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Service Code HCPCS C1874
Hospital Charge Code 66523399
Hospital Revenue Code 278
Min. Negotiated Rate $265.52
Max. Negotiated Rate $2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $265.52
Rate for Payer: Aetna Government $265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,265.00
Rate for Payer: Fidelis Medicare Advantage $2,310.00
Rate for Payer: Group Health Inc Commercial $1,100.00
Rate for Payer: Group Health Inc Medicare $770.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,430.00
Service Code HCPCS C1874
Hospital Charge Code 66523420
Hospital Revenue Code 278
Min. Negotiated Rate $265.52
Max. Negotiated Rate $2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $265.52
Rate for Payer: Aetna Government $265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,265.00
Rate for Payer: Fidelis Medicare Advantage $2,310.00
Rate for Payer: Group Health Inc Commercial $1,100.00
Rate for Payer: Group Health Inc Medicare $770.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,430.00
Service Code HCPCS C1874
Hospital Charge Code 66523420
Hospital Revenue Code 278
Min. Negotiated Rate $1,100.00
Max. Negotiated Rate $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Service Code HCPCS C1874
Hospital Charge Code 66523421
Hospital Revenue Code 278
Min. Negotiated Rate $1,100.00
Max. Negotiated Rate $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Service Code HCPCS C1874
Hospital Charge Code 66523421
Hospital Revenue Code 278
Min. Negotiated Rate $265.52
Max. Negotiated Rate $2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $265.52
Rate for Payer: Aetna Government $265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,265.00
Rate for Payer: Fidelis Medicare Advantage $2,310.00
Rate for Payer: Group Health Inc Commercial $1,100.00
Rate for Payer: Group Health Inc Medicare $770.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,430.00
Service Code HCPCS C1874
Hospital Charge Code 66523422
Hospital Revenue Code 278
Min. Negotiated Rate $1,100.00
Max. Negotiated Rate $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Service Code HCPCS C1874
Hospital Charge Code 66523422
Hospital Revenue Code 278
Min. Negotiated Rate $265.52
Max. Negotiated Rate $2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $265.52
Rate for Payer: Aetna Government $265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,265.00
Rate for Payer: Fidelis Medicare Advantage $2,310.00
Rate for Payer: Group Health Inc Commercial $1,100.00
Rate for Payer: Group Health Inc Medicare $770.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,430.00
Service Code HCPCS C1874
Hospital Charge Code 66523423
Hospital Revenue Code 278
Min. Negotiated Rate $1,100.00
Max. Negotiated Rate $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Service Code HCPCS C1874
Hospital Charge Code 66523423
Hospital Revenue Code 278
Min. Negotiated Rate $265.52
Max. Negotiated Rate $2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $265.52
Rate for Payer: Aetna Government $265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,265.00
Rate for Payer: Fidelis Medicare Advantage $2,310.00
Rate for Payer: Group Health Inc Commercial $1,100.00
Rate for Payer: Group Health Inc Medicare $770.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,430.00
Service Code HCPCS C1874
Hospital Charge Code 66523424
Hospital Revenue Code 278
Min. Negotiated Rate $1,100.00
Max. Negotiated Rate $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Service Code HCPCS C1874
Hospital Charge Code 66523424
Hospital Revenue Code 278
Min. Negotiated Rate $265.52
Max. Negotiated Rate $2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $265.52
Rate for Payer: Aetna Government $265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,265.00
Rate for Payer: Fidelis Medicare Advantage $2,310.00
Rate for Payer: Group Health Inc Commercial $1,100.00
Rate for Payer: Group Health Inc Medicare $770.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,430.00
Service Code HCPCS C1874
Hospital Charge Code 66523425
Hospital Revenue Code 278
Min. Negotiated Rate $1,100.00
Max. Negotiated Rate $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Service Code HCPCS C1874
Hospital Charge Code 66523425
Hospital Revenue Code 278
Min. Negotiated Rate $265.52
Max. Negotiated Rate $2,310.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,210.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $265.52
Rate for Payer: Aetna Government $265.52
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $1,265.00
Rate for Payer: Fidelis Medicare Advantage $2,310.00
Rate for Payer: Group Health Inc Commercial $1,100.00
Rate for Payer: Group Health Inc Medicare $770.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,100.00
