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Service Code HCPCS J0295
Hospital Charge Code 5515011720
Hospital Revenue Code 250
Min. Negotiated Rate $1.39
Max. Negotiated Rate $11.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial $8.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.21
Rate for Payer: Aetna Government $2.21
Rate for Payer: Brighton Health Commercial $10.95
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $11.68
Rate for Payer: Cigna LocalPlus Benefit Plan $9.93
Rate for Payer: EmblemHealth Commercial $7.30
Rate for Payer: Group Health Inc Commercial $7.30
Rate for Payer: Group Health Inc Medicare $5.11
Rate for Payer: Hamaspik Choice Inc Medicaid $7.30
Rate for Payer: Hamaspik Choice Inc Medicare $7.30
Rate for Payer: Healthfirst CHP/FHP/Medicaid $1.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $9.49
Service Code HCPCS J0295
Hospital Charge Code 5515011710
Hospital Revenue Code 250
Min. Negotiated Rate $7.30
Max. Negotiated Rate $7.30
Rate for Payer: Hamaspik Choice Inc Medicaid $7.30
Service Code HCPCS J0295
Hospital Charge Code 5515011720
Hospital Revenue Code 250
Min. Negotiated Rate $7.30
Max. Negotiated Rate $7.30
Rate for Payer: Hamaspik Choice Inc Medicaid $7.30
Service Code HCPCS J0295
Hospital Charge Code 4456721110
Hospital Revenue Code 250
Min. Negotiated Rate $1.39
Max. Negotiated Rate $15.31
Rate for Payer: 1199SEIU National Benefit Fund Commercial $10.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.21
Rate for Payer: Aetna Government $2.21
Rate for Payer: Brighton Health Commercial $14.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $15.31
Rate for Payer: Cigna LocalPlus Benefit Plan $13.02
Rate for Payer: EmblemHealth Commercial $9.57
Rate for Payer: Group Health Inc Commercial $9.57
Rate for Payer: Group Health Inc Medicare $6.70
Rate for Payer: Hamaspik Choice Inc Medicaid $9.57
Rate for Payer: Hamaspik Choice Inc Medicare $9.57
Rate for Payer: Healthfirst CHP/FHP/Medicaid $1.39
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $12.44
Service Code HCPCS J0295
Hospital Charge Code 7248541701
Hospital Revenue Code 250
Min. Negotiated Rate $3.18
Max. Negotiated Rate $3.18
Rate for Payer: Hamaspik Choice Inc Medicaid $3.18
Service Code HCPCS J0295
Hospital Charge Code 0049001483
Hospital Revenue Code 250
Min. Negotiated Rate $8.74
Max. Negotiated Rate $8.74
Rate for Payer: Hamaspik Choice Inc Medicaid $8.74
Service Code APR-DRG 3054
Min. Negotiated Rate $61,247.00
Max. Negotiated Rate $142,849.33
Rate for Payer: Affinity Essential Plan 1&2 $142,849.33
Rate for Payer: Affinity Essential Plan 3&4 $142,849.33
Rate for Payer: Affinity Medicaid/CHP/HARP $63,488.59
Rate for Payer: Amida Care Medicaid $63,488.59
Rate for Payer: EmblemHealth Essential Plan 1&2 $142,849.33
Rate for Payer: EmblemHealth Essential Plan 3&4 $63,488.59
Rate for Payer: Fidelis CHP/HARP/Medicaid $63,488.59
Rate for Payer: Fidelis Qualified Health Plan $76,186.31
Rate for Payer: Hamaspik Choice Inc Medicaid $63,488.59
Rate for Payer: Healthfirst CHP/FHP/Medicaid $63,488.59
Rate for Payer: Healthfirst Commercial $125,142.00
Rate for Payer: Healthfirst Essential Plan $142,849.33
Rate for Payer: Healthfirst QHP $61,247.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $63,488.59
