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Charge Type Setting Price  
Service Code NDC 4970220718
Hospital Charge Code 4970220718
Hospital Revenue Code 250
Min. Negotiated Rate $8.11
Max. Negotiated Rate $18.54
Rate for Payer: 1199SEIU National Benefit Fund Commercial $12.74
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $11.59
Rate for Payer: Aetna Government $11.59
Rate for Payer: Brighton Health Commercial $17.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $18.54
Rate for Payer: Cigna LocalPlus Benefit Plan $15.76
Rate for Payer: EmblemHealth Commercial $11.59
Rate for Payer: Group Health Inc Commercial $11.59
Rate for Payer: Group Health Inc Medicare $8.11
Rate for Payer: Hamaspik Choice Inc Medicaid $11.59
Rate for Payer: Hamaspik Choice Inc Medicare $11.59
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $15.06
Service Code NDC 4970220718
Hospital Charge Code 4970220718
Hospital Revenue Code 250
Min. Negotiated Rate $11.59
Max. Negotiated Rate $11.59
Rate for Payer: Hamaspik Choice Inc Medicaid $11.59
Service Code NDC 6330458360
Hospital Charge Code 6330458360
Hospital Revenue Code 250
Min. Negotiated Rate $7.29
Max. Negotiated Rate $16.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial $11.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $10.42
Rate for Payer: Aetna Government $10.42
Rate for Payer: Brighton Health Commercial $15.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $16.66
Rate for Payer: Cigna LocalPlus Benefit Plan $14.17
Rate for Payer: EmblemHealth Commercial $10.42
Rate for Payer: Group Health Inc Commercial $10.42
Rate for Payer: Group Health Inc Medicare $7.29
Rate for Payer: Hamaspik Choice Inc Medicaid $10.42
Rate for Payer: Hamaspik Choice Inc Medicare $10.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $13.54
Service Code NDC 6330458360
Hospital Charge Code 6330458360
Hospital Revenue Code 250
Min. Negotiated Rate $10.42
Max. Negotiated Rate $10.42
Rate for Payer: Hamaspik Choice Inc Medicaid $10.42
Service Code HCPCS J1453
Hospital Charge Code 3172216531
Hospital Revenue Code 258
Min. Negotiated Rate $160.88
Max. Negotiated Rate $160.88
Rate for Payer: Hamaspik Choice Inc Medicaid $160.88
Service Code HCPCS J1453
Hospital Charge Code 0006306100
Hospital Revenue Code 258
Min. Negotiated Rate $200.78
Max. Negotiated Rate $200.78
Rate for Payer: Hamaspik Choice Inc Medicaid $200.78
Service Code HCPCS J1453
Hospital Charge Code 3172216531
Hospital Revenue Code 258
Min. Negotiated Rate $0.24
Max. Negotiated Rate $257.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $176.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.24
Rate for Payer: Aetna Government $0.24
Rate for Payer: Affinity Essential Plan 1&2 $3.94
Rate for Payer: Affinity Essential Plan 3&4 $3.94
Rate for Payer: Affinity Medicaid/CHP/HARP $1.75
Rate for Payer: Amida Care Medicaid $1.75
Rate for Payer: Brighton Health Commercial $241.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $257.40
Rate for Payer: Cigna LocalPlus Benefit Plan $218.79
Rate for Payer: EmblemHealth Commercial $160.88
Rate for Payer: EmblemHealth Essential Plan 1&2 $3.94
Rate for Payer: EmblemHealth Essential Plan 3&4 $1.75
Rate for Payer: Fidelis CHP/HARP/Medicaid $1.75
Rate for Payer: Fidelis Essential Plan Aliesa $3.94
Rate for Payer: Fidelis Essential Plan QHP $3.94
Rate for Payer: Fidelis Qualified Health Plan $1.84
Rate for Payer: Group Health Inc Commercial $160.88
Rate for Payer: Group Health Inc Medicare $112.61
Rate for Payer: Hamaspik Choice Inc Medicaid $1.75
Rate for Payer: Hamaspik Choice Inc Medicare $160.88
