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Charge Type Setting Price  
Service Code NDC 0054356699
Hospital Charge Code 0054356699
Hospital Revenue Code 250
Min. Negotiated Rate $0.75
Max. Negotiated Rate $1.72
Rate for Payer: 1199SEIU National Benefit Fund Commercial $1.19
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $1.08
Rate for Payer: Aetna Government $1.08
Rate for Payer: Brighton Health Commercial $1.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.72
Rate for Payer: Cigna LocalPlus Benefit Plan $1.47
Rate for Payer: EmblemHealth Commercial $1.08
Rate for Payer: Group Health Inc Commercial $1.08
Rate for Payer: Group Health Inc Medicare $0.75
Rate for Payer: Hamaspik Choice Inc Medicaid $1.08
Rate for Payer: Hamaspik Choice Inc Medicare $1.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $1.40
Service Code NDC 0054356699
Hospital Charge Code 0054356699
Hospital Revenue Code 250
Min. Negotiated Rate $1.08
Max. Negotiated Rate $1.08
Rate for Payer: Hamaspik Choice Inc Medicaid $1.08
Service Code NDC 6809476459
Hospital Charge Code 6809476459
Hospital Revenue Code 250
Min. Negotiated Rate $0.73
Max. Negotiated Rate $0.73
Rate for Payer: Hamaspik Choice Inc Medicaid $0.73
Service Code NDC 6068757686
Hospital Charge Code 6068757686
Hospital Revenue Code 250
Min. Negotiated Rate $0.52
Max. Negotiated Rate $1.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.74
Rate for Payer: Aetna Government $0.74
Rate for Payer: Brighton Health Commercial $1.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.18
Rate for Payer: Cigna LocalPlus Benefit Plan $1.01
Rate for Payer: EmblemHealth Commercial $0.74
Rate for Payer: Group Health Inc Commercial $0.74
Rate for Payer: Group Health Inc Medicare $0.52
Rate for Payer: Hamaspik Choice Inc Medicaid $0.74
Rate for Payer: Hamaspik Choice Inc Medicare $0.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.96
Service Code NDC 6809476459
Hospital Charge Code 6809476459
Hospital Revenue Code 250
Min. Negotiated Rate $0.51
Max. Negotiated Rate $1.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.73
Rate for Payer: Aetna Government $0.73
Rate for Payer: Brighton Health Commercial $1.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.17
Rate for Payer: Cigna LocalPlus Benefit Plan $1.00
Rate for Payer: EmblemHealth Commercial $0.73
Rate for Payer: Group Health Inc Commercial $0.73
Rate for Payer: Group Health Inc Medicare $0.51
Rate for Payer: Hamaspik Choice Inc Medicaid $0.73
Rate for Payer: Hamaspik Choice Inc Medicare $0.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.95
Service Code NDC 6809476462
Hospital Charge Code 6809476462
Hospital Revenue Code 250
Min. Negotiated Rate $0.51
Max. Negotiated Rate $1.17
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.73
Rate for Payer: Aetna Government $0.73
Rate for Payer: Brighton Health Commercial $1.10
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.17
Rate for Payer: Cigna LocalPlus Benefit Plan $1.00
Rate for Payer: EmblemHealth Commercial $0.73
Rate for Payer: Group Health Inc Commercial $0.73
Rate for Payer: Group Health Inc Medicare $0.51
Rate for Payer: Hamaspik Choice Inc Medicaid $0.73
Rate for Payer: Hamaspik Choice Inc Medicare $0.73
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.95
Service Code NDC 6809476462
Hospital Charge Code 6809476462
Hospital Revenue Code 250
Min. Negotiated Rate $0.73
Max. Negotiated Rate $0.73
Rate for Payer: Hamaspik Choice Inc Medicaid $0.73
Service Code NDC 6068757640
Hospital Charge Code 6068757640
Hospital Revenue Code 250
Min. Negotiated Rate $0.74
Max. Negotiated Rate $0.74
Rate for Payer: Hamaspik Choice Inc Medicaid $0.74
Service Code NDC 6068757640
Hospital Charge Code 6068757640
Hospital Revenue Code 250
Min. Negotiated Rate $0.52
Max. Negotiated Rate $1.18
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.81
