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Hospital Charge Code 64905299
Hospital Revenue Code 270
Min. Negotiated Rate $627.00
Max. Negotiated Rate $1,433.14
Rate for Payer: 1199SEIU National Benefit Fund Commercial $985.29
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $895.72
Rate for Payer: Aetna Government $895.72
Rate for Payer: Brighton Health Commercial $1,343.57
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,433.14
Rate for Payer: Cigna LocalPlus Benefit Plan $1,218.17
Rate for Payer: Group Health Inc Commercial $895.72
Rate for Payer: Group Health Inc Medicare $627.00
Rate for Payer: Hamaspik Choice Inc Medicaid $895.72
Rate for Payer: Hamaspik Choice Inc Medicare $895.72
Hospital Charge Code 64904964
Hospital Revenue Code 270
Min. Negotiated Rate $35.00
Max. Negotiated Rate $80.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $55.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $50.00
Rate for Payer: Aetna Government $50.00
Rate for Payer: Brighton Health Commercial $75.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $80.00
Rate for Payer: Cigna LocalPlus Benefit Plan $68.00
Rate for Payer: Group Health Inc Commercial $50.00
Rate for Payer: Group Health Inc Medicare $35.00
Rate for Payer: Hamaspik Choice Inc Medicaid $50.00
Rate for Payer: Hamaspik Choice Inc Medicare $50.00
Hospital Charge Code 64904968
Hospital Revenue Code 270
Min. Negotiated Rate $65.89
Max. Negotiated Rate $150.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial $103.54
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $94.12
Rate for Payer: Aetna Government $94.12
Rate for Payer: Brighton Health Commercial $141.19
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $150.60
Rate for Payer: Cigna LocalPlus Benefit Plan $128.01
Rate for Payer: Group Health Inc Commercial $94.12
Rate for Payer: Group Health Inc Medicare $65.89
Rate for Payer: Hamaspik Choice Inc Medicaid $94.12
Rate for Payer: Hamaspik Choice Inc Medicare $94.12
Hospital Charge Code 64905555
Hospital Revenue Code 270
Min. Negotiated Rate $284.38
Max. Negotiated Rate $650.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $446.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $406.25
Rate for Payer: Aetna Government $406.25
Rate for Payer: Brighton Health Commercial $609.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $650.00
Rate for Payer: Cigna LocalPlus Benefit Plan $552.50
Rate for Payer: Group Health Inc Commercial $406.25
Rate for Payer: Group Health Inc Medicare $284.38
Rate for Payer: Hamaspik Choice Inc Medicaid $406.25
Rate for Payer: Hamaspik Choice Inc Medicare $406.25
Hospital Charge Code 64905866
Hospital Revenue Code 270
Min. Negotiated Rate $284.38
Max. Negotiated Rate $650.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $446.88
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $406.25
Rate for Payer: Aetna Government $406.25
Rate for Payer: Brighton Health Commercial $609.38
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $650.00
Rate for Payer: Cigna LocalPlus Benefit Plan $552.50
Rate for Payer: Group Health Inc Commercial $406.25
Rate for Payer: Group Health Inc Medicare $284.38
Rate for Payer: Hamaspik Choice Inc Medicaid $406.25
Rate for Payer: Hamaspik Choice Inc Medicare $406.25
Hospital Charge Code 64906049
Hospital Revenue Code 270
Min. Negotiated Rate $19.64
Max. Negotiated Rate $44.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial $30.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $28.05
Rate for Payer: Aetna Government $28.05
Rate for Payer: Brighton Health Commercial $42.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $44.88
Rate for Payer: Cigna LocalPlus Benefit Plan $38.15
Rate for Payer: Group Health Inc Commercial $28.05
Rate for Payer: Group Health Inc Medicare $19.64
Rate for Payer: Hamaspik Choice Inc Medicaid $28.05
Rate for Payer: Hamaspik Choice Inc Medicare $28.05
Hospital Charge Code 64906050
Hospital Revenue Code 270
Min. Negotiated Rate $3.93
Max. Negotiated Rate $8.98
Rate for Payer: 1199SEIU National Benefit Fund Commercial $6.17
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $5.61
Rate for Payer: Aetna Government $5.61
Rate for Payer: Brighton Health Commercial $8.42