Rate for Payer: Healthfirst CHP/FHP/Medicaid $175.00
Rate for Payer: Healthfirst Essential Plan $3.94
Rate for Payer: Healthfirst QHP $2.85
Rate for Payer: SOMOS CHP/HARP/Medicaid $1.75
Rate for Payer: SOMOS Essential $3.94
Rate for Payer: United Healthcare Essential Plan 1&2 $3.94
Rate for Payer: United Healthcare Essential Plan 3&4 $1.93
Rate for Payer: United Healthcare Medicaid $1.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $209.14
Rate for Payer: Wellcare CHP/FHP/Medicaid $1.75
Service Code HCPCS J1453
Hospital Charge Code 0006306100
Hospital Revenue Code 258
Min. Negotiated Rate $0.24
Max. Negotiated Rate $321.25
Rate for Payer: 1199SEIU National Benefit Fund Commercial $220.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.24
Rate for Payer: Aetna Government $0.24
Rate for Payer: Affinity Essential Plan 1&2 $3.94
Rate for Payer: Affinity Essential Plan 3&4 $3.94
Rate for Payer: Affinity Medicaid/CHP/HARP $1.75
Rate for Payer: Amida Care Medicaid $1.75
Rate for Payer: Brighton Health Commercial $301.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $321.25
Rate for Payer: Cigna LocalPlus Benefit Plan $273.06
Rate for Payer: EmblemHealth Commercial $200.78
Rate for Payer: EmblemHealth Essential Plan 1&2 $3.94
Rate for Payer: EmblemHealth Essential Plan 3&4 $1.75
Rate for Payer: Fidelis CHP/HARP/Medicaid $1.75
Rate for Payer: Fidelis Essential Plan Aliesa $3.94
Rate for Payer: Fidelis Essential Plan QHP $3.94
Rate for Payer: Fidelis Qualified Health Plan $1.84
Rate for Payer: Group Health Inc Commercial $200.78
Rate for Payer: Group Health Inc Medicare $140.55
Rate for Payer: Hamaspik Choice Inc Medicaid $1.75
Rate for Payer: Hamaspik Choice Inc Medicare $200.78
Rate for Payer: Healthfirst CHP/FHP/Medicaid $175.00
Rate for Payer: Healthfirst Essential Plan $3.94
Rate for Payer: Healthfirst QHP $2.85
Rate for Payer: SOMOS CHP/HARP/Medicaid $1.75
Rate for Payer: SOMOS Essential $3.94
Rate for Payer: United Healthcare Essential Plan 1&2 $3.94
Rate for Payer: United Healthcare Essential Plan 3&4 $1.93
Rate for Payer: United Healthcare Medicaid $1.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $261.01
Rate for Payer: Wellcare CHP/FHP/Medicaid $1.75
Service Code NDC 7070026894
Hospital Charge Code 7070026894
Hospital Revenue Code 250
Min. Negotiated Rate $50.20
Max. Negotiated Rate $50.20
Rate for Payer: Hamaspik Choice Inc Medicaid $50.20
Service Code NDC 7070026894
Hospital Charge Code 7070026894
Hospital Revenue Code 250
Min. Negotiated Rate $35.14
Max. Negotiated Rate $80.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial $55.22
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $50.20
Rate for Payer: Aetna Government $50.20
Rate for Payer: Brighton Health Commercial $75.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $80.32
Rate for Payer: Cigna LocalPlus Benefit Plan $68.27
Rate for Payer: EmblemHealth Commercial $50.20
Rate for Payer: Group Health Inc Commercial $50.20
Rate for Payer: Group Health Inc Medicare $35.14
Rate for Payer: Hamaspik Choice Inc Medicaid $50.20
Rate for Payer: Hamaspik Choice Inc Medicare $50.20
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $65.26
Service Code NDC 0641613601
Hospital Charge Code 0641613601
Hospital Revenue Code 250
Min. Negotiated Rate $3.11
Max. Negotiated Rate $7.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.44
Rate for Payer: Aetna Government $4.44
Rate for Payer: Brighton Health Commercial $6.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $7.10
Rate for Payer: Cigna LocalPlus Benefit Plan $6.04
Rate for Payer: EmblemHealth Commercial $4.44
