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Charge Type Price  
Service Code HCPCS C1876
Hospital Charge Code 66528569
Hospital Revenue Code 278
Min. Negotiated Rate $1,618.50
Max. Negotiated Rate $1,618.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,618.50
Rate for Payer: Hamaspik Choice Inc Medicare $1,618.50
Service Code HCPCS C1876
Hospital Charge Code 66528573
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,432.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,274.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,158.30
Rate for Payer: Cigna LocalPlus Benefit Plan $1,332.04
Rate for Payer: Fidelis Medicare Advantage $2,432.43
Rate for Payer: Group Health Inc Commercial $1,158.30
Rate for Payer: Group Health Inc Medicare $810.81
Rate for Payer: Hamaspik Choice Inc Medicaid $1,158.30
Rate for Payer: Hamaspik Choice Inc Medicare $1,158.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,505.79
Service Code HCPCS C1876
Hospital Charge Code 66528573
Hospital Revenue Code 278
Min. Negotiated Rate $1,158.30
Max. Negotiated Rate $1,158.30
Rate for Payer: Hamaspik Choice Inc Medicaid $1,158.30
Rate for Payer: Hamaspik Choice Inc Medicare $1,158.30
Service Code HCPCS C1876
Hospital Charge Code 66528572
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,694.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,411.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,283.10
Rate for Payer: Cigna LocalPlus Benefit Plan $1,475.56
Rate for Payer: Fidelis Medicare Advantage $2,694.51
Rate for Payer: Group Health Inc Commercial $1,283.10
Rate for Payer: Group Health Inc Medicare $898.17
Rate for Payer: Hamaspik Choice Inc Medicaid $1,283.10
Rate for Payer: Hamaspik Choice Inc Medicare $1,283.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,668.03
Service Code HCPCS C1876
Hospital Charge Code 66528572
Hospital Revenue Code 278
Min. Negotiated Rate $1,283.10
Max. Negotiated Rate $1,283.10
Rate for Payer: Hamaspik Choice Inc Medicaid $1,283.10
Rate for Payer: Hamaspik Choice Inc Medicare $1,283.10
Service Code HCPCS C1876
Hospital Charge Code 66528571
Hospital Revenue Code 278
Min. Negotiated Rate $1,283.10
Max. Negotiated Rate $1,283.10
Rate for Payer: Hamaspik Choice Inc Medicaid $1,283.10
Rate for Payer: Hamaspik Choice Inc Medicare $1,283.10
Service Code HCPCS C1876
Hospital Charge Code 66528570
Hospital Revenue Code 278
Min. Negotiated Rate $1,540.50
Max. Negotiated Rate $1,540.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,540.50
Rate for Payer: Hamaspik Choice Inc Medicare $1,540.50
Service Code HCPCS C1876
Hospital Charge Code 66528571
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,694.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,411.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,283.10
Rate for Payer: Cigna LocalPlus Benefit Plan $1,475.56
Rate for Payer: Fidelis Medicare Advantage $2,694.51
Rate for Payer: Group Health Inc Commercial $1,283.10
Rate for Payer: Group Health Inc Medicare $898.17
Rate for Payer: Hamaspik Choice Inc Medicaid $1,283.10
Rate for Payer: Hamaspik Choice Inc Medicare $1,283.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,668.03
Service Code HCPCS C1876
Hospital Charge Code 66528570
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $3,235.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,694.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,540.50
Rate for Payer: Cigna LocalPlus Benefit Plan $1,771.58
Rate for Payer: Fidelis Medicare Advantage $3,235.05
Rate for Payer: Group Health Inc Commercial $1,540.50
Rate for Payer: Group Health Inc Medicare $1,078.35
Rate for Payer: Hamaspik Choice Inc Medicaid $1,540.50
Rate for Payer: Hamaspik Choice Inc Medicare $1,540.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,002.65
Service Code HCPCS C1876
Hospital Charge Code 66528568
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,432.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,274.13
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,158.30
Rate for Payer: Cigna LocalPlus Benefit Plan $1,332.04
Rate for Payer: Fidelis Medicare Advantage $2,432.43
Rate for Payer: Group Health Inc Commercial $1,158.30
Rate for Payer: Group Health Inc Medicare $810.81
Rate for Payer: Hamaspik Choice Inc Medicaid $1,158.30
Rate for Payer: Hamaspik Choice Inc Medicare $1,158.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,505.79
