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Charge Type Price  
Hospital Charge Code 64904014
Hospital Revenue Code 279
Min. Negotiated Rate $18.56
Max. Negotiated Rate $42.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial $29.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $26.52
Rate for Payer: Aetna Government $26.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $42.42
Rate for Payer: Cigna LocalPlus Benefit Plan $36.06
Rate for Payer: Group Health Inc Commercial $26.52
Rate for Payer: Group Health Inc Medicare $18.56
Rate for Payer: Hamaspik Choice Inc Medicaid $26.52
Rate for Payer: Hamaspik Choice Inc Medicare $26.52
Hospital Charge Code 40203064
Hospital Revenue Code 272
Min. Negotiated Rate $125.08
Max. Negotiated Rate $285.90
Rate for Payer: 1199SEIU National Benefit Fund Commercial $196.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $178.68
Rate for Payer: Aetna Government $178.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $285.90
Rate for Payer: Cigna LocalPlus Benefit Plan $243.01
Rate for Payer: Group Health Inc Commercial $178.68
Rate for Payer: Group Health Inc Medicare $125.08
Rate for Payer: Hamaspik Choice Inc Medicaid $178.68
Rate for Payer: Hamaspik Choice Inc Medicare $178.68
Hospital Charge Code 40203065
Hospital Revenue Code 272
Min. Negotiated Rate $383.83
Max. Negotiated Rate $877.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial $603.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $548.34
Rate for Payer: Aetna Government $548.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $877.34
Rate for Payer: Cigna LocalPlus Benefit Plan $745.74
Rate for Payer: Group Health Inc Commercial $548.34
Rate for Payer: Group Health Inc Medicare $383.83
Rate for Payer: Hamaspik Choice Inc Medicaid $548.34
Rate for Payer: Hamaspik Choice Inc Medicare $548.34
Hospital Charge Code 64903037
Hospital Revenue Code 279
Min. Negotiated Rate $8.47
Max. Negotiated Rate $19.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial $13.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $12.10
Rate for Payer: Aetna Government $12.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $19.35
Rate for Payer: Cigna LocalPlus Benefit Plan $16.45
Rate for Payer: Group Health Inc Commercial $12.10
Rate for Payer: Group Health Inc Medicare $8.47
Rate for Payer: Hamaspik Choice Inc Medicaid $12.10
Rate for Payer: Hamaspik Choice Inc Medicare $12.10
Hospital Charge Code 64907362
Hospital Revenue Code 270
Min. Negotiated Rate $21.70
Max. Negotiated Rate $49.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $34.10
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $31.00
Rate for Payer: Aetna Government $31.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $49.60
Rate for Payer: Cigna LocalPlus Benefit Plan $42.16
Rate for Payer: Group Health Inc Commercial $31.00
Rate for Payer: Group Health Inc Medicare $21.70
Rate for Payer: Hamaspik Choice Inc Medicaid $31.00
Rate for Payer: Hamaspik Choice Inc Medicare $31.00
Hospital Charge Code 64902950
Hospital Revenue Code 279
Min. Negotiated Rate $376.25
Max. Negotiated Rate $860.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $591.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $537.50
Rate for Payer: Aetna Government $537.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $860.00
Rate for Payer: Cigna LocalPlus Benefit Plan $731.00
Rate for Payer: Group Health Inc Commercial $537.50
Rate for Payer: Group Health Inc Medicare $376.25
Rate for Payer: Hamaspik Choice Inc Medicaid $537.50
Rate for Payer: Hamaspik Choice Inc Medicare $537.50
Service Code HCPCS C1726
Hospital Charge Code 64906893
Hospital Revenue Code 278
Min. Negotiated Rate $17.43
Max. Negotiated Rate $266.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial $139.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $17.43
Rate for Payer: Aetna Government $17.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $126.75
Rate for Payer: Cigna LocalPlus Benefit Plan $145.76
Rate for Payer: Fidelis Medicare Advantage $266.18
Rate for Payer: Group Health Inc Commercial $126.75
Rate for Payer: Group Health Inc Medicare $88.72
Rate for Payer: Hamaspik Choice Inc Medicaid $126.75
Rate for Payer: Hamaspik Choice Inc Medicare $126.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $164.78
Service Code HCPCS C1726
Hospital Charge Code 64906893
Hospital Revenue Code 278
Min. Negotiated Rate $126.75
Max. Negotiated Rate $126.75
Rate for Payer: Hamaspik Choice Inc Medicaid $126.75
Rate for Payer: Hamaspik Choice Inc Medicare $126.75
Hospital Charge Code 64903177
Hospital Revenue Code 279
Min. Negotiated Rate $7.22
