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Service Code HCPCS C1713
Hospital Charge Code 40200706
Hospital Revenue Code 278
Min. Negotiated Rate $290.30
Max. Negotiated Rate $290.30
Rate for Payer: Hamaspik Choice Inc Medicaid $290.30
Rate for Payer: Hamaspik Choice Inc Medicare $290.30
Service Code HCPCS C1713
Hospital Charge Code 40200706
Hospital Revenue Code 278
Min. Negotiated Rate $134.20
Max. Negotiated Rate $609.63
Rate for Payer: 1199SEIU National Benefit Fund Commercial $319.33
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $134.20
Rate for Payer: Aetna Government $134.20
Rate for Payer: Brighton Health Commercial $348.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $290.30
Rate for Payer: Cigna LocalPlus Benefit Plan $333.84
Rate for Payer: EmblemHealth Commercial $290.30
Rate for Payer: Fidelis Medicare Advantage $609.63
Rate for Payer: Group Health Inc Commercial $290.30
Rate for Payer: Group Health Inc Medicare $203.21
Rate for Payer: Hamaspik Choice Inc Medicaid $290.30
Rate for Payer: Hamaspik Choice Inc Medicare $290.30
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $377.39
Service Code HCPCS C1713
Hospital Charge Code 40200076
Hospital Revenue Code 278
Min. Negotiated Rate $133.00
Max. Negotiated Rate $399.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $209.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $134.20
Rate for Payer: Aetna Government $134.20
Rate for Payer: Brighton Health Commercial $228.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $190.00
Rate for Payer: Cigna LocalPlus Benefit Plan $218.50
Rate for Payer: EmblemHealth Commercial $190.00
Rate for Payer: Fidelis Medicare Advantage $399.00
Rate for Payer: Group Health Inc Commercial $190.00
Rate for Payer: Group Health Inc Medicare $133.00
Rate for Payer: Hamaspik Choice Inc Medicaid $190.00
Rate for Payer: Hamaspik Choice Inc Medicare $190.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $247.00
Service Code HCPCS C1713
Hospital Charge Code 40200076
Hospital Revenue Code 278
Min. Negotiated Rate $190.00
Max. Negotiated Rate $190.00
Rate for Payer: Hamaspik Choice Inc Medicaid $190.00
Rate for Payer: Hamaspik Choice Inc Medicare $190.00
Service Code HCPCS C1781
Hospital Charge Code 40209728
Hospital Revenue Code 278
Min. Negotiated Rate $69.35
Max. Negotiated Rate $399.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $209.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $69.35
Rate for Payer: Aetna Government $69.35
Rate for Payer: Brighton Health Commercial $228.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $190.00
Rate for Payer: Cigna LocalPlus Benefit Plan $218.50
Rate for Payer: EmblemHealth Commercial $190.00
Rate for Payer: Fidelis Medicare Advantage $399.00
Rate for Payer: Group Health Inc Commercial $190.00
Rate for Payer: Group Health Inc Medicare $133.00
Rate for Payer: Hamaspik Choice Inc Medicaid $190.00
Rate for Payer: Hamaspik Choice Inc Medicare $190.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $247.00
Service Code HCPCS C1781
Hospital Charge Code 40209728
Hospital Revenue Code 278
Min. Negotiated Rate $190.00
Max. Negotiated Rate $190.00
Rate for Payer: Hamaspik Choice Inc Medicaid $190.00
Rate for Payer: Hamaspik Choice Inc Medicare $190.00
Service Code HCPCS C1781
Hospital Charge Code 40209729
Hospital Revenue Code 278
Min. Negotiated Rate $304.00
Max. Negotiated Rate $304.00
Rate for Payer: Hamaspik Choice Inc Medicaid $304.00
Rate for Payer: Hamaspik Choice Inc Medicare $304.00
Service Code HCPCS C1781
Hospital Charge Code 40209729
Hospital Revenue Code 278