Service Code HCPCS C1876
Hospital Charge Code 66528568
Hospital Revenue Code 278
Min. Negotiated Rate $1,158.30
Max. Negotiated Rate $1,158.30
Rate for Payer: Hamaspik Choice Inc Medicaid $1,158.30
Rate for Payer: Hamaspik Choice Inc Medicare $1,158.30
Service Code HCPCS C1876
Hospital Charge Code 66528567
Hospital Revenue Code 278
Min. Negotiated Rate $1,283.10
Max. Negotiated Rate $1,283.10
Rate for Payer: Hamaspik Choice Inc Medicaid $1,283.10
Rate for Payer: Hamaspik Choice Inc Medicare $1,283.10
Service Code HCPCS C1876
Hospital Charge Code 66528567
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $2,694.51
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,411.41
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,283.10
Rate for Payer: Cigna LocalPlus Benefit Plan $1,475.56
Rate for Payer: Fidelis Medicare Advantage $2,694.51
Rate for Payer: Group Health Inc Commercial $1,283.10
Rate for Payer: Group Health Inc Medicare $898.17
Rate for Payer: Hamaspik Choice Inc Medicaid $1,283.10
Rate for Payer: Hamaspik Choice Inc Medicare $1,283.10
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,668.03
Service Code HCPCS C1876
Hospital Charge Code 66528566
Hospital Revenue Code 278
Min. Negotiated Rate $1,540.50
Max. Negotiated Rate $1,540.50
Rate for Payer: Hamaspik Choice Inc Medicaid $1,540.50
Rate for Payer: Hamaspik Choice Inc Medicare $1,540.50
Service Code HCPCS C1876
Hospital Charge Code 66528566
Hospital Revenue Code 278
Min. Negotiated Rate $398.18
Max. Negotiated Rate $3,235.05
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,694.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $398.18
Rate for Payer: Aetna Government $398.18
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,540.50
Rate for Payer: Cigna LocalPlus Benefit Plan $1,771.58
Rate for Payer: Fidelis Medicare Advantage $3,235.05
Rate for Payer: Group Health Inc Commercial $1,540.50
Rate for Payer: Group Health Inc Medicare $1,078.35
Rate for Payer: Hamaspik Choice Inc Medicaid $1,540.50
Rate for Payer: Hamaspik Choice Inc Medicare $1,540.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2,002.65
Service Code HCPCS C1887
Hospital Charge Code 66528427
Hospital Revenue Code 278
Min. Negotiated Rate $3.21
Max. Negotiated Rate $231.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $121.00
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 $110.00
Rate for Payer: Cigna LocalPlus Benefit Plan $126.50
Rate for Payer: Fidelis Medicare Advantage $231.00
Rate for Payer: Group Health Inc Commercial $110.00
Rate for Payer: Group Health Inc Medicare $77.00
Rate for Payer: Hamaspik Choice Inc Medicaid $110.00
Rate for Payer: Hamaspik Choice Inc Medicare $110.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $143.00
Service Code HCPCS C1887
Hospital Charge Code 66528427
Hospital Revenue Code 278
Min. Negotiated Rate $110.00
Max. Negotiated Rate $110.00
Rate for Payer: Hamaspik Choice Inc Medicaid $110.00
Rate for Payer: Hamaspik Choice Inc Medicare $110.00
Service Code HCPCS C1887
Hospital Charge Code 66529921
Hospital Revenue Code 278
Min. Negotiated Rate $3.21
Max. Negotiated Rate $231.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $121.00
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 $110.00
Rate for Payer: Cigna LocalPlus Benefit Plan $126.50
Rate for Payer: Fidelis Medicare Advantage $231.00
Rate for Payer: Group Health Inc Commercial $110.00
Rate for Payer: Group Health Inc Medicare $77.00
Rate for Payer: Hamaspik Choice Inc Medicaid $110.00
Rate for Payer: Hamaspik Choice Inc Medicare $110.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $143.00
Service Code HCPCS C1887
Hospital Charge Code 66529921
Hospital Revenue Code 278
Min. Negotiated Rate $110.00
Max. Negotiated Rate $110.00
Rate for Payer: Hamaspik Choice Inc Medicaid $110.00
Rate for Payer: Hamaspik Choice Inc Medicare $110.00
Hospital Charge Code 66528368
Hospital Revenue Code 270
Min. Negotiated Rate $2.11
Max. Negotiated Rate $4.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $3.02
Rate for Payer: Aetna Government $3.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $4.83
Rate for Payer: Cigna LocalPlus Benefit Plan $4.11
Rate for Payer: Group Health Inc Commercial $3.02
Rate for Payer: Group Health Inc Medicare $2.11
Rate for Payer: Hamaspik Choice Inc Medicaid $3.02
Rate for Payer: Hamaspik Choice Inc Medicare $3.02