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $8.98
Rate for Payer: Cigna LocalPlus Benefit Plan $7.63
Rate for Payer: Group Health Inc Commercial $5.61
Rate for Payer: Group Health Inc Medicare $3.93
Rate for Payer: Hamaspik Choice Inc Medicaid $5.61
Rate for Payer: Hamaspik Choice Inc Medicare $5.61
Hospital Charge Code 64906048
Hospital Revenue Code 270
Min. Negotiated Rate $19.64
Max. Negotiated Rate $44.88
Rate for Payer: 1199SEIU National Benefit Fund Commercial $30.86
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $28.05
Rate for Payer: Aetna Government $28.05
Rate for Payer: Brighton Health Commercial $42.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $44.88
Rate for Payer: Cigna LocalPlus Benefit Plan $38.15
Rate for Payer: Group Health Inc Commercial $28.05
Rate for Payer: Group Health Inc Medicare $19.64
Rate for Payer: Hamaspik Choice Inc Medicaid $28.05
Rate for Payer: Hamaspik Choice Inc Medicare $28.05
Hospital Charge Code 64905942
Hospital Revenue Code 270
Min. Negotiated Rate $406.88
Max. Negotiated Rate $930.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $639.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $581.25
Rate for Payer: Aetna Government $581.25
Rate for Payer: Brighton Health Commercial $871.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $930.00
Rate for Payer: Cigna LocalPlus Benefit Plan $790.50
Rate for Payer: Group Health Inc Commercial $581.25
Rate for Payer: Group Health Inc Medicare $406.88
Rate for Payer: Hamaspik Choice Inc Medicaid $581.25
Rate for Payer: Hamaspik Choice Inc Medicare $581.25
Hospital Charge Code 64902973
Hospital Revenue Code 270
Min. Negotiated Rate $84.96
Max. Negotiated Rate $194.19
Rate for Payer: 1199SEIU National Benefit Fund Commercial $133.51
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $121.37
Rate for Payer: Aetna Government $121.37
Rate for Payer: Brighton Health Commercial $182.06
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $194.19
Rate for Payer: Cigna LocalPlus Benefit Plan $165.06
Rate for Payer: Group Health Inc Commercial $121.37
Rate for Payer: Group Health Inc Medicare $84.96
Rate for Payer: Hamaspik Choice Inc Medicaid $121.37
Rate for Payer: Hamaspik Choice Inc Medicare $121.37
Hospital Charge Code 64902972
Hospital Revenue Code 270
Min. Negotiated Rate $126.79
Max. Negotiated Rate $289.80
Rate for Payer: 1199SEIU National Benefit Fund Commercial $199.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $181.12
Rate for Payer: Aetna Government $181.12
Rate for Payer: Brighton Health Commercial $271.69
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $289.80
Rate for Payer: Cigna LocalPlus Benefit Plan $246.33
Rate for Payer: Group Health Inc Commercial $181.12
Rate for Payer: Group Health Inc Medicare $126.79
Rate for Payer: Hamaspik Choice Inc Medicaid $181.12
Rate for Payer: Hamaspik Choice Inc Medicare $181.12
Hospital Charge Code 64904646
Hospital Revenue Code 270
Min. Negotiated Rate $50.25
Max. Negotiated Rate $114.86
Rate for Payer: 1199SEIU National Benefit Fund Commercial $78.97
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $71.79
Rate for Payer: Aetna Government $71.79
Rate for Payer: Brighton Health Commercial $107.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $114.86
Rate for Payer: Cigna LocalPlus Benefit Plan $97.63
Rate for Payer: Group Health Inc Commercial $71.79
Rate for Payer: Group Health Inc Medicare $50.25
Rate for Payer: Hamaspik Choice Inc Medicaid $71.79
Rate for Payer: Hamaspik Choice Inc Medicare $71.79
Hospital Charge Code 64902986
Hospital Revenue Code 270
Min. Negotiated Rate $94.12
Max. Negotiated Rate $215.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial $147.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $134.46
Rate for Payer: Aetna Government $134.46
Rate for Payer: Brighton Health Commercial $201.68
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $215.13
Rate for Payer: Cigna LocalPlus Benefit Plan $182.86
Rate for Payer: Group Health Inc Commercial $134.46
Rate for Payer: Group Health Inc Medicare $94.12
Rate for Payer: Hamaspik Choice Inc Medicaid $134.46
Rate for Payer: Hamaspik Choice Inc Medicare $134.46
Hospital Charge Code 40200408
Hospital Revenue Code 270
Min. Negotiated Rate $562.97