Rate for Payer: SOMOS Essential $142,849.33
Rate for Payer: United Healthcare Essential Plan 1&2 $142,849.33
Rate for Payer: United Healthcare Essential Plan 3&4 $142,849.33
Rate for Payer: United Healthcare Medicaid $63,488.59
Rate for Payer: Wellcare CHP/FHP/Medicaid $63,488.59
Service Code APR-DRG 3052
Min. Negotiated Rate $21,769.00
Max. Negotiated Rate $65,733.59
Rate for Payer: Affinity Essential Plan 1&2 $65,733.59
Rate for Payer: Affinity Essential Plan 3&4 $65,733.59
Rate for Payer: Affinity Medicaid/CHP/HARP $29,214.93
Rate for Payer: Amida Care Medicaid $29,214.93
Rate for Payer: EmblemHealth Essential Plan 1&2 $65,733.59
Rate for Payer: EmblemHealth Essential Plan 3&4 $29,214.93
Rate for Payer: Fidelis CHP/HARP/Medicaid $29,214.93
Rate for Payer: Fidelis Qualified Health Plan $35,057.92
Rate for Payer: Hamaspik Choice Inc Medicaid $29,214.93
Rate for Payer: Healthfirst CHP/FHP/Medicaid $29,214.93
Rate for Payer: Healthfirst Commercial $38,655.00
Rate for Payer: Healthfirst Essential Plan $65,733.59
Rate for Payer: Healthfirst QHP $21,769.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $29,214.93
Rate for Payer: SOMOS Essential $65,733.59
Rate for Payer: United Healthcare Essential Plan 1&2 $65,733.59
Rate for Payer: United Healthcare Essential Plan 3&4 $65,733.59
Rate for Payer: United Healthcare Medicaid $29,214.93
Rate for Payer: Wellcare CHP/FHP/Medicaid $29,214.93
Service Code APR-DRG 3051
Min. Negotiated Rate $15,487.00
Max. Negotiated Rate $55,956.71
Rate for Payer: Affinity Essential Plan 1&2 $55,956.71
Rate for Payer: Affinity Essential Plan 3&4 $55,956.71
Rate for Payer: Affinity Medicaid/CHP/HARP $24,869.65
Rate for Payer: Amida Care Medicaid $24,869.65
Rate for Payer: EmblemHealth Essential Plan 1&2 $55,956.71
Rate for Payer: EmblemHealth Essential Plan 3&4 $24,869.65
Rate for Payer: Fidelis CHP/HARP/Medicaid $24,869.65
Rate for Payer: Fidelis Qualified Health Plan $29,843.58
Rate for Payer: Hamaspik Choice Inc Medicaid $24,869.65
Rate for Payer: Healthfirst CHP/FHP/Medicaid $24,869.65
Rate for Payer: Healthfirst Commercial $29,901.00
Rate for Payer: Healthfirst Essential Plan $55,956.71
Rate for Payer: Healthfirst QHP $15,487.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $24,869.65
Rate for Payer: SOMOS Essential $55,956.71
Rate for Payer: United Healthcare Essential Plan 1&2 $55,956.71
Rate for Payer: United Healthcare Essential Plan 3&4 $55,956.71
Rate for Payer: United Healthcare Medicaid $24,869.65
Rate for Payer: Wellcare CHP/FHP/Medicaid $24,869.65
Service Code APR-DRG 3053
Min. Negotiated Rate $33,121.00
Max. Negotiated Rate $91,495.71
Rate for Payer: Affinity Essential Plan 1&2 $91,495.71
Rate for Payer: Affinity Essential Plan 3&4 $91,495.71
Rate for Payer: Affinity Medicaid/CHP/HARP $40,664.76
Rate for Payer: Amida Care Medicaid $40,664.76
Rate for Payer: EmblemHealth Essential Plan 1&2 $91,495.71
Rate for Payer: EmblemHealth Essential Plan 3&4 $40,664.76
Rate for Payer: Fidelis CHP/HARP/Medicaid $40,664.76
Rate for Payer: Fidelis Qualified Health Plan $48,797.71
Rate for Payer: Hamaspik Choice Inc Medicaid $40,664.76
Rate for Payer: Healthfirst CHP/FHP/Medicaid $40,664.76