Min. Negotiated Rate $69.35
Max. Negotiated Rate $638.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $334.40
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $69.35
Rate for Payer: Aetna Government $69.35
Rate for Payer: Brighton Health Commercial $364.80
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $304.00
Rate for Payer: Cigna LocalPlus Benefit Plan $349.60
Rate for Payer: EmblemHealth Commercial $304.00
Rate for Payer: Fidelis Medicare Advantage $638.40
Rate for Payer: Group Health Inc Commercial $304.00
Rate for Payer: Group Health Inc Medicare $212.80
Rate for Payer: Hamaspik Choice Inc Medicaid $304.00
Rate for Payer: Hamaspik Choice Inc Medicare $304.00
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $395.20
Service Code HCPCS 86631
Hospital Charge Code 40729353
Hospital Revenue Code 300
Rate for Payer: Cash Price $11.82
Service Code HCPCS 86631
Hospital Charge Code 40729353
Hospital Revenue Code 300
Min. Negotiated Rate $8.27
Max. Negotiated Rate $22.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial $16.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $11.82
Rate for Payer: Aetna Government $11.82
Rate for Payer: Affinity Essential Plan 1&2 $8.27
Rate for Payer: Affinity Essential Plan 3&4 $8.27
Rate for Payer: Affinity Medicaid/CHP/HARP $8.27
Rate for Payer: Brighton Health Commercial $22.16
Rate for Payer: Cash Price $11.82
Rate for Payer: Cash Price $11.82
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $11.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $18.80
Rate for Payer: Cigna LocalPlus Benefit Plan $15.91
Rate for Payer: Elderplan Medicare Advantage $11.82
Rate for Payer: EmblemHealth Commercial $11.82
Rate for Payer: Fidelis Essential Plan Aliesa $10.05
Rate for Payer: Fidelis Essential Plan QHP $10.52
Rate for Payer: Fidelis Medicare Advantage $11.82
Rate for Payer: Fidelis Qualified Health Plan $10.52
Rate for Payer: Group Health Inc Commercial $11.82
Rate for Payer: Group Health Inc Medicare $11.82
Rate for Payer: Hamaspik Choice Inc Medicaid $14.78
Rate for Payer: Hamaspik Choice Inc Medicare $11.82
Rate for Payer: Healthfirst Medicare Advantage $11.82
Rate for Payer: Healthfirst QHP $11.82
Rate for Payer: Humana Medicare $12.06
Rate for Payer: Senior Whole Health Medicare Advantage $11.82
Rate for Payer: United Healthcare Commercial $14.98
Rate for Payer: United Healthcare Medicare Advantage $11.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $11.82
Rate for Payer: Wellcare CHP/FHP/Medicaid $9.46
Rate for Payer: Wellcare Medicare $10.64
Service Code HCPCS 87491
Hospital Charge Code 40619197
Hospital Revenue Code 300
Rate for Payer: Cash Price $35.09
Service Code HCPCS 87491
Hospital Charge Code 40619197
Hospital Revenue Code 300
Min. Negotiated Rate $24.56
Max. Negotiated Rate $65.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $48.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $35.09
Rate for Payer: Aetna Government $35.09
Rate for Payer: Affinity Essential Plan 1&2 $24.56
Rate for Payer: Affinity Essential Plan 3&4 $24.56
Rate for Payer: Affinity Medicaid/CHP/HARP $24.56
Rate for Payer: Brighton Health Commercial $65.80
Rate for Payer: Cash Price $35.09
Rate for Payer: Cash Price $35.09
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $35.09
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $55.78
Rate for Payer: Cigna LocalPlus Benefit Plan $47.20
Rate for Payer: Elderplan Medicare Advantage $35.09
Rate for Payer: EmblemHealth Commercial $35.09
Rate for Payer: Fidelis Essential Plan Aliesa $29.83
Rate for Payer: Fidelis Essential Plan QHP $31.23
