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Charge Type Price  
Service Code HCPCS J0770
Hospital Charge Code 41642826
Hospital Revenue Code 636
Min. Negotiated Rate $10.93
Max. Negotiated Rate $10.93
Rate for Payer: Hamaspik Choice Inc Medicaid $10.93
Rate for Payer: Hamaspik Choice Inc Medicare $10.93
Hospital Charge Code 41657809
Hospital Revenue Code 250
Min. Negotiated Rate $61.45
Max. Negotiated Rate $140.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial $96.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $87.78
Rate for Payer: Aetna Government $87.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $140.46
Rate for Payer: Cigna LocalPlus Benefit Plan $119.39
Rate for Payer: Group Health Inc Commercial $87.78
Rate for Payer: Group Health Inc Medicare $61.45
Rate for Payer: Hamaspik Choice Inc Medicaid $87.78
Rate for Payer: Hamaspik Choice Inc Medicare $87.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $114.12
Hospital Charge Code 41647809
Hospital Revenue Code 250
Min. Negotiated Rate $61.45
Max. Negotiated Rate $140.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial $96.56
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $87.78
Rate for Payer: Aetna Government $87.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $140.46
Rate for Payer: Cigna LocalPlus Benefit Plan $119.39
Rate for Payer: Group Health Inc Commercial $87.78
Rate for Payer: Group Health Inc Medicare $61.45
Rate for Payer: Hamaspik Choice Inc Medicaid $87.78
Rate for Payer: Hamaspik Choice Inc Medicare $87.78
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $114.12
Hospital Charge Code 41657170
Hospital Revenue Code 250
Min. Negotiated Rate $54.25
Max. Negotiated Rate $124.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $85.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $77.50
Rate for Payer: Aetna Government $77.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $124.00
Rate for Payer: Cigna LocalPlus Benefit Plan $105.40
Rate for Payer: Group Health Inc Commercial $77.50
Rate for Payer: Group Health Inc Medicare $54.25
Rate for Payer: Hamaspik Choice Inc Medicaid $77.50
Rate for Payer: Hamaspik Choice Inc Medicare $77.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $100.75
Hospital Charge Code 41647170
Hospital Revenue Code 250
Min. Negotiated Rate $54.25
Max. Negotiated Rate $124.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $85.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $77.50
Rate for Payer: Aetna Government $77.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $124.00
Rate for Payer: Cigna LocalPlus Benefit Plan $105.40
Rate for Payer: Group Health Inc Commercial $77.50
Rate for Payer: Group Health Inc Medicare $54.25
Rate for Payer: Hamaspik Choice Inc Medicaid $77.50
Rate for Payer: Hamaspik Choice Inc Medicare $77.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $100.75
Hospital Charge Code 41653621
Hospital Revenue Code 250
Min. Negotiated Rate $18.20
Max. Negotiated Rate $41.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $28.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $26.00
Rate for Payer: Aetna Government $26.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $41.60
Rate for Payer: Cigna LocalPlus Benefit Plan $35.36
Rate for Payer: Group Health Inc Commercial $26.00
Rate for Payer: Group Health Inc Medicare $18.20
Rate for Payer: Hamaspik Choice Inc Medicaid $26.00
Rate for Payer: Hamaspik Choice Inc Medicare $26.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $33.80
Hospital Charge Code 41643621
Hospital Revenue Code 250
Min. Negotiated Rate $18.20
Max. Negotiated Rate $41.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $28.60
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $26.00
Rate for Payer: Aetna Government $26.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $41.60
Rate for Payer: Cigna LocalPlus Benefit Plan $35.36
Rate for Payer: Group Health Inc Commercial $26.00
Rate for Payer: Group Health Inc Medicare $18.20
Rate for Payer: Hamaspik Choice Inc Medicaid $26.00
Rate for Payer: Hamaspik Choice Inc Medicare $26.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $33.80
Hospital Charge Code 41645596
Hospital Revenue Code 250
Min. Negotiated Rate $54.25
Max. Negotiated Rate $124.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $85.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $77.50
Rate for Payer: Aetna Government $77.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $124.00
Rate for Payer: Cigna LocalPlus Benefit Plan $105.40
Rate for Payer: Group Health Inc Commercial $77.50
Rate for Payer: Group Health Inc Medicare $54.25
Rate for Payer: Hamaspik Choice Inc Medicaid $77.50
Rate for Payer: Hamaspik Choice Inc Medicare $77.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $100.75
Hospital Charge Code 41655596
Hospital Revenue Code 250