Rate for Payer: Hamaspik Choice Inc Medicare $1,100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,430.00
Service Code HCPCS C1769
Hospital Charge Code 66521956
Hospital Revenue Code 278
Min. Negotiated Rate $4.08
Max. Negotiated Rate $210.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $110.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.08
Rate for Payer: Aetna Government $4.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $100.00
Rate for Payer: Cigna LocalPlus Benefit Plan $115.00
Rate for Payer: Fidelis Medicare Advantage $210.00
Rate for Payer: Group Health Inc Commercial $100.00
Rate for Payer: Group Health Inc Medicare $70.00
Rate for Payer: Hamaspik Choice Inc Medicaid $100.00
Rate for Payer: Hamaspik Choice Inc Medicare $100.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $130.00
Service Code HCPCS C1769
Hospital Charge Code 66521956
Hospital Revenue Code 278
Min. Negotiated Rate $100.00
Max. Negotiated Rate $100.00
Rate for Payer: Hamaspik Choice Inc Medicaid $100.00
Rate for Payer: Hamaspik Choice Inc Medicare $100.00
Hospital Charge Code 41645061
Hospital Revenue Code 636
Min. Negotiated Rate $758.48
Max. Negotiated Rate $758.48
Rate for Payer: Hamaspik Choice Inc Medicaid $758.48
Rate for Payer: Hamaspik Choice Inc Medicare $758.48
Service Code HCPCS J0130
Hospital Charge Code 41655061
Hospital Revenue Code 636
Min. Negotiated Rate $758.48
Max. Negotiated Rate $758.48
Rate for Payer: Hamaspik Choice Inc Medicaid $758.48
Rate for Payer: Hamaspik Choice Inc Medicare $758.48
Service Code HCPCS J0130
Hospital Charge Code 41655061
Hospital Revenue Code 636
Min. Negotiated Rate $530.94
Max. Negotiated Rate $1,116.30
Rate for Payer: 1199SEIU National Benefit Fund Commercial $834.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,116.30
Rate for Payer: Aetna Government $1,116.30
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $758.48
Rate for Payer: Cigna LocalPlus Benefit Plan $872.25
Rate for Payer: Group Health Inc Commercial $758.48
Rate for Payer: Group Health Inc Medicare $530.94
Rate for Payer: Hamaspik Choice Inc Medicaid $758.48
Rate for Payer: Hamaspik Choice Inc Medicare $758.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $986.02
Hospital Charge Code 41645061
Hospital Revenue Code 636
Min. Negotiated Rate $530.94
Max. Negotiated Rate $986.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial $834.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $758.48
Rate for Payer: Aetna Government $758.48
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $758.48
Rate for Payer: Cigna LocalPlus Benefit Plan $872.25
Rate for Payer: Group Health Inc Commercial $758.48
Rate for Payer: Group Health Inc Medicare $530.94
Rate for Payer: Hamaspik Choice Inc Medicaid $758.48
Rate for Payer: Hamaspik Choice Inc Medicare $758.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $986.02
Service Code HCPCS 49082
Hospital Charge Code 40019635
Hospital Revenue Code 360
Min. Negotiated Rate $80.29
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,048.28
Rate for Payer: Aetna Government $1,048.28
Rate for Payer: Cash Price $1,048.28
Rate for Payer: Cash Price $1,048.28
Rate for Payer: Cash Price $1,048.28
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $1,048.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $1,048.28
Rate for Payer: EmblemHealth Commercial $1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid $80.29
Rate for Payer: Fidelis Essential Plan Aliesa $891.04
Rate for Payer: Fidelis Essential Plan QHP $932.97
Rate for Payer: Fidelis Medicare Advantage $1,048.28
Rate for Payer: Fidelis Qualified Health Plan $932.97
Rate for Payer: Group Health Inc Commercial $1,048.28
Rate for Payer: Group Health Inc Medicare $1,048.28
Rate for Payer: Hamaspik Choice Inc Medicaid $1,190.18
Rate for Payer: Hamaspik Choice Inc Medicare $1,048.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid $89.21
Rate for Payer: Healthfirst Medicare Advantage $891.04
Rate for Payer: Healthfirst QHP $1,048.28
Rate for Payer: Senior Whole Health Medicare Advantage $1,048.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,048.28
Rate for Payer: Wellcare CHP/FHP/Medicaid $838.62
Rate for Payer: Wellcare Medicare $995.87
Hospital Charge Code 40207596
Hospital Revenue Code 270
Min. Negotiated Rate $12.53
Max. Negotiated Rate $28.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial $19.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $17.90
Rate for Payer: Aetna Government $17.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $28.63
Rate for Payer: Cigna LocalPlus Benefit Plan $24.34
Rate for Payer: Group Health Inc Commercial $17.90
Rate for Payer: Group Health Inc Medicare $12.53
Rate for Payer: Hamaspik Choice Inc Medicaid $17.90