Max. Negotiated Rate $16.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $11.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $10.32
Rate for Payer: Aetna Government $10.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $16.50
Rate for Payer: Cigna LocalPlus Benefit Plan $14.03
Rate for Payer: Group Health Inc Commercial $10.32
Rate for Payer: Group Health Inc Medicare $7.22
Rate for Payer: Hamaspik Choice Inc Medicaid $10.32
Rate for Payer: Hamaspik Choice Inc Medicare $10.32
Hospital Charge Code 64903181
Hospital Revenue Code 279
Min. Negotiated Rate $7.22
Max. Negotiated Rate $16.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $11.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $10.32
Rate for Payer: Aetna Government $10.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $16.50
Rate for Payer: Cigna LocalPlus Benefit Plan $14.03
Rate for Payer: Group Health Inc Commercial $10.32
Rate for Payer: Group Health Inc Medicare $7.22
Rate for Payer: Hamaspik Choice Inc Medicaid $10.32
Rate for Payer: Hamaspik Choice Inc Medicare $10.32
Hospital Charge Code 64903183
Hospital Revenue Code 279
Min. Negotiated Rate $7.77
Max. Negotiated Rate $17.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial $12.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $11.10
Rate for Payer: Aetna Government $11.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $17.77
Rate for Payer: Cigna LocalPlus Benefit Plan $15.10
Rate for Payer: Group Health Inc Commercial $11.10
Rate for Payer: Group Health Inc Medicare $7.77
Rate for Payer: Hamaspik Choice Inc Medicaid $11.10
Rate for Payer: Hamaspik Choice Inc Medicare $11.10
Hospital Charge Code 64903184
Hospital Revenue Code 279
Min. Negotiated Rate $7.77
Max. Negotiated Rate $17.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial $12.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $11.10
Rate for Payer: Aetna Government $11.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $17.77
Rate for Payer: Cigna LocalPlus Benefit Plan $15.10
Rate for Payer: Group Health Inc Commercial $11.10
Rate for Payer: Group Health Inc Medicare $7.77
Rate for Payer: Hamaspik Choice Inc Medicaid $11.10
Rate for Payer: Hamaspik Choice Inc Medicare $11.10
Hospital Charge Code 64903967
Hospital Revenue Code 279
Min. Negotiated Rate $10.42
Max. Negotiated Rate $23.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial $16.37
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $14.88
Rate for Payer: Aetna Government $14.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $23.81
Rate for Payer: Cigna LocalPlus Benefit Plan $20.24
Rate for Payer: Group Health Inc Commercial $14.88
Rate for Payer: Group Health Inc Medicare $10.42
Rate for Payer: Hamaspik Choice Inc Medicaid $14.88
Rate for Payer: Hamaspik Choice Inc Medicare $14.88
Hospital Charge Code 64903970
Hospital Revenue Code 279
Min. Negotiated Rate $10.41
Max. Negotiated Rate $23.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $16.36
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $14.88
Rate for Payer: Aetna Government $14.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $23.80
Rate for Payer: Cigna LocalPlus Benefit Plan $20.23
Rate for Payer: Group Health Inc Commercial $14.88
Rate for Payer: Group Health Inc Medicare $10.41
Rate for Payer: Hamaspik Choice Inc Medicaid $14.88
Rate for Payer: Hamaspik Choice Inc Medicare $14.88
Hospital Charge Code 64904234
Hospital Revenue Code 279
Min. Negotiated Rate $0.95
Max. Negotiated Rate $2.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.35
Rate for Payer: Aetna Government $1.35
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2.16
Rate for Payer: Cigna LocalPlus Benefit Plan $1.84
Rate for Payer: Group Health Inc Commercial $1.35
Rate for Payer: Group Health Inc Medicare $0.95
Rate for Payer: Hamaspik Choice Inc Medicaid $1.35
Rate for Payer: Hamaspik Choice Inc Medicare $1.35
Service Code HCPCS C1725
Hospital Charge Code 40200683
Hospital Revenue Code 278
Min. Negotiated Rate $44.85
Max. Negotiated Rate $5,798.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3,037.10
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 $2,761.00
Rate for Payer: Cigna LocalPlus Benefit Plan $3,175.15
Rate for Payer: Fidelis Medicare Advantage $5,798.10
Rate for Payer: Group Health Inc Commercial $2,761.00
Rate for Payer: Group Health Inc Medicare $1,932.70
Rate for Payer: Hamaspik Choice Inc Medicaid $2,761.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,761.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3,589.30
Service Code HCPCS C1725
Hospital Charge Code 40200683
Hospital Revenue Code 278
Min. Negotiated Rate $2,761.00