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.74
Rate for Payer: Aetna Government $0.74
Rate for Payer: Brighton Health Commercial $1.11
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.18
Rate for Payer: Cigna LocalPlus Benefit Plan $1.01
Rate for Payer: EmblemHealth Commercial $0.74
Rate for Payer: Group Health Inc Commercial $0.74
Rate for Payer: Group Health Inc Medicare $0.52
Rate for Payer: Hamaspik Choice Inc Medicaid $0.74
Rate for Payer: Hamaspik Choice Inc Medicare $0.74
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.96
Service Code NDC 6068757686
Hospital Charge Code 6068757686
Hospital Revenue Code 250
Min. Negotiated Rate $0.74
Max. Negotiated Rate $0.74
Rate for Payer: Hamaspik Choice Inc Medicaid $0.74
Service Code HCPCS J2250
Hospital Charge Code 0641606010
Hospital Revenue Code 250
Min. Negotiated Rate $0.13
Max. Negotiated Rate $0.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.13
Rate for Payer: Aetna Government $0.13
Rate for Payer: Brighton Health Commercial $0.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.66
Rate for Payer: Cigna LocalPlus Benefit Plan $0.56
Rate for Payer: EmblemHealth Commercial $0.41
Rate for Payer: Group Health Inc Commercial $0.41
Rate for Payer: Group Health Inc Medicare $0.29
Rate for Payer: Hamaspik Choice Inc Medicaid $0.41
Rate for Payer: Hamaspik Choice Inc Medicare $0.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid $0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.54
Service Code HCPCS J2250
Hospital Charge Code 7261174910
Hospital Revenue Code 250
Min. Negotiated Rate $0.35
Max. Negotiated Rate $0.35
Rate for Payer: Hamaspik Choice Inc Medicaid $0.35
Service Code HCPCS J2250
Hospital Charge Code 0641606001
Hospital Revenue Code 250
Min. Negotiated Rate $0.41
Max. Negotiated Rate $0.41
Rate for Payer: Hamaspik Choice Inc Medicaid $0.41
Service Code HCPCS J2250
Hospital Charge Code 0641606001
Hospital Revenue Code 250
Min. Negotiated Rate $0.13
Max. Negotiated Rate $0.66
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.13
Rate for Payer: Aetna Government $0.13
Rate for Payer: Brighton Health Commercial $0.62
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.66
Rate for Payer: Cigna LocalPlus Benefit Plan $0.56
Rate for Payer: EmblemHealth Commercial $0.41
Rate for Payer: Group Health Inc Commercial $0.41
Rate for Payer: Group Health Inc Medicare $0.29
Rate for Payer: Hamaspik Choice Inc Medicaid $0.41
Rate for Payer: Hamaspik Choice Inc Medicare $0.41
Rate for Payer: Healthfirst CHP/FHP/Medicaid $0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.54
Service Code HCPCS J2250
Hospital Charge Code 0641606010
Hospital Revenue Code 250
Min. Negotiated Rate $0.41
Max. Negotiated Rate $0.41
Rate for Payer: Hamaspik Choice Inc Medicaid $0.41
Service Code HCPCS J2250
Hospital Charge Code 7261174910
Hospital Revenue Code 250
Min. Negotiated Rate $0.13
Max. Negotiated Rate $0.57
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.39
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.13
Rate for Payer: Aetna Government $0.13
Rate for Payer: Brighton Health Commercial $0.53
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.57
Rate for Payer: Cigna LocalPlus Benefit Plan $0.48
Rate for Payer: EmblemHealth Commercial $0.35
Rate for Payer: Group Health Inc Commercial $0.35
Rate for Payer: Group Health Inc Medicare $0.25
Rate for Payer: Hamaspik Choice Inc Medicaid $0.35
Rate for Payer: Hamaspik Choice Inc Medicare $0.35
Rate for Payer: Healthfirst CHP/FHP/Medicaid $0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.46
Service Code HCPCS J2250
Hospital Charge Code 0641606125
Hospital Revenue Code 250
Min. Negotiated Rate $0.13
Max. Negotiated Rate $1.15
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.79
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.13