Rate for Payer: Group Health Inc Commercial $4.44
Rate for Payer: Group Health Inc Medicare $3.11
Rate for Payer: Hamaspik Choice Inc Medicaid $4.44
Rate for Payer: Hamaspik Choice Inc Medicare $4.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $5.77
Service Code NDC 0069600125
Hospital Charge Code 0069600125
Hospital Revenue Code 250
Min. Negotiated Rate $12.13
Max. Negotiated Rate $12.13
Rate for Payer: Hamaspik Choice Inc Medicaid $12.13
Service Code NDC 0641613601
Hospital Charge Code 0641613601
Hospital Revenue Code 250
Min. Negotiated Rate $4.44
Max. Negotiated Rate $4.44
Rate for Payer: Hamaspik Choice Inc Medicaid $4.44
Service Code NDC 0069600125
Hospital Charge Code 0069600125
Hospital Revenue Code 250
Min. Negotiated Rate $8.49
Max. Negotiated Rate $19.41
Rate for Payer: 1199SEIU National Benefit Fund Commercial $13.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $12.13
Rate for Payer: Aetna Government $12.13
Rate for Payer: Brighton Health Commercial $18.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $19.41
Rate for Payer: Cigna LocalPlus Benefit Plan $16.50
Rate for Payer: EmblemHealth Commercial $12.13
Rate for Payer: Group Health Inc Commercial $12.13
Rate for Payer: Group Health Inc Medicare $8.49
Rate for Payer: Hamaspik Choice Inc Medicaid $12.13
Rate for Payer: Hamaspik Choice Inc Medicare $12.13
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $15.77
Service Code NDC 6846262102
Hospital Charge Code 6846262102
Hospital Revenue Code 250
Min. Negotiated Rate $4.44
Max. Negotiated Rate $4.44
Rate for Payer: Hamaspik Choice Inc Medicaid $4.44
Service Code NDC 6846262102
Hospital Charge Code 6846262102
Hospital Revenue Code 250
Min. Negotiated Rate $3.11
Max. Negotiated Rate $7.10
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.44
Rate for Payer: Aetna Government $4.44
Rate for Payer: Brighton Health Commercial $6.66
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $7.10
Rate for Payer: Cigna LocalPlus Benefit Plan $6.04
Rate for Payer: EmblemHealth Commercial $4.44
Rate for Payer: Group Health Inc Commercial $4.44
Rate for Payer: Group Health Inc Medicare $3.11
Rate for Payer: Hamaspik Choice Inc Medicaid $4.44
Rate for Payer: Hamaspik Choice Inc Medicare $4.44
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $5.77
Service Code NDC 0641613701
Hospital Charge Code 0641613701
Hospital Revenue Code 250
Min. Negotiated Rate $2.85
Max. Negotiated Rate $2.85
Rate for Payer: Hamaspik Choice Inc Medicaid $2.85
Service Code NDC 0069600121
Hospital Charge Code 0069600121
Hospital Revenue Code 250
Min. Negotiated Rate $5.09
Max. Negotiated Rate $11.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial $8.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $7.28
Rate for Payer: Aetna Government $7.28
Rate for Payer: Brighton Health Commercial $10.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $11.64
Rate for Payer: Cigna LocalPlus Benefit Plan $9.90
Rate for Payer: EmblemHealth Commercial $7.28
Rate for Payer: Group Health Inc Commercial $7.28
Rate for Payer: Group Health Inc Medicare $5.09
Rate for Payer: Hamaspik Choice Inc Medicaid $7.28
Rate for Payer: Hamaspik Choice Inc Medicare $7.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $9.46
Service Code NDC 0069600110
Hospital Charge Code 0069600110
Hospital Revenue Code 250
Min. Negotiated Rate $7.28
Max. Negotiated Rate $7.28
Rate for Payer: Hamaspik Choice Inc Medicaid $7.28
Service Code NDC 0069600110
Hospital Charge Code 0069600110
Hospital Revenue Code 250
Min. Negotiated Rate $5.09
Max. Negotiated Rate $11.64