Rate for Payer: Fidelis Medicare Advantage $35.09
Rate for Payer: Fidelis Qualified Health Plan $31.23
Rate for Payer: Group Health Inc Commercial $35.09
Rate for Payer: Group Health Inc Medicare $35.09
Rate for Payer: Hamaspik Choice Inc Medicaid $43.86
Rate for Payer: Hamaspik Choice Inc Medicare $35.09
Rate for Payer: Healthfirst Medicare Advantage $35.09
Rate for Payer: Healthfirst QHP $35.09
Rate for Payer: Humana Medicare $35.79
Rate for Payer: Senior Whole Health Medicare Advantage $35.09
Rate for Payer: United Healthcare Commercial $44.45
Rate for Payer: United Healthcare Medicare Advantage $35.09
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $35.09
Rate for Payer: Wellcare CHP/FHP/Medicaid $28.07
Rate for Payer: Wellcare Medicare $31.58
Service Code HCPCS 86632
Hospital Charge Code 40729456
Hospital Revenue Code 300
Rate for Payer: Cash Price $12.68
Service Code HCPCS 86632
Hospital Charge Code 40729456
Hospital Revenue Code 300
Min. Negotiated Rate $8.88
Max. Negotiated Rate $23.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial $17.44
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $12.68
Rate for Payer: Aetna Government $12.68
Rate for Payer: Affinity Essential Plan 1&2 $8.88
Rate for Payer: Affinity Essential Plan 3&4 $8.88
Rate for Payer: Affinity Medicaid/CHP/HARP $8.88
Rate for Payer: Brighton Health Commercial $23.78
Rate for Payer: Cash Price $12.68
Rate for Payer: Cash Price $12.68
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $12.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $20.18
Rate for Payer: Cigna LocalPlus Benefit Plan $17.07
Rate for Payer: Elderplan Medicare Advantage $12.68
Rate for Payer: EmblemHealth Commercial $12.68
Rate for Payer: Fidelis Essential Plan Aliesa $10.78
Rate for Payer: Fidelis Essential Plan QHP $11.29
Rate for Payer: Fidelis Medicare Advantage $12.68
Rate for Payer: Fidelis Qualified Health Plan $11.29
Rate for Payer: Group Health Inc Commercial $12.68
Rate for Payer: Group Health Inc Medicare $12.68
Rate for Payer: Hamaspik Choice Inc Medicaid $15.85
Rate for Payer: Hamaspik Choice Inc Medicare $12.68
Rate for Payer: Healthfirst Medicare Advantage $12.68
Rate for Payer: Healthfirst QHP $12.68
Rate for Payer: Humana Medicare $12.93
Rate for Payer: Senior Whole Health Medicare Advantage $12.68
Rate for Payer: United Healthcare Commercial $16.07
Rate for Payer: United Healthcare Medicare Advantage $12.68
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $12.68
Rate for Payer: Wellcare CHP/FHP/Medicaid $10.14
Rate for Payer: Wellcare Medicare $11.41
Service Code HCPCS 86631
Hospital Charge Code 40728121
Hospital Revenue Code 302
Rate for Payer: Cash Price $11.82
Service Code HCPCS 86631
Hospital Charge Code 40728121
Hospital Revenue Code 302
Min. Negotiated Rate $8.27
Max. Negotiated Rate $22.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial $16.25
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $11.82
Rate for Payer: Aetna Government $11.82
Rate for Payer: Affinity Essential Plan 1&2 $8.27
Rate for Payer: Affinity Essential Plan 3&4 $8.27
Rate for Payer: Affinity Medicaid/CHP/HARP $8.27
Rate for Payer: Brighton Health Commercial $22.16
Rate for Payer: Cash Price $11.82
Rate for Payer: Cash Price $11.82
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $11.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $18.80
Rate for Payer: Cigna LocalPlus Benefit Plan $15.91
Rate for Payer: Elderplan Medicare Advantage $11.82
Rate for Payer: EmblemHealth Commercial $11.82
Rate for Payer: Fidelis Essential Plan Aliesa $10.05