Rate for Payer: Aetna Government $0.13
Rate for Payer: Brighton Health Commercial $1.08
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $1.15
Rate for Payer: Cigna LocalPlus Benefit Plan $0.98
Rate for Payer: EmblemHealth Commercial $0.72
Rate for Payer: Group Health Inc Commercial $0.72
Rate for Payer: Group Health Inc Medicare $0.50
Rate for Payer: Hamaspik Choice Inc Medicaid $0.72
Rate for Payer: Hamaspik Choice Inc Medicare $0.72
Rate for Payer: Healthfirst CHP/FHP/Medicaid $0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.94
Service Code HCPCS J2250
Hospital Charge Code 0641606125
Hospital Revenue Code 250
Min. Negotiated Rate $0.72
Max. Negotiated Rate $0.72
Rate for Payer: Hamaspik Choice Inc Medicaid $0.72
Service Code HCPCS J2250
Hospital Charge Code 6332341225
Hospital Revenue Code 250
Min. Negotiated Rate $0.13
Max. Negotiated Rate $3.13
Rate for Payer: 1199SEIU National Benefit Fund Commercial $2.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.13
Rate for Payer: Aetna Government $0.13
Rate for Payer: Brighton Health Commercial $2.93
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $3.13
Rate for Payer: Cigna LocalPlus Benefit Plan $2.66
Rate for Payer: EmblemHealth Commercial $1.96
Rate for Payer: Group Health Inc Commercial $1.96
Rate for Payer: Group Health Inc Medicare $1.37
Rate for Payer: Hamaspik Choice Inc Medicaid $1.96
Rate for Payer: Hamaspik Choice Inc Medicare $1.96
Rate for Payer: Healthfirst CHP/FHP/Medicaid $0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $2.54
Service Code HCPCS J2250
Hospital Charge Code 6332341225
Hospital Revenue Code 250
Min. Negotiated Rate $1.96
Max. Negotiated Rate $1.96
Rate for Payer: Hamaspik Choice Inc Medicaid $1.96
Service Code HCPCS J2250
Hospital Charge Code 0409000101
Hospital Revenue Code 250
Min. Negotiated Rate $0.29
Max. Negotiated Rate $0.29
Rate for Payer: Hamaspik Choice Inc Medicaid $0.29
Service Code HCPCS J2250
Hospital Charge Code 0409000101
Hospital Revenue Code 250
Min. Negotiated Rate $0.13
Max. Negotiated Rate $0.46
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.13
Rate for Payer: Aetna Government $0.13
Rate for Payer: Brighton Health Commercial $0.43
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.46
Rate for Payer: Cigna LocalPlus Benefit Plan $0.39
Rate for Payer: EmblemHealth Commercial $0.29
Rate for Payer: Group Health Inc Commercial $0.29
Rate for Payer: Group Health Inc Medicare $0.20
Rate for Payer: Hamaspik Choice Inc Medicaid $0.29
Rate for Payer: Hamaspik Choice Inc Medicare $0.29
Rate for Payer: Healthfirst CHP/FHP/Medicaid $0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.37
Service Code HCPCS J2250
Hospital Charge Code 0409230505
Hospital Revenue Code 250
Min. Negotiated Rate $0.14
Max. Negotiated Rate $0.14
Rate for Payer: Hamaspik Choice Inc Medicaid $0.14
Service Code HCPCS J2250
Hospital Charge Code 0409230505
Hospital Revenue Code 250
Min. Negotiated Rate $0.10
Max. Negotiated Rate $0.22
Rate for Payer: 1199SEIU National Benefit Fund Commercial $0.15
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper $0.13
Rate for Payer: Aetna Government $0.13
Rate for Payer: Brighton Health Commercial $0.20
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access $0.22
Rate for Payer: Cigna LocalPlus Benefit Plan $0.19
Rate for Payer: EmblemHealth Commercial $0.14
Rate for Payer: Group Health Inc Commercial $0.14
Rate for Payer: Group Health Inc Medicare $0.10
Rate for Payer: Hamaspik Choice Inc Medicaid $0.14
Rate for Payer: Hamaspik Choice Inc Medicare $0.14
Rate for Payer: Healthfirst CHP/FHP/Medicaid $0.15
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual $0.18
Service Code HCPCS J2250
Hospital Charge Code 0409230821
Hospital Revenue Code 250
Min. Negotiated Rate $0.70
Max. Negotiated Rate $0.70
Rate for Payer: Hamaspik Choice Inc Medicaid $0.70