Rate for Payer: Healthfirst Commercial $57,153.00
Rate for Payer: Healthfirst Essential Plan $91,495.71
Rate for Payer: Healthfirst QHP $33,121.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $40,664.76
Rate for Payer: SOMOS Essential $91,495.71
Rate for Payer: United Healthcare Essential Plan 1&2 $91,495.71
Rate for Payer: United Healthcare Essential Plan 3&4 $91,495.71
Rate for Payer: United Healthcare Medicaid $40,664.76
Rate for Payer: Wellcare CHP/FHP/Medicaid $40,664.76
Service Code APR-DRG 2264
Min. Negotiated Rate $17,265.00
Max. Negotiated Rate $95,839.81
Rate for Payer: Affinity Essential Plan 1&2 $95,839.81
Rate for Payer: Affinity Essential Plan 3&4 $95,839.81
Rate for Payer: Affinity Medicaid/CHP/HARP $42,595.47
Rate for Payer: Amida Care Medicaid $42,595.47
Rate for Payer: EmblemHealth Essential Plan 1&2 $95,839.81
Rate for Payer: EmblemHealth Essential Plan 3&4 $42,595.47
Rate for Payer: Fidelis CHP/HARP/Medicaid $42,595.47
Rate for Payer: Fidelis Qualified Health Plan $51,114.56
Rate for Payer: Hamaspik Choice Inc Medicaid $42,595.47
Rate for Payer: Healthfirst CHP/FHP/Medicaid $42,595.47
Rate for Payer: Healthfirst Commercial $36,064.00
Rate for Payer: Healthfirst Essential Plan $95,839.81
Rate for Payer: Healthfirst QHP $17,265.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $42,595.47
Rate for Payer: SOMOS Essential $95,839.81
Rate for Payer: United Healthcare Essential Plan 1&2 $95,839.81
Rate for Payer: United Healthcare Essential Plan 3&4 $95,839.81
Rate for Payer: United Healthcare Medicaid $42,595.47
Rate for Payer: Wellcare CHP/FHP/Medicaid $42,595.47
Service Code APR-DRG 2263
Min. Negotiated Rate $16,652.00
Max. Negotiated Rate $58,369.72
Rate for Payer: Affinity Essential Plan 1&2 $58,369.72
Rate for Payer: Affinity Essential Plan 3&4 $58,369.72
Rate for Payer: Affinity Medicaid/CHP/HARP $25,942.10
Rate for Payer: Amida Care Medicaid $25,942.10
Rate for Payer: EmblemHealth Essential Plan 1&2 $58,369.72
Rate for Payer: EmblemHealth Essential Plan 3&4 $25,942.10
Rate for Payer: Fidelis CHP/HARP/Medicaid $25,942.10
Rate for Payer: Fidelis Qualified Health Plan $31,130.52
Rate for Payer: Hamaspik Choice Inc Medicaid $25,942.10
Rate for Payer: Healthfirst CHP/FHP/Medicaid $25,942.10
Rate for Payer: Healthfirst Commercial $29,389.00
Rate for Payer: Healthfirst Essential Plan $58,369.72
Rate for Payer: Healthfirst QHP $16,652.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $25,942.10
Rate for Payer: SOMOS Essential $58,369.72
Rate for Payer: United Healthcare Essential Plan 1&2 $58,369.72
Rate for Payer: United Healthcare Essential Plan 3&4 $58,369.72
Rate for Payer: United Healthcare Medicaid $25,942.10
Rate for Payer: Wellcare CHP/FHP/Medicaid $25,942.10
Service Code APR-DRG 2261
Min. Negotiated Rate $7,058.00
Max. Negotiated Rate $42,901.54
Rate for Payer: Affinity Essential Plan 1&2 $42,901.54
Rate for Payer: Affinity Essential Plan 3&4 $42,901.54
Rate for Payer: Affinity Medicaid/CHP/HARP $19,067.35
Rate for Payer: Amida Care Medicaid $19,067.35
Rate for Payer: EmblemHealth Essential Plan 1&2 $42,901.54
Rate for Payer: EmblemHealth Essential Plan 3&4 $19,067.35
Rate for Payer: Fidelis CHP/HARP/Medicaid $19,067.35
Rate for Payer: Fidelis Qualified Health Plan $22,880.82