Rate for Payer: Fidelis Essential Plan QHP $10.52
Rate for Payer: Fidelis Medicare Advantage $11.82
Rate for Payer: Fidelis Qualified Health Plan $10.52
Rate for Payer: Group Health Inc Commercial $11.82
Rate for Payer: Group Health Inc Medicare $11.82
Rate for Payer: Hamaspik Choice Inc Medicaid $14.78
Rate for Payer: Hamaspik Choice Inc Medicare $11.82
Rate for Payer: Healthfirst Medicare Advantage $11.82
Rate for Payer: Healthfirst QHP $11.82
Rate for Payer: Humana Medicare $12.06
Rate for Payer: Senior Whole Health Medicare Advantage $11.82
Rate for Payer: United Healthcare Commercial $14.98
Rate for Payer: United Healthcare Medicare Advantage $11.82
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $11.82
Rate for Payer: Wellcare CHP/FHP/Medicaid $9.46
Rate for Payer: Wellcare Medicare $10.64
Service Code HCPCS 87110
Hospital Charge Code 40619188
Hospital Revenue Code 300
Min. Negotiated Rate $13.72
Max. Negotiated Rate $36.75
Rate for Payer: 1199SEIU National Benefit Fund Commercial $26.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $19.60
Rate for Payer: Aetna Government $19.60
Rate for Payer: Affinity Essential Plan 1&2 $13.72
Rate for Payer: Affinity Essential Plan 3&4 $13.72
Rate for Payer: Affinity Medicaid/CHP/HARP $13.72
Rate for Payer: Brighton Health Commercial $36.75
Rate for Payer: Cash Price $19.60
Rate for Payer: Cash Price $19.60
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $19.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $31.14
Rate for Payer: Cigna LocalPlus Benefit Plan $26.34
Rate for Payer: Elderplan Medicare Advantage $19.60
Rate for Payer: EmblemHealth Commercial $19.60
Rate for Payer: Fidelis Essential Plan Aliesa $16.66
Rate for Payer: Fidelis Essential Plan QHP $17.44
Rate for Payer: Fidelis Medicare Advantage $19.60
Rate for Payer: Fidelis Qualified Health Plan $17.44
Rate for Payer: Group Health Inc Commercial $19.60
Rate for Payer: Group Health Inc Medicare $19.60
Rate for Payer: Hamaspik Choice Inc Medicaid $24.50
Rate for Payer: Hamaspik Choice Inc Medicare $19.60
Rate for Payer: Healthfirst Medicare Advantage $19.60
Rate for Payer: Healthfirst QHP $19.60
Rate for Payer: Humana Medicare $19.99
Rate for Payer: Senior Whole Health Medicare Advantage $19.60
Rate for Payer: United Healthcare Commercial $24.81
Rate for Payer: United Healthcare Medicare Advantage $19.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $19.60
Rate for Payer: Wellcare CHP/FHP/Medicaid $15.68
Rate for Payer: Wellcare Medicare $17.64
Service Code HCPCS 87110
Hospital Charge Code 40619188
Hospital Revenue Code 300
Rate for Payer: Cash Price $19.60
Hospital Charge Code 41640715
Hospital Revenue Code 250
Min. Negotiated Rate $0.35
Max. Negotiated Rate $0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.50
Rate for Payer: Aetna Government $0.50
Rate for Payer: Brighton Health Commercial $0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.80
Rate for Payer: Cigna LocalPlus Benefit Plan $0.68
Rate for Payer: Group Health Inc Commercial $0.50
Rate for Payer: Group Health Inc Medicare $0.35
Rate for Payer: Hamaspik Choice Inc Medicaid $0.50
Rate for Payer: Hamaspik Choice Inc Medicare $0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.65
Hospital Charge Code 41650715
Hospital Revenue Code 250
Min. Negotiated Rate $0.35
Max. Negotiated Rate $0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.50
Rate for Payer: Aetna Government $0.50
Rate for Payer: Brighton Health Commercial $0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.80
Rate for Payer: Cigna LocalPlus Benefit Plan $0.68
