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Service Code HCPCS J1631
Hospital Charge Code 1014709213
Hospital Revenue Code 250
Min. Negotiated Rate $15.53
Max. Negotiated Rate $15.53
Rate for Payer: Hamaspik Choice Inc Medicaid $15.53
Service Code HCPCS J1631
Hospital Charge Code 7006938110
Hospital Revenue Code 250
Min. Negotiated Rate $13.34
Max. Negotiated Rate $13.34
Rate for Payer: Hamaspik Choice Inc Medicaid $13.34
Service Code HCPCS J1631
Hospital Charge Code 7006938101
Hospital Revenue Code 250
Min. Negotiated Rate $4.40
Max. Negotiated Rate $21.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial $14.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $9.57
Rate for Payer: Aetna Government $9.57
Rate for Payer: Brighton Health Commercial $20.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $21.34
Rate for Payer: Cigna LocalPlus Benefit Plan $18.14
Rate for Payer: EmblemHealth Commercial $13.34
Rate for Payer: Group Health Inc Commercial $13.34
Rate for Payer: Group Health Inc Medicare $9.34
Rate for Payer: Hamaspik Choice Inc Medicaid $13.34
Rate for Payer: Hamaspik Choice Inc Medicare $13.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid $4.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $17.34
Service Code HCPCS J1631
Hospital Charge Code 7006938110
Hospital Revenue Code 250
Min. Negotiated Rate $4.40
Max. Negotiated Rate $21.34
Rate for Payer: 1199SEIU National Benefit Fund Commercial $14.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $9.57
Rate for Payer: Aetna Government $9.57
Rate for Payer: Brighton Health Commercial $20.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $21.34
Rate for Payer: Cigna LocalPlus Benefit Plan $18.14
Rate for Payer: EmblemHealth Commercial $13.34
Rate for Payer: Group Health Inc Commercial $13.34
Rate for Payer: Group Health Inc Medicare $9.34
Rate for Payer: Hamaspik Choice Inc Medicaid $13.34
Rate for Payer: Hamaspik Choice Inc Medicare $13.34
Rate for Payer: Healthfirst CHP/FHP/Medicaid $4.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $17.34
Service Code NDC 0904711241
Hospital Charge Code 0904711241
Hospital Revenue Code 250
Min. Negotiated Rate $0.44
Max. Negotiated Rate $0.44
Rate for Payer: Hamaspik Choice Inc Medicaid $0.44
Service Code NDC 0121058104
Hospital Charge Code 0121058104
Hospital Revenue Code 250
Min. Negotiated Rate $0.16
Max. Negotiated Rate $0.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.23
Rate for Payer: Aetna Government $0.23
Rate for Payer: Brighton Health Commercial $0.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.36
Rate for Payer: Cigna LocalPlus Benefit Plan $0.31
Rate for Payer: EmblemHealth Commercial $0.23
Rate for Payer: Group Health Inc Commercial $0.23
Rate for Payer: Group Health Inc Medicare $0.16
Rate for Payer: Hamaspik Choice Inc Medicaid $0.23
Rate for Payer: Hamaspik Choice Inc Medicare $0.23
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.29
Service Code NDC 0121058105
Hospital Charge Code 0121058105
Hospital Revenue Code 250
Min. Negotiated Rate $0.42
Max. Negotiated Rate $0.42
Rate for Payer: Hamaspik Choice Inc Medicaid $0.42
Service Code NDC 0904711270
Hospital Charge Code 0904711270
Hospital Revenue Code 250
Min. Negotiated Rate $0.31
Max. Negotiated Rate $0.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.49
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 $0.71
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.57
Service Code NDC 0904711270
Hospital Charge Code 0904711270
Hospital Revenue Code 250
Min. Negotiated Rate $0.44
Max. Negotiated Rate $0.44
Rate for Payer: Hamaspik Choice Inc Medicaid $0.44
Service Code NDC 0121058104
Hospital Charge Code 0121058104
Hospital Revenue Code 250
Min. Negotiated Rate $0.23
Max. Negotiated Rate $0.23
Rate for Payer: Hamaspik Choice Inc Medicaid $0.23
Service Code NDC 0904711241
Hospital Charge Code 0904711241
Hospital Revenue Code 250
Min. Negotiated Rate $0.31
Max. Negotiated Rate $0.71
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.49