Max. Negotiated Rate $2,761.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2,761.00
Rate for Payer: Hamaspik Choice Inc Medicare $2,761.00
Hospital Charge Code 40201052
Hospital Revenue Code 270
Min. Negotiated Rate $37.10
Max. Negotiated Rate $84.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $58.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $53.00
Rate for Payer: Aetna Government $53.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $84.80
Rate for Payer: Cigna LocalPlus Benefit Plan $72.08
Rate for Payer: Group Health Inc Commercial $53.00
Rate for Payer: Group Health Inc Medicare $37.10
Rate for Payer: Hamaspik Choice Inc Medicaid $53.00
Rate for Payer: Hamaspik Choice Inc Medicare $53.00
Hospital Charge Code 64904090
Hospital Revenue Code 279
Min. Negotiated Rate $258.12
Max. Negotiated Rate $590.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $405.62
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $368.75
Rate for Payer: Aetna Government $368.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $590.00
Rate for Payer: Cigna LocalPlus Benefit Plan $501.50
Rate for Payer: Group Health Inc Commercial $368.75
Rate for Payer: Group Health Inc Medicare $258.12
Rate for Payer: Hamaspik Choice Inc Medicaid $368.75
Rate for Payer: Hamaspik Choice Inc Medicare $368.75
Service Code HCPCS C1758
Hospital Charge Code 64903178
Hospital Revenue Code 279
Min. Negotiated Rate $2.97
Max. Negotiated Rate $17.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial $12.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.97
Rate for Payer: Aetna Government $2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $17.64
Rate for Payer: Cigna LocalPlus Benefit Plan $14.99
Rate for Payer: Group Health Inc Commercial $11.02
Rate for Payer: Group Health Inc Medicare $7.72
Rate for Payer: Hamaspik Choice Inc Medicaid $11.02
Rate for Payer: Hamaspik Choice Inc Medicare $11.02
Service Code HCPCS C1758
Hospital Charge Code 64903180
Hospital Revenue Code 279
Min. Negotiated Rate $2.97
Max. Negotiated Rate $16.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $11.35
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.97
Rate for Payer: Aetna Government $2.97
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $16.50
Rate for Payer: Cigna LocalPlus Benefit Plan $14.03
Rate for Payer: Group Health Inc Commercial $10.32
Rate for Payer: Group Health Inc Medicare $7.22
Rate for Payer: Hamaspik Choice Inc Medicaid $10.32
Rate for Payer: Hamaspik Choice Inc Medicare $10.32
Hospital Charge Code 40201053
Hospital Revenue Code 270
Min. Negotiated Rate $16.80
Max. Negotiated Rate $38.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $26.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $24.00
Rate for Payer: Aetna Government $24.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $38.40
Rate for Payer: Cigna LocalPlus Benefit Plan $32.64
Rate for Payer: Group Health Inc Commercial $24.00
Rate for Payer: Group Health Inc Medicare $16.80
Rate for Payer: Hamaspik Choice Inc Medicaid $24.00
Rate for Payer: Hamaspik Choice Inc Medicare $24.00
Hospital Charge Code 40201054
Hospital Revenue Code 270
Min. Negotiated Rate $16.80
Max. Negotiated Rate $38.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $26.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $24.00
Rate for Payer: Aetna Government $24.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $38.40
Rate for Payer: Cigna LocalPlus Benefit Plan $32.64
Rate for Payer: Group Health Inc Commercial $24.00
Rate for Payer: Group Health Inc Medicare $16.80
Rate for Payer: Hamaspik Choice Inc Medicaid $24.00
Rate for Payer: Hamaspik Choice Inc Medicare $24.00
Service Code HCPCS C1887
Hospital Charge Code 64906924
Hospital Revenue Code 278
Min. Negotiated Rate $3.21
Max. Negotiated Rate $192.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial $100.64
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $3.21
Rate for Payer: Aetna Government $3.21
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $91.49
Rate for Payer: Cigna LocalPlus Benefit Plan $105.21
Rate for Payer: Fidelis Medicare Advantage $192.13
Rate for Payer: Group Health Inc Commercial $91.49
Rate for Payer: Group Health Inc Medicare $64.04
Rate for Payer: Hamaspik Choice Inc Medicaid $91.49
Rate for Payer: Hamaspik Choice Inc Medicare $91.49
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $118.94
Service Code HCPCS C1887
Hospital Charge Code 64906924
Hospital Revenue Code 278
Min. Negotiated Rate $91.49
Max. Negotiated Rate $91.49
Rate for Payer: Hamaspik Choice Inc Medicaid $91.49
Rate for Payer: Hamaspik Choice Inc Medicare $91.49