Rate for Payer: Group Health Inc Commercial $0.50
Rate for Payer: Group Health Inc Medicare $0.35
Rate for Payer: Hamaspik Choice Inc Medicaid $0.50
Rate for Payer: Hamaspik Choice Inc Medicare $0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.65
Hospital Charge Code 41652357
Hospital Revenue Code 250
Min. Negotiated Rate $0.35
Max. Negotiated Rate $0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.50
Rate for Payer: Aetna Government $0.50
Rate for Payer: Brighton Health Commercial $0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.80
Rate for Payer: Cigna LocalPlus Benefit Plan $0.68
Rate for Payer: Group Health Inc Commercial $0.50
Rate for Payer: Group Health Inc Medicare $0.35
Rate for Payer: Hamaspik Choice Inc Medicaid $0.50
Rate for Payer: Hamaspik Choice Inc Medicare $0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.65
Hospital Charge Code 41642357
Hospital Revenue Code 250
Min. Negotiated Rate $0.35
Max. Negotiated Rate $0.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.55
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.50
Rate for Payer: Aetna Government $0.50
Rate for Payer: Brighton Health Commercial $0.75
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.80
Rate for Payer: Cigna LocalPlus Benefit Plan $0.68
Rate for Payer: Group Health Inc Commercial $0.50
Rate for Payer: Group Health Inc Medicare $0.35
Rate for Payer: Hamaspik Choice Inc Medicaid $0.50
Rate for Payer: Hamaspik Choice Inc Medicare $0.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.65
Service Code NDC 69784061025
Hospital Charge Code 69784061025
Hospital Revenue Code 250
Min. Negotiated Rate $110.88
Max. Negotiated Rate $253.44
Rate for Payer: 1199SEIU National Benefit Fund Commercial $174.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $158.40
Rate for Payer: Aetna Government $158.40
Rate for Payer: Brighton Health Commercial $237.60
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $253.44
Rate for Payer: Cigna LocalPlus Benefit Plan $215.42
Rate for Payer: Group Health Inc Commercial $158.40
Rate for Payer: Group Health Inc Medicare $110.88
Rate for Payer: Hamaspik Choice Inc Medicaid $158.40
Rate for Payer: Hamaspik Choice Inc Medicare $158.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $205.92
Service Code HCPCS J8999
Hospital Charge Code 41654054
Hospital Revenue Code 636
Min. Negotiated Rate $2.45
Max. Negotiated Rate $4.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $3.50
Rate for Payer: Aetna Government $3.50
Rate for Payer: Brighton Health Commercial $4.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $3.50
Rate for Payer: Cigna LocalPlus Benefit Plan $4.02
Rate for Payer: Group Health Inc Commercial $3.50
Rate for Payer: Group Health Inc Medicare $2.45
Rate for Payer: Hamaspik Choice Inc Medicaid $3.50
Rate for Payer: Hamaspik Choice Inc Medicare $3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $4.55
Service Code HCPCS J8999
Hospital Charge Code 41644054
Hospital Revenue Code 636
Min. Negotiated Rate $2.45
Max. Negotiated Rate $4.55
Rate for Payer: 1199SEIU National Benefit Fund Commercial $3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $3.50
Rate for Payer: Aetna Government $3.50
Rate for Payer: Brighton Health Commercial $4.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $3.50
Rate for Payer: Cigna LocalPlus Benefit Plan $4.02
Rate for Payer: Group Health Inc Commercial $3.50
Rate for Payer: Group Health Inc Medicare $2.45
Rate for Payer: Hamaspik Choice Inc Medicaid $3.50
Rate for Payer: Hamaspik Choice Inc Medicare $3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $4.55