Max. Negotiated Rate $1,286.78
Rate for Payer: 1199SEIU National Benefit Fund Commercial $884.66
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $804.24
Rate for Payer: Aetna Government $804.24
Rate for Payer: Brighton Health Commercial $1,206.36
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1,286.78
Rate for Payer: Cigna LocalPlus Benefit Plan $1,093.77
Rate for Payer: Group Health Inc Commercial $804.24
Rate for Payer: Group Health Inc Medicare $562.97
Rate for Payer: Hamaspik Choice Inc Medicaid $804.24
Rate for Payer: Hamaspik Choice Inc Medicare $804.24
Hospital Charge Code 64905884
Hospital Revenue Code 270
Min. Negotiated Rate $175.00
Max. Negotiated Rate $400.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $275.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $250.00
Rate for Payer: Aetna Government $250.00
Rate for Payer: Brighton Health Commercial $375.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $400.00
Rate for Payer: Cigna LocalPlus Benefit Plan $340.00
Rate for Payer: Group Health Inc Commercial $250.00
Rate for Payer: Group Health Inc Medicare $175.00
Rate for Payer: Hamaspik Choice Inc Medicaid $250.00
Rate for Payer: Hamaspik Choice Inc Medicare $250.00
Hospital Charge Code 64902995
Hospital Revenue Code 270
Min. Negotiated Rate $90.16
Max. Negotiated Rate $206.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial $141.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $128.80
Rate for Payer: Aetna Government $128.80
Rate for Payer: Brighton Health Commercial $193.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $206.08
Rate for Payer: Cigna LocalPlus Benefit Plan $175.17
Rate for Payer: Group Health Inc Commercial $128.80
Rate for Payer: Group Health Inc Medicare $90.16
Rate for Payer: Hamaspik Choice Inc Medicaid $128.80
Rate for Payer: Hamaspik Choice Inc Medicare $128.80
Hospital Charge Code 40200643
Hospital Revenue Code 270
Min. Negotiated Rate $111.30
Max. Negotiated Rate $254.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial $174.90
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $159.00
Rate for Payer: Aetna Government $159.00
Rate for Payer: Brighton Health Commercial $238.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $254.40
Rate for Payer: Cigna LocalPlus Benefit Plan $216.24
Rate for Payer: Group Health Inc Commercial $159.00
Rate for Payer: Group Health Inc Medicare $111.30
Rate for Payer: Hamaspik Choice Inc Medicaid $159.00
Rate for Payer: Hamaspik Choice Inc Medicare $159.00
Service Code HCPCS 36568
Hospital Charge Code 40000030
Hospital Revenue Code 360
Min. Negotiated Rate $954.82
Max. Negotiated Rate $2,915.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1,412.00
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1,852.05
Rate for Payer: Aetna Government $1,852.05
Rate for Payer: Affinity Essential Plan 1&2 $1,296.44
Rate for Payer: Affinity Essential Plan 3&4 $1,296.44
Rate for Payer: Affinity Medicaid/CHP/HARP $1,296.44
Rate for Payer: Brighton Health Commercial $1,432.24
Rate for Payer: Cash Price $1,852.05
Rate for Payer: Cash Price $1,852.05
Rate for Payer: Cash Price $1,852.05
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $1,852.05
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 $1,852.05
Rate for Payer: EmblemHealth Commercial $1,505.00
Rate for Payer: Fidelis Essential Plan Aliesa $1,574.24
Rate for Payer: Fidelis Essential Plan QHP $1,648.32
Rate for Payer: Fidelis Medicare Advantage $1,852.05
Rate for Payer: Fidelis Qualified Health Plan $1,648.32
Rate for Payer: Group Health Inc Commercial $1,852.05
Rate for Payer: Group Health Inc Medicare $1,852.05
Rate for Payer: Hamaspik Choice Inc Medicaid $954.82
Rate for Payer: Hamaspik Choice Inc Medicare $1,852.05
Rate for Payer: Healthfirst Medicare Advantage $1,574.24
Rate for Payer: Healthfirst QHP $1,852.05
Rate for Payer: Humana Medicare $1,889.09
Rate for Payer: Senior Whole Health Medicare Advantage $1,852.05
Rate for Payer: United Healthcare Commercial $1,188.00
Rate for Payer: United Healthcare Medicare Advantage $1,852.05
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1,852.05
Rate for Payer: Wellcare CHP/FHP/Medicaid $1,481.64
Rate for Payer: Wellcare Medicare $1,759.45