Min. Negotiated Rate $54.25
Max. Negotiated Rate $124.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $85.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $77.50
Rate for Payer: Aetna Government $77.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $124.00
Rate for Payer: Cigna LocalPlus Benefit Plan $105.40
Rate for Payer: Group Health Inc Commercial $77.50
Rate for Payer: Group Health Inc Medicare $54.25
Rate for Payer: Hamaspik Choice Inc Medicaid $77.50
Rate for Payer: Hamaspik Choice Inc Medicare $77.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $100.75
Hospital Charge Code 40201964
Hospital Revenue Code 270
Min. Negotiated Rate $15.89
Max. Negotiated Rate $36.32
Rate for Payer: 1199SEIU National Benefit Fund Commercial $24.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $22.70
Rate for Payer: Aetna Government $22.70
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $36.32
Rate for Payer: Cigna LocalPlus Benefit Plan $30.87
Rate for Payer: Group Health Inc Commercial $22.70
Rate for Payer: Group Health Inc Medicare $15.89
Rate for Payer: Hamaspik Choice Inc Medicaid $22.70
Rate for Payer: Hamaspik Choice Inc Medicare $22.70
Hospital Charge Code 64901896
Hospital Revenue Code 270
Min. Negotiated Rate $2.99
Max. Negotiated Rate $6.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.26
Rate for Payer: Aetna Government $4.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $6.82
Rate for Payer: Cigna LocalPlus Benefit Plan $5.80
Rate for Payer: Group Health Inc Commercial $4.26
Rate for Payer: Group Health Inc Medicare $2.99
Rate for Payer: Hamaspik Choice Inc Medicaid $4.26
Rate for Payer: Hamaspik Choice Inc Medicare $4.26
Hospital Charge Code 64901891
Hospital Revenue Code 270
Min. Negotiated Rate $2.99
Max. Negotiated Rate $6.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.26
Rate for Payer: Aetna Government $4.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $6.82
Rate for Payer: Cigna LocalPlus Benefit Plan $5.80
Rate for Payer: Group Health Inc Commercial $4.26
Rate for Payer: Group Health Inc Medicare $2.99
Rate for Payer: Hamaspik Choice Inc Medicaid $4.26
Rate for Payer: Hamaspik Choice Inc Medicare $4.26
Hospital Charge Code 64901012
Hospital Revenue Code 270
Min. Negotiated Rate $26.25
Max. Negotiated Rate $60.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $41.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $37.50
Rate for Payer: Aetna Government $37.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $60.00
Rate for Payer: Cigna LocalPlus Benefit Plan $51.00
Rate for Payer: Group Health Inc Commercial $37.50
Rate for Payer: Group Health Inc Medicare $26.25
Rate for Payer: Hamaspik Choice Inc Medicaid $37.50
Rate for Payer: Hamaspik Choice Inc Medicare $37.50
Hospital Charge Code 64901890
Hospital Revenue Code 270
Min. Negotiated Rate $2.99
Max. Negotiated Rate $6.82
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4.69
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.26
Rate for Payer: Aetna Government $4.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $6.82
Rate for Payer: Cigna LocalPlus Benefit Plan $5.80
Rate for Payer: Group Health Inc Commercial $4.26
Rate for Payer: Group Health Inc Medicare $2.99
Rate for Payer: Hamaspik Choice Inc Medicaid $4.26
Rate for Payer: Hamaspik Choice Inc Medicare $4.26
Hospital Charge Code 64901020
Hospital Revenue Code 270
Min. Negotiated Rate $26.25
Max. Negotiated Rate $60.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $41.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $37.50
Rate for Payer: Aetna Government $37.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $60.00
Rate for Payer: Cigna LocalPlus Benefit Plan $51.00
Rate for Payer: Group Health Inc Commercial $37.50
Rate for Payer: Group Health Inc Medicare $26.25
Rate for Payer: Hamaspik Choice Inc Medicaid $37.50
Rate for Payer: Hamaspik Choice Inc Medicare $37.50
Hospital Charge Code 64901592
Hospital Revenue Code 270
Min. Negotiated Rate $36.10
Max. Negotiated Rate $82.50
Rate for Payer: 1199SEIU National Benefit Fund Commercial $56.72
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $51.56
Rate for Payer: Aetna Government $51.56
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $82.50
Rate for Payer: Cigna LocalPlus Benefit Plan $70.13
Rate for Payer: Group Health Inc Commercial $51.56
Rate for Payer: Group Health Inc Medicare $36.10
Rate for Payer: Hamaspik Choice Inc Medicaid $51.56
Rate for Payer: Hamaspik Choice Inc Medicare $51.56
Hospital Charge Code 64901589
Hospital Revenue Code 270
Min. Negotiated Rate $29.47
Max. Negotiated Rate $67.36
Rate for Payer: 1199SEIU National Benefit Fund Commercial $46.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $42.10
Rate for Payer: Aetna Government $42.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $67.36
Rate for Payer: Cigna LocalPlus Benefit Plan $57.26