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 $0.71
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: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.57
Service Code NDC 0121058105
Hospital Charge Code 0121058105
Hospital Revenue Code 250
Min. Negotiated Rate $0.29
Max. Negotiated Rate $0.67
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.42
Rate for Payer: Aetna Government $0.42
Rate for Payer: Brighton Health Commercial $0.63
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.67
Rate for Payer: Cigna LocalPlus Benefit Plan $0.57
Rate for Payer: EmblemHealth Commercial $0.42
Rate for Payer: Group Health Inc Commercial $0.42
Rate for Payer: Group Health Inc Medicare $0.29
Rate for Payer: Hamaspik Choice Inc Medicaid $0.42
Rate for Payer: Hamaspik Choice Inc Medicare $0.42
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.54
Service Code HCPCS J1630
Hospital Charge Code 6332347401
Hospital Revenue Code 250
Min. Negotiated Rate $3.59
Max. Negotiated Rate $3.59
Rate for Payer: Hamaspik Choice Inc Medicaid $3.59
Service Code HCPCS J1630
Hospital Charge Code 6332347410
Hospital Revenue Code 250
Min. Negotiated Rate $3.45
Max. Negotiated Rate $3.45
Rate for Payer: Hamaspik Choice Inc Medicaid $3.45
Service Code HCPCS J1630
Hospital Charge Code 6745742600
Hospital Revenue Code 250
Min. Negotiated Rate $0.72
Max. Negotiated Rate $0.72
Rate for Payer: Hamaspik Choice Inc Medicaid $0.72
Service Code HCPCS J1630
Hospital Charge Code 2502180601
Hospital Revenue Code 250
Min. Negotiated Rate $0.80
Max. Negotiated Rate $4.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3.30
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.46
Rate for Payer: Aetna Government $1.46
Rate for Payer: Brighton Health Commercial $4.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $4.80
Rate for Payer: Cigna LocalPlus Benefit Plan $4.08
Rate for Payer: EmblemHealth Commercial $3.00
Rate for Payer: Group Health Inc Commercial $3.00
Rate for Payer: Group Health Inc Medicare $2.10
Rate for Payer: Hamaspik Choice Inc Medicaid $3.00
Rate for Payer: Hamaspik Choice Inc Medicare $3.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid $0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $3.90
Service Code HCPCS J1630
Hospital Charge Code 2502180601
Hospital Revenue Code 250
Min. Negotiated Rate $3.00
Max. Negotiated Rate $3.00
Rate for Payer: Hamaspik Choice Inc Medicaid $3.00
Service Code HCPCS J1630
Hospital Charge Code 6745742600
Hospital Revenue Code 250
Min. Negotiated Rate $0.50
Max. Negotiated Rate $1.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.46
Rate for Payer: Aetna Government $1.46
Rate for Payer: Brighton Health Commercial $1.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.15
Rate for Payer: Cigna LocalPlus Benefit Plan $0.98
Rate for Payer: EmblemHealth Commercial $0.72
Rate for Payer: Group Health Inc Commercial $0.72
Rate for Payer: Group Health Inc Medicare $0.50
Rate for Payer: Hamaspik Choice Inc Medicaid $0.72
Rate for Payer: Hamaspik Choice Inc Medicare $0.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid $0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.94
Service Code HCPCS J1630
Hospital Charge Code 6745742612
Hospital Revenue Code 250
Min. Negotiated Rate $0.72
Max. Negotiated Rate $0.72
Rate for Payer: Hamaspik Choice Inc Medicaid $0.72
Service Code HCPCS J1630
Hospital Charge Code 6332347401
Hospital Revenue Code 250
Min. Negotiated Rate $0.80
Max. Negotiated Rate $5.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.46
Rate for Payer: Aetna Government $1.46
Rate for Payer: Brighton Health Commercial $5.39
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $5.75
Rate for Payer: Cigna LocalPlus Benefit Plan $4.89
Rate for Payer: EmblemHealth Commercial $3.59
Rate for Payer: Group Health Inc Commercial $3.59
Rate for Payer: Group Health Inc Medicare $2.52
Rate for Payer: Hamaspik Choice Inc Medicaid $3.59