Service Code HCPCS 36568
Hospital Charge Code 40000030
Hospital Revenue Code 360
Rate for Payer: Cash Price $1,852.05
Hospital Charge Code 40200980
Hospital Revenue Code 270
Min. Negotiated Rate $18.73
Max. Negotiated Rate $42.81
Rate for Payer: 1199SEIU National Benefit Fund Commercial $29.43
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $26.76
Rate for Payer: Aetna Government $26.76
Rate for Payer: Brighton Health Commercial $40.13
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $42.81
Rate for Payer: Cigna LocalPlus Benefit Plan $36.39
Rate for Payer: Group Health Inc Commercial $26.76
Rate for Payer: Group Health Inc Medicare $18.73
Rate for Payer: Hamaspik Choice Inc Medicaid $26.76
Rate for Payer: Hamaspik Choice Inc Medicare $26.76
Hospital Charge Code 64904587
Hospital Revenue Code 270
Min. Negotiated Rate $165.67
Max. Negotiated Rate $378.68
Rate for Payer: 1199SEIU National Benefit Fund Commercial $260.34
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $236.68
Rate for Payer: Aetna Government $236.68
Rate for Payer: Brighton Health Commercial $355.01
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $378.68
Rate for Payer: Cigna LocalPlus Benefit Plan $321.88
Rate for Payer: Group Health Inc Commercial $236.68
Rate for Payer: Group Health Inc Medicare $165.67
Rate for Payer: Hamaspik Choice Inc Medicaid $236.68
Rate for Payer: Hamaspik Choice Inc Medicare $236.68
Service Code HCPCS 82600
Hospital Charge Code 40609890
Hospital Revenue Code 301
Min. Negotiated Rate $13.58
Max. Negotiated Rate $36.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial $26.68
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $19.40
Rate for Payer: Aetna Government $19.40
Rate for Payer: Affinity Essential Plan 1&2 $13.58
Rate for Payer: Affinity Essential Plan 3&4 $13.58
Rate for Payer: Affinity Medicaid/CHP/HARP $13.58
Rate for Payer: Brighton Health Commercial $36.38
Rate for Payer: Cash Price $19.40
Rate for Payer: Cash Price $19.40
Rate for Payer: Centers Plan For Healthy Living Dual Advantage/Medicare Advantage/Medicare Advantage Plus $19.40
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $30.85
Rate for Payer: Cigna LocalPlus Benefit Plan $26.10
Rate for Payer: Elderplan Medicare Advantage $19.40
Rate for Payer: EmblemHealth Commercial $19.40
Rate for Payer: Fidelis Essential Plan Aliesa $16.49
Rate for Payer: Fidelis Essential Plan QHP $17.27
Rate for Payer: Fidelis Medicare Advantage $19.40
Rate for Payer: Fidelis Qualified Health Plan $17.27
Rate for Payer: Group Health Inc Commercial $19.40
Rate for Payer: Group Health Inc Medicare $19.40
Rate for Payer: Hamaspik Choice Inc Medicaid $24.25
Rate for Payer: Hamaspik Choice Inc Medicare $19.40
Rate for Payer: Healthfirst Medicare Advantage $19.40
Rate for Payer: Healthfirst QHP $19.40
Rate for Payer: Humana Medicare $19.79
Rate for Payer: Senior Whole Health Medicare Advantage $19.40
Rate for Payer: United Healthcare Commercial $24.57
Rate for Payer: United Healthcare Medicare Advantage $19.40
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $19.40
Rate for Payer: Wellcare CHP/FHP/Medicaid $15.52
Rate for Payer: Wellcare Medicare $17.46
Service Code HCPCS 82600
Hospital Charge Code 40609890
Hospital Revenue Code 301
Rate for Payer: Cash Price $19.40
Service Code HCPCS J3420
Hospital Charge Code 41644513
Hospital Revenue Code 636
Min. Negotiated Rate $1.52
Max. Negotiated Rate $1.52
Rate for Payer: Hamaspik Choice Inc Medicaid $1.52
Rate for Payer: Hamaspik Choice Inc Medicare $1.52
Service Code HCPCS J3420
Hospital Charge Code 41644513
Hospital Revenue Code 636
Min. Negotiated Rate $1.06
Max. Negotiated Rate $2.12
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $2.12
Rate for Payer: Aetna Government $2.12
Rate for Payer: Brighton Health Commercial $1.82
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.52
Rate for Payer: Cigna LocalPlus Benefit Plan $1.75
Rate for Payer: Group Health Inc Commercial $1.52
Rate for Payer: Group Health Inc Medicare $1.06
Rate for Payer: Hamaspik Choice Inc Medicaid $1.52
Rate for Payer: Hamaspik Choice Inc Medicare $1.52
Rate for Payer: SOMOS CHP/HARP/Medicaid $1.51
Rate for Payer: SOMOS Essential $1.51
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.98