Rate for Payer: 1199SEIU National Benefit Fund Commercial $8.01
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $7.28
Rate for Payer: Aetna Government $7.28
Rate for Payer: Brighton Health Commercial $10.92
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $11.64
Rate for Payer: Cigna LocalPlus Benefit Plan $9.90
Rate for Payer: EmblemHealth Commercial $7.28
Rate for Payer: Group Health Inc Commercial $7.28
Rate for Payer: Group Health Inc Medicare $5.09
Rate for Payer: Hamaspik Choice Inc Medicaid $7.28
Rate for Payer: Hamaspik Choice Inc Medicare $7.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $9.46
Service Code NDC 0641613701
Hospital Charge Code 0641613701
Hospital Revenue Code 250
Min. Negotiated Rate $2.00
Max. Negotiated Rate $4.56
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.85
Rate for Payer: Aetna Government $2.85
Rate for Payer: Brighton Health Commercial $4.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $4.56
Rate for Payer: Cigna LocalPlus Benefit Plan $3.88
Rate for Payer: EmblemHealth Commercial $2.85
Rate for Payer: Group Health Inc Commercial $2.85
Rate for Payer: Group Health Inc Medicare $2.00
Rate for Payer: Hamaspik Choice Inc Medicaid $2.85
Rate for Payer: Hamaspik Choice Inc Medicare $2.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3.71
Service Code NDC 0069600121
Hospital Charge Code 0069600121
Hospital Revenue Code 250
Min. Negotiated Rate $7.28
Max. Negotiated Rate $7.28
Rate for Payer: Hamaspik Choice Inc Medicaid $7.28
Service Code NDC 4970225018
Hospital Charge Code 4970225018
Hospital Revenue Code 250
Min. Negotiated Rate $63.07
Max. Negotiated Rate $144.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial $99.11
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $90.10
Rate for Payer: Aetna Government $90.10
Rate for Payer: Brighton Health Commercial $135.15
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $144.16
Rate for Payer: Cigna LocalPlus Benefit Plan $122.54
Rate for Payer: EmblemHealth Commercial $90.10
Rate for Payer: Group Health Inc Commercial $90.10
Rate for Payer: Group Health Inc Medicare $63.07
Rate for Payer: Hamaspik Choice Inc Medicaid $90.10
Rate for Payer: Hamaspik Choice Inc Medicare $90.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $117.13
Service Code NDC 4970225018
Hospital Charge Code 4970225018
Hospital Revenue Code 250
Min. Negotiated Rate $90.10
Max. Negotiated Rate $90.10
Rate for Payer: Hamaspik Choice Inc Medicaid $90.10
Service Code APR-DRG 3401
Min. Negotiated Rate $7,074.00
Max. Negotiated Rate $41,315.15
Rate for Payer: Affinity Essential Plan 1&2 $41,315.15
Rate for Payer: Affinity Essential Plan 3&4 $41,315.15
Rate for Payer: Affinity Medicaid/CHP/HARP $18,362.29
Rate for Payer: Amida Care Medicaid $18,362.29
Rate for Payer: EmblemHealth Essential Plan 1&2 $41,315.15
Rate for Payer: EmblemHealth Essential Plan 3&4 $18,362.29
Rate for Payer: Fidelis CHP/HARP/Medicaid $18,362.29
Rate for Payer: Fidelis Qualified Health Plan $22,034.75
Rate for Payer: Hamaspik Choice Inc Medicaid $18,362.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid $18,362.29
Rate for Payer: Healthfirst Commercial $11,587.00
Rate for Payer: Healthfirst Essential Plan $41,315.15
Rate for Payer: Healthfirst QHP $7,074.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $18,362.29
Rate for Payer: SOMOS Essential $41,315.15
Rate for Payer: United Healthcare Essential Plan 1&2 $41,315.15
Rate for Payer: United Healthcare Essential Plan 3&4 $41,315.15
Rate for Payer: United Healthcare Medicaid $18,362.29
Rate for Payer: Wellcare CHP/FHP/Medicaid $18,362.29