Rate for Payer: Hamaspik Choice Inc Medicaid $19,067.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid $19,067.35
Rate for Payer: Healthfirst Commercial $12,262.00
Rate for Payer: Healthfirst Essential Plan $42,901.54
Rate for Payer: Healthfirst QHP $7,058.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $19,067.35
Rate for Payer: SOMOS Essential $42,901.54
Rate for Payer: United Healthcare Essential Plan 1&2 $42,901.54
Rate for Payer: United Healthcare Essential Plan 3&4 $42,901.54
Rate for Payer: United Healthcare Medicaid $19,067.35
Rate for Payer: Wellcare CHP/FHP/Medicaid $19,067.35
Service Code APR-DRG 2262
Min. Negotiated Rate $9,020.00
Max. Negotiated Rate $47,546.39
Rate for Payer: Affinity Essential Plan 1&2 $47,546.39
Rate for Payer: Affinity Essential Plan 3&4 $47,546.39
Rate for Payer: Affinity Medicaid/CHP/HARP $21,131.73
Rate for Payer: Amida Care Medicaid $21,131.73
Rate for Payer: EmblemHealth Essential Plan 1&2 $47,546.39
Rate for Payer: EmblemHealth Essential Plan 3&4 $21,131.73
Rate for Payer: Fidelis CHP/HARP/Medicaid $21,131.73
Rate for Payer: Fidelis Qualified Health Plan $25,358.08
Rate for Payer: Hamaspik Choice Inc Medicaid $21,131.73
Rate for Payer: Healthfirst CHP/FHP/Medicaid $21,131.73
Rate for Payer: Healthfirst Commercial $16,654.00
Rate for Payer: Healthfirst Essential Plan $47,546.39
Rate for Payer: Healthfirst QHP $9,020.00
Rate for Payer: SOMOS CHP/HARP/Medicaid $21,131.73
Rate for Payer: SOMOS Essential $47,546.39
Rate for Payer: United Healthcare Essential Plan 1&2 $47,546.39
Rate for Payer: United Healthcare Essential Plan 3&4 $47,546.39
Rate for Payer: United Healthcare Medicaid $21,131.73
Rate for Payer: Wellcare CHP/FHP/Medicaid $21,131.73
Service Code NDC 0093753656
Hospital Charge Code 0093753656
Hospital Revenue Code 250
Min. Negotiated Rate $4.72
Max. Negotiated Rate $10.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $7.42
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $6.75
Rate for Payer: Aetna Government $6.75
Rate for Payer: Brighton Health Commercial $10.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $10.80
Rate for Payer: Cigna LocalPlus Benefit Plan $9.18
Rate for Payer: EmblemHealth Commercial $6.75
Rate for Payer: Group Health Inc Commercial $6.75
Rate for Payer: Group Health Inc Medicare $4.72
Rate for Payer: Hamaspik Choice Inc Medicaid $6.75
Rate for Payer: Hamaspik Choice Inc Medicare $6.75
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $8.77
Service Code NDC 6068711211
Hospital Charge Code 6068711211
Hospital Revenue Code 250
Min. Negotiated Rate $0.73
Max. Negotiated Rate $1.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.04
Rate for Payer: Aetna Government $1.04
Rate for Payer: Brighton Health Commercial $1.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.66
Rate for Payer: Cigna LocalPlus Benefit Plan $1.41
Rate for Payer: EmblemHealth Commercial $1.04
Rate for Payer: Group Health Inc Commercial $1.04
Rate for Payer: Group Health Inc Medicare $0.73
Rate for Payer: Hamaspik Choice Inc Medicaid $1.04
Rate for Payer: Hamaspik Choice Inc Medicare $1.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.35
Service Code NDC 5026807511