Rate for Payer: Hamaspik Choice Inc Medicare $3.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid $0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $4.67
Service Code HCPCS J1630
Hospital Charge Code 6745742612
Hospital Revenue Code 250
Min. Negotiated Rate $0.50
Max. Negotiated Rate $1.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.46
Rate for Payer: Aetna Government $1.46
Rate for Payer: Brighton Health Commercial $1.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.15
Rate for Payer: Cigna LocalPlus Benefit Plan $0.98
Rate for Payer: EmblemHealth Commercial $0.72
Rate for Payer: Group Health Inc Commercial $0.72
Rate for Payer: Group Health Inc Medicare $0.50
Rate for Payer: Hamaspik Choice Inc Medicaid $0.72
Rate for Payer: Hamaspik Choice Inc Medicare $0.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid $0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.94
Service Code HCPCS J1630
Hospital Charge Code 6332347410
Hospital Revenue Code 250
Min. Negotiated Rate $0.80
Max. Negotiated Rate $5.52
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.46
Rate for Payer: Aetna Government $1.46
Rate for Payer: Brighton Health Commercial $5.17
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $5.52
Rate for Payer: Cigna LocalPlus Benefit Plan $4.69
Rate for Payer: EmblemHealth Commercial $3.45
Rate for Payer: Group Health Inc Commercial $3.45
Rate for Payer: Group Health Inc Medicare $2.42
Rate for Payer: Hamaspik Choice Inc Medicaid $3.45
Rate for Payer: Hamaspik Choice Inc Medicare $3.45
Rate for Payer: Healthfirst CHP/FHP/Medicaid $0.80
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $4.49
Service Code EAPG 00048
Min. Negotiated Rate $870.18
Max. Negotiated Rate $1,199.32
Rate for Payer: Healthfirst CHP/FHP/Medicaid $870.18
Rate for Payer: Healthfirst Commercial $1,199.32
Service Code APR-DRG 3162
Min. Negotiated Rate $11,299.00
Max. Negotiated Rate $52,780.43
Rate for Payer: Affinity Essential Plan 1&2 $52,780.43
Rate for Payer: Affinity Essential Plan 3&4 $52,780.43
Rate for Payer: Affinity Medicaid/CHP/HARP $23,457.97
Rate for Payer: Amida Care Medicaid $23,457.97
Rate for Payer: EmblemHealth Essential Plan 1&2 $52,780.43
Rate for Payer: EmblemHealth Essential Plan 3&4 $23,457.97
Rate for Payer: Fidelis CHP/HARP/Medicaid $23,457.97
Rate for Payer: Fidelis Qualified Health Plan $28,149.56
Rate for Payer: Hamaspik Choice Inc Medicaid $23,457.97
Rate for Payer: Healthfirst CHP/FHP/Medicaid $23,457.97
Rate for Payer: Healthfirst Commercial $20,998.00
Rate for Payer: Healthfirst Essential Plan $52,780.43
Rate for Payer: Healthfirst QHP $11,299.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $23,457.97
Rate for Payer: SOMOS Essential $52,780.43
Rate for Payer: United Healthcare Essential Plan 1&2 $52,780.43
Rate for Payer: United Healthcare Essential Plan 3&4 $52,780.43
Rate for Payer: United Healthcare Medicaid $23,457.97
Rate for Payer: Wellcare CHP/FHP/Medicaid $23,457.97
Service Code APR-DRG 3164
Min. Negotiated Rate $20,488.00
Max. Negotiated Rate $74,004.98
Rate for Payer: Affinity Essential Plan 1&2 $74,004.98
Rate for Payer: Affinity Essential Plan 3&4 $74,004.98
Rate for Payer: Affinity Medicaid/CHP/HARP $32,891.10
Rate for Payer: Amida Care Medicaid $32,891.10
Rate for Payer: EmblemHealth Essential Plan 1&2 $74,004.98
Rate for Payer: EmblemHealth Essential Plan 3&4 $32,891.10
Rate for Payer: Fidelis CHP/HARP/Medicaid $32,891.10
Rate for Payer: Fidelis Qualified Health Plan $39,469.32
Rate for Payer: Hamaspik Choice Inc Medicaid $32,891.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid $32,891.10
Rate for Payer: Healthfirst Commercial $36,562.00
Rate for Payer: Healthfirst Essential Plan $74,004.98
Rate for Payer: Healthfirst QHP $20,488.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $32,891.10
Rate for Payer: SOMOS Essential $74,004.98
Rate for Payer: United Healthcare Essential Plan 1&2 $74,004.98
Rate for Payer: United Healthcare Essential Plan 3&4 $74,004.98
Rate for Payer: United Healthcare Medicaid $32,891.10
Rate for Payer: Wellcare CHP/FHP/Medicaid $32,891.10