Rate for Payer: Hamaspik Choice Inc Medicare $17.90
Service Code HCPCS 58150
Hospital Charge Code 40052180
Hospital Revenue Code 360
Min. Negotiated Rate $1,073.88
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,687.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,267.60
Rate for Payer: Aetna Government $1,267.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: EmblemHealth Commercial $1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid $1,135.39
Rate for Payer: Group Health Inc Commercial $1,534.12
Rate for Payer: Group Health Inc Medicare $1,073.88
Rate for Payer: Hamaspik Choice Inc Medicaid $1,534.12
Rate for Payer: Hamaspik Choice Inc Medicare $1,534.12
Rate for Payer: Healthfirst CHP/FHP/Medicaid $1,261.54
Service Code CPT 49083
Hospital Revenue Code 360
Min. Negotiated Rate $112.16
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,048.28
Rate for Payer: Aetna Government $1,048.28
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $1,048.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $1,048.28
Rate for Payer: EmblemHealth Commercial $1,505.00
Rate for Payer: Fidelis CHP/HARP/Medicaid $112.16
Rate for Payer: Fidelis Essential Plan Aliesa $891.04
Rate for Payer: Fidelis Essential Plan QHP $932.97
Rate for Payer: Fidelis Medicare Advantage $1,048.28
Rate for Payer: Fidelis Qualified Health Plan $932.97
Rate for Payer: Group Health Inc Commercial $1,048.28
Rate for Payer: Group Health Inc Medicare $1,048.28
Rate for Payer: Hamaspik Choice Inc Medicare $1,048.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid $124.62
Rate for Payer: Healthfirst Medicare Advantage $891.04
Rate for Payer: Healthfirst QHP $1,048.28
Rate for Payer: Senior Whole Health Medicare Advantage $1,048.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,048.28
Rate for Payer: Wellcare CHP/FHP/Medicaid $838.62
Rate for Payer: Wellcare Medicare $995.87
Service Code CPT 49083
Hospital Revenue Code 361
Min. Negotiated Rate $112.16
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,048.28
Rate for Payer: Aetna Government $1,048.28
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $1,048.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $1,048.28
Rate for Payer: EmblemHealth Commercial $1,048.28
Rate for Payer: Fidelis CHP/HARP/Medicaid $112.16
Rate for Payer: Fidelis Essential Plan Aliesa $891.04
Rate for Payer: Fidelis Essential Plan QHP $932.97
Rate for Payer: Fidelis Medicare Advantage $1,048.28
Rate for Payer: Fidelis Qualified Health Plan $932.97
Rate for Payer: Group Health Inc Commercial $1,048.28
Rate for Payer: Group Health Inc Medicare $1,048.28
Rate for Payer: Hamaspik Choice Inc Medicare $1,048.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid $124.62
Rate for Payer: Healthfirst Medicare Advantage $891.04
Rate for Payer: Healthfirst QHP $1,048.28
Rate for Payer: Senior Whole Health Medicare Advantage $1,048.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,048.28
Rate for Payer: Wellcare CHP/FHP/Medicaid $838.62
Rate for Payer: Wellcare Medicare $995.87
Service Code HCPCS 49082
Hospital Charge Code 30105548
Hospital Revenue Code 450
Min. Negotiated Rate $80.29
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,888.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,048.28
Rate for Payer: Aetna Government $1,048.28
Rate for Payer: Brighton Health Commercial $874.00
Rate for Payer: Carelon Behavioral Health CHP/Medicaid $1,048.28
Rate for Payer: Carelon Behavioral Health Medicare Advantage $1,048.28
Rate for Payer: Cash Price $1,048.28
Rate for Payer: Cash Price $1,048.28
Rate for Payer: Cash Price $1,048.28
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $1,048.28
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $2,915.00
Rate for Payer: Cigna LocalPlus Benefit Plan $2,477.75
Rate for Payer: Elderplan Medicare Advantage $1,048.28
Rate for Payer: EmblemHealth Commercial $525.00
Rate for Payer: Fidelis CHP/HARP/Medicaid $80.29
Rate for Payer: Fidelis Essential Plan Aliesa $891.04
Rate for Payer: Fidelis Essential Plan QHP $932.97
Rate for Payer: Fidelis Medicare Advantage $1,048.28
Rate for Payer: Fidelis Qualified Health Plan $932.97
Rate for Payer: Group Health Inc Commercial $525.00
Rate for Payer: Group Health Inc Medicare $525.00
Rate for Payer: Hamaspik Choice Inc Medicaid $1,190.18
Rate for Payer: Hamaspik Choice Inc Medicare $1,048.28
Rate for Payer: Healthfirst CHP/FHP/Medicaid $165.00
Rate for Payer: Healthfirst Medicare Advantage $225.00
Rate for Payer: Healthfirst QHP $1,048.28
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage $1,048.28
Rate for Payer: Senior Whole Health Medicare Advantage $1,048.28
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,048.28
Rate for Payer: Wellcare CHP/FHP/Medicaid $838.62
Rate for Payer: Wellcare Medicare $995.87