Rate for Payer: Group Health Inc Commercial $42.10
Rate for Payer: Group Health Inc Medicare $29.47
Rate for Payer: Hamaspik Choice Inc Medicaid $42.10
Rate for Payer: Hamaspik Choice Inc Medicare $42.10
Hospital Charge Code 64902587
Hospital Revenue Code 270
Min. Negotiated Rate $3.51
Max. Negotiated Rate $8.02
Rate for Payer: 1199SEIU National Benefit Fund Commercial $5.52
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $5.02
Rate for Payer: Aetna Government $5.02
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $8.02
Rate for Payer: Cigna LocalPlus Benefit Plan $6.82
Rate for Payer: Group Health Inc Commercial $5.02
Rate for Payer: Group Health Inc Medicare $3.51
Rate for Payer: Hamaspik Choice Inc Medicaid $5.02
Rate for Payer: Hamaspik Choice Inc Medicare $5.02
Hospital Charge Code 64901282
Hospital Revenue Code 270
Min. Negotiated Rate $2.08
Max. Negotiated Rate $4.76
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3.27
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.98
Rate for Payer: Aetna Government $2.98
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $4.76
Rate for Payer: Cigna LocalPlus Benefit Plan $4.05
Rate for Payer: Group Health Inc Commercial $2.98
Rate for Payer: Group Health Inc Medicare $2.08
Rate for Payer: Hamaspik Choice Inc Medicaid $2.98
Rate for Payer: Hamaspik Choice Inc Medicare $2.98
Hospital Charge Code 64901518
Hospital Revenue Code 270
Min. Negotiated Rate $3.02
Max. Negotiated Rate $6.91
Rate for Payer: 1199SEIU National Benefit Fund Commercial $4.75
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $4.32
Rate for Payer: Aetna Government $4.32
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $6.91
Rate for Payer: Cigna LocalPlus Benefit Plan $5.88
Rate for Payer: Group Health Inc Commercial $4.32
Rate for Payer: Group Health Inc Medicare $3.02
Rate for Payer: Hamaspik Choice Inc Medicaid $4.32
Rate for Payer: Hamaspik Choice Inc Medicare $4.32
Hospital Charge Code 64901521
Hospital Revenue Code 270
Min. Negotiated Rate $7.88
Max. Negotiated Rate $18.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $12.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $11.25
Rate for Payer: Aetna Government $11.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $18.00
Rate for Payer: Cigna LocalPlus Benefit Plan $15.30
Rate for Payer: Group Health Inc Commercial $11.25
Rate for Payer: Group Health Inc Medicare $7.88
Rate for Payer: Hamaspik Choice Inc Medicaid $11.25
Rate for Payer: Hamaspik Choice Inc Medicare $11.25
Hospital Charge Code 64901523
Hospital Revenue Code 270
Min. Negotiated Rate $7.88
Max. Negotiated Rate $18.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $12.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $11.25
Rate for Payer: Aetna Government $11.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $18.00
Rate for Payer: Cigna LocalPlus Benefit Plan $15.30
Rate for Payer: Group Health Inc Commercial $11.25
Rate for Payer: Group Health Inc Medicare $7.88
Rate for Payer: Hamaspik Choice Inc Medicaid $11.25
Rate for Payer: Hamaspik Choice Inc Medicare $11.25
Hospital Charge Code 64901209
Hospital Revenue Code 270
Min. Negotiated Rate $8.94
Max. Negotiated Rate $20.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial $14.04
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $12.76
Rate for Payer: Aetna Government $12.76
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $20.42
Rate for Payer: Cigna LocalPlus Benefit Plan $17.36
Rate for Payer: Group Health Inc Commercial $12.76
Rate for Payer: Group Health Inc Medicare $8.94
Rate for Payer: Hamaspik Choice Inc Medicaid $12.76
Rate for Payer: Hamaspik Choice Inc Medicare $12.76
Hospital Charge Code 64901117
Hospital Revenue Code 270
Min. Negotiated Rate $7.88
Max. Negotiated Rate $18.01
Rate for Payer: 1199SEIU National Benefit Fund Commercial $12.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $11.26
Rate for Payer: Aetna Government $11.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $18.01
Rate for Payer: Cigna LocalPlus Benefit Plan $15.31
Rate for Payer: Group Health Inc Commercial $11.26
Rate for Payer: Group Health Inc Medicare $7.88
Rate for Payer: Hamaspik Choice Inc Medicaid $11.26
Rate for Payer: Hamaspik Choice Inc Medicare $11.26
Hospital Charge Code 64901207
Hospital Revenue Code 270
Min. Negotiated Rate $9.03
Max. Negotiated Rate $20.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial $14.18
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $12.90
Rate for Payer: Aetna Government $12.90
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $20.63
Rate for Payer: Cigna LocalPlus Benefit Plan $17.54
Rate for Payer: Group Health Inc Commercial $12.90
Rate for Payer: Group Health Inc Medicare $9.03
Rate for Payer: Hamaspik Choice Inc Medicaid $12.90
Rate for Payer: Hamaspik Choice Inc Medicare $12.90