Hospital Charge Code 5026807511
Hospital Revenue Code 250
Min. Negotiated Rate $0.73
Max. Negotiated Rate $1.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.04
Rate for Payer: Aetna Government $1.04
Rate for Payer: Brighton Health Commercial $1.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.66
Rate for Payer: Cigna LocalPlus Benefit Plan $1.41
Rate for Payer: EmblemHealth Commercial $1.04
Rate for Payer: Group Health Inc Commercial $1.04
Rate for Payer: Group Health Inc Medicare $0.73
Rate for Payer: Hamaspik Choice Inc Medicaid $1.04
Rate for Payer: Hamaspik Choice Inc Medicare $1.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.35
Service Code NDC 6068711211
Hospital Charge Code 6068711211
Hospital Revenue Code 250
Min. Negotiated Rate $1.04
Max. Negotiated Rate $1.04
Rate for Payer: Hamaspik Choice Inc Medicaid $1.04
Service Code NDC 6838220906
Hospital Charge Code 6838220906
Hospital Revenue Code 250
Min. Negotiated Rate $6.74
Max. Negotiated Rate $6.74
Rate for Payer: Hamaspik Choice Inc Medicaid $6.74
Service Code NDC 5026807515
Hospital Charge Code 5026807515
Hospital Revenue Code 250
Min. Negotiated Rate $1.04
Max. Negotiated Rate $1.04
Rate for Payer: Hamaspik Choice Inc Medicaid $1.04
Service Code NDC 5026807515
Hospital Charge Code 5026807515
Hospital Revenue Code 250
Min. Negotiated Rate $0.73
Max. Negotiated Rate $1.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.04
Rate for Payer: Aetna Government $1.04
Rate for Payer: Brighton Health Commercial $1.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.66
Rate for Payer: Cigna LocalPlus Benefit Plan $1.41
Rate for Payer: EmblemHealth Commercial $1.04
Rate for Payer: Group Health Inc Commercial $1.04
Rate for Payer: Group Health Inc Medicare $0.73
Rate for Payer: Hamaspik Choice Inc Medicaid $1.04
Rate for Payer: Hamaspik Choice Inc Medicare $1.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.35
Service Code NDC 5026807511
Hospital Charge Code 5026807511
Hospital Revenue Code 250
Min. Negotiated Rate $1.04
Max. Negotiated Rate $1.04
Rate for Payer: Hamaspik Choice Inc Medicaid $1.04
Service Code NDC 6068711221
Hospital Charge Code 6068711221
Hospital Revenue Code 250
Min. Negotiated Rate $0.73
Max. Negotiated Rate $1.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.14
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.04
Rate for Payer: Aetna Government $1.04
Rate for Payer: Brighton Health Commercial $1.55
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.66
Rate for Payer: Cigna LocalPlus Benefit Plan $1.41
Rate for Payer: EmblemHealth Commercial $1.04
Rate for Payer: Group Health Inc Commercial $1.04
Rate for Payer: Group Health Inc Medicare $0.73
Rate for Payer: Hamaspik Choice Inc Medicaid $1.04
Rate for Payer: Hamaspik Choice Inc Medicare $1.04
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.35
Service Code NDC 6068711221
Hospital Charge Code 6068711221
Hospital Revenue Code 250
Min. Negotiated Rate $1.04
Max. Negotiated Rate $1.04
Rate for Payer: Hamaspik Choice Inc Medicaid $1.04
Service Code NDC 0093753656
Hospital Charge Code 0093753656
Hospital Revenue Code 250
Min. Negotiated Rate $6.75
Max. Negotiated Rate $6.75
Rate for Payer: Hamaspik Choice Inc Medicaid $6.75