3.22
Max. Negotiated Rate $7.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial $5.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.60
Rate for Payer: Aetna Government $4.60
Rate for Payer: Brighton Health Commercial $6.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $7.36
Rate for Payer: Cigna LocalPlus Benefit Plan $6.25
Rate for Payer: EmblemHealth Commercial $4.60
Rate for Payer: Group Health Inc Commercial $4.60
Rate for Payer: Group Health Inc Medicare $3.22
Rate for Payer: Hamaspik Choice Inc Medicaid $4.60
Rate for Payer: Hamaspik Choice Inc Medicare $4.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $5.98
Service Code NDC 1366860601
Hospital Charge Code 1366860601
Hospital Revenue Code 250
Min. Negotiated Rate $4.36
Max. Negotiated Rate $9.97
Rate for Payer: 1199SEIU National Benefit Fund Commercial $6.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $6.23
Rate for Payer: Aetna Government $6.23
Rate for Payer: Brighton Health Commercial $9.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $9.97
Rate for Payer: Cigna LocalPlus Benefit Plan $8.47
Rate for Payer: EmblemHealth Commercial $6.23
Rate for Payer: Group Health Inc Commercial $6.23
Rate for Payer: Group Health Inc Medicare $4.36
Rate for Payer: Hamaspik Choice Inc Medicaid $6.23
Rate for Payer: Hamaspik Choice Inc Medicare $6.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $8.10
Service Code NDC 1366860601
Hospital Charge Code 1366860601
Hospital Revenue Code 250
Min. Negotiated Rate $6.23
Max. Negotiated Rate $6.23
Rate for Payer: Hamaspik Choice Inc Medicaid $6.23
Service Code HCPCS J1364
Hospital Charge Code 1478911605
Hospital Revenue Code 258
Min. Negotiated Rate $120.00
Max. Negotiated Rate $120.00
Rate for Payer: Hamaspik Choice Inc Medicaid $120.00
Service Code HCPCS J1364
Hospital Charge Code 1478911605
Hospital Revenue Code 258
Min. Negotiated Rate $64.62
Max. Negotiated Rate $192.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $132.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $77.75
Rate for Payer: Aetna Government $77.75
Rate for Payer: Brighton Health Commercial $180.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $192.00
Rate for Payer: Cigna LocalPlus Benefit Plan $163.20
Rate for Payer: EmblemHealth Commercial $120.00
Rate for Payer: Group Health Inc Commercial $120.00
Rate for Payer: Group Health Inc Medicare $84.00
Rate for Payer: Hamaspik Choice Inc Medicaid $120.00
Rate for Payer: Hamaspik Choice Inc Medicare $120.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid $64.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $156.00
Service Code HCPCS J1364
Hospital Charge Code 0409648201
Hospital Revenue Code 258
Min. Negotiated Rate $38.17
Max. Negotiated Rate $87.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial $59.98
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $77.75
Rate for Payer: Aetna Government $77.75
Rate for Payer: Brighton Health Commercial $81.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $87.25
Rate for Payer: Cigna LocalPlus Benefit Plan $74.16
Rate for Payer: EmblemHealth Commercial $54.53
Rate for Payer: Group Health Inc Commercial $54.53
Rate for Payer: Group Health Inc Medicare $38.17
Rate for Payer: Hamaspik Choice Inc Medicaid $54.53
Rate for Payer: Hamaspik Choice Inc Medicare $54.53
Rate for Payer: Healthfirst CHP/FHP/Medicaid $64.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $70.89
Service Code HCPCS J1364
Hospital Charge Code 0409648201
Hospital Revenue Code 258
Min. Negotiated Rate $54.53
Max. Negotiated Rate $54.53
Rate for Payer: Hamaspik Choice Inc Medicaid $54.53
Service Code HCPCS J1364
Hospital Charge Code 1478911607
Hospital Revenue Code 258
Min. Negotiated Rate $120.00
Max. Negotiated Rate $120.00
Rate for Payer: Hamaspik Choice Inc Medicaid $120.00
Service Code HCPCS J1364
Hospital Charge Code 1478911607
Hospital Revenue Code 258
Min. Negotiated Rate $64.62
Max. Negotiated Rate $192.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $132.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $77.75
Rate for Payer: Aetna Government $77.75
Rate for Payer: Brighton Health Commercial $180.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $192.00
Rate for Payer: Cigna LocalPlus Benefit Plan $163.20
Rate for Payer: EmblemHealth Commercial $120.00
Rate for Payer: Group Health Inc Commercial $120.00
Rate for Payer: Group Health Inc Medicare $84.00
Rate for Payer: Hamaspik Choice Inc Medicaid $120.00
Rate for Payer: Hamaspik Choice Inc Medicare $120.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid $64.62
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $156.00
Service Code HCPCS J1805
Hospital Charge Code 6332365210
Hospital Revenue Code 258
Min. Negotiated Rate $0.95
Max. Negotiated Rate $0.95
Rate for Payer: Hamaspik Choice Inc Medicaid $0.95
Service Code HCPCS J1805
Hospital Charge Code 6745718210
Hospital Revenue Code 258
Min. Negotiated Rate $0.44
Max. Negotiated Rate $0.44
Rate for Payer: Hamaspik Choice Inc Medicaid $0.44
Service Code HCPCS J1805
Hospital Charge Code 5515019410
Hospital Revenue Code 258
Min. Negotiated Rate $0.22
Max. Negotiated Rate $0.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.44
Rate for Payer: Aetna Government $0.44
Rate for Payer: Brighton Health Commercial $0.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.70
Rate for Payer: Cigna LocalPlus Benefit Plan $0.60
Rate for Payer: EmblemHealth Commercial $0.44
Rate for Payer: Group Health Inc Commercial $0.44
Rate for Payer: Group Health Inc Medicare $0.31
Rate for Payer: Hamaspik Choice Inc Medicaid $0.44
Rate for Payer: Hamaspik Choice Inc Medicare $0.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid $0.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.57
Service Code HCPCS J1805
Hospital Charge Code 1001912001
Hospital Revenue Code 258
Min. Negotiated Rate $0.73
Max. Negotiated Rate $0.73
Rate for Payer: Hamaspik Choice Inc Medicaid $0.73
Service Code HCPCS J1805
Hospital Charge Code 5515019410
Hospital Revenue Code 258
Min. Negotiated Rate $0.44
Max. Negotiated Rate $0.44
Rate for Payer: Hamaspik Choice Inc Medicaid $0.44
Service Code HCPCS J1805
Hospital Charge Code 6745718210
Hospital Revenue Code 258
Min. Negotiated Rate $0.22
Max. Negotiated Rate $0.70
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.44
Rate for Payer: Aetna Government $0.44
Rate for Payer: Brighton Health Commercial $0.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.70
Rate for Payer: Cigna LocalPlus Benefit Plan $0.60
Rate for Payer: EmblemHealth Commercial $0.44
Rate for Payer: Group Health Inc Commercial $0.44
Rate for Payer: Group Health Inc Medicare $0.31
Rate for Payer: Hamaspik Choice Inc Medicaid $0.44
Rate for Payer: Hamaspik Choice Inc Medicare $0.44
Rate for Payer: Healthfirst CHP/FHP/Medicaid $0.22
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.57