Service Code HCPCS 92997
Hospital Charge Code 66528253
Hospital Revenue Code 480
Min. Negotiated Rate $708.98
Max. Negotiated Rate $24,008.24
Rate for Payer: 1199SEIU National Benefit Fund Commercial $16,505.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $12,721.98
Rate for Payer: Aetna Government $12,721.98
Rate for Payer: Cash Price $12,721.98
Rate for Payer: Cash Price $12,721.98
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $12,721.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $24,008.24
Rate for Payer: Cigna LocalPlus Benefit Plan $20,407.00
Rate for Payer: Elderplan Medicare Advantage $12,721.98
Rate for Payer: EmblemHealth Commercial $12,721.98
Rate for Payer: Fidelis CHP/HARP/Medicaid $708.98
Rate for Payer: Fidelis Essential Plan Aliesa $10,813.68
Rate for Payer: Fidelis Essential Plan QHP $11,322.56
Rate for Payer: Fidelis Medicare Advantage $12,721.98
Rate for Payer: Fidelis Qualified Health Plan $11,322.56
Rate for Payer: Group Health Inc Commercial $12,721.98
Rate for Payer: Group Health Inc Medicare $12,721.98
Rate for Payer: Hamaspik Choice Inc Medicaid $15,005.15
Rate for Payer: Hamaspik Choice Inc Medicare $12,721.98
Rate for Payer: Healthfirst CHP/FHP/Medicaid $787.76
Rate for Payer: Healthfirst Medicare Advantage $10,813.68
Rate for Payer: Healthfirst QHP $12,721.98
Rate for Payer: Senior Whole Health Medicare Advantage $12,721.98
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $12,721.98
Rate for Payer: Wellcare CHP/FHP/Medicaid $10,177.58
Rate for Payer: Wellcare Medicare $12,085.88
Service Code HCPCS 93454 TC
Hospital Charge Code 66528894
Hospital Revenue Code 481
Min. Negotiated Rate $747.27
Max. Negotiated Rate $6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4,747.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4,315.89
Rate for Payer: Aetna Government $4,315.89
Rate for Payer: Brighton Health Commercial $6,937.00
Rate for Payer: Cash Price $3,768.27
Rate for Payer: Cash Price $3,768.27
Rate for Payer: Cash Price $3,768.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $4,959.74
Rate for Payer: Cigna LocalPlus Benefit Plan $4,215.78
Rate for Payer: Fidelis CHP/HARP/Medicaid $747.27
Rate for Payer: Group Health Inc Commercial $4,315.89
Rate for Payer: Group Health Inc Medicare $3,021.12
Rate for Payer: Hamaspik Choice Inc Medicaid $4,315.89
Rate for Payer: Hamaspik Choice Inc Medicare $4,315.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid $830.30
Service Code HCPCS 93455 TC
Hospital Charge Code 66528895
Hospital Revenue Code 481
Min. Negotiated Rate $818.98
Max. Negotiated Rate $6,937.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4,747.48
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4,315.89
Rate for Payer: Aetna Government $4,315.89
Rate for Payer: Brighton Health Commercial $6,937.00
Rate for Payer: Cash Price $3,768.27
Rate for Payer: Cash Price $3,768.27
Rate for Payer: Cash Price $3,768.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $4,959.74
Rate for Payer: Cigna LocalPlus Benefit Plan $4,215.78
Rate for Payer: Fidelis CHP/HARP/Medicaid $818.98
Rate for Payer: Group Health Inc Commercial $4,315.89
Rate for Payer: Group Health Inc Medicare $3,021.12
Rate for Payer: Hamaspik Choice Inc Medicaid $4,315.89
Rate for Payer: Hamaspik Choice Inc Medicare $4,315.89
Rate for Payer: Healthfirst CHP/FHP/Medicaid $909.98
Service Code HCPCS C1882
Hospital Charge Code 66571448
Hospital Revenue Code 278
Min. Negotiated Rate $18,750.00
Max. Negotiated Rate $18,750.00
Rate for Payer: Hamaspik Choice Inc Medicaid $18,750.00
Rate for Payer: Hamaspik Choice Inc Medicare $18,750.00
Service Code HCPCS C1882
Hospital Charge Code 66571448
Hospital Revenue Code 278
Min. Negotiated Rate $4,752.01
Max. Negotiated Rate $39,375.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $20,625.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4,752.01
Rate for Payer: Aetna Government $4,752.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $18,750.00
Rate for Payer: Cigna LocalPlus Benefit Plan $21,562.50
Rate for Payer: Fidelis Medicare Advantage $39,375.00
Rate for Payer: Group Health Inc Commercial $18,750.00
Rate for Payer: Group Health Inc Medicare $13,125.00
Rate for Payer: Hamaspik Choice Inc Medicaid $18,750.00
Rate for Payer: Hamaspik Choice Inc Medicare $18,